Substance Use in Pregnancy - Optimizing Retention in Treatment by Maximizing Opportunities for Management

Overdose is a national top-three leading cause of pregnancy-associated death, and maternal substance use disorder (SUD) accounts for an estimated $1.5 billion in healthcare spending each year. Treatment with medication and behavioral therapy lowers morbidity and overdose risk. However, studies have shown 55% to 80% of patients stop treatment within one year postpartum. Additionally, as a result of systemic inequities, historically marginalized patients are at greatest risk of overdose or death. We are conducting a study at WashU Medicine and University of Maryland, Baltimore clinics that offer prenatal care, addiction treatment, and extended postpartum support for patients facing the challenges of a SUD. Study participants will complete a structured screening and management of their social needs, and then will be randomly assigned to continue their usual care or to participate in a contingency management program, which provides incentives to continue treatment.

Inclusion Criteria: * Confirmed viable intrauterine pregnancy at any gestational age; OR postpartum with at least six months remaining until 365 days after deliver * Diagnosis of SUD as defined by DSM-5 and/or as documented in the clinical record * 18 years of age or older * Two or more positive domains in first screening for social drivers of health * Receiving ongoing care at participating study site Exclusion Criteria: * Declining follow-up care at participating study site * Participated in R61 pilot study for CM * Requiring immediate hospitalization for unstable medical or psychiatric conditions making patient clinically unsuitable for research participation at the time of enrollment approach * Unable to participate in English