Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

IntroductionSerious mental illness (SMI) is associated with high rates of tobacco and other drug dependence, poor treatment compliance, obesity and low levels of physical activity, which have severe medical and psychosocial consequences. Interventions that effectively reduce these health risk behaviors among people with SMI are urgently needed.MethodsPublished reports from studies evaluating incentive-based treatments for promoting tobacco and other drug abstinence, treatment attendance, medication use and increased physical activity are reviewed.ResultsResults of this review indicate the efficacy of incentive-based treatments for reducing tobacco and other drug use among people with SMI. Few studies have examined whether incentive-based treatments improve treatment attendance, medication use and physical activity levels in people with SMI; however, initial evidence is positive and indicates that further research in these areas is warranted.ConclusionGiven the medical and psychosocial costs of tobacco and other drug use, treatment non-compliance and physical inactivity, and the efficacy of incentive-based treatments for improving these behaviors, such interventions should be further developed and integrated into behavioral health treatment programs for people with SMI.

► People with serious mental illness have high rates of tobacco and other drug use.
► These patients also have low medication compliance and physical activity levels.
► Contingent incentives effectively reduce health risk behaviors in these patients.
► Incentives should be integrated into behavioral health treatment for these patients.