Interventions to promote retention in substance abuse treatment

Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio 43210, USA.
Brain Injury (Impact Factor: 1.81). 05/2007; 21(4):343-56. DOI: 10.1080/02699050701253103
Source: PubMed


Compare two methods of improving retention in substance abuse treatment for persons with traumatic brain injury.
Randomized clinical trial with control group comparison.
Provision of a financial incentive and reduction of logistical barriers.
Treatment attendance, perceived therapeutic alliance, premature termination.
Provision of a financial incentive was highly effective for facilitating early attendance and appeared to promote eventual successful treatment completion. Reduction of logistical barriers did not significantly improve attendance or successful discharge. The hypothesized role of improved therapeutic alliance as a consequence of intervention and a mediator for preventing premature termination was not supported. However, results suggested that intervention, particularly financial incentives, promoted congruence between counsellor and client perceived therapeutic alliance.
For clients with traumatic brain injuries, provision of a financial incentive at an early point in substance abuse treatment substantially improves attendance and reduces the likelihood of premature termination. The basis for this effect appears to involve more than enhancement of the therapeutic alliance. We posit that concrete incentives can provide an opportunity for successful rule-governed behaviour that may generalize to other areas of improved impulse control.

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    • "vouchers or fine reductions for early and complete participation ) might be particularly relevant for offenders who are prone to seek immediate gratification and fail to value delayed positive consequences. An analogous approach involving offering vouchers for treatment attendance has produced consistently positive results in drug-dependent individuals and individuals with frontal lobe lesions [151] that appear similar to those observed in DWI offenders. Although the biological routes from psychobiological dysregulation to increased drinking are not fully understood , possible mechanisms include modulation of mood and anxiety symptoms, dopaminergic release in the nucleus accumbens and/or hippocampal and amygdala activation. "
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