Interventions to promote retention in substance abuse treatment

Objectives: Compare two methods of improving retention in substance abuse treatment for persons with traumatic brain injury. Design: Randomized clinical trial with control group comparison. Interventions: Provision of a financial incentive and reduction of logistical barriers. Outcome measures: Treatment attendance, perceived therapeutic alliance, premature termination. Results: 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. Conclusions: 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.