About Incentives

Motivational Incentives or Contingency Management in Substance Abuse treatment are based on the principles of Operant Conditioning , which were originally developed by B.F. Skinner.

The model typically involves promoting therapeutic behavior change by providing desirable items or experiences (i.e., “reinforcers”) for meeting goals set by clinicians. In substance abuse treatment, the principle was first applied to alcohol use in the late 1960’s. In the early 70’s the focus began expanding to include illicit drugs and cigarette smoking.

About MIEDAR - Multi-Site Clinical Trial of Motivational Incentives

The National Institute of Drug Abuse (NIDA) created the Clinical Trials Network (CTN) in order to facilitate the dissemination of its research findings to the outpatient clinics, because most drug abuse patients in the United States receive their treatment in outpatient clinics. A key strategy in accomplishing this goal is to conduct multi-site clinical trials in real outpatient clinics that are representative of clinics across the country. One of the first major undertakings by the CTN involved researching motivational incentives as an evidence-based practice. The project included two studies. Both studies were designed to evaluate the effectiveness of low-cost motivational incentives as an adjunct to usual care. One study was conducted in outpatient psychosocial substance abuse treatment clinics, and the other study was conducted in methadone maintenance clinics.

The project was called MIEDAR (Motivational Incentives for Enhanced Drug Abuse Treatment). Dr. Maxine Stitzer, served as the Principle Investigator (i.e., lead scientist) for the project. Dr. Stitzer is well known for her groundbreaking work on the different methods of establishing incentives for the treatment of substance abuse populations.

In the MIEDAR studies, new patients (target population) were randomly assigned to receive usual care, or usual care plus a motivational incentive program. The target behavior was abstinence from stimulants such as cocaine, methamphetamine, and amphetamines. Urine samples were used as the basis for deciding whether a participant had abstained from stimulant use. When participants abstained from using stimulants, they earned the opportunity to draw tickets from a prize bowl. The tickets specified the prize that the participant received. This is commonly known as the fishbowl method, and was developed by Nancy Petry. The fishbowl method is popular with administrators because it can keep down the cost of the intervention. Half of the tickets in the bowl, said “Good Job,” and the rest were labeled with the value of the prize that the participant could choose (e.g., small, medium, large and jumbo). (Click here to learn more about the Fishbowl Method). These manuscripts describing these trials are housed at the CTN Dissemination Library.

About This Website

Research is constantly contributing new knowledge to the fields of substance abuse prevention and treatment. However, it can be a long and slow process. One study showed that it takes an average of 17 years before practice can actually benefit from its incorporation (Lamb, Greenlick, and McCarty 1998).

We also know that, for many people, conventional training on a new clinical technique or skill is not enough support to the adoption or sustained use of the new practice when we return to the workplace. Often, we need a form on ongoing support to encourage implementation.

This website is designed to (1) serve as a resource for those who are implementing, who are thinking about implementing, or who have already implemented a project involving the use of Motivational Incentives and (2) provide a community in which people who use Motivational Incentives to improve substance abuse treatment can connect and share ideas. .

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