Incentivizing behavior with rewards is a controversial practice. I have friends who are vehemently against their children receiving “participation awards” for being on youth athletic teams; these parents claim that rewards cheapen their child’s efforts and removes the incentive to excel.

Michelle Rhee, the former chancellor of the Washington, DC, public school system, voiced a similar opposition to participation rewards. A 2013 issue of Education Week featured a review about Rhee’s controversial views:

“Rhee says the United States has ‘gone soft as a nation’ when it comes to public education. ‘We are not doing our kids any favors by teaching them to celebrate mediocrity, to revel in the average, and to delight in merely participating,’ Rhee writes. In fact, Rhee even cringes when she considers the number of soccer trophies and medals her 2 daughters have collected. ‘They suck at soccer,’ she says.”1

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Incentivizing participation by rewarding completing treatment plans has moved into medical care as well. I know of a local clinic that has used similar efforts to retain patients in treatment, such as providing rewards for attending patient orientations. When I’ve discussed this issue with friends and associates, I’ve frequently heard feedback similar to Rhee’s take: “So now we’re going to give patients prizes for showing up?”

Published data provide evidence of the potential effectiveness of providing participation rewards for patients, particularly in addiction and mental health settings. The National Institute on Drug Abuse’s online “Principles of Drug Addiction Treatment” includes a small piece titled “Contingency Management Interventions/Motivational Incentives,” which cites research about the effectiveness of incentive-based interventions called Contingency Management (CM).2  

“Research has demonstrated the effectiveness of treatment approaches using CM principles, which involve giving patients tangible rewards to reinforce positive behaviors such as abstinence. Studies conducted in both methadone programs and psychosocial counseling treatment programs demonstrate that incentive-based interventions are highly effective in increasing treatment retention and promoting abstinence from drugs,” noted the authors.2

Such efforts include Voucher-based Reinforcement and Prize Incentives CM. Voucher-based Reinforcement usually augments other treatments and provides vouchers with monetary value to patients who produce drug-negative urine samples. The value of these vouchers begins at a low rate and increases with additional negative urine samples. If the urine sample is positive, the voucher resets to the initial value. 

Prize Incentive CM varies slightly in that it can offer cash incentives for various treatment-positive activities including attendance for medical, counseling, and/or medication dispensing sessions. 

Of interest, a small study conducted in 2010 indicates the success of using CM to increase glucose monitoring in patients with diabetes.3

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In spite of positive data indicating the potential of CM, my discussions with colleagues indicate strong opposition to the concept of providing rewards to maintain patient engagement and performance in treatment. Addressing these concerns seems to be a missing component in the expansion of CM; focusing on providers reservations is necessary to integrate the principles of CM into new settings.


1. Cardino CA. Book Review: The One-Sided Radicalism of Michelle Rhee. Education Week website. Published May 30, 2013. Accessed December 5, 2019.

2. National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Updated January 17, 2018. Accessed December 5, 2019.

3. Raiff BR, Dallery J. Internet-based contingency management to improve adherence with blood glucose testing recommendations for teens with type 1 diabetes. J Appl Behav Anal. 2010;43(3):487-491.