Enhancing participation in substance abuse treatment using an incentive system

A contingency management system is described for enhancing participation in an inpatient chemical dependency rehabilitation program. The system employs reinforcers that are readily available in a residential milieu and makes receipt of them contingent upon appropriate patient behaviors. The behaviors include arranging aftercare treatment, involving family members in the treatment process, appropriate participation in ongoing treatment activities, and assisting with unit chores. A patient's status within the program is first regulated on a noncontingent basis, after which an accumulation of nine specified accomplishments results in the acquisition of a number of privileges. Accumulation of three demerits, given for inappropriate behaviors, results in a status reduction that can only be restored by completing ten additional behaviors. Improvement in patients' program involvement was documented in a number of areas, with a concomitant reduction in resistance to treatment. The system also resulted in an improvement in staff's charting of patients' behavior.