Nancy A. Haug

Motivational enhancement therapy for nicotine dependence in methadone-maintained pregnant women.

Pregnant women who are dependent on nicotine and illicit substances are at especially high risk for health complications and psychosocial problems. Motivational enhancement therapy (MET) for reducing smoking during pregnancy was compared with standard-care practitioner advice in a 2-group randomized design. Participants were 63 pregnant opioid-dependent smokers seeking substance abuse treatment, methadone maintenance, and prenatal care. At a 10-week follow-up, self-report and biological measures (i.e., CO, cotinine) indicated no differences in smoking between the MET and standard-care groups. However, MET participants were more likely to have moved forward on the stage of change continuum than those in standard care. Intensive treatment for nicotine dependence, environmental interventions, and innovative harm reduction strategies are recommended to address the barriers to quitting observed in this population of pregnant women.

Improving treatment outcomes for pregnant drug-dependent women using low-magnitude voucher incentives

The aim of this study was to examine the effectiveness of low-magnitude behavioral incentives in improving attendance for abstinence-treated patients and sustaining illicit-drug abstinence for methadone-treated patients. Subjects were randomly assigned to either incentive or control conditions, with target behaviors differing for the two patient groups (attendance for abstinence-treated and abstinence for methadone-treated patients). Controls received no incentives, whereas incentive subjects could earn

Clinical and psychosocial characteristics of substance-dependent pregnant women with and without PTSD

5/day in vouchers during the first 7 days of an intensive outpatient treatment. Results showed that

Gender differences among HIV-positive methadone maintenance patients enrolled in a medication adherence trial

5/day did not significantly improve attendance in abstinence-treated patients or impact drug abstinence in methadone-treated patients. The data suggest that low-magnitude voucher incentives enhanced treatment attendance by methadone-treated subjects. Although modest monetary incentives had some utility in improving attendance in methadone-treated patients, more potent interventions are needed to improve attendance and maintain abstinence in this high-risk population.

Effect of incentives for medication adherence on health care use and costs in methadone patients with HIV

The present study compared psychiatric and psychosocial functioning in 123 pregnant opiate- and/or cocaine-dependent women with and without a comorbid diagnosis of posttraumatic stress disorder (PTSD). Participants were enrolled in a comprehensive perinatal drug treatment program and completed assessments upon admission. Lifetime diagnostic prevalence of PTSD [Structured Clinical Interview for DSM-IV Disorders (SCID) confirmed] among the sample was 19%. Participants with PTSD (n=24) reported greater need for psychiatric treatment, were more likely to report a previous suicide attempt, and had more previous drug treatments than participants without PTSD (n=99). Women with PTSD were twice as likely to have lifetime Axis I and Axis II disorders and had higher rates of abuse than women without PTSD. Lifetime sexual abuse and ASI family/social composite scores were significant predictors of PTSD. Findings suggest that pregnant drug-dependent women with comorbid PTSD may benefit from specialized treatment services for trauma and/or abuse issues.

Smoking during pregnancy and intention to quit: A profile of methadone-maintained women

Abstract This study examined baseline gender differences among HIV-positive methadone maintenance outpatients currently prescribed antiretroviral medications. Participants were enrolled in a larger clinical trial, which included a 4-week observation period using electronic monitors to track medication adherence. Contrary to previous literature, no significant differences were detected between men (n = 42) and women (n = 36) on medication adherence or depression. Both groups showed remarkably poor adherence during baseline (M = 56% of doses taken on time), high overall prevalence of depression (47%) and illicit cocaine use (47%). Women reported significantly more medication side effects (M = 21.4 vs. 14.9), higher severity of ASI psychiatric problems (M = 0.50 vs. 0.40), and lower SF-36 health-related quality of life in physical (M = 42.1 vs. 63.3) and emotional functioning (M = 26.9 vs. 58.9) than men. Women tested positive for opioids at higher rates than men (53% vs. 29%, respectively), whereas men were more likely to be positive for benzodiazepines than women (26% vs. 6%, respectively). Findings suggest that gender differences between male and female methadone maintenance patients have relevance to treatment providers. Extensive assessment, specialized medical care and mental health services may be warranted in the treatment of HIV-positive female drug abusers.

Acceptance of nicotine dependence treatment among currently depressed smokers.

BACKGROUND The potential benefits of anti-retroviral therapy for HIV is not fully realized because of difficulties in adherence with demanding treatment regimens, especially among injection drug users. METHODS HIV-positive methadone patients who were less than 80% adherent with their primary anti-retroviral therapy were randomized to a trial of incentives for on-time adherence. Adherence was rewarded with an escalating scale of vouchers redeemable for goods. Both intervention and control group visited a medication coach twice a month. The cost of the intervention was determined by micro-costing. Other costs were obtained from administrative data and patient report of out-of-system care. RESULTS During the 12-week intervention period, the incremental direct cost of the intervention, including treatment vouchers, was

Validation and predictive utility of the Sociocultural Attitudes Toward Appearance Questionnaire for Eating Disorders (SATAQ-ED): Internalization of sociocultural ideals predicts weight gain

942. The voucher group incurred

Directly administered antiretroviral therapy: Pilot study of a structural intervention in methadone maintenance

2572 in anti-retroviral drug cost, significantly more than the

Cigarette Smoking Among Opioid-Dependent Clients in a Therapeutic Community

1973 incurred by the comparison group (p<.01). Adherence, as measured by on-time openings of an electronically monitored vial, was 78% in the intervention group and 56% in the control group. CONCLUSIONS The incremental direct cost of voucher incentives was