Using behavioral reinforcement to improve methadone treatment participation.

A new service delivery system for the treatment of opioid dependence, called motivational stepped care, matches the intensity of counseling services to each patient's clinical progress. Adherence to a counseling schedule is reinforced through the linking of counseling attendance with the patient's methadone dispensing schedule and, ultimately, his or her ability to continue receiving treatment services. The article describes the scientific evidence supporting the major elements of the model, the model in action, and evaluations that have been conducted to date.