BEHAVIORAL THERAPIES FOR DRUG DEPENDENT PREGNANT WOMEN

成瘾和怀孕中心(CAP)是一个专门的多学科治疗方案，旨在满足怀孕药物依赖妇女的治疗需求。然而，许多妇女过早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资助的治疗中心赠款的一部分，行为研究程序被纳入CAP正在进行的临床实践中，并进行了一系列凭证激励研究，以提高治疗参与度和减少药物使用。目前的建议建立在这项研究的基础上，并对其进行扩展。具体地说，它比较了加强怀孕药物依赖妇女戒毒的替代代金券激励方法的有效性，并审查了此类激励计划对母亲和婴儿的临床和经济好处。提出了一个大型研究(N=420)，其中有两个实验条件和一个控制条件。这项研究将比较两种代金券支付计划与轭控制条件下的相对有效性和实用性。这两个代金券条件将包括：1)逐步升级的时间表，旨在促进长期持续禁欲，并在迄今进行的研究中广泛采用；以及(2)更简单的固定费率时间表，为每个无毒尿液提供固定的货币支付，而且可能同样有效。除了评估对留存和药物使用的影响外，这项研究还将检查激励程序在以下方面的次要好处：参与个人和集体咨询、对产前护理服务的遵从性以及母婴临床结果(例如出生体重、分娩时的EGA、阿普加评分、医疗并发症)作为治疗条件和药物使用结果的函数。这项研究还将提供有价值的信息，说明在参与CAP治疗期间被分配(根据临床特征)接受美沙酮维持治疗与以禁欲为基础的(非美沙酮)治疗的妇女的代金券激励效应。由于怀孕的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，因此母婴临床结果的改善可能会产生大量的医疗费用节约，这很容易抵消用于支付凭单的资金。研究发现，治疗提供者和管理护理组织都会感兴趣，因为它们可以很容易地在各种治疗环境中使用。

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.