(744) Initial results of contingency management to treat substance use disorders in postpartum individuals

The postpartum period is the highest risk time for individuals with substance use disorders (SUD), where treatment retention can be difficult. Contingency management (CM) is a behavioral treatment that provides positive rewards for targeted behaviors, such as treatment attendance or urine drug screen results. CM is one of the most powerful tools to improve outcomes, but is understudied in the obstetric population. We sought to evaluate the impact of a CM program targeting postpartum (PP) patients in a maternal SUD clinic.

Study Design:

We conducted a pre-post study in an urban maternal SUD clinic that provides treatment for SUD. A CM program was implemented and PP individuals received a grocery gift card of escalating amounts for attending a PP appointment each month, up to the one-year PP mark (Table 1). If a participant missed an appointment and was unable to reschedule within 2 weeks, this was treated as a gap in treatment and the monetary amount was reset back to the baseline amount. We included all PP patients seen 6 months pre-CM (August 1^st 2024 through January 31^st 2025) and compared to patients seen 6 months post-CM implementation (February 1^st through July 31^st 2025). Our primary outcome was percent of attended visits. Our secondary outcome was average CM compensation per patient over 6 months.

Results:

43 patients were included (29 pre-CM, 14 post-CM). The majority (67%) had opioid use disorder and 49% had stimulant use disorder; 60% had multiple substance use disorders. 63% had a co-occurring psychiatric condition, of which 44% were prescribed psychiatric medication. Pre-CM, PP appointment attendance was 27% (30 of 110 appointments, n=29 patients). Post-CM, PP appointment attendance significantly increased to 70% (45 of 64 appointments, n=14 patients; p=0.0007). Average time PP at time of initial enrollment was 3 months but most often was 1 month (50%). Average total grocery gift card amount dispensed throughout the 6-month period was $82.86 (± 55.89).

Conclusion:

Contingency management may be a helpful strategy to improve treatment attendance and retention during the high-risk PP period.