Michelle Tuten

Methadone Maintenance vs. Methadone Taper During Pregnancy: Maternal and Neonatal Outcomes

This study compared five groups of participants: those receiving either three-day methadone-assisted withdrawal (MAW) alone (n = 67), three-day MAW followed by methadone maintenance (MM) (n = 8), seven-day MAW alone (n = 28), seven-day MAW followed by MM (n = 20), or a continuous MM sample (n = 52) enrolled between 1995-2001 in an urban drug treatment center. On average, patients in the three MM groups remained in treatment longer, attended more obstetrical visits, and more often delivered at the program hospital than patients in the two MAW alone groups. Given the poor maternal MAW outcomes, methadone maintenance should be considered as the primary treatment approach for opioid-dependent pregnant women.

A partner's drug-using status impacts women's drug treatment outcome

The role that male sexual partners play in the treatment outcome of drug dependent pregnant women deserves greater attention. Pregnant women enrolled in a comprehensive treatment program with drug-free (n=85) or drug-using (n=82) male sexual partners completed a relationship survey and were compared on partner and psychosocial variables. Compared with male drug-free partners, male drug-using partners had more unemployment and more current legal involvement, less education, were less likely to be supportive of the pregnant womans recovery efforts and were more likely to give them money to buy drugs. Male drug-free partners also had fewer medical, dental, legal and transportation needs than male drug-using partners. Data from treatment retention suggests that women with male drug-using partners are retained in a comprehensive treatment for a shorter time than women with male drug-free partners. A male partners drug-using status should be considered when treating pregnant drug dependent women.

Comparing homeless and domiciled pregnant substance dependent women on psychosocial characteristics and treatment outcomes

The present study compared pregnant drug-dependent women reporting homelessness (n=117) or being domiciled (n=118) at treatment enrollment on initial psychosocial functioning and subsequent drug treatment outcome. Homeless pregnant women presented with greater drug use and medical problems, less social service income, and more family/social difficulties than domiciled women. Homeless women had greater rates of psychiatric problems including suicidality and higher rates of physical, emotional and sexual abuse than their domiciled counterparts. Treatment retention was poorer for homeless than domiciled pregnant women. Results suggest that treatment should address the housing needs of pregnant drug abusers as well as their related social and psychiatric problems.

Cigarette smoking in opioid-dependent pregnant women: neonatal and maternal outcomes.

BACKGROUND The relationship between cigarette smoking and neonatal and maternal clinical outcomes among opioid-agonist-treated pregnant patients is sparse. OBJECTIVES (1) Is smoking measured at study entry related to neonatal and maternal outcomes in pregnant women receiving opioid-agonist medication? (2) Is it more informative to use a multi-item measure of smoking dependence or a single-item measure of daily smoking? (3) Is the relationship between smoking at study entry and outcomes different between methadone and buprenorphine? METHODS Secondary analyses examined the ability of the tobacco dependence screener (TDS) and self-reported past 30-day daily average number of cigarettes smoked, both measured at study entry, to predict 12 neonatal and 9 maternal outcomes in 131 opioid-agonist-maintained pregnant participants. RESULTS Past 30-day daily average number of cigarettes smoked was significantly positively associated with total amount of morphine (mg) needed to treat neonatal abstinence syndrome (NAS), Adjusted Odds Ratio (AOR)=1.06 (95% CI: 1.02, 1.09), number of days medicated for NAS, AOR=1.04 (95% CI: 1.01, 1.06), neonatal length of hospital stay in days, AOR=1.03 (95% CI: 1.01, 1.05), and negatively associated with 1-AOR=.995 (95% CI: .991,.999) and 5-min Apgar scores, AOR=.996 (95% CI: .994,.998). Simple effect tests of the two significant TDS×medication condition effects found TDS was unrelated to non-normal presentation and amount of voucher money earned in the methadone [AORs=.90 (95% CI: .74, 1.08, p>.24) and 1.0 (95% CI: .97, 1.03, p>.9)] but significant in the buprenorphine condition [AORs=1.57 (95% CI: 1.01, 2.45, p<.05) and 1.08 (95% CI: 1.04, 1.12, p<.01)]. CONCLUSIONS Regardless of prenatal methadone or buprenorphine exposure, heavier cigarette smoking was associated with more compromised birth outcomes.

Reinforcement-based treatment improves the maternal treatment and neonatal outcomes of pregnant patients enrolled in comprehensive care treatment.

This randomized clinical trial examined the efficacy of comprehensive usual care (UC) alone (n = 42) or enhanced by reinforcement-based treatment (RBT) (n = 47) to produce improved treatment outcomes, maternal delivery, and neonatal outcomes in pregnant women with opioid and/or cocaine substance use disorders. RBT participants spent, on average, 32.6 days longer in treatment (p < .001) and almost six times longer in recovery housing than did UC participants (p = .01). There were no significant differences between the RBT and UC conditions in proportion of participants testing positive for any illegal substance. Neonates in the RBT condition spent 1.3 fewer days hospitalized after birth than UC condition neonates (p = .03), although the two conditions did not differ significantly in neonatal gestational age at delivery, birth weight, or number of days hospitalized. Integrating RBT into a rich array of comprehensive care treatment components may be a promising approach to increase maternal treatment retention and reduce neonatal length of hospital stay.

