Pregnant women's substance abuse treatment completion rates: Effects of referral sources and treatment settings

Background: The harmful effects of prenatal drug exposure are well documented, and alcohol and drug use among women are most prevalent in their childbearing years. The overall treatment patterns of pregnant women and treatment effectiveness, however, are not well investigated. This study compares treatment completion rates between pregnant and non-pregnant women. Methods: Using 86,648 non-duplicated administrative records of childbearing age women (18-44) admitted to and discharged from publically funded treatment programs in a Midwestern state, we explore the effects of treatment mode and referral sources on treatment completion of pregnant and non-pregnant women. Multilevel random intercept models are used to adjust for patient nesting within clinics. Results: The overall treatment completion rate was 38.5%. The completion rate was lower among pregnant women (33.3%) compared to non-pregnant women (38.8%). Among the self-referred, there was a significantly lower rate among pregnant women (29.5%) compared to non-pregnant women (35.9%). Among those treated in outpatient settings, pregnant women were also less likely to complete treatment (31.3% vs. 37.0%).  In residential rehabilitation settings, pregnant women’s completion rate was substantially lower (36.8%) than among non-pregnant women (45.9%). Conclusion: Pregnant women’s treatment completion rates were lower than that of non-pregnant women. In order to optimize opportunities to intervene during pregnancy, more investigation is needed to identify treatment barriers that are specific to referral systems and modalities in terms of timeliness and appropriateness to meeting the special needs of pregnant women.