Voucher-based reinforcement of attendance by unemployed methadone patients in a job skills training program.

This study evaluated the use of voucher reinforcement for maintaining attendance of unemployed methadone patients in a job skills training program. Participants received vouchers for attending daily 2-h computer data entry training sessions. The vouchers had monetary values and were exchangeable for goods and services. During the first 6-week condition, daily vouchers were initially worth $8, increased by $0.90 for every consecutive day of attendance to a maximum of $34.10, and reset to $8 following any day of missed attendance. During the second 6-week condition, voucher values decreased each day by 20% of that individuals' earnings on the previous day. During a final 4-week condition, the highest pay level previously achieved by each individual was reinstated and stayed at that level for the remainder of the condition, except that voucher values reset back to $8 following any missed session. Five of 7 participants completed the study. For those 5 participants, 94% and 98% attendance rates were sustained during first and second high pay conditions, respectively. Four of 5 subjects stopped attending when pay fell to $6-$9 (median = $7) per session in the descending pay amount condition (the fifth subject continued to attend throughout). Mean percent of work days attended was significantly higher during the two high pay conditions than during the decreasing pay condition (P < 0.001). All participants acquired data entry skills. Participants reliably rated the work experience as 'interesting', 'enjoyable', 'challenging', and 'helpful'. Mean ratings for these adjectives obtained on all days attended were significantly higher than ratings of the experience as 'frustrating', 'boring', or a 'waste of time' (P < 0.001). These data show that voucher-based reinforcement can promote sustained attendance of chronically unemployed substance abusers in intensive employment training programs and support the continued evaluation of these incentive procedures under a wider range of worksite training conditions.