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Drug and Alcohol Dependence 2010;107(2-3):149-153. [doi: 10.1016/j.drugalcdep.2009.10.004]
Steven J. Ondersma, PhD (Wayne State University), Theresa M. Winhusen, PhD (University of Cincinnati/CinARC, OV Node), Daniel F. Lewis (University of Cincinnati/CinARC, OV Node).
The weight of evidence suggests that legal pressure to enter treatment facilitates retention. However, the extent to which such mandates (a) influence actual levels of substance use, or (b) also facilitate retention among pregnant women, is unclear. Associations between external pressure -- defined as self-reported pressure to attend treatment under threat of incarceration, loss of child custody, and/or loss of subsidized housing -- and the key outcomes of retention and substance use were therefore examined in a sample of 200 pregnant women participating in protocol CTN-0013 (Motivational Enhancement Therapy to Improve Treatment Utilization and Outcome in Pregnant Substance Users). The role of external pressure was examined in a series of Cox and GEE regressions, which suggested that external pressure as measured at baseline was associated with decreased risk of dropout (Hazard Ratio = .47, p = .001) and fewer drug-positive urine tests throughout treatment and 12-week follow-up (OR = .48, p = .03). These differences did not appear to be the result of baseline differences between coerced and non-coerced participants in education, legal history, the presence or absence of a substance use disorder, employment, or motivation. The present findings extend the larger literature on external pressure by demonstrating effects on drug use as well as on retention, and among pregnant women. (Article (Peer-Reviewed), PDF, English, 2009)
 Keywords:
Behavior therapy |
Community health services |
Contingency Management (CM) | CTN platform/ancillary study |
Gender-specific interventions |
Motivational Enhancement Therapy (MET) |
Motivational incentives |
Motivational interviewing (MI) |
Pregnant women | Retention - Treatment | Women |
Drug and Alcohol Dependence (journal)
Document No: 399, PMID: 19926408, PMCID: PMC2822112
Submitted by Jack Blaine, MD, CCTN (10/7/2009). |
