Grantcoulson's Blog

from the book: Shadow Dancing on the Grave of Hope:

Application of the Community Reinforcement Procedures to Users of Illegal Drugs

    Users of illegal drugs have unique problems. The drugs are less available than alcohol, possession is illegal and maintaining a steady supply of the drug is costly and usually difficult. Azrin and his colleagues, using the community reinforcement approach for alcoholism as a guide, produced a program for drug users with many of the same components. This program shares many of the characteristics of other successful programs and concentrates on changing what the client does. The program group was abstinent 65% of the time after 12 months with the non-program group abstinent 25% of the time. Additional follow-up showed that the control group did not change drug use during treatment or follow-up while the drug use of the treatment group decreased by 63% at the end of treatment and 73% at the end of the 9 months of the follow-up period.

    The Stimulus Control procedure ensured that the client would avoid those situations which made drug use more likely. Daily logs were kept and the counsellor reinforced engaging in drug free behavior and avoiding situations where the probability of drug use was high. Urge Control was designed to control the internal stimuli arising from the desire to take drugs. Behavioral Contracting required behavior incompatible with drug use in return for agreed upon reinforcers such as increased allowance, social activities and sexual activities. The required behavior had to be measurable. Attendance at school or work were two of the main measurable objectives.  An Annoyance Review outlined the major consequences for drug use. The client requested reinforcers from others using a Positive Request Procedure. The Annoyance/Anger Prevention procedure was used to reduce anger towards others who were significant in the social world of the client. The Problem Solving procedure was used when the client was having difficulty in choosing drug-incompatible courses of action. The Relationship Enhancement procedure demonstrated how to give non-contingent reinforcers such as compliments, express appreciation, offer help, etc. The Job Club was essentially that used in the procedure for alcoholics.

    Treatment integrity was monitored by audio-taping the sessions, having non-participating observers sit in on some sessions and using a session checklist which listed the components of the program which had to be covered. Integrity assurance procedures, absent in most programs, ensure that the program is being carried out in the same way as it is described.

Azrin, N.H., Acierno, R., Kogan, E., Donahue, B., Besalel, V., & McMahon, P.T., (1996). Follow-up results of supportive versus behavioral therapy for illicit drug abuse. Behavioral Research & Therapy, 34 (1), 41-46.

Azrin, N. H., McMahon, P. T., Donohue, B., Besallel, V. A., Lapinski, K. J., Cogan, E. S., Acierno, R.E., & Galloway, E. (1994). Behavior therapy for drug abuse: A controlled treatment outcome study. Behavior Research and Therapy, 32, 857-866.

Cheerio and ttfn,

Grant Coulson

   One of our students in special education called her mother and asked her to get her out of school. She asked why God hated her because he made her so dumb that she had to watch Barney videos with the “special” kids. Another has delivered mail for years as part of her “schooling”. Both learn very well when taught.

    In another school, the “special” kids are placed in a large room where the students are kept minimally busy and the EAs (Educational Assistants) socialize.

    How does anyone  justify working in such organizations? Why do some choose the hammock and others the plow?

    Back to the finish of the Community Reinforcement Approach to Alcohol Rehabilitation from the book: Shadow Dancing on the Grave of Hope:

    Notice the last paragraph–Although the Community Reinforcement Approach is the most effective alcoholism treatment, but is not used in one government treatment programs.

    “The program was constructed with as many effective elements as possible, each one of which has been demonstrated as successful on its own.  Arrangements were made to provide the drug disulfiram (Antabuse) at certain times. Drinking alcohol after taking disulfiram produces nausea and vomiting. A Job Club provided techniques to find a job which was permanent, satisfying, well-paying and produced wider social contacts. Reciprocity Marriage Counseling was provided for those who were married. Advice was provided on how to improve the person’s social and recreational activities. A buddy procedure was instituted to provide practical advice on everyday problems. The client was taught refusing skills to be used when someone offered alcohol. The client was taught relaxation skills to control drinking urges. The client was taught positive methods for dealing with difficult social situations. A synthetic family was created for clients who were alone. Contracts were drawn up with those who had social relations with the client. The client agreed to do certain things and abstain from certain things. In return, the other person agreed to provide the client with certain things such as companionship. A social club was set up to provide social meetings without alcohol. An early-warning system was in place to alert the counsellors to impending trouble with alcohol. Daily reports were reviewed during the early part of the program. Some clients were encouraged to adopt pets to alleviate loneliness. All of these program components were used in the community in the context of the client’s everyday life. Alcohol use was recorded by the client and others in his environment.

    The investigators provide a composite of the clients in the experimental group. "Carl" was currently married but his marriage was in trouble, had no friends but his "drinking buddies", had been hospitalized three times for excessive drinking and had not worked regularly for seven months. He took his Antabuse regularly, used the Job Club techniques to find the best job he had ever had, went to the social club meetings and received marital counseling. His wife, agreeing to give the marriage one more chance, ensured that he continued to take his Antabuse. Using the principles of the behavioral counselling, Carl thanked her regularly for her help. He got a better job and established new friendships and reestablished old ones outside his former drinking group. His friends called him "a completely new man". Carl was a completely new man because he was doing completely new things. The program had placed him in a different world of reinforcers which drinking would have eliminated. I wonder what happened to Carl’s "deep personality structure" which "motivated" his drinking as he tried to "escape the demons of his past".

