The Utility of Operant Conditioning to Address Poverty and Drug Addiction

Abstract

Poverty is associated with poor health. This article reviews research on proximal and distal operant interventions to address drug addiction and poverty. Proximal interventions promote health behaviors directly. Abstinence reinforcement, a common proximal intervention for the treatment of drug addiction, can be effective. Manipulating familiar parameters of operant conditioning can improve the effectiveness of abstinence reