I work with DWI offenders in outpatient substance abuse treatment. Mostly men, mostly in their 20’s and early 30’s. They face pretty stiff consequences for not attending sessions, but we still have a problem with no-shows. I’ve tried calling the Court the day after a missed session, but they don’t respond quick enough to make a difference. What else can I try?”

You mentioned the penalties – what about perceived benefits? In other words, is there any practical incentive for attendance, other than just avoiding trouble with the Court? Because as you noted, the Court may not move very fast.

There’s some solid science behind ‘fishbowl’ drawings. Same method used by churches and lodge brothers to get members to pony up for good causes. You’d be amazed how well people respond to the opportunity to ‘win’ a gift card from the local pizza joint or discount emporium. The better his attendance, the more slips the client gets to place in the fishbowl. Here are NIDA’s resources on the process.

Twelve Step groups learned a long time ago about the value of feeding people. Most of the time participants can feed themselves; try ‘pot luck’ occasions, particularly in programs that operate in the evening. Make sure there’s an opportunity for socializing. You want groups to bond, right? That’s how they go about it.

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One program I work with is in a community that’s 80% Hispanic – a culture that values hospitality and interpersonal warmth. A certain amount of socializing is expected, and it doesn’t hurt to provide it.

But the thing we find most helpful is simply to improve the quality of the sessions. Coerced clients share two traits. First, they don’t understand why they’re in treatment, or how it could possibly benefit them. Second, they’re ticked off about having been coerced.

They couldn’t be more different from self-referred clients. I think of them almost as a separate category. Many are in pre-contemplation. Some are in pre-pre-pre-contemplation. With groups like that, I look for a ‘back door’. By that I mean a way around rather than through their resistance.

Instead of the hazards of drunk driving, I’ll start by talking about the odds of winning or losing on a slot machine. Why? Because almost everybody plays the slots, and everybody who plays is interested in winning. They’ll pay attention. It’s easy to move from there into a discussion of the risks associated with drunk driving. The hook is a discussion of probabilities – in other words, the odds.

Or I might start off with an example from the complex world of pro football. You have any male clients who don’t follow the NFL? I didn’t think so. It’s an easy leap from there to a look at your values in other areas of life. Discussion is always lively.

Three months later, your clients won’t recall the discussion. But they’ll remember how it felt to be engaged.