Incentives Promote Abstinence

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Staying the course and achieving abstinence in substance abuse treatment are two strong indicators that a patient is on the way to stable recovery. Patients who attend more therapy sessions gain more assets for long-term recovery, such as drug-avoidance skills and awareness of the benefits of healthy recreational activities and drug-free social networks. During drug-free intervals, patients accumulate experience in living without drugs.

Motivational incentives—tangible rewards for verifiable abstinence—are powerful tools for promoting both goals. In typical motivational incentive programs, patients receive vouchers for cash or goods each time they show up for a therapy session, pass a Breathalyzer test, or submit a drug-free urine sample. Studies have shown that substance abuse patients are better able to maintain desirable behaviors when they are rewarded daily or weekly rather than when they are asked to focus solely on the ultimate goal of long-term recovery. This accords with other research showing that addiction changes the brain in ways that make individuals more responsive to short-term rewards and less able to forgo them in the interest of longer term benefits.

Incentives extend abstinence during treatment for addiction to cocaine, methamphetamine, opioids, and nicotine, and they help cocaine abusers remain in treatment longer. Although the effectiveness of incentives tends to weaken after they are discontinued, some studies have found that benefits persist for 1 to 2 years.

Motivational incentives can promote and reinforce multiple healthy behaviors. For example, such interventions have improved drug abusers' adherence to HIV antiviral medication regimens and helped patients maintain regular exercise, job-hunting, and other activities that support a drug-free lifestyle. Investigators are currently examining how to tailor incentive programs for adolescents and pregnant women.

Motivational incentives need not strain budgets. NIDA-supported researchers have developed a program in which the rewards cost about $200 per patient. Each drug-free sample earns the right to draw from a container of chips. Most of the chips say "good job" or can be traded for $1 prizes, such as personal care products and bus tokens, but a few can be exchanged for prizes of greater value, such as music and video players. In a study conducted in the community-based facilities of the Clinical Trials Network, adding this program to usual care quadrupled the likelihood of stimulant abusers attaining 12 weeks of continuous abstinence. This is important because the longer patients are continuously abstinent, the greater their chances of maintaining future abstinence. NIDA hopes that these findings will encourage more clinics to adopt motivational incentives.