Incentives can help promote drug abstinence among pregnant women with heroin or cocaine addiction

A "contingency management" approach—offering incentives for negative drug tests—can help promote drug abstinence among pregnant women with heroin or cocaine addiction, reports a study in the September Addictive Disorders & Their Treatment. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Contingency management (CM) works just as well whether the incentives are increased (escalating) or fixed over time, the study finds. Incentives may also be useful in promoting other healthy behaviors during pregnancy, such as quitting smoking. "These results further the scientific knowledge regarding CM treatment in opioid-dependent pregnant women by supporting the finding that the escalating and fixed CM schedules produce similar amounts of drug negatives urine samples early in treatment," according to the new research by Hendrée E. Jones, PhD, and colleagues of The Johns Hopkins University School of Medicine, Baltimore.

Whether Fixed or Increasing, Incentives Promote Drug Abstinence
The researchers evaluated two approaches to contingency management in pregnant women being treated for addiction to opioids (heroin and related drugs) or cocaine. Especially combined with poverty and mental health issues, cocaine and/or heroin abuse during pregnancy can lead to adverse health outcomes for both mother and child.

The study included 90 opioid-addicted women being treated at the Center for Addiction and Pregnancy in Baltimore. Two-thirds of the women were randomly assigned to contingency management. In the contingency management approach, patients receive incentives in the form of vouchers as a "reward" for achieving desired outcomes—in this case, negative urine tests showing abstinence from drugs.

One group received escalating incentives, with increasing rewards for each negative urine test. The other group received fixed incentives—the same reward for each negative test. Previous research has shown that incentives can quickly increase rates of targeted behavior in patients with substance abuse problems.

The vouchers could be exchanged for merchandise or gift certificates. In the escalating group, the vouchers had a starting value of $7.50, which increased by $1 per sample day (MWF) as long as the tests remained negative. In the fixed group, the vouchers were worth $25 for each negative urine test.

Both incentive programs continued for thirteen weeks. All women received other standard counseling and treatment, including methadone replacement therapy for heroin addiction.

All measures of opioid and heroin dependence were similar in the two contingency management groups. With 14 opportunities to provide urine samples, the average number of negative test results was 8.1 in the escalating incentive group and 7.4 in the fixed incentive group.

There was a tendency toward higher cocaine abstinence rates among women receiving escalating incentives. However, after five weeks there was no significant difference between groups.

Added to previous studies, the new results strengthen the evidence that providing incentives for staying drug-free is a useful part of the treatment strategy for pregnant women with opioid dependency. The researchers believe contingency management may be especially valuable in pregnant women—to quickly reduce drug exposure to the developing fetus, and to help in meeting the goal of having both the mother and baby be drug-free at delivery.

Other reports have suggested promising effects of incentive programs in reducing smoking among pregnant women with substance use disorders. "One recent study found that voucher reinforcement for smoking reductions during pregnancy had a significant impact on the smoking reduction and abstinence rates in this vulnerable population," comments coauthor Michelle Tuten, LCSW-C. "These interventions appear to have a clinically meaningful impact on birth outcomes as well, although larger studies are needed to more fully explore birth outcome differences." Professor Tuten is conducting further research on contingency management to reduce exposure to maternal smoking.

For her work in developing behavioral and drug treatments for substance abuse in pregnant and parenting women, Dr Jones has been selected to receive the 2012 Association for Medical Education and Research in Substance Abuse (AMERSA) Betty Ford Award. The award will be presented during this year's AMERSA national conference on November 1 in Bethesda, Md., where Dr Jones will discuss new research affecting the clinical management of opioid dependence during pregnancy.