Survey assessment of methadone treatment services as reinforcers

Offering incentives contingent on behavioral change can be an effective method for improving treatment outcome in methadone maintenance. Further, there are several incentives available within the daily operation of methadone clinics that can be used in this way. This study describes patient preferences for clinic service incentives as identified by three types of survey methodologies: multiple choice procedures, visual analog scales, and rank ordering. Methadone patients (n = 111) rated preference for three service incentives (take-home medication, dose increase, counseling sessions) using each survey. Mean and individual responses were highly consistent across surveys and indicated that, in general, take-homes were the most preferred, followed by dose increases and then counseling. The rank order survey also assessed an additional 18 service items (e.g., rent, food or gas payments; employment assistance; medical care). Consistent with other measures, most patients (64%) placed take-homes within their top five rankings, indicating a high level of preference, but this survey also revealed wide individual differences in preference ranking. The surveys described can be used to identify preferred incentives for clinic-wide use in contingency management programs or can be used to select individualized incentives for each patient. This is useful information for maximizing utilization of clinic resources.