The Office of National Drug Control Policy recently honored Johns Hopkins University’s School of Medicine researcher Kenneth Silverman for his work with drug addiction recovery programs. Silverman, a professor of psychiatry and a behavior scientist, investigates the efficacy of “therapeutic workplaces” in which recovering heroin and cocaine users have the opportunity to earn wages contingent upon abstaining from drug use. Research results show workers in therapeutic workplaces stay clean longer than workers in other treatment programs. Furthermore, paying people to refrain from using drugs is highly effective as a long-term treatment, even for chronic drug users.
The idea of cash for quitting relates to behavior analysis on a number of levels:
1) Because access to the opportunity to the workplace where they can earn money and bonuses is contingent upon engaging in behavior other than drug use, the program is reinforcing an alternative behavior.
2) It addresses the delay discountingissue with which many substance abusers struggle (see bSci21’s recent post about the January 2015 special issue of JEAB). While drug use results in immediate reinforcement, reinforcers in traditional substance abuse programs are far in the future (e.g., you have to stay clean for weeks or months before being able to hold down a job) hence seem to have less value. Therapeutic workplaces provide near-immediate reinforcement via frequent paychecks and bonuses for working and abstaining from drug use.
3) Furthermore, the therapeutic workplace deals with relapse in accordance with behavior analytic principles. If a urine test shows no drugs in the person’s system, that person gains access to the workplace and the ability to earn money. However, if the urine test is positive for drug use, the person does not gain access to the workplace and instead can have another chance the following work period.
4) Researchers have examined some of the externalities (e.g., Biglan, 2009) associated with this approach to drug addiction treatment and found the financial cost alone is less that of other treatment approaches. Other variables being examined include HIV risk and family poverty levels.
The next logical steps in this line of research would involve further replication and extension of the therapeutic workplace model, including ways to transition participants into more traditional types of employment settings. Dr. Silverman says he is already preparing for the next phase in this line of research. He and his team are pursuing three models “to apply the therapeutic workplace approach more broadly in society.”
What do you think about Dr. Silverman’s work? Let us know in the comments below, and stay in the loop by subscribing to bSci21 via email to receive the latest articles directly to your inbox!
About the author:
Chelsea Wilhite, M.A., BCBA has always wanted to better understand the world around us. As a television journalist, Chelsea worked her way up the ranks to produce the number one rated television news broadcast in the Fresno television market, an area covering five California counties. Along the way, she won two regional news Emmys and a Radio and Television News Directors Award for best news producer. In an effort to further her understanding of natural phenomena, Chelsea left television after more than a decade, turning to Behavior Analysis. She is currently a doctoral student at the University of Nevada, Reno. While behavior science research and instruction is now her primary interest, Chelsea never lost her passion for journalism and regularly contributes to behavior science oriented blogs, magazines, and newsletters.
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