Psychosocial interventions for pregnant women in outpatient illicit drug treatment programs compared to other interventions

The effectiveness of psychosocial interventions in pregnant women enrolled in illicit drug treatment programs.Women who use illicit drugs while pregnant are more likely to give birth early and have low weight infants that are at risk of neonatal abstinence syndrome and requiring intensive care. A pregnant woman reduces the risk of these complications by undergoing prenatal drug treatment. Maternal concern for the infant can also motivate her. The length of time on treatment is important. Psychosocial interventions may help to overcome the many barriers to staying in a treatment program and reduce the use of illicit drugs.Contingency management uses positive, supportive reinforcement with, for example, monetary vouchers or giving work and a salary only when abstaining from drug use or attending treatment to change behaviour. Manual based interventions include motivational interviewing with a
directive, counselling style.
This systematic review found that contingency management is effective in improving retention of pregnant women in illicit drug treatment programs but with minimal effects on their abstaining from illicit drugs. Motivational interviewing over three to six sessions may, if anything, lead to poorer retention in treatment. These findings are based on nine controlled trials over 14 days to 24 weeks, five studies used contingency management (346 women) and four studies (266 women) that considered motivational interviewing.All but one took place in the United States. Many of the young women were African American, single, never married or divorced, and unemployed. They were receiving methadone maintenance, using cocaine, or opiate dependent and marijuana and alcohol use was also involved in six studies. In two trials, almost all women were nicotine dependent. No difference in birth outcomes or length of hospital detoxification for the newborns was found, from two studies.None of the included studies stated how the women were referred to treatment. Manual based interventions are less likely to be effective among coerced individuals. it is also unlikely to be used on their own in clinical practice.