    In spite of its success, relative low cost and comprehensiveness, the Community Reinforcement Approach, according to Stanton Peele,  ”is not in regular use at a single treatment center in the United States.” ”

Cheerio and ttfn,

Grant Coulson

     Governments need not reduce taxes, they must reduce expenditures. Each American now owes about $40,000 in federal debt, each Canadian about $14,000. A few years ago, the relative positions were reversed. This represents a fiscal “death spiral”, “critical mass” and other descriptions of an unpleasant nature.

    A slave is someone who has no economic choices. The more of our money we give up, the closer we move to slave status.

    We’re getting close to the Copenhagen conference on Climate Change. I would say, “Let the posturing begin.”, but it’s been going on for a couple of decades. In the same way that Cold War hysteria was fueled by huge overestimations of the ability of the Soviets to project power beyond their borders, the Climate Changers fuel hysteria by predictions of disaster. None of their predictions has come true, so why do we have faith in their version of a disastrous future?

    On another hysterical front, the H1N1 virus is just not performing as  predicted. The scenario, as many have pointed out, shifted from the “epidemic” and value of the vaccine, to its availability. A certain number of people will desperately need something as soon as it’s not available.

    Over on anti-positivist (see blogroll to the right), Jim Fedako relates Karl Popper’s point about non-refutation to the Climate Hysteriacs–if all evidence must point to something and no evidence can point away–there’s something seriously wrong with the theory.

    More from    Hester, R.K., & Miller, W.R. (Eds), (2002) Handbook of Alcoholism Treatment Approaches: Effective Alternatives.  Boston: Allyn and Bacon.

     Confrontational counseling styles have enjoyed particular popularity in U.S. alcoholism treatment. Yet confrontational approaches have failed to yield a single positive outcome study.  (p. 27). 

    GC–Good drama– poor technique.

      Although Alcoholics Anonymous (AA) is widely recommended by U.S. treatment programs, its efficacy has rarely been studied [….]  Only two controlled trials were found in which AA was studied as a distinct alternative, both with offender populations required to attend AA or other conditions, and both finding no beneficial effect. (p. 31).

     GC–Good myth–poor therapy.

      One’s own professional hunches about what works and what doesn’t are well known to be fallible. One outcome evaluation, for example, showed that a ‘prevention’ program, about which both teachers and students were highly enthusiastic, actually increased students’ use of drugs.  Though we would like to believe that it isn’t so, ‘therapeutic’ interventions similarly can be ineffective or even detrimental.  (p. 81).

    GC–Good arrogance–poor effectiveness.

     Fifty years of both psychological […] and longitudinal studies […] have failed to reveal a consistent ‘alcoholic personality.’  Attempts to derive a set of alcoholic psychometric personality subtypes have yielded profiles similar to those found when subtyping a general population […].  That is, alcoholics appear to be as variable in personality as are nonalcoholics.  Studies of character defense mechanisms among alcoholics have yielded a similar picture.  Denial and other defense mechanisms have been found to be no more nor less frequent among alcoholics than among people in general. […]  There was simply no support for the view that alcoholics in general come into treatment with a consistent set of personality traits and defenses.  (p. 90).

     GC–Good layman theory–zero support.

     A strong and consistent finding in research on motivation is that people are most likely to undertake and persist in an action when they perceive that they have personally chosen to do so.  One study, for example, found that a particular alcohol treatment approach was more effective when a client chose it from among alternatives than when it was assigned to the client as his or her only option .  […]  Perceived freedom of choice also appears to reduce client resistance and dropout [….]  When clients are told they have no choice, they tend to resist change.  When their freedom of choice is acknowledged, they are freed to choose change.  (p. 93). 

      GC–Good elitism–poor technique. You can’t push a string.

Cheerio and ttfn,

Grant Coulson

     While I was a graduate student in psychology, I began to wonder why psychology seemed so insipid. “We give the same exam every year, we just change the answers.” I wrote a paper about this problem. In the graduate program in which I was enrolled, we had to write a “major” paper, a “minor” paper, and do a dissertation, as requirements for the Ph.D.. My first attempt at the minor paper was an attempt to provide guidelines for important research in psychology. I used criteria such as amount, duration and transferability of change produced, repeatability, speed of change, efficiency and so on. So many revisions of this paper were required by my supervising professor (that’s academia’s way of refusing to accept something–require endless revisions) that I gave up and wrote a paper on "Observational Learning" which was bland enough to be acceptable.

    For lo these many years, this problem vexed me until I decided to write a book about the matter. Still unpublished, but nearing completion, I called it: Shadow Dancing on the Grave of Hope:

    This creation has gone through three stages. Originally, I intended it to contain a catalog of principles underlying effective programs along with exemplar programs illustrating these principles. It still contains these features, but as I read and thought about the problem,  exemplified by this quote, about alcohol rehabilitation from Hester and Miller:

     "The negative correlation between scientific evidence and application in standard practice could hardly be larger if one intentionally constructed treatment programs from those approaches with the least evidence of efficacy."  (p. 33).

