A mom wrote in asking for guidance on whether she should offer to reward her son for attending addiction recovery group meetings. However, she is unsure if she’s implementing the CRAFT concept of “rewards” correctly. Laurie MacDougall, an Allies in Recovery virtual program trainer – who herself has a loved one with SUD – explains the important differences between bribes, incentives, and positive reinforcement. Laurie advises steering away from the first two and sticking with positive reinforcement instead.
“My son is 23 and a cocaine addict. We have had a conversation about recovery groups. I was thinking about offering to sponsor him to attend a few meetings, i.e.: a reward for attending a meeting…. maybe offering to pay for some food that week. What are your thoughts on this?”
NOTE: This question originally appeared on the Allies in Recovery ‘Pose a Question’ blog, where site members can ask for expert advice about their situation. We also offer exclusive, members-only trainings, weekly support groups, and more at AlliesinRecovery.net.
Understanding all the fine details of how and when to reward our loved ones with Substance Use Disorder (SUD) can be complicated and daunting. I’ll map out a few ways of distinguishing between bribes, incentives, and positive reinforcement that I learned on my own journey with a loved one with SUD. Rewards – and using them wisely – are an important part of the CRAFT approach (Community Reinforcement and Family Training – the evidence-based method used by Allies in Recovery). We also do a deep dive into how and when to use rewards in our eLearning Module 5, “My Loved One Isn’t Using Right Now: Now What?” available to subscribers of our virtual program at AlliesinRecovery.net.
Rewards: What might your loved one appreciate?
The first thing to take into account is that a reward should be something that is pleasurable to our loved one and NOT something WE want or think our loved one needs. So, rewards can be some form of affection like a hand on the shoulder, a smile, a favorite video game, having lunch together, encouraging words, etc., It could also be a book with inspirational ideas or quotes – if our loved one wants to read that book. However, if only you find the book inspiring and want your loved one to read it because you feel it pertains to them, that may not actually be rewarding. In fact, they may see it as a judgement or an attempt to control them.
Bribes and incentives are not generally sustainable
The second concept that took me a while to grasp is that bribes or incentives are not ways of reinforcing positive behavior. In particular, bribing almost never works. Often it makes situations worse. Incentives might work once or twice, but they can fall apart quickly. I want to explain the difference, so you can keep yourself aware of why something you offer in one scenario might fall flat, while in a different situation, it might work great (i.e., when it’s positive reinforcement).
Mom is on the phone and the child is loud and disruptive while mom is talking. Mom then gives the child a lollipop as long as the child stays quiet. The problem then becomes, the child finishes the lollypop and there is no reason to stay quiet anymore. Instead, it would benefit the child to act up because mom may produce another lollipop. If mom gives a second lollipop, the child’s bad behavior is now reinforced. The child has now learned that acting up produces a reward!
A BRIBE IS A REWARD GIVEN BEFORE WITH THE PROMISE OF A PARTICULAR BEHAVIOR.
Dad wants his son to go to Refuge Recovery meetings because he is sure his son will like them. Dad promises his son to buy him cigarettes if he attends a meeting. After the meeting dad gives his son a couple of cigarettes out of the pack and promises more if he will attend more meetings. The son does and after each meeting, dad gives him more cigarettes. After a while, the son starts to complain that his dad is trying to control him. His dad is forcing him into something. Really, Dad is manipulating his son into doing something he thinks is beneficial.
AN INCENTIVE IS SOMETHING THAT IS PROMISED BEFORE AN EXPECTED BEHAVIOR BUT GIVEN AFTER IT OCCURS.
Another issue I have found with both bribery and incentives is that they show all of your cards. It becomes very clear what YOU want out of your loved one and, if they cannot produce, you might be disappointed. In the second scenario, what if the son does not like Refuge Recovery meetings? Will Dad be let down? Does he have to keep going just to get cigarettes? All of this makes the situation a lot more complicated… just one hiccup and it could all backfire.
So, what does reinforcing positive behavior look like?
