According to research in the September issue of Addictive Disorders & Their Treatment, the importance of drug abstinence among pregnant women with heroin or cocaine addiction can be promoted by a “contingency management” approach, which offers incentives for women when their drug tests come out negative.

The team discovered that contingency management (CM) works just as effectively whether the incentives remain the same or are increased over time.

To help females develop other healthy behaviors during pregnancy, such as quitting smoking, researchers believe that incentives are an effective strategy.

Hendrée E. Jones, PhD, and colleagues of The Johns Hopkins University School of Medicine, Baltimore, explained in their study:

“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.”

The scientists observed two approaches to CM in pregnant women being treated for addiction to cocaine or opioids (such as heroin and other related drugs). Both mom and child can develop serious health issues if the mother abuses cocaine and/or heroin during pregnancy, especially when the mom is suffering in poverty or has mental health issues.

Ninety females being treated for their opioid addiction at the Center for Addiction and Pregnancy in Baltimore participated in the study. The CM approach was randomly assigned to two-thirds of the ladies, in which they received incentives in the form of vouchers as a “reward” for a negative urine test (meaning no drugs were in their system).

One group received fixed incentives, meaning they got the same prize for each negative urine test; and the other group received escalating incentives, which meant the rewards increased with each negative test.

Incentives can rapidly increase rates of targeted behavior in people with substance abuse problems, according to previous research.

The vouchers in the escalating group had a starting value of $7.50, but increased by one dollar each time they produced a negative test (tests were given mondays, wednesdays, and fridays). The fixed group received vouchers that were worth $25 each time. Participants could exchange their vouchers for merchandise or gift certificates.

Both groups were tested for thirteen weeks while receiving other standard counseling and treatment, such as methadone replacement therapy for those addicted to heroin.

The two CM groups had similar measurements of opioid and heroin dependence. After reviewing all of the 14 urine samples from each subject, scientists discovered that the average number of negative test results was 8.1 in the escalating incentive group and 7.4 in the fixed incentive group.

For those receiving escalating incentives, the investigators saw a tendency toward higher cocaine abstinence rates; however, there was no significant difference between the groups after 5 weeks.

The findings support previous research that suggest that offering incentives for remaining drug-free is a beneficial part of the treatment strategy for women with opioid dependency.

The authors recommend pregnant women with drug addiction use CM to quickly reduce drug exposure to the developing fetus, and to help the mother and her baby be drug-free at delivery.

There has been other research suggesting that smoking in pregnant women with substance use disorders can be greatly reduced with incentive programs.

Michelle Tuten, LCSW-C and co-author, said:

“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. 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.”

More research is being conducted by Professor Tuten to further explore contingent management and how it can be used to reduce exposure to maternal smoking.

Written by Sarah Glynn