Motivational Incentives
Getting Started
Incentives can be individualized or group-based.- Ask local businesses if they can donate small items to use as incentives.
- Inexpensive incentives like raffle tickets for less-frequent prizes or even "recognition" certificates can be effective.
- Plan rewards around common treatment drop-out times.
- Offer staff incentives for successful process improvements as well!
(Adapted from NIATx.)
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.
Two success stories (find more at NIATx)
Client Incentives: 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).
Staff Incentives: The Jackie Nitschke Center in Green Bay, Wisconsin used punch cards to reward staff for increased access and retention. Once each counselor had 7 punches, one for each type of cognitive mapping, they received a box of chocolates. This system helped identify which staff needed more training, and also helped build relationships between staff and increase motivation.
Resources
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:
- Promoting Awareness of Motivational Incentives (PAMI) is an introductory training for organizations, with instruction on the basic principles of incentives and evidence of their effectiveness.
- Motivational Incentives: Positive Reinforcers to Enhance Successful Treatment Outcomes (MI:PRESTO), a self-guided, interactive online course for behavioral healthcare practitioners ready to deepen their knowledge of motivational incentives.
- Motivational Incentives Implementation Software (MIIS), a desktop application developed by NIDA to provide mechanisms for maintaining patient information and incentive activities.
References & Readings
- Peirce J, et al. Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment. Arch Gen Psychiatry 2006;63:201-208. [free online]
- Petry N, et al. Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs. Arch Gen Psychiatry 2005;62:1148-1156. [view abstract]
- Drebing CE, Van Ormer EA, Mueller L, et al. Adding contingency management intervention to vocational rehabilitation: Outcomes for dually diagnosed veterans. J Rehabil Res Dev 2007;44(6):851-66. [free online]
- Ghitza UE, Epstein DH, Preston KL. Contingency management reduces injection-related HIV risk behaviors in heroin and cocaine using outpatients. Addictive Behaviors 2008;33(4):593-604. [free online]
- Kellogg SH, Burns M, Coleman P, et al. Something of value: The introduction of contingency management interventions into the New York City Health and Hospital Addiction Treatment Services. J Subst Abuse Treat 2005;28:57-65. [view abstract]
- Petry NM, Bohn MJ. Fishbowls and candy bars: Using low-cost incentives to increase treatment retention. Sci Pract Perspectives 2003;2(1):55-61. [free online]
- Olmstead TA, Sindelar JL, Petry NM. Cost-effectiveness of prize-based incentives for stimulant abusers in outpatient psychosocial treatment programs. Drug Alcohol Depend 2008;87(2-3):175-182. [free online]
