Recovery Housing for Pregnant Women

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DESCRIPTION: (provided by applicant) Misuse of illicit drugs including heroin and cocaine during pregnancy, is considered a significant public health problem. Although specialized multidisciplinary treatment programs have been developed to address the "barriers to care" and prevent the adverse consequences of prenatal drug abuse, previous research has shown that many drug dependent pregnant women leave treatment prematurely and relapse to drug use increasing the risks for poor clinical outcomes. Thus, identifying effective methods for reducing or eliminating illicit drug use in pregnant drug dependent women in treatment is imperative. The present project proposes to modify and extend to the special population of drug dependent women, a treatment used successfully to treat detoxified heroin dependent men and women drawn from similar inner city Baltimore catchment area. All women will receive standard care in a specialized center for pregnant drug dependent women, the Center for Addiction and Pregnancy (CAP). Using a 2 group randomized design (N = 64 per group), we will test the efficacy of standard versus enhanced CAP treatment using a modified Community Reinforcement Approach plus Vouchers model. In this model, enhanced therapy consists of abstinence-contingent recovery house living combined with an active, goal-oriented individual therapy based on the Community Reinforcement Approach. Women will be enrolled in the study for 6 months. Treatment retention, illicit drug use, and other psychosocial outcomes will be examined at 1, 3, 6 and 12-month follow-ups. Birth outcomes will also be compared across groups. It is hypothesized that the enhanced care intervention will result in better treatment retention and compliance, less drug use and improved birth outcomes and that the intervention will be cost-effective. This project will make substantial contributions to the understanding of the Community Reinforcement Approach plus vouchers in the form of residential drug free housing and it's impact on maternal and child outcomes.