The Role of PTSD in relapse among pregnant substance using women

The immediate goal of this pilot study is to examine the feasibility of using ecological momentary assessment (EMA) to gather daily posttraumatic stress disorder (PTSD) symptom, fetal bonding, emotional regulation/anxiety sensitivity, and substance use data among a population of pregnant substance use disorder (SUD) patients. The overall goal of the study is to use this pilot data to design a larger proposal examining direct or indirect relationships between PTSD and SUD symptoms and their potential mediation by daily antenatal bonding or moderation by baseline anxiety sensitivity or emotion regulation. This study has three aims: 1) Examine the feasibility of using EMA to determine the role of PTSD symptoms as direct and indirect predictors of immediate substance use, and of antenatal bonding as a mediator, and baseline anxiety sensitivity and deficits in emotion regulation as moderators, of direct and indirect associations between PTSD symptoms and substance use outcomes, 2) Examine processes women in prenatal SUD treatment believe influence relapse, and 3) Determine the feasibility of using EMA devices prenatally for interventions to increase fetal bonding or reduce psychiatric symptoms and substance use in order to improve birth outcome. This pilot study will recruit 33 pregnant women in outpatient prenatal SUD treatment. Aim 1 will be pursued by the collection of baseline interview and paper assessments followed by collection of EMA data 3 times per day for 4 weeks. Aim 2 will be pursued by collecting qualitative data in a subsample of women following instances of substance use with an open-ended oral questionnaire that will be recorded and then coded and analyzed for common themes and concepts, to then be used to guide development of the R21 proposal. Aim 3 will be pursued by examining participant retention, use of EMA devices, and birth outcomes. The long term goal of this study is to develop additional components to prenatal SUD treatment, perhaps focusing on fetal bonding, emotion regulation, and/or anxiety sensitivity in addition to PTSD and SUD symptoms. Approximately 5% of women entering treatment for SUD are pregnant and pregnancy is associated with high rates of treatment discontinuation. While many women obtain sobriety during pregnancy, the majority of pregnant women in SUD treatment continue some prenatal substance use, and even those who do not relapse prenatally often relapse soon postpartum. Current interventions may not sufficiently meet the needs of this special population and their infants. Additionally targeting PTSD, emotion regulation, anxiety sensitivity, or fetal bonding may reduce perinatal substance use and thus reduce suffering among these women and infants.