A Cochrane review [Abstract] 1 included 14 trials involving a total of 1 298 pregnant women (most unemployed, poor, African American). 9 (n=704) studies considered contingency management (CM, positive, supportive reinforcement with, for example, monetary vouchers or giving work and a salary only when abstaining from drug use or attending treatment to change behaviour), and 5 (n=594) studies considered manual based interventions such as motivational interviewing (MI, 3-6 sessions with a directive, counselling style). There were no differences observed at the end of studies in retention or abstinence (as assessed by positive drug test at the end of treatment) in any psychosocial intervention group compared to control (Retention: RR 0.99, 95% CI 0.93 to 1.06, 9 trials, n=743; and Abstinence: RR 1.14, 95% CI 0.75 to 1.73, 3 trials, n=367). These results held for both CM and MI combined. For both, no difference in birth or neonatal outcomes was found, but this was an outcome rarely captured in the studies.
Comment: The quality of evidence is downgraded by study quality (several limitations), by inconsistency (heterogeneity in interventions and outcomes), and by imprecise results (few patients for each comparison).
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