Past studies indicate that pregnant substance-using women have many unmet psychosocial needs and are difficult to retain in treatment. This study examined whether motivational enhancement therapy (MET) increased treatment retention and decreased substance use in pregnant substance users compared with treatment as usual (TAU). Two-hundred women enrolled in 4 different treatment programs were randomized to receive either 3 individual sessions of MET, a systematic intervention approach designed to produce internally motivated change, or 3 individual non-MET (TAU) sessions normally provided by the treatment program over a 1-month period (TAU treatments not specified). All sessions were audiotaped, and recordings supported the discriminability between TAU and MET sessions. Follow-up assessments were conducted at 1 and 3 months following treatment.

• No significant differences between the 2 groups were found on number of hours attended for scheduled treatment or number of days until drop-out.
• A significant decrease in alcohol and drug use was seen in both groups during the treatment period.
• Minority participants were significantly less likely to have received at least 1 treatment session and attended significantly fewer weeks of treatment than nonminority participants regardless of group assignment.
• Minority participants in the MET group reported a greater decrease in substance use compared with minority participants in the TAU group at follow-up but not during the treatment period.

Comments by Norma Finkelstein, PhD
Motivational enhancement therapy was no more effective than TAU in increasing treatment retention or decreasing substance use in this study. However, outcomes may have been affected by site differences, differences in training and counseling skills between MET and TAU clinicians, and differences in baseline characteristics, despite randomization, between MET and TAU groups. Evidence-based treatment tools specifically for pregnant women with substance use disorders still hold the promise of greater effectiveness than less specific interventions.