title: Reinforcement-based treatment improves the maternal treatment and neonatal outcomes of pregnant patients enrolled in comprehensive care treatment.
abstract: 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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. hjones@rti.org
authors.forename: Hendrée E
authors.initials: HE
authors.lastname: Jones
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.forename: Michelle
authors.initials: M
authors.lastname: Tuten
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D001724:Birth Weight; D019970:Cocaine-Related Disorders / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods*; D003191:Comprehensive Health Care / Q000379:methods*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006760:Hospitalization / Q000706:statistics & numerical data; D006798:Housing; D006801:Humans; D007231:Infant, Newborn; D015233:Models, Statistical; D009293:Opioid-Related Disorders / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012720:Severity of Illness Index; D016896:Treatment Outcome