Motivation Hit: Reward system helps addicts January 01, 2007
By Maggie Rauch
Smart companies know that rewards and recognition can effectively drive strong work performance, but incentives also are gaining credibility in a completely different arena—the treatment of recovering drug addicts. At Johns Hopkins University in the 1980s, Dr. Maxine Stitzer conducted the earliest studies of what is called contingency management therapy, leading to wide acceptance of incentive use in cocaine addiction treatment. And last November, the American Journal of Psychiatry published the first formal report demonstrating the effectiveness of this therapy in treating methamphetamine addicts. "Drugs hijack the user's motivational system, altering their reward circuitry so the drug becomes a very powerful reinforcer," says John Roll, Ph.D., lead author on the report and a Washington State University professor. "We try to hijack it back, using a new reinforcer to alter that cycle." Roll's study tracked 113 participants. About half received "treatment as usual." The others participated in a program that included merchandise awards. When these patients tested negative for drugs, they were able to draw from a supply of chips, with reward values ranging from intangible recognition ("good job") to prizes worth $80 to $100. The prizes included snacks, bus tokens, stereos and business suits for job interviews. To discourage relapses, the number of chips drawn increased with consecutive weeks of negative test results; testing positive for drugs bumped participants back down to one draw at their next negative result. The study yielded convincing evidence: Subjects submitted a mean of 13.9 negative drug tests during the study's 12-week period, versus only 9.9 negative results for non-participants. While using incentives to promote treatment is not exactly controversial, the practice does have its detractors, Roll says.
"People say, 'I don't use drugs and no one's giving me prizes,'" he says. "But [addiction] is a serious public health problem, and here's a proven way to treat it."
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