Contingent incentives can increase retention and cocaine abstinence among cocaine-dependent outpatients. There is evidence demonstrating that the use of incentives early in treatment can produce discernible improvements during later follow-up. Manuals do not allow clinical flexibility. A good manual overrides the need to build working relationships with patients. Manual-guided therapies bear no relationship to actual clinical practice.
Manuals make treatment overly complicated.
You are an underappreciated and overworked clinician in a busy substance abuse treatment clinic. You're using a cognitive-behavioral approach with a very bright, but somewhat antisocial young cocaine abuser. While she clearly understands the coping skills you've reviewed with her, and her drug use has decreased significantly, she's never done any of the practice exercises you've assigned. Tell her if she doesn't do her homework, you'll assign her to group treatment. Call her probation officer to ask him to increase the pressure on her.