Reinforcing positive behavior is waiting until our loved one behaves in a particular way and then rewarding them for it. So, reworking the two scenarios given above:
- Mom notices that the child is quietly playing with a toy while mom is on the phone. Mom keeps the conversation short and then says something like, “Thank you so much for giving me the time to take that important phone call. How about you and I sit at the table and have some milk and cookies together?”
- Dad notices his son has started attending Refuge Recovery meetings once a week and says something like, “I appreciate how tired and difficult it must be to get to a meeting after a day at work, I am proud of your effort. Let’s grab a bite to eat together.”
REINFORCING POSITIVE BEHAVIOR IS WHEN THE REWARD IS GIVEN AFTER THE BEHAVIOR IS OBSERVED.
Incentives: When they might backfire
We, as loving family members, start to attach our feelings, wants and expectations to the strategies we try, including bribes or incentives. Here’s a scenario where “showing all your cards” can really backfire:
Incentive Scenario Gone Wrong:
The son with SUD comes home talking about Refuge Recovery (RR) meetings he learned about that day. He expresses that a few of his friends have been talking them up and the son thinks he might give them a try. Dad listens and thinks this is great. Knowing the son is struggling to make ends meet and with good intentions, dad holds out an incentive to buy groceries for his son if the son attends a meeting. The son says, “Really? You would do that?” Dad is now elated because he believes he may have hit on something that might work.
A day or two later, Dad asks the son, “Where and when are the Refuge Recovery meetings?” The son tells Dad he is not sure, he needs to look them up. A day later Dad asks, “Did you look up the times and locations of the Refuge Recovery meetings?” The son replies, “Nope. I will…” The next day, Dad offers to look up the information on the meetings. Again, a negative response from the son and now he is starting to seem a little irritated.
A couple of days later, as anxiety starts to come to the surface for Dad because it does not seem his son is going to take him up on his offer, he asks, “Hey son. Don’t you want those groceries I promised? All you have to do is attend a meeting?” The son yells, “God dad, can’t you just leave me alone?! Stay out of my life, I can figure things out on my own. You have to control everything. I’m not going to a RR meeting. Not now, not ever, because of you!”
What went wrong?
Everything Dad did and said was well intended. Can’t we all imagine what was going on in Dad’s head? “Great! I am on to something. Something that might help my son with his recovery. I’m on it.” Then a couple of days later: “Why won’t he just go to a meeting? If he would just go, I really think he will like it. He might meet people and have some new friends that are sober. He might find some more support for his recovery. And groceries to boot! Why isn’t he taking me up on my offer? I know, I’ll help by offering to look up information for him.”
Then when none of this works, he brings up the groceries again!!!
Showing all your cards might mean you’re trying to control instead of listen
Dad allowed his obsessive thoughts, worries, and expectations of his son to take hold and derail his well-intentioned plan. In fact, it seems that in that moment, he may have pushed his son away from attending RR meetings. Dad is “showing all of his cards” because the son now knows that his incentive goes deeper than just support. It is attached to a particular behavior and expectation. It’s Dad’s attempt to control the situation. Maybe Dad can take this opportunity to really listen and respect his son’s wishes and, most of all, to let him find his own pathway to recovery.
The son’s response can also spiral Dad into feelings of hurt, frustration, anger and/or fear. I often hear family members express confusion about why their loved one might respond this way in similar situations. Many times, they will internalize and take the comments personally. Our thoughts can turn to, “I’m just trying to help,” “If she would just listen,” and many other negative thoughts and feelings about our loved one and ourselves. Confused and upset, we start to assume and assign beliefs onto our loved one like, “She’s so ungrateful,” “He has no respect for me,” and “She’s so selfish.”
Instead, maybe we can break the pattern of our own negative behavior by taking a pause, reflecting, and determining what about our actions and words we can alter for the better. Placing ourselves in our loved one’s shoes might help in future interactions.
“One and Done” – How incentives can be used more successfully
I have found that incentives can work with a method I call “One and Done.” It’s very simple but can be difficult to implement because it requires that the caring family member not let their obsessive thoughts take the lead. Also, they cannot show any expectation of a particular behavior from their loved one.
