Philadelphia, PA (August 30, 2012) - 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
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
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
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
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
About Addictive Disorders & Their Treatmen
Disorders & Their Treatment is a quarterly
international journal devoted to practical clinical
research and treatment issues related to the misuses of
alcohol and licit and illicit drugs and the study and
treatment of addictive disorders and their behaviors. The
journal publishes broad-spectrum, patient-oriented coverage
of all aspects of addiction, directed toward an audience of
psychiatrists, clinical psychologists,
psychopharmacologists, and primary care practitioners
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