    This situation obtains for almost every area in psychology.

    Using effective psychology to determine why most psychology is ineffective, it came to me that most social service programs are run under the direct or indirect aegis of government agencies. This means that all the political considerations such as rhetoric, intention and misrepresentation apply. All of this is inimical to good results. Where contingencies are not centered on results, results will be ignored.

    Then came the third act when it occurred to me that all situations involving coercion and limited choice produce the same things, costly and ineffective interventions. When Adam Smith’s Invisible Hand becomes visible, chaos results.      

    The only solution to this is to put all social sciences into the free marketplace and let the customers decide which methods work.

Hester, R.K., & Miller, W.R. (Eds), (2002). Handbook of Alcoholism Treatment Approaches: Effective Alternatives.  Boston: Allyn and Bacon.

Cheerio and ttfn,

Grant Coulson

      From Marginal Revolution comes a question: “When will there be an auction for Treasury Bills with too few bidders?” This exotic question means, “When the government tries to turn over its debt, when will there be too few takers? When this happens, interest rates, now artificially low must be raised and things will get bad again. Watch for it.

    One of my most terrifying memories is when our glorious Canadian leader, Trudeau, said that the purpose of government was to “manage the wealth of the nation”, a task for which the government is least suited. It’ll be fun to watch, but not so much fun when we all suffer. The media will blame “greed” and completely miss the point. The old Chinese curse, “May you live in interesting times.”, comes to mind.

    And, on the never-ending Global Warming front, someone hacked the email accounts of many of the alarmists which show that harassment and dishonesty, the hallmarks of failed science, are in full force.

     Again from Marginal Revolution, “Here’s all you need to know about the real estate market in Michigan: The 80,000-seat enclosed Silverdome, built for $55.7 million in 1975 to house the Detroit Lions, has sold for $583,000.” Included is 127 acres of land.

    The original cost was the equivalent of $223 million in inflation-adjusted money. Imagine the rationale for the original construction. “Tremendous stimulus for Pontiac (the now-bankrupt area where the stadium is located).”  “Public money well spent.” “Jobs created.” If you spend Other People’s Money (OPM), you’ll never go bankrupt. And that, dear friend, is an example of the WRONG INCENTIVES.

from the book: Shadow Dancing on the Grave of Hope:

An Exemplar of an Effective Alcoholism Treatment Program: Community Reinforcement

    When you finish the next two sections, you will, because you are an attentive reader, be wondering why these programs aren’t used regularly for alcoholics and drug abusers. From a rational point of view, the answer to this question, as always, lies in the contingencies of the service providers. Without the guidance of economic incentive, nonsense prevails. This nonsense appears as incorrect assumptions, inability of most people in the social sciences to deal with the myriad of details such programs require and the notion that such programs are superficial because they don’t deal with the "deep" problems of the clients. The only answer to any of these nonsensical objections is that the objectors cannot produce programs with results which are even close to the successes of  programs which work. Not using successful programs on a wide-spread basis and not aiding clients are the result of laymanship in place of integrated programs and dependence on cute stories in place of data.

    N.H. Azrin and his collaborators have published the results of several experiments using what they call the community reinforcement approach to programming for alcohol and drug use. Naturally, we start at the results and find that the alcohol reduction program reduced alcohol use to 2% of the time versus 55% of the time for matched subjects receiving traditional treatment, a differential in alcohol consumption of 27.5 to 1. The program group spent considerably more time employed and considerably less time in institutions. The experimental group spent less than 1% of their time in institutions versus 45% for the control group. The experimental group was absent from their homes 7% of the time versus 67% for the control group. The results were stable over a two-year, post-program period. The program  reduced drinking by 98% at the 2 year follow-up. The poor results for the control group show that the matched program clients were also high-need alcoholics and their lives were changed markedly by the program. The  community reinforcement program passes the DIW test. It also passes the test of being more effective than any other program for alcoholism, undoubtedly because it has a great number of effective components.

    The basis of this program, and the one that follows for illegal drugs is, "…to rearrange the alcoholic’s social environment such that other, more reinforcing, activities compete with drinking behavior. The client is then motivated to reject alcohol as a reinforcer because of the resulting loss of so many other reinforcers." This is a push-pull program. The client is pulled to the new reinforcers and pushed away from alcohol because the consequences of drinking will result in the loss of both new and existing reinforcers.

Azrin, N.H., Acierno, R., Kogan, E., Donahue, B., Besalel, V., & McMahon, P.T., (1996). Follow-up results of supportive versus behavioral therapy for illicit drug abuse. Behavioral Research & Therapy, 34, 41-46.

Azrin, N. H., McMahon, P. T., Donohue, B., Besallel, V. A., Lapinski, K. J., Cogan, E. S., Acierno, R.E., & Galloway, E. (1994). Behavior therapy for drug abuse: A controlled treatment outcome study. Behavior Research and Therapy, 32, 857-866.

