Behavioral contingencies improve counseling attendance in an adaptive treatment model

Robert Brooner, Michael S. Kidorf, Van King, Kenneth B. Stoller, Jessica Peirce, George E. Bigelow, Ken Kolodner

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Poor patient adherence remains a serious obstacle to improving the effectiveness of many drug abuse therapies and the overall quality of care delivered in programs. The present study evaluated the utility and efficacy of incorporating behavioral contingencies in a stepped care treatment approach to motivate patient attendance to the varying amounts of prescribed weekly counseling. Study participants were opioid-dependent patients (n = 127) newly admitted to an ambulatory treatment program that provides methadone. Participants were randomly assigned to a Motivated Stepped Care condition (MSC; n = 65) with behavioral contingencies to specifically motivate counseling attendance vs. a Standard Stepped Care condition (SSC; n = 62) without these contingencies. The MSC vs. SSC condition was associated with a higher rate of counseling attendance (83% vs. 44%, p <. 001) and a lower rate of poor treatment response (46% vs. 79%, p <. 001). The behavioral contingencies were well tolerated and strongly associated with excellent attendance across both lower and higher doses of weekly counseling.

Original languageEnglish (US)
Pages (from-to)223-232
Number of pages10
JournalJournal of Substance Abuse Treatment
Issue number3
StatePublished - Oct 2004


  • Adaptive treatment
  • Behavioral reinforcement
  • Contingency management
  • Drug abuse treatment
  • Stepped care

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health


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