Contingent incentives reduce cigarette smoking among pregnant, methadone-maintained women: Results of an initial feasibility and efficacy randomized clinical trial

AIMS This study examined the feasibility and efficacy of behavioral incentives for reducing cigarette smoking among pregnant methadone-maintained patients. DESIGN Participants (n = 102) were assigned randomly to: (i) contingent behavioral incentives (CBI: n = 42); (ii) non-contingent behavioral incentives (NCBI: n = 28); or (iii) treatment as usual (TAU: n = 32). SETTING Study procedures were implemented at the Center for Addiction and Pregnancy in Baltimore, MD. PARTICIPANTS Study participants were pregnant, methadone-maintained women enrolled in substance use disorder treatment. MEASUREMENTS Baseline carbon monoxide (CO) levels were calculated for each participant. Subsequently, breath samples were tested three times weekly to measure changes in smoking behavior. CBI participants received incentives for target reductions from baseline: any reduction (week 1); 10% reduction (weeks 2-4), 25% reduction (weeks 5-7), 50% reduction (weeks 8-9), 75% reduction (week 10-11); and abstinence [CO < 4 parts per million (p.p.m.)] (week 12 until delivery). NCBI participants received incentives independent of smoking CO measurement results. TAU participants received no incentives, the standard treatment at the program. FINDINGS CBI condition participants submitted significantly lower mean CO values than the NCBI and TAU conditions over the course of the intervention (P < 0.0001). Nearly half (48%) of the CBI participants met the 75% smoking reduction target and one-third (31%) met the abstinence target at week 12. In contrast, none of the NCBI met either the 75% or abstinence targets. Only 2% of the TAU participants met the 75% reduction and none of the TAU participants met the abstinence targets. These smoking behavior reductions did not yield significant differences in birth outcomes. CONCLUSIONS Cigarette smoking may be reduced significantly among pregnant, methadone-maintained women through the use of contingent reinforcement for gradual reductions in breath carbon monoxide levels.

What if they do not want treatment?: lessons learned from intervention studies of non-treatment-seeking, drug-using pregnant women.

Despite specialized drug treatment, many pregnant drug-using women do not seek admission to such programs. This study examined two types of brief drug use intervention models for attracting and retaining pregnant women in drug abuse treatment. Both models offered motivational interviewing (MI) + behavioral incentives (BI) for drug abstinence. One model had an additional case management (CM) component. The addition of CM resulted in less drug use and fewer psychosocial needs, but similar levels of poor participation in the intervention was observed with both models. The intensity of effort expended to retain participants is discussed.

Suicidality, aggression, and other treatment considerations among pregnant, substance-dependent women with posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) and other Axis I comorbidity among women with substance use disorders (SUDs) appear similarly prevalent and are associated with comparable negative clinical profiles and treatment outcomes. The relative contribution of comorbid PTSD vs other Axis I psychiatric disorders to clinical characteristics is largely unexamined, however, despite theory and empirical data indicating that PTSD and SUDs may have a unique relationship that confers specific risk for clinical severity and poor treatment outcome. In a sample of pregnant, opioid- and/or cocaine-dependent women entering substance abuse treatment, women with PTSD (SUD-PTSD; n = 23) were compared to those with other Axis I comorbidity (SUD-PSY; n = 45) and those without Axis I comorbidity (SUD-only; n = 37). Data were collected via face-to-face interviews and urinalysis drug assays. Although the study groups had similar substance use severity, the SUD-PTSD group was more likely to report suicidality, aggression, and psychosocial impairment than both the SUD-PSY and SUD-only groups. Findings indicate treatment considerations for substance-dependent women with PTSD are broader and more severe than those with other Axis I conditions or substance dependence alone.

A comparison of cigarette smoking profiles in opioid-dependent pregnant patients receiving methadone or buprenorphine

INTRODUCTION Little is known about the relationship between cigarette smoking and agonist treatment in opioid-dependent pregnant patients. The objective of this study is to examine the extent to which cigarette smoking profiles differentially changed during the course of pregnancy in opioid-dependent patients receiving either double-blind methadone or buprenorphine. Patients were participants in the international, randomized controlled Maternal Opioid Treatment: Human Experimental Research (MOTHER) study. METHODS A sample of opioid-maintained pregnant patients (18-41 years old) with available smoking data who completed a multisite, double-blind, double-dummy, randomized controlled trial of methadone (n = 67) and buprenorphine (n = 57) between 2005 and 2008. Participants were compared on smoking variables based on opioid agonist treatment condition. RESULTS Overall, 95% of the sample reported cigarette smoking at treatment entry. Participants in the two medication conditions were similar on pretreatment characteristics including smoking rates and daily cigarette amounts. Over the course of the pregnancy, no meaningful changes in cigarette smoking were observed for either medication condition. The fitted difference in change in adjusted cigarettes per day between the two conditions was small and nonsignificant (β = -0.08, SE = 0.05, p = .132). CONCLUSIONS Results support high rates of smoking with little change during pregnancy among opioid-dependent patients, regardless of the type of agonist medication received. These findings are consistent with evidence that suggests nicotine effects, and interactions may be similar for buprenorphine compared with methadone. The outcomes further highlight that aggressive efforts are needed to reduce/eliminate smoking in opioid-dependent pregnant women.

Aftercare Plans of Inpatients Undergoing Detoxification

Drug use relapse rates are high following residential detoxification. This study examined the aftercare plans and desired services of participants currently enrolled in residential detoxification programs. Participants completed a survey regarding their aftercare plans and services that they desired from an aftercare program. Participants (98%) reported some form of aftercare plans following detoxification. Among the services that participants endorsed wanting were individual counseling, help with finding a job, and Narcotics Anonymous (NA) meetings. With low rates of enrollment in aftercare programs, the findings of this study may be of help in determining what services will best assist individuals recovering from addiction.