Cheerio and ttfn,

Grant Coulson

    There are millions of examples of incentives misapplied, but there are fewer of incentives misapplied and incentives corrected. In the immortal words of Dragnet, “This is one of them.” The only times incentives are misapplied is through coercion. Lack of coercion lets incentives take care of themselves so the only correction is removal of coercion.

    This information, not as well known as it should be, is from the antipositivist blog to the right of this blog and comes from here.

     “Feast and football. That’s what many of us think about at Thanksgiving. Most people identify the origin of the holiday with the Pilgrims’ first bountiful harvest. But few understand how the Pilgrims actually solved their chronic food shortages.

    Many people believe that after suffering through a severe winter, the Pilgrims’ food shortages were resolved the following spring when the Native Americans taught them to plant corn and a Thanksgiving celebration resulted. In fact, the pilgrims continued to face chronic food shortages for three years until the harvest of 1623. Bad weather or lack of farming knowledge did not cause the pilgrims’ shortages. Bad economic incentives did.

    In 1620 Plymouth Plantation was founded with a system of communal property rights. Food and supplies were held in common and then distributed based on equality and need as determined by Plantation officials. People received the same rations whether or not they contributed to producing the food, and residents were forbidden from producing their own food. Governor William Bradford, in his 1647 history, Of Plymouth Plantation, wrote that this system was found to breed much confusion and discontent and retard much employment that would have been to their benefit and comfort. The problem was that young men, that were most able and fit for labour, did repine that they should spend their time and strength to work for other men’s wives and children without any recompense. Because of the poor incentives, little food was produced.

    Faced with potential starvation in the spring of 1623, the colony decided to implement a new economic system. Every family was assigned a private parcel of land. They could then keep all they grew for themselves, but now they alone were responsible for feeding themselves. While not a complete private property system, the move away from communal ownership had dramatic results.

    This change, Bradford wrote, had very good success, for it made all hands very industrious, so as much more corn was planted than otherwise would have been. Giving people economic incentives changed their behavior. Once the new system of property rights was in place, the women now went willingly into the field, and took their little ones with them to set corn; which before would allege weakness and inability.

    Once the Pilgrims in the Plymouth Plantation abandoned their communal economic system and adopted one with greater individual property rights, they never again faced the starvation and food shortages of the first three years. It was only after allowing greater property rights that they could feast without worrying that famine was just around the corner.

    We are direct beneficiaries of the economics lesson the pilgrims learned in 1623. Today we have a much better developed and well-defined set of property rights. Our economic system offers incentives for us—in the form of prices and profits—to coordinate our individual behavior for the mutual benefit of all; even those we may not personally know.

    It is customary in many families to give thanks to the hands that prepared this feast during the Thanksgiving dinner blessing. Perhaps we should also be thankful for the millions of other hands that helped get the dinner to the table: the grocer who sold us the turkey, the truck driver who delivered it to the store, and the farmer who raised it all contributed to our Thanksgiving dinner because our economic system rewards them. That’s the real lesson of Thanksgiving. The economic incentives provided by private competitive markets where people are left free to make their own choices make bountiful feasts possible.”

    Back to our rehabilitation considerations.

from the book: Shadow Dancing on the Grave of Hope:

    Alcohol and Other Drugs: Potent Reinforcers

"Why do you drink so much?"
"I drink to forget."
"Forget what?"
"It works so well I can’t remember."

    As in all areas of the social sciences, the causes, "cures" and effects of drug use are riddled with myth and misinformation. As usual, the most damaging misinformation is centered on what works. As usual, in-depth psychotherapy is favored. As usual, in-depth psychotherapy is ineffective. As usual, any set of practices based on faulty assumptions will lead to ineffective practices.

    People take drugs because drug use is reinforcing. No cocaine user, no drunk and no heroin user has ever said to me, "I really hate getting high. It makes me sick. I do it because of the rigid belief that it is my duty." Remember, any consequence of a behavior which maintains or increases the probability of the behavior it follows is a reinforcer. Using drugs is a reinforcer for obtaining, preparing and ingesting drugs. As usual in human behavior, many different reinforcers are available to a person simultaneously and drugs are just one more category. Some drug users will go through long and difficult behavior chains to consume drugs and\or take drugs frequently. These users are labelled addicts and their drug use is explained by their addiction. See how easy it is. As usual, the label starts as a description, ends as a cause and deludes us into thinking we know something useful.

    Effective Programs for Drug and Alcohol Do Not Involve the 3R Method

    In 1991, several workers in the field of alcoholism reviewed the effectiveness of alcoholism programs. The results were; 1). The most productive programs are those which emphasize changes in the environment and\or demonstrate and monitor the changes the client needs to make in his\her environment in relation to alcohol use., 2) The most ineffective programs were those which dealt with in-depth psychotherapy (change the essence of the person and alcoholism will disappear) and\or took the person away from his\her environment for a "cure". The take-away-from-environment programs follow the medical model of take-into-hospital-take-out-the-appendix-return-to-house which is appropriate for appendicitis but not for behavioral problems. Alcoholism, by the way, is not a disease. Calling it a disease leads to mischievous treatments which look medically appropriate but don’t result in long-term decreases in drinking. One of the most telling arguments against the medical model is that, the stronger the social network, the less likely addiction. The most successful programs for addiction do not depend on the medical model., and, 3) The most expensive programs, as the reader, who should not only be prepared for but, expecting irony and paradox, will not find surprising, were the least effective. Although the review doesn’t make this point, it appears that the loosely structured programs were the least effective while those with specific procedures were the most effective. If the Devil is in the details, salvation can be found in the same place. The Devil is always found where there are no details.

