Up to 80 percent of pregnant and postpartum patients stop treatment within a year of giving birth, according to Washington University School of Medicine, which has received federal funding to test whether that can be changed.

For anyone weighing addiction treatment options around a pregnancy, this is the retention question that decides outcomes. The care has to survive the transition home.

What the Trial Is Testing

WashU announced on Aug. 17 that it received NIH and NIDA funding for a randomized controlled trial of contingency management in pregnant and postpartum patients with substance use disorder. The award is R33DA062321, part of the NIH HEAL Initiative.

The trial will enroll 270 patients across two sites, WashU’s CARE Clinic in St. Louis and the University of Maryland in Baltimore. It is led by investigators Jeannie Chen Kelly, MD, and Ana Baumann Walker, PhD.

The stakes are stated plainly in the announcement. Overdose is among the top three causes of pregnancy-associated death in the United States.

Understanding Contingency Management

Contingency management is a behavioral treatment that provides tangible incentives, usually modest financial ones, when a person meets an objectively verified goal. That might be a negative drug screen or attendance at a scheduled appointment.

It is among the best-supported behavioral interventions in addiction medicine, particularly for stimulant use disorder, where no FDA-approved medication exists. It is also among the least available, largely because paying patients raises regulatory and funding questions that many programs have not resolved.

WashU describes it as a proven approach being tested in a population where it has not been widely deployed. The trial is asking whether it can hold people in care through the postpartum window specifically.

Why Addiction Treatment Breaks Down Postpartum

The year after birth reorganizes a person’s entire schedule, and treatment is usually what gives way. Appointments that were manageable during prenatal care compete with newborn care, lost sleep, and the loss of the obstetric team that had been the point of contact. Insurance changes can land in the same window.

In many states, pregnancy-related Medicaid coverage has historically ended well before the first postpartum year was over, though several states have extended it.

None of that is a motivation problem, which is the framing this population usually gets. It is a logistics problem layered on top of a clinical one, and it explains why a retention-focused intervention is being tested rather than another treatment-initiation program.

What This Means for Treatment Seekers

If you or someone in your family is entering addiction treatment during a pregnancy, ask specifically what happens after delivery. Who owns the handoff from the obstetric team to ongoing care, and when is the first appointment after discharge scheduled.

Ask about insurance continuity too. Confirm how long postpartum coverage lasts in your state and what happens to medication for opioid use disorder if coverage lapses, because interruptions in that medication carry real overdose risk.

Exploring Treatment Options

Programs vary widely in how they handle this stretch of care, and the differences are worth asking about directly:

Whether the program treats pregnant and postpartum patients regularly, or would be doing so as an exception.
Whether it continues medication for opioid use disorder through pregnancy and after, since guidelines support continuation rather than tapering.
Whether behavioral treatment and prenatal or postpartum care are coordinated, or run as separate appointments in separate places
Whether childcare, transportation, or telehealth options exist, since those are usually what determine whether someone can actually attend.
What the plan is if someone misses appointments, and whether that triggers support or discharge.

Rehab.com’s directory lets you compare treatment centers on programs offered, insurance accepted, levels of care, and accreditation, so you can evaluate these questions before committing to a program.

Peter Lee Written By: Peter Lee PhD
Peter W.Y. Lee is a PhD in history and culture, specializing in American Cold War culture and youth culture. He has published dozens of academic essays and online articles, edited three anthologies, and written one monograph on boyhood in postwar Hollywood films.