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| Low-Cost Incentives to Improve Counseling Attendance |
| Feature Articles - Treatment Strategies or Protocols | |
| Written by Stacey C. Sigmon, PhD, and Maxine L. Stitzer, PhD | |
| Tuesday, 10 April 2007 | |
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Would you like to see more clients attending your groups and more
enthusiasm among those who do attend? There are new methods available
to help attract and sustain group therapy participation in addiction
treatment programs. These methods, known as an approach called
contingency management, use positive reinforcement to acknowledge and
reward client participation. They have shown to be highly effective in
motivating better treatment attendance as well as other important
clinical behaviors (Higgins & Silverman, 1999).
It is very important to motivate clients to attend therapy sessions since this is the core of their treatment and, if they don’t come, they will not benefit from the therapy that is offered. Some of the original research demonstrating the ability of incentives to motivate better therapy attendance was conducted at Johns Hopkins School of Medicine at a small methadone maintenance treatment research program. One study (Stitzer et al., 1977) targeted methadone clients who had been attending their required therapy sessions only sporadically (45 percent of the time). When these clients were offered the chance to receive methadone take-home doses for the weekend each time they attended therapy during the week, attendance rates jumped up to 90 percent. In another study conducted later at the same clinic, a group of clients with ongoing cocaine use was offered the chance to attend an optional relapse prevention group (Kidorf et al., 1994). Perhaps not surprisingly, since the group was optional, virtually no one attended in the absence of incentives. However, when these same clients could earn a single take-home dose each time they went, attendance rates increased dramatically, to 75 percent. Other studies have shown that therapy attendance can be increased with incentives in special populations including mentally ill substance abusers (Carey and Carey, 1990); pregnant substance abusing women (Jones et al. 2001); and clients attending a structured vocational training program (Silverman et al., 1996). The methadone take-home privilege that has been used as an incentive in some previous studies allows clients to skip a day of travel to the clinic to pick up their dose, and it is a desirable incentive that can be delivered with virtually no cost to the clinic. However, the very same principles can be applied in any outpatient program that offers group therapy, provided that other low-cost incentives can be found. A prize drawing method (“the fishbowl”) is a recently-developed variation of contingency management that delivers incentives with modest costs by giving clients a chance to draw slips from a bowl and win prizes on a probability basis (Petry et al, 2000). The secret to cutting cost is that not every slip is a winner, and even among the winning slips, most indicate a small low-cost prize rather than a larger, more expensive prize. However, larger prizes are available and can be won more or less frequently, depending on the number of large prize slips in the bowl. Also, the more groups people attend in a row, the more draws they get from the bowl, which increases their chances of winning the larger prizes. In one study, Petry and her colleagues (Petry et al., 2001) used this method to reinforce group counseling attendance at a community-based HIV drop-in center. Clients started with one draw on the first meeting they attended, got two draws for the next consecutive meeting, three draws for the third and so on, up to 14 draws if they attended all the scheduled meetings. This incentive system had a big impact on group counseling attendance; average number of clients attending group went from 0.7 (range 0-4 clients) to 7.0 (range 2-12 clients) — a 10-fold increase — after the incentive program was implemented. Petry also has shown that this fishbowl method can increase group therapy attendance in a methadone program (Petry et al., 2005). A study recently reported in the Journal of Substance Abuse Treatment (Sigmon and Stitzer, 2006) also used the prize draw system at a methadone maintenance clinic to see if it would improve group counseling attendance. This study was meant to simulate the situation in community clinics where the incentive program would be implemented by the counselors charged with running group sessions. The rest of this article describes how that study was done and what its outcome looked like. Want to read the entire article? Don't miss out...Subscribe now to Counselor Magazine—or buy the single issue! It's easy. Just follow the links below:
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