Motivational enhancement therapy coupled with cognitive behavioral therapy versus brief advice: a randomized trial for treatment of hazardous substance use in pregnancy and after delivery

Abstract

Objective To compare the efficacy of motivational enhancement therapy coupled with cognitive behavioral therapy (MET-CBT) to brief advice for treatment of substance use in pregnancy. Method This was a randomized, parallel, controlled trial that was yoked to prenatal care and delivered at hospital outpatient clinics. We enrolled 168 substance using women who had not yet completed an estimated 28 weeks of pregnancy. Obstetrical clinicians provided brief advice and study nurses administered manualized MET-CBT. The primary outcome was percentage of days in the prior 28 days, that alcohol and/or drugs were used immediately before and three months post delivery. Results There were no significant differences across groups in terms of self-reported percentage of days that drugs or alcohol were used prior to and three months post delivery. Biological measures showed similar results. There was a trend (p=0.08) for lower risk of preterm birth among those who received MET-CBT. Conclusions The tested interventions had similar therapeutic effects. Hence, both treatments may be suitable for pregnant substance users, depending on the population, setting, and provider availability. Interventions that are intensified after delivery may decrease postpartum ‘rebound’ effects in substance misuse.

Progesterone for the reduction of cocaine use in post-partum women with a cocaine use disorder: a randomised, double-blind, placebo-controlled, pilot study

“…21 All participants were administered the Structured Clinical Interview for DSM-IV modules for cocaine abuse and dependence to confirm the diagnosis. We offered all randomized participants Cognitive Behavioral Therapy 3 at this and subsequent visits although this treatment was not mandatory. Upon completion of the visit, we reimbursed participants $50 for their time and scheduled a follow-up visit for one week later.…”

“…The therapy was based upon motivational enhancement therapy and cognitive behavioral therapy for cocaine addiction and was adapted for use in pregnant and postpartum women. 3 It included six modules that addressed substance use, safe sexual behavior and relapse prevention. At the final treatment visit, we gave participants referrals for ongoing treatment.…”

“…3 Reduction in drug use during pregnancy and relapse in the post-partum period coincides with increases and reductions in progesterone and estradiol levels in women, respectively. To investigate the plausible mechanism of these observations, we conducted a PubMed search using terms ‘estradiol’, ‘progesterone’, ‘cocaine’ and ‘ female’.…”

“…Pregnancy and the postpartum period may inform us about treatment for a CUD. 3 Women with cocaine addiction typically decrease drug use during pregnancy when progesterone levels are high, but often relapse after delivery when endogenous progesterone levels fall. Other work specifically implicates progesterone as therapeutic for a CUD.…”

“…Given that cocaine-using women frequently abstain or reduce use until after delivery, 3 we posited that postpartum progesterone treatment might prolong abstinence or stem postnatal increases in cocaine use. We hypothesized that replacement of endogenous with exogenous progesterone, compared to replacement with placebo, would lower the use of cocaine during the postpartum period in women with a recent or current history of cocaine abuse or dependence.…”