Supporting Patients in Recovery: Researcher Tests the Efficacy of Incentives on Behavior Change

May 26, 2022

Key Findings 

  • Wage supplements significantly increase the likelihood that patients with substance use disorders will remain drug abstinent.
  • Contingency management is an effective program at maintaining both drug abstinence and employment.

Substance use disorder (SUD) is a growing epidemic in the United States, with overdose deaths climbing every year. This is the field where Dr. Shrinidhi Subramaniam, assistant professor of Psychology and Child Development at California State University, Stanislaus, researches a method that can lead to sustained behavior change for individuals impacted by SUD.

Dr. Subramaniam was recently awarded an Early Career Impact Award from the Federation of Associations in Behavioral and Brain Sciences, as nominated by the Association for Behavioral Analysis International (ABAI). Her research investigates the efficacy of incentives-based interventions in clinical populations to encourage drug abstinence and a successful return to the workforce.

“We are looking at how we can harness the power of behavioral interventions to help people meet their goals,” she explains. Her research focuses on contingency management treatment, one of the most effective psychosocial interventions for substance use disorders, wherein patients identify specific goals and use incentives (usually in the form of wages or vouchers) to promote the intended behavior.

“The Therapeutic Workplace” is one such program that evaluates the efficacy of contingency management in patients aiming to remain drug abstinent, while actively working to secure employment. In the program, Dr. Subramaniam collaborated with other researchers in incentivizing the patients’ goals of drug abstinence, engagement in job skills training programs, and employment. Their findings shed light on how wage supplements can help people get and stay employed a year after initiating drug abstinence.

In the first phase of “The Therapeutic Workplace,” participants worked on education and job skills training, such as math, typing, and reading skills. They were paid in wages where they received a base pay and productivity pay for progressing through the trainings. The maximum base pay was based on maintaining drug abstinence. Following the first phase, participants graduated to the second phase where they had the opportunity to work with an employment counselor and could earn wage supplements for obtaining competitive employment and maintaining drug abstinence.

In the wage supplement group, participants submitted twice as many drug-free urine samples than the control group. Importantly, over 60% of the wage supplement participants were able to work their way out of poverty, compared to only 30% of participants in the control group. As Dr. Subramaniam summarizes, “when applied over the long term, these incentive interventions can be incredibly effective at addressing health and life satisfaction outcomes.”

We are looking at how we can harness the power of behavioral interventions to help people meet their goals.

– Shrinidhi Subramaniam

Results such as these have the potential to inform policies that are currently based on incentive systems. Dr. Subramaniam aims to understand the best way to design these systems to better assist recipients of the services. The work will provide guidance on when and how often to deliver incentives in order to maximize their efficacy.

Federal funding from the NIH, in the form of a T32 training grant during her work as postdoctoral researcher, was crucial in starting her career. One of her dreams is to set up her own therapeutic workplace in the local community. With enough funding through federal grants and contracts, she could set up an incentive-based program to provide continuing care for people with substance use disorder. These programs can be especially helpful following intensive, residential treatment programs. As she describes, “hopefully, after residential treatment, we can help patients continue to make those sustained behavioral changes.”

In addition to her research, Dr. Subramaniam dedicates much of her time to mentoring undergraduate and master’s students. Many of these students become practitioners, influencing the lives of patients they treat.

Potential for Future Impact

  • This work will inform policy on how to best implement incentive systems in a variety of social support programs.

Dr. Shrinidhi Subramaniam is a recipient of the 2022 Federation of Associations in Behavioral & Brain Sciences (FABBS) Early Career Impact Award and was nominated by the Association for Behavioral Analysis International (ABAI). ABAI’s 48th Annual Convention, takes place in Boston, Massachusetts, on May 28-30. See more about the conference here

You can read more about Dr. Subramaniam’s work at the links below: