Substance Abuse Rehabilitation Continued

 

      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

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