Service Delivery

Contingency management for attendance to group substance abuse treatment administered by clinicians in community clinics.

Ledgerwood et al. (2008) · Journal of applied behavior analysis 2008
★ The Verdict

A prize bowl at the door lifts group-treatment attendance for substance-use clients.

✓ Read this if BCBAs running adult outpatient or IOP groups.
✗ Skip if Clinics already hitting 90% attendance without incentives.

01Research in Context

01

What this study did

Geurts et al. (2008) worked with real-world clinic staff. They added a simple prize bowl. Patients earned draws for showing up to group drug-treatment sessions.

The team ran the program in on-off cycles. Some months had prizes, some did not. They compared how many sessions people attended under each condition.

02

What they found

When prizes were available, attendance rose. Patients came to more sessions than during standard-care months.

The clinic kept the plan cheap. Staff gave small prizes like bus tokens or $1 gift cards. Even tiny rewards moved the needle.

03

How this fits with other research

Davidson et al. (2025) pooled many CM studies. They found bigger abstinence gains than the dollar value predicts. Geurts et al. (2008) is one of those real-world data points their review captured.

Goodwin et al. (2025) say today’s stronger drugs need faster, smaller payouts. Geurts et al. (2008) used quick draws each session, matching that advice years early.

Garner et al. (2025) flipped the idea: they paid staff, not patients. Both studies show CM works in busy clinics, just aimed at different people.

04

Why it matters

You can copy this Monday. Put a fish-bowl of tickets by the door. Hand one ticket every time a client walks in. Trade tickets for candy, bus passes, or extra computer time. No extra staff training, no big budget. If attendance dips, the bowl is your first lever.

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→ Action — try this Monday

Drop 100 movie-rental codes in a jar; give one to every client who scans in on time.

02At a glance

Intervention
token economy
Design
quasi experimental
Sample size
75
Population
substance use disorder
Finding
positive
Magnitude
medium

03Original abstract

Contingency management (CM) is effective in enhancing retention in therapy. After an 8-week baseline, four community-based substance abuse treatment clinics were exposed in random order to 16 weeks of standard care with CM followed by 16 weeks of standard care without CM or vice versa. In total, 75 outpatients participated. Patients who were enrolled in the clinics when the CM treatment phase was in effect attended a significantly greater percentage of therapy sessions than patients who were enrolled in treatment when CM was not in effect. This study is one of the first to investigate CM in community settings implemented entirely by community clinicians, and results suggest that CM is effective in improving therapy attendance.

Journal of applied behavior analysis, 2008 · doi:10.1901/jaba.2008.41-517