2014 DBHR WA State Provider Survey
Use of motivational incentives, also sometimes called "contingency management," is a behavior therapy-based intervention that provides tangible incentives to patients in treatment for substance use disorders based on objective indicators of drug abstinence (clean urine tests, coming to appointments/group, etc.).
Like motivational interviewing, motivational incentives address patients’ ambivalence about stopping or reducing substance use and help them make the decision to modify their behaviors and pursue recovery.
Why use it?
A common concern regarding incentives use is: "Isn't this just rewarding patients for what they should be doing anyway?”
Although incentives/rewards may seem to externally reward a person for their program participation, the longer they engage in treatment, the closer they are to experiencing the internal rewards of recovery. Often when providers and staff see the positive impact of incentives, objections and misgivings about them diminish. "We came to see that we need to reward people where rewards are few and far between. We use rewards as a clinical tool – not as bribery – but for recognition. The really profound rewards will come later." 5,6
Numerous research studies on the use of motivational incentives have found increased retention and higher rates of abstinence for patients participating. A common concern about the use of incentives is cost; however, research shows that even intermittent, low-cost reinforcements, in which patients earn a chance to draw tickets from a container and win prizes of varying magnitudes has a significant impact on both retention and abstinence, relative to standard treatment 6.
For example, two studies in NIDA’s National Drug Abuse Treatment Clinical Trials Network (CTN), looking at the use of voucher-based motivational incentives in methadone clinics and drug-free clinics, found that an average cost of $120-$200 in prizes per participant over the total course of treatment as much as doubled rates of abstinence1,2. The most commonly used incentives were food, gift cards to local businesses, bus tickets, certificates, and time reduction for attendance.
There are a variety of ways to implement motivational incentives, and research has consistently demonstrated that this intervention can be highly effective. It has been used successfully with single addictions as well as dual diagnoses3, and has also been shown to reduce HIV risk behaviors in heroin- and cocaine-using outpatients4.
Some Advice from NIATx
Two success stories (from NIATx)
Mid-Columbia Center for Living in The Dalles, OR increased continuation from 46% to 73% by giving clients a $10 gift certificate after the fourth treatment session and by throwing a pizza party to celebrate every four sessions in which the group achieved 100 percent attendance. For more information, see the Mid-Columbia change bulletin (on the NIATx web site).
Palladia, Inc. in New York, NY reduced no-shows for outpatient intake appointments from 50% to zero by giving rewards -- additional time for their weekend passes -- to residential clients at their Esperanza halfway house who attended the outpatient intake appointment prior to discharge. For more information about other changes that Palladia made, see Palladia’s case study.
NIATx Resources on Motivational Incentives
Includes stories about successful implementation at real treatment agencies, lessons learned, tracking measures, action steps, and more.
Motivational Incentives – A Proven Approach to Treatment – NIDA/SAMHSA
This collection of NIDA/SAMHSA Blending Team Products related to motivational incentives provides a range of tools for clinicians and agencies to use for training and implementing low-cost incentive programs in their organizations. Products include:
References & Readings