Page 210 - The Power to Change Anything

Design Rewards and Demand Accountability 199

So, the question is, how do you use incentives wisely?
Take care to ensure that the rewards come soon, are gratify-
ing, and are clearly tied to vital behaviors. When you do so, even
small rewards can be used to help people overcome some of the
most profound and persistent problems. For example, Johns
Hopkins Hospital completed a study of alcoholics who had been
admitted to the hospital to, of all things, drink alcohol—but only
in moderate quantities. The idea of the project wasn’t to encour-
age the subjects to climb on the wagon or to go cold turkey, but
to learn how to drink in moderation.
To influence patients’ behavior, each day staff members
determined privileges on the basis of how much alcohol the
patients consumed. If they drank too much, they were given
pureed food instead of the normal offering. Their amount of
consumption also affected phone privileges, visiting hours,
and so on. When compared to control patients who were sim-
ply told how much to drink with no incentives, experimental
subjects were 60 percent more likely to reach their target con-
sumption level.
When you first hear that a simple incentive such as phone
privileges can help patients break free from something as pow-
erful as the steel grip of alcoholism, it’s a bit hard to believe.
Nevertheless, this example pales in comparison to the work of
Dr. Stephen Higgins, who routinely uses vouchers to help
direct the behavior of cocaine addicts. Cocaine addicts typically
fail to make progress in recovery programs because they quit
before the program starts to take effect. With Dr. Higgins’s
voucher system, outpatients are required to submit a urine sam-
ple three times a week. If all three samples test negative, the
subjects receive a bonus voucher that they can exchange for
goods and services provided by the research staff.
With something as tremendously addictive as cocaine,
you’d expect that a simple voucher that could be traded only
for a rather small prize wouldn’t have much of an effect. In Dr.
Higgins’s own words: “It surprises many people that a stack of