1. Are Incentives Effective in Improving Participation and Outcomes in Treatment for Substance-Abusing Offenders? Michael L. Prendergast, Ph.D. Elizabeth A. Hall, Ph.D. Integrated Substance Abuse Programs University of California, Los Angeles ACJRC October 22, 2010

2. Contingency Management Procedures that arrange the environment so that certain actions (behaviors) are reliably and predictably followed by certain consequences. Procedures that arrange the environment so that certain actions (behaviors) are reliably and predictably followed by certain consequences. Consists of a schedule of reinforcement, which specifies the relationship between the behavior and the delivery of the consequence, either a reinforcer or a punisher. Consists of a schedule of reinforcement, which specifies the relationship between the behavior and the delivery of the consequence, either a reinforcer or a punisher.

3. Operant Conditioning  Operant Conditioning  type of learning in which behavior is strengthened if followed by reinforcement or diminished if followed by punishment  Law of Effect  Thorndike’s principle that behaviors followed by favorable consequences become more likely, and behaviors followed by unfavorable consequences become less likely

4. Operant Conditioning  Reinforcer  any event that strengthens the behavior it follows

5. Ways to increase behavior: Operant conditioning term Positive reinforcement Positive reinforcement Negative reinforcement Negative reinforcementDescription Add a positive stimulus (e.g., incentives such as a privilege, money, candy) Add a positive stimulus (e.g., incentives such as a privilege, money, candy) Remove an aversive stimulus (e.g., daily reporting, seatbelt buzzer) Remove an aversive stimulus (e.g., daily reporting, seatbelt buzzer)

6. Principles of Reinforcement  Primary reinforcer  innately reinforcing stimulus  i.e., satisfies a biological need (fish)  Conditioned reinforcer  stimulus that gains its reinforcing power through its association with primary reinforcer (e.g., fishclicker)  secondary reinforcer (e.g., money)

7. Typical Contingency Management Procedures in Drug Treatment Participants earn vouchers for providing drug-free urines, which indicate recent abstinence. Participants earn vouchers for providing drug-free urines, which indicate recent abstinence. Participants may also earn vouchers for other behaviors that promote treatment goals. Participants may also earn vouchers for other behaviors that promote treatment goals. Vouchers can be exchanged for goods or services that are consistent with the individual participant's treatment plan. Vouchers can be exchanged for goods or services that are consistent with the individual participant's treatment plan.

8. Increasing Engagement in Prison- based Drug Treatment PI: William Burdon, PhD Aims: Test the impact of a behavioral reinforcement intervention on inmate engagement in prison- based substance abuse treatment Test the impact of a behavioral reinforcement intervention on inmate engagement in prison- based substance abuse treatment thereby improving psychosocial functioning over the course of treatment and post-release outcomes (e.g., decreased drug use, reincarceration)thereby improving psychosocial functioning over the course of treatment and post-release outcomes (e.g., decreased drug use, reincarceration) Assess the process by which this evidence-based innovation is implemented and sustained within prison-based treatment programs Assess the process by which this evidence-based innovation is implemented and sustained within prison-based treatment programs

9. Study Features Variety of behaviors were reinforced Variety of behaviors were reinforced Client and staff buy-in Client and staff buy-in Low cost incentives Low cost incentives

10. Evaluating Voucher-based Contingencies in a Drug Court & SACPA (Prop 36) Court PI: Michael Prendergast, PhD Aims: Determine the impact of vouchers to reinforce abstinence from illicit drugs and completion of treatment plan goals during participation in a drug court treatment program. Determine the impact of vouchers to reinforce abstinence from illicit drugs and completion of treatment plan goals during participation in a drug court treatment program. Determine the impact of vouchers to reinforce abstinence from illicit drugs and completion of treatment plan goals six months after completing the drug court treatment program. Determine the impact of vouchers to reinforce abstinence from illicit drugs and completion of treatment plan goals six months after completing the drug court treatment program.

11. Study Features Participants were referred by the Drug Court or Prop 36 Court into substance abuse treatment (MATRIX model) Participants were referred by the Drug Court or Prop 36 Court into substance abuse treatment (MATRIX model)

12. Participants were randomly assigned to 1 of 4 experimental conditions: Standard Treatment (ST) ($0) Standard Treatment (ST) ($0) ST + Drug Testing Group ($20/wk; $540 max) ST + Drug Testing Group ($20/wk; $540 max) ST + Treatment Plan Group ($20/wk; $540 max) ST + Treatment Plan Group ($20/wk; $540 max) ST + Combined Group ($40/wk; $1,080 max) ST + Combined Group ($40/wk; $1,080 max)

13. Study Features (cont.) Flat reinforcement schedule Flat reinforcement schedule Incentives were delivered by research staff Incentives were delivered by research staff Vouchers were exchangeable for goods or services that were consistent with the participant’s treatment goals Vouchers were exchangeable for goods or services that were consistent with the participant’s treatment goals

14. Behaviors Performed (Drug Court)

15. Items for Which Vouchers Were Exchanged (Drug Court)

16. Mean # of Consecutive Abstinences During Months 1-6

17. Using Incentives to Improve Parolee Participation and Attendance in Community Treatment PI: Michael Prendergast, PhD Aims: Determine whether offering an incentive (voucher) increases admission to community treatment Determine whether offering an incentive (voucher) increases admission to community treatment Determine whether providing incentives for attendance results in greater retention in treatment Determine whether providing incentives for attendance results in greater retention in treatment Assess the long-term impact of the use of incentives on drug use, crime, and psychosocial outcomes Assess the long-term impact of the use of incentives on drug use, crime, and psychosocial outcomes Assess issues of acceptability, satisfaction, and sustainability of the use of incentives among staff and clients Assess issues of acceptability, satisfaction, and sustainability of the use of incentives among staff and clients

18. Study Features One behavior (attendance) reinforced One behavior (attendance) reinforced Escalating reinforcement schedule Escalating reinforcement schedule Staff involvement in design and delivery of incentive Staff involvement in design and delivery of incentive

19. Thank You Questions?www.uclaisap.org Acknowledgements NIDA Grants R01DA13114, R01DA13114S, R01DA017856