Let’s take a look at how Dad could have had a better outcome in the previous example:
The son with SUD comes home talking about Refuge Recovery meetings he learned about that day. He expresses that a few of his friends have been talking them up and the son thinks he might give them a try. Dad listens and thinks this is great. With good intentions, Dad holds out an incentive to buy groceries for his son if the son attends a meeting, knowing the son is struggling to make ends meet. The son says, “Really? You would do that?” Dad is now elated because he believes he may have hit on something that might work.
And that’s it. The loved one’s choice. Wait for it.
Dad offers the incentive up once and that’s it. There is no questioning or digging into what the son is doing to make it happen. Dad just waits. Dad must also understand that the son might not take him up on his offer. But that’s the son’s choice. Dad’s only responsibility after the offer is to take care of himself: to keep his thoughts, worries, and expectations at bay.
If the son takes Dad up on his offer, great. That may lead to the offer of a second incentive or maybe reinforce positive behavior by picking the son up after the next meeting and taking him out for a bite to eat. If the son does not take Dad up on his offer, then he waits for the next opportunity to reinforce positive behavior or to offer another incentive.
Incentives used outside the home: The Legal System, Drug Courts, etc.,: Why do they seem to have more success?
The legal system, including drug courts, probation, and the department of motor registry, etc., often use incentives to encourage individuals to modify their behavior. There are also phone applications being designed to utilize incentives and they show some promise with SUD. Why might incentives work better in these programs than in a family setting? The answer is simple: There are no emotions or expectations attached to them. The incentive is offered and it’s up to the person to earn it or not. Basically, it’s “One and Done.” For example:
A loved one has their license suspended because of being an ‘Immediate Threat’. After a couple of months’ worth of diligent work on their sobriety, they want to earn the ability to drive again. The incentive is to have the suspension revoked and, in turn, they earn the privilege to drive again. The motor registry might require them to attend meetings, test negative on a certain number of urine tests, and/or complete an Intensive Outpatient Program (IOP).
In this case, it is all up to the loved one to do what is required to get his/her license back. No one is going to hunt them down, dangle another incentive, or inquire if they are going to follow through. It’s a “take it or leave it” situation and the loved one’s motivation level is what drives the action (no pun intended!). Once again, keep in mind that our loved one might not be successful. Maybe they are not motivated at this time or maybe it is just too overwhelming, and they will have to try again later. But the key here is that no one from the motor registry is following them around reminding them of their lack of accomplishment.
Family support, step by step
There is a way for families to give support to their loved one with these incentive-based programs by reinforcing positive behavior. With each step that is accomplished, making a comment, and giving a reward will make it more likely that our loved one will continue with their efforts. Recognition with statements like, “Wow! You’ve had three negative test screenings, regularly attend your IOP, and have made meetings a part of your daily routine. Pretty impressive. How about we go and catch a movie together this weekend? My treat?”
I have found that earning these privileges back can be a daunting task and may take a long time. Helping my loved one see how much he/she has accomplished can encourage continued efforts versus their feeling defeated by how long and how many steps they have yet to complete before receiving their reward. I like give my son little rewards along the way, after the positive behavior (reinforcing positive behavior), to help make the steps more manageable.
“Buyer beware” with incentives…
These incentive programs are not without their weaknesses. What happens after our loved one reaches their goal, and the incentive is not there anymore? There is no reason to continue the positive behavior. Just imagine being on a diet for 6 months and losing a whopping 20 pounds. The incentive to stay with the diet was the weight loss and now you’ve reached your goal. You treat yourself to a dinner out. Feeling accomplished, you think you earned a break and order an oversized piece of cheesecake. You deserve it right? Our loved one may experience similar thoughts, “I’ve been doing well. I should be able to loosen my tie and reward myself. I can control myself. Just this once.” (What to do if this happens is another post altogether.)
I can say that I have yet to see bribes and incentives work well. However, I have reinforced positive behavior in my own house and witnessed success. None of this is easy and it takes both practice and patience on our part. It is great to hear from people working on how to utilize the CRAFT skills they’ve learned at AlliesinRecovery.net. I strongly encourage you to stick with our virtual program. You and your loved one are worth it.