    The people who go on talk shows come from that part of the alcoholic sample which would improve as a matter of course. If they go through treatment, they attribute the improvement to the treatment. Another disciple is created and another myth supported. Popular television–poor science.

    W.R. Miller labelled as 3R those programs which remove the person from his\her environment, subject him\her to psychotherapy, and return him\her to the old environment. 3R stands for remove, repair, and replace. This technique works for vehicles with faulty alternators. The reason it doesn’t work for people is that the person is returned to the same environment which supports and\or doesn’t discourage drug use.

    A Short Comment About the "Successes" of Some Programs

    Many social sciences programs have a religious fervor about them which means they rely on guilt, expostulation, proselytizing and true belief and does not look favorably upon dissent. Such programs give examples of success those who have joined the program as staff members and have remained "clean and sober". This "works" for a small percentage, because staff numbers are limited, but cannot work for the majority of drug\alcohol abusers who must return to the everyday world. Staying clean and sober as a member of a special community does; however, show the importance of the environment in maintaining a drug free life.

Holder, H., Longabaugh, R., Miller, W. R., & Rubonis, A. V. (1991). The cost effectiveness of treatment for alcoholism: A first approximation. Journal of Studies on Alcohol, 52, 517-540.

Cheerio and ttfn,

Grant Coulson

    Thomas Sowell, as usual, gets to the point of politics in an effective, and unusual way:

     “No one will really understand politics until they understand that politicians are not trying to solve our problems. They are trying to solve their own problems– of which getting elected and re-elected are number one and number two. Whatever is number three is far behind.

      Many of the things the government does that may seem stupid are not stupid at all, from the standpoint of the elected officials or bureaucrats who do these things.

     The current economic downturn that has cost millions of people their jobs began with successive administrations of both parties pushing banks and other lenders to make mortgage loans to people whose incomes, credit history and inability or unwillingness to make a substantial down payment on a house made them bad risks.

      Was that stupid? Not at all. The money that was being put at risk was not the politicians’ money, and in most cases was not even the government’s money. Moreover, the jobs that are being lost by the millions are not the politicians’ jobs– and jobs in the government’s bureaucracies are increasing.”

    These are political incentives–Incentives which invariably have a detrimental effect.

    Thomas Kuhn, a philosopher of science, points out that science moves ahead by a series of Paradigm Shifts (yes, this concept is important enough to get capitalized) where the assumptions of the “new” science are substantially different from those of the “old”. For example, the Earth was once regarded as the center of the Universe. This model, although incorrect, explained a lot of Heavenly motion, but the “Earth revolves around the Sun” explains more. So it will be, I predict, for the notion of the importance of Incentives (capitalization again) in the explanation of human affairs.

T. S. Kuhn, (1962). The Structure of Scientific Revolutions,  Chicago: University of Chicago Press.

    On to rehabilitation for substance abusers.

from the Book: Shadow Dancing on the Grave of Hope: 

 
     Since most drug and alcohol abusers quit on their own, or reduce their use to a level where it is not a problem,  there is no evidence that addiction is “an overpowering physiological condition requiring medical treatment”. The facts are conclusive. Addiction must not be viewed as a lifelong “illness”. Indeed, any behavioral tendency can only be an “illness” metaphorically .

     Most of the “evidence” for, and myth about, drug addiction and alcoholism comes from those who have had long-term problems with addictions. These people, some of whom are “addicted” for years and do not represent the majority of users, find themselves in parlous medical and\or social straits, and then stop or moderate their substance abuse. The extreme of any group, by definition, cannot represent the average.

    Drug Use, Personality and the Big-Bang Theory

    The popular media are full of examples of the big-bang (a really traumatic event) theory as the cause of drug use. In the film, The Country Girl, Bing Crosby’s character becomes an alcoholic to block out the memory of  momentary negligence which caused his daughter’s death. Alcoholics drink to forget an unfaithful partner, an unsuccessful childhood, or a failed career. More recently, in keeping with academics blaming bad things on bad things, based on no evidence,  drug abuse is supposed to come from discrimination, lack of economic opportunity, or abuse in childhood. Decades of research have shown that personality characteristics, however created, do not differentiate drug abusers from non-abusers. The relative reinforcing effects and  social reinforcers which come from  drug use are neglected. Laboratory animals and humans will do less of a drug when other reinforcers are made available.  The statistics on drug use are further skewed away from popular belief by the fact that most illegal drug users are responsible and lead relatively average lives.

