PHOENIX – Small awards for good attendance and clean urine tests can help keep more addicts in treatment longer, greatly improving their chances of staying drug free, a federally sponsored study shows.
The feasibility and benefit of this “motivational incentives” approach has been demonstrated before. But in previous trials, the awards were rather large. They could equal $1,000 total, said Maxine Stitzer, Ph.D., in presenting the new study at the annual meeting of the American Academy of Addiction Psychiatry.
The new trial used a door-prize-like system, in which patients who met attendance and abstinence milestones drew chips from a hat. Some chips had value, but half had none at all, and the patients had only a 0.2% chance of drawing a chip with the highest value, worth $80-$100 toward merchandise. The longer a patient stayed on the straight and narrow, the greater the number of draws they earned–and relapses set them back. The chips were redeemed for items such as kitchenware, cordless telephones, and DVD players, all of which were kept on site at the clinic.
The door-prize system makes this rewards approach much cheaper than previous systems, said Dr. Stitzer, a professor of behavioral biology at Johns Hopkins University, Baltimore. The most a patient could win was merchandise worth $400.
The aim of the system is to change the culture of the treatment environment to some extent, Dr. Stitzer said. “Rather than looking for ways to punish people who are doing wrong, what this program is trying to do is to catch people doing good and to reward them for their successes. “My conclusion is that everybody should be using incentives, because they work so well.”
The study was conducted at eight outpatient clinics, and the patients were followed for 12 weeks, during which time they had twice-weekly urine testing. A total of 415 methamphetamine and cocaine abusers were randomized to either usual care or usual care plus the incentive system.
At 12 weeks, retention in the incentive-system patient group was 49%, compared with only 35% in the control group. The patients were also more likely to test negative for drug use. Almost 40% of the patients in the incentive group had 18–24 negative urine tests, a range known to be associated with a higher rate of long-term success, compared with less than 25% of the control group patients.
The study also sought to determine if the incentives would work as well for methamphetamine abusers as for cocaine abusers, who were the sole subjects of previous experiments with the system, Dr. Stitzer said. On the West Coast, stimulant abusers tend to be methamphetamine abusers; on the East Coast, they tend to be cocaine abusers. A subanalysis of the study data did find that the results with the methamphetamine abusers mirrored those for the study as a whole.
The study had 113 methamphetamine abusers, 51 of whom were randomized to the incentive system and 62 of whom were controls. Full, 12-week retention was 55% for the incentive group and 39% for the control group. Fifty-eight percent of the urine tests submitted by the incentive group patients were negative for stimulants, compared with 42% of the control group's tests, and 18% of the incentive group had 24 negative tests, compared with only 6% of the control group. Because of this and previous research, the National Institute on Drug Abuse plans to spread the word about the incentive system to drug abuse clinic administrators, Dr. Stitzer said.