Pregnant women with drug dependence have historically poor attendance in treatment and high treatment drop-out rates. This study examined whether behavioral incentives, specifically escalating monetary vouchers, integrated into an ongoing substance abuse treatment program could enhance treatment participation and retention in these women.

Researchers randomized 91 pregnant women in treatment for opiate and/or cocaine dependence (7-day residential program followed by a 7-day intensive outpatient program) to receive vouchers that increased in value for each full day of counseling completed or no vouchers (control group). Most subjects were African American (84%) with an average age of 30.

• Retention and length of stay in residential treatment (first 7 days) was not affected by vouchers.
• During residential treatment, a little over one-third of both groups left against medical advice. Most who left did so within the first 2 days of care.
• Of the remaining women, those in the voucher group stayed in treatment longer (average of 11 days versus 9 days for the control group) and were more likely to attend treatment consistently (i.e., for 12 to 14 full days) (46% versus 16%)
• During the 30-day follow-up period, women who consistently (versus inconsistently) attended treatment stayed in treatment longer (25 days versus 18 days).

Comments by Norma Finkelstein, Ph.D., LICSW:
There is a critical need to develop better polices, programs, and treatment tools to prevent early treatment drop-out and to retain pregnant women in substance abuse treatment. These findings suggest that while behavioral incentives, such as monetary vouchers, might help improve some aspects of treatment attendance, they do not affect early drop-out or retention in later treatment. Therefore, it is worth examining whether addressing other variables, such as co-occurring psychiatric or medical disorders, trauma history, and/or family support might be more critical in preventing early treatment drop-out.