Therapeutic Responsiveness in the Psychosocial Treatment of Pregnant Mothers with Opiate Use Disorder

Alarming escalation of the opiate epidemic makes clarity of best practice essential. Medication assisted treatment with psychotherapy is accepted as best practice but consensus about the most effective psychosocial strategies remain elusive. A careful review of existing guidelines, prominent meta-analyses and patient opinion, reveals dynamic and clear evidence based strategies for providers. Data indicates a strong correlation between ‘time in treatment’ and ‘treatment approach’. Contingency management is the only approach consistently shown effective during the first twelve weeks of treatment. Cognitive restructuring approaches generally show efficacy when treatment extends beyond twelve weeks and are well supported in research. The authors present a strategic model consistent with the presented data. Recommendations Treatment approaches using a complex systems framework is sparsely represented in existing meta-analyses on treatment efficacy, are preferred by mothers in treatment include an increased emphasis on contingency management during the stabilization phase, a dynamic evolution of therapeutic approach over the course of treatment and a persistent focus on social network development throughout treatment.