Department of Psychiatry, the School of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06510, USA.
Gen Hosp Psychiatry. 2012 Sep-Oct;34(5):439-49. doi: 10.1016/j.genhosppsych.2012.06.002. Epub 2012 Jul 12.
The objective was to compare the efficacy of motivational enhancement therapy coupled with cognitive behavioral therapy (MET-CBT) to brief advice for treatment of substance use in pregnancy.
This was a randomized, parallel, controlled trial that was yoked to prenatal care and delivered at hospital outpatient clinics. We enrolled 168 substance-using women who had not yet completed an estimated 28 weeks of pregnancy. Obstetrical clinicians provided brief advice, and study nurses administered manualized MET-CBT. The primary outcome was percentage of days in the prior 28 days in which alcohol and/or drugs were used immediately before and 3 months postdelivery.
There were no significant differences across groups in terms of self-reported percentage of days in which drugs or alcohol were used prior to and 3 months postdelivery. Biological measures showed similar results. There was a trend (P=.08) for lower risk of preterm birth among those who received MET-CBT.
The tested interventions had similar therapeutic effects. Hence, both treatments may be suitable for pregnant substance users, depending on the population, setting and provider availability. Interventions that are intensified after delivery may decrease postpartum "rebound" effects in substance misuse.
比较动机增强治疗联合认知行为疗法（MET-CBT）与简短建议在治疗妊娠物质使用中的疗效。
这是一项随机、平行、对照试验，与产前护理相关联，并在医院门诊诊所进行。我们招募了 168 名尚未完成估计 28 周妊娠的物质使用女性。产科临床医生提供简短建议，研究护士实施规范化 MET-CBT。主要结局是在过去 28 天内，在分娩前和分娩后 3 个月内每天使用酒精和/或药物的天数百分比。
在分娩前和分娩后 3 个月内每天使用药物或酒精的自我报告百分比方面，两组之间没有显著差异。生物测量结果也显示出类似的结果。接受 MET-CBT 的患者早产风险较低（P=.08），这一趋势存在。
经过测试的干预措施具有相似的治疗效果。因此，根据人群、环境和提供者的可用性，这两种治疗方法都可能适用于妊娠物质使用者。分娩后强化的干预措施可能会减少物质滥用的产后“反弹”效应。
