Some clients need more frequent reinforcement than others – those with poor impulse control, for instance, or who struggle with cravings, or are less motivated for other reasons.

iStock_000000884791MediumOur problem in our outpatient programs is no-shows. We know you’re a supporter of incentive programs to improve session attendance. How would you go about setting one up? We serve about 1000 clients a year.”

I don’t know if I’d qualify as a ‘supporter’ of incentives — it’s just that I recognize they seem to work. Strange thing is that I doubt they’d work for me if I were a client. I’d probably just give the gift card to somebody who needed it more than I did. But then hypnotherapy doesn’t work for me, either, and yet I suggest it to people who are looking for a non-pharmaceutical way to reduce pain, quit smoking, etc. Seems to help some of them, and that’s really all I’m interested in.

Anyway, here’s an oversimplified design for such a program:

First, select the target behavior. The area for improvement, so to speak. In your case, regular session attendance. Could have been clean drug screens. Negative breathalyzer tests. Whatever.

Second, select the target population. Might be only one track or program within your agency. Or might be all of them. Where is the improvement needed?

Third, choose your reinforcer. Might be a gift card, or movie passes, or candy bars. etc. Most programs use the Fishbowl method — a drawing. The number of draws a client earns might depend on the number of consecutive sessions attended during the required period.

Fourth, select the frequency. How often does a client get to draw from the Fishbowl? Some clients need more frequent reinforcement than others – those with poor impulse control, for instance, or who struggle with cravings, or are less motivated for other reasons.

NIDA has actually funded a database to help you manage your incentive program. It’s free. Here’s the link:

Better Treatment Outcomes

Let us know how it works for you.


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