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.
OBJECTIVE
The objective was 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.


METHODS
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 in which alcohol and/or drugs were used immediately before and 3 months postdelivery.


RESULTS
There were no significant differences across groups in terms of self-reported percentage of days in which drugs or alcohol were used prior to and 3 months postdelivery. Biological measures showed similar results. There was a trend (P=.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.
Department of Psychiatry, the School of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06510, USA. Kimberly.Yonkers@yale.edu
Kimberly A
KA
Yonkers
Ariadna
A
Forray
Heather B
HB
Howell
Nathan
N
Gotman
Trace
T
Kershaw
Bruce J
BJ
Rounsaville
Kathleen M
KM
Carroll
D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy / Q000379:methods; D003376:Counseling; D005260:Female; D006801:Humans; D009042:Motivation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D019966:Substance-Related Disorders / Q000628:therapy*; D014481:United States; D055815:Young Adult