    When certain types of verbal behavior are not in accord with the observer’s version of reality, they are called "denial" and believers say the person who is disagreeing is "in denial", a perfect example of the nominalist fallacy. The observation produces the label which becomes the cause. Once the hypothetical cause is "known", work is directed to hypothetical changes. As usual, changing hypothetical entities produces hypothetical results. Attention is directed to attempting to "break down" the hypothetical state of denial by confrontation and intervention. This is based on the notion that, "You can’t do therapy until the patient realizes he has a problem." There is no evidence for this. There is no relation between "acknowledging a drug abuse problem" and success in programs or success of programs. Sometimes irrational behavior is called incorrect, at other times, politics. Behavior analysts call it behavior. Labelling behavior does not help change it and hysterical confrontation does not produce client engagement.

    Treatment Retention and Motivation Must be Part of the Program

    As in all other programs in the social sciences laymen, and most practitioners, get the notion of motivation wrong. They place it inside the client, not inside the program.

    The notions of "denial" and "nobody will change until they’re ready to change”, are part of these assumptions based, as usual, on beliefs about The Proper Way to Behave. These assumptions have no value in programs. Many things can be done to improve program participation including positive interactions, handwritten notes encouraging participation, telephone calls checking on progress and giving reminders of appointments, dealing with real problems immediately and showing the client that quick improvement is possible. All of these techniques increase "retention rate", the probability that the person will keep participating in the program. No program will work without the client. (“Look Maude, he’s being clever by stating the obvious.”) The notion that "motivation must come from deep within the person" removes responsibility from the client and programmer and places it in the realm of the hypothetical where live the angels.

    Assumptions About Drug Use and the State of Grace

    The most widespread notions about alcohol use come from Alcoholics Anonymous (AA), a religious movement based on the experience of two former alcoholics. Two of the primary assumptions of the AA movement are "one drink then drunk" and "once a drunk, always a drunk". These assumptions are based on belief rather than science. Several decades ago, two scientists, Linda and Mark Sobell, presented data which indicated that "alcoholics" could be trained to decrease their alcohol consumption to a non-harmful level. Although the data that have accumulated since then support this way of doing things, the resistance to this notion dwarfed a tornado in violence. The Sobells were accused of falsifying data, the most serious charge that can be brought against a scientist. They, and their data, were subject to intense scrutiny which supported the Sobells on every major point. Controlled drinking is possible.

    One of the best known refutations of  "once a drunk, always a drunk" comes from the life of General U. S. Grant–born Hiram Ulysses Grant. Grant was a hard drinker at one point in his life. Although he was accused of drinking later, when he was in charge of large numbers of troops during the War for Southern Independence, there is little evidence of it. When faced with large responsibility, General Grant drank moderately, usually in social situations.

    The same vehemence has been encountered by those who don’t believe in the usefulness or truth of other sacred cows such as multiple personalities, repressed memories, in-depth psychotherapy and learning disabilities. Vehemence in defence of a belief is a strong clue its irrationality
.
    One of the Sobells’s most vocal opponents, who devoutly believed she knew the TRUTH about alcoholism, was murdered by her "companion", a “recovering alcoholic”, who was in a drunken rage. If this reads like a bad soap opera, it is, because all unscientific, laymen-based movements are bad soap operas.

    Alcoholics Anonymous is in many ways a cult. The belief that any person could write a book which is the final word on alcoholic rehabilitation is similar to the belief that Marx could provide a blueprint for economics which is better than the thousands of adjustments made every second by the free market. Outcome data have not been kind to AA treatment methods and the influence of this movement will fade away in spite of its dramatic usefulness to TV movies of the week and the popular press.

    The fury against the Sobells came from those who believed, incorrectly, in the one drink-drunk and once a drunk-always a drunk assumptions promulgated by AA. Currently, due to no small extent to the persistence of the Sobells, a new notion of "harm reduction" has come to drug programming. Harm reduction holds that a program should focus on reducing the damage of drug use by reducing drug use, not always to zero. This has less drama than the saved-not, saved category, but reflects reality. The total abstinence goal has some very strange consequences. I worked in a drug treatment program within a jail where one of the criteria for being removed from the program was–now wait for it–using drugs. People weren’t "sincere" and didn’t have "motivation for treatment" if they didn’t give up drugs. In other words,  the program was only for those who could demonstrate they didn’t need it. Motivation, according to this assumption, is an internal essence, which has to come from "within", and can’t be affected by a mere program.

cheerio and ttfn,

Grant Coulson

     Never believe anything or do anything until you have studied the incentives that apply in the situation. When government activity occurs, the incentives point in the wrong direction.

    For example, the U.S. government bailout was more than G.M. is worth at the height of its value so that to pay back its "loans", G.M. will have to have profits of much more than its value. If this happens, all the laws of economics will be revoked and everyone can have chocolate.

              The G.M. Volt will be the automotive equivalent of vaporware. G.M.’s bow to the "green revolution" will be the disaster it cannot help to be and all the endorsements from show business intellectuals will not save it.

    Now, back to considerations of a social science nature wherein I will consider rehabilitation for substance overuse.

from the book: Shadow Dancing on the Grave of Hope:
Author’s Point of View on Street Drugs.

