BEHAVIORAL THERAPIES FOR DRUG DEPENDENT PREGNANT WOMEN

成瘾和妊娠中心（CAP）是一个专门的多学科治疗计划，旨在解决妊娠药物依赖妇女的治疗需求。然而，许多妇女过早地退出治疗并重新使用药物，使母亲和婴儿面临更大的不良后果风险。从1994年开始，作为NIDA资助的治疗中心补助金的一部分，行为研究程序被纳入CAP正在进行的临床实践，并进行了一系列代金券激励研究，以提高治疗参与率并减少药物使用。目前的建议建立在并扩大了这项研究。具体而言，它比较了替代券激励方法的有效性，以加强药物依赖的孕妇戒毒，并检查临床和经济效益的激励计划，为母亲和婴儿。提出了一项大型（N=420）研究，包括两个实验条件和一个对照条件。该研究将比较两种代金券支付时间表的相对功效和实用性，以控制条件。这两个代金券条件将包括：1）一个逐步增加的时间表，旨在促进长期持续的禁欲，并广泛应用于迄今为止进行的研究，和（2）一个更容易实施的恒定速率时间表，为每个无药物的尿液提供固定的货币支付，并且可能同样有效。除了评估对保留和药物使用的影响外，该研究还将检查激励程序的次要益处：参与个人和团体咨询，产前护理服务的依从性以及母婴临床结局（例如，出生体重、分娩时EGA、Apgar评分、医学并发症）作为治疗条件和药物使用结果的函数。该研究还将提供有关在参与CAP治疗期间被分配（根据临床特征）接受美沙酮维持治疗与基于禁欲（非美沙酮）治疗的女性的代金券激励效果的宝贵信息。由于妊娠药物依赖妇女及其子女面临各种不良后果的风险增加，需要昂贵的医疗护理，改善孕产妇和婴儿临床结果可能会节省大量医疗成本，这很容易抵消用于代金券支付的资金。研究结果将引起治疗提供者和管理式护理组织的兴趣，因为它们可以很容易地用于各种治疗环境。

The Center for Addiction and Pregnancy (CAP) is a specialized multi- disciplinary treatment program developed to address the treatment needs of pregnant drug dependent women. However, many women drop out of treatment prematurely and relapse to substance use, placing both mother and infant at increased risk for adverse outcomes. Beginning in 1994, as a component of a NIDA-funded treatment center grant, behavioral research procedures were integrated into ongoing clinical practice at CAP and a series of voucher incentive studies were conducted to improve treatment participation and reduce substance use. The current proposal builds upon and expands this research. Specifically, it compares the effectiveness of alternative voucher incentive methodologies for reinforcing drug abstinence in pregnant drug dependent women and examines clinical and economic benefits of such incentive programs for both mother and infant. One large (N=420) study is proposed with two experimental and one control condition. The study will compare the relative efficacy and utility of two voucher payment schedules to a yoked control condition. The two voucher conditions will include: 1) an escalating schedule, designed to promote long periods of continuous abstinence and widely employed in research conducted to-date, and (2) a simpler-to implement constant rate schedule that provides a fixed monetary payment for each drug-free urine,a nd that may be equally effective. In addition to assessing the effects on retention and drug use, the study will examine secondary benefits of the incentive procedures on: participation in individual and group counseling, compliance with prenatal care services, and maternal and infant clinical outcomes (e.g., birthweight, EGA at delivery, Apgar scores, medical complications) as a function of treatment condition and drug use outcomes. The study will also provide valuable information about voucher incentive effects in women who are assigned (based on clinical characteristics) to methadone maintenance versus abstinence-based (non-methadone) therapy during CAP treatment participation. Since pregnant drug dependent women and their children are at increased risk for a variety of adverse outcomes that requires expensive medical care, improved maternal and infant clinical outcomes are likely to produce substantial medical cost savings which could easily offset the monies invested in voucher payments. Study finding swill be of interest to both treatment providers and managed care organizations as they can easily be adopted for use in a variety of treatment settings.