title: Making the hard work of recovery more attractive for those with substance use disorders.
abstract: BACKGROUND
  Research has led to improvements in the effectiveness of interventions for substance use disorders (SUD), but for the most part progress has been modest, particularly with regard to longer-term outcomes. Moreover, most individuals with SUD do not seek out treatment.
  This paper presents two recommendations on how to improve treatment engagement and long-term outcomes for those with SUD. First, treatments should go beyond a focus on reducing or eliminating substance use to target greater access to and more time spent in experiences that will be enjoyable or otherwise rewarding to clients. Secondly, there must be sufficient incentives in the environment to justify the effort needed to sustain long-term abstinence for individuals who often have limited access to such incentives.
  
  
  CONCLUSIONS
  To increase rates of long-term recovery from substance misuse, treatments should link clients to reinforcers that will make continued abstinence more appealing. This work needs to extend beyond interventions focused on the individual or family to include the local community and national policy in an effort to incentivize longer-term recoveries more strongly.
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: McKay
mesh_terms: D006801:Humans; D000073038:Mental Health Recovery; D009042:Motivation; D010342:Patient Acceptance of Health Care; D012201:Reward; D019966:Substance-Related Disorders / Q000534:rehabilitation*
keywords: Community; debate; incentives; long-term recovery; motivation; national policy; substance use disorders; treatment