    In case anyone cares or is  curious,  the author believes that all “street” drugs should be legal and no one should ever use them. This has nothing to do with what follows in this chapter because personal and conceptual are unrelated, but some people think it is important. One thing that brings out high volume hysterical rhetoric at the gallop is a debate about mood-altering substances. One of the great paradoxes in contemporary society he said, pontifically, is the ease with which drugs are obtained for unhappy adults and fidgeting children and the difficulty, or at least legality, of obtaining street drugs for self-medication. Again, you must trust us, the elites know best. Look it up, it’s in all the books.

    The legalization arguments are fairly standard, but the best rationale I’ve found is in Peter Moskos’s book, Cop in the Hood.

    “Policymakers’ reasoning, based on our experience with alcohol, is backward: Since alcohol is legal, drinkers cause trouble when they’re drunk, not when they’re trying to procure their drug of choice. Alcohol-related violence and drunk driving is tied directly to levels of consumption: more drinking, more death. So if public policy can control the consumption of alcohol, it can control violence. Simple–but wrong when applied to drug violence. Other drugs aren’t like alcohol: Drug users aren’t responsible for violence–high people just want to enjoy their high. Drug violence is business violence. Since prohibition can’t end drug dealing, dealing should be regulated and controlled. It would simply be ironic if it weren’t so tragic: drug prohibition creates an unregulated, chaotic, and violent drug culture.” p. 159.

    “At come point we have to accept drugs. Until then, we live with drugs and violence. Like Sisyphus’s eternal effort pushing a rock uphill, the war on drugs is at times heroic. But more often it is simply absurd. After all these years, if the war on drugs were winnable, it would already be won.” p. 193

    And further–"A legal product is produced and traded openly, and is therefore subject to competition and civilizing custom. If two beer distributors have a disagreement or if a liquor retailer fails to pay his wholesaler, the wronged parties can go to court. There’s no need to take matters violently into their own hands. As a result, in legal industries the ability to commit mayhem is not a valued skill." John Stossel

                Drug and Alcohol Rehabilitation

    Prohibition is an awful flop.
    We like it.
    It can’t stop what it’s meant to stop.
    We like it.
    It’s left a trail of graft and slime,
    It don’t prohibit worth a dime,
    It’s filled our land with vice and crime.
    Nevertheless, we’re for it.
    Franklin P. Adams (1931)

    “The government profits from the same things as Al Capone killed to make his own.” Paul Mousseau

      "…policies are judged by their consequences, but crusades are judged by how good they make the crusaders feel." Thomas Sowell

    "American substance abuse treatment services, like those for mental health problems more generally, have evolved on the basis of factors other than empirical evidence for their efficacy….”, W. R. Miller and S. Brown. Similar findings in other areas appear agonizingly often in this book. W. R. Miller and his colleagues have done extensive research on how well programs work in alcoholism treatment. They found, as usual, that the programs which worked best were used least often, and those which had no effect, were used most often. As is typical, there was no correlation between cost of treatment and effectiveness.

Miller, W.R., & Brown, S.A. (1997). Why psychologists should treat alcohol and drug problems. American Psychologist, 52(12),  1269-1279.

Moskos, P. (2008). Cop in the Hood: My Year Policing Baltimore’s Eastern District. Princeton: Princeton University Press.

Cheers and ttfn,

Grant Coulson

lack of incentives produce predictable results

arrogance, incompetence and self-congratulation go together

laziness is not relevant when behavior is counterproductive or nonproductive

a cult is a description of what happens with a non-contingent flow of money–not an explanation

a very large percentage of what is wrong in government-provided social science is the result of a faulty Incentive Structure

reform of government services will occur frequently and never work because the Incentive Structure cannot be improved

there are many–at least several dozen programs– in the social sciences which are very effective

some people believe they are uniquely capable of directing the affairs of others

if these people are given an opportunity to direct the affairs of others, they will do so with stunning, and predictable, incompetence

pay for performance in any government agency will either be a sham or, if effective, short-lived

public education is a hurdle, not a ladder

public education is a long, costly IQ test

public education consists of frantic calls to do something about the environment, social justice, discrimination, etc.–to get everyone riled up about even more government intervention

unionism is dying everywhere but where government workers dwell–this is free enterprise’s verdict on unions

the purpose of unions is to give union members benefits independent of production–to sever the real-world connection between performance and reward

I will be illustrating more examples of effective programs in psychotherapy, drug and alcohol rehabilitation and criminal rehabilitation–none of these programs will ever be run effectively under government auspices

Cheerio and ttfn,

Grant Coulson

from the book: Shadow Dancing on the Grave of Hope:

Dedication

    To Thomas Aikenhead, Edinburgh student  hanged in 1697 for blasphemy, who said that religion was “a rhapsody of feigned and ill-invented nonsense” made up of  “poetical fictions and extravagant chimeras”. Aikenhead repented under the threat of death, but repentance did not save his life and hanging him did not make anything less poetically nonsensical. His death,  the Church which put him to death, and the beliefs he railed against are standard, although extreme,  examples of what happens when a  cult has  power. Today, cultish organizations take our money and freedom while telling us that what they do is not only best for us, but the best there is. Their dominion is inevitable, they contend, because, like the Church in Aikenhead’s time, their supremacy is morally and practically unequalled. The fictions are still poetical and the chimeras extravagant. Aikenhead would understand. To Thomas and those who think things can be done without “poetical fictions and extravagant chimeras”.

    I do not pretend to give a blueprint of the developmental stages of  a cult or what the specific outline of cult activity will look like. Cults believe themselves to be superior and have methods to recruit, indoctrinate and discipline members. They should be avoided. Government cults are as useless and pernicious as all cults, but are able to intrude themselves via the well-proven method of coercion. With a little thought, they can be avoided and it is recommended that they be. Avoiding their conceptual basis is most important because these bases are based on power and custom, not reality. Examples are education, rehabilitation and economics. Where concepts are not guided by reality, the most nonsensical things occur.

Foreword       

    When couples are angry at one another, they use the “talking to the dog device”. “Mommy should have listened to Daddy when he told her not to drive so fast. Now the car’s gonna cost $7300 to fix. Mommy should listen.” When an author wants to be cute and annoying, he uses the Martian device. A Martian visits the earth and sees the social sciences in action. He says, “OK. I see the comedy skit. Now where’s the real thing?”

    The social sciences puzzling our Martian observer encompass education, rehabilitation of criminals and drug abusers, psychotherapy, and other applications where behavior change is supposedly the common element. Billions of dollars are spent annually on these endeavors. Almost all of this money is wasted.

    What prompted me to write this book was the unbridged gap between what works  and what is done in the social sciences. In business, knowledge is translated immediately into new and improved products because of  the incentives provided by competition. Business is about getting ahead and keeping up.  In the majority of instances in the social sciences, such as education and rehabilitation, new methods are constantly being introduced although the new methods are not better than the old. There are many examples of this divide between knowledge and application, and some are on the following pages. I kept looking for a unifying principle as I found more and more relentless inefficiency. Why is the gulf so wide between what is done and what could be done? It then occurred to me that, universal laws of behavior must necessarily be universal. If behavioral principles explain the behavior and learning of clients, the same principles must also explain the behavior of those who run programs.  If there is no payoff for success, failure is inevitable and success, accidental. If effectiveness is punished, prevented and\or,  not rewarded, effectiveness will not occur. This argument will be developed during the book and summarized in the final chapter. This book follows the formula that you should, “Tell ‘em what you’re gonna tell ‘em, tell ‘em and then, tell ‘em what you’ve told ‘em.”

    To those for whom results are not important, data are merely an annoyance. There is no point, therefore, debating those in the public service who have theories about the social sciences. These theories are not based on reality and have no value. One need only to listen to official pronouncements on ending poverty or ending violence or improving education which illustrate the usefulness of not paying attention to these folks.  Although they use words and phrases such as “world class”, “innovative”, “cutting edge”, and etc., they can be safely ignored. If your main product is spin, you must use extravagant, empty words.

    What I will show is that the largest percentage by far of  applications in the social sciences are done under conditions which require, compel and excuse failure. The lack of direct relation between the provider and the client has the same effect as any enterprise with the same relation between outcome and reward: When there are no consequences for the provider, there will be no efficiency in operation. None of the actions of anyone in the social sciences can be understood without knowledge of the contingencies affecting these actions. Although not all important consequences are economic, the lack of economic consequences inevitably results in failure. The same analysis  was done by Adam Smith, in 1776. In many ways, Smith developed an evaluation of economic behavior which has survived the centuries and cannot be improved. Some have suggested that "modern complexity" has made Smith’s analyses "outdated" as if the Law of Human Nature depends on the century. His concepts are universal and timeless . Had we paid heed to Smith and acted as he suggested, we would be much better off.

    Although I am a libertarian, someone who believes that government intervention should be kept to a minimum, this book is not a political argument and should not be regarded as such. A contingency analysis did not come from libertarianism, although libertarianism may have come from a rudimentary understanding of contingencies. Libertarianism predates the formal and experimental analysis of contingencies by several centuries. The argument in this book is based on well-known effects of contingencies on human behavior. The theory is not new, although its application may be in terms of explaining the failures of the social sciences. The observation applies to Soviet agriculture, public schooling, criminal rehabilitation and the hysteria surrounding  “ritual abuse” in the most unlikely places. What I will do in this book is to use effective psychology to explain why most psychology is ineffective.

    Some may read this book as the outline of a conspiracy, but there is none. Consistency of failure does not require a conspiracy. Consistency of improper  contingencies produces failure inevitably and efficiently without communication among those who fail.  This book is the profile of what happens when economic consequences are unrelated to results. It is not an attack on the social sciences, but on those shadow “programs” which are presented as effective in improving lives.

    This book has two main points. The first is that there are many successful programs. Several are described in detail. The second is the reason why successful programs are rarely used and\or are not used for very long. It will be much more difficult for most readers to accept the second point than the first. The inefficiency of government is not confined to social sciences programs, but activity in the social sciences is that this book is about.

Cheerio and ttfn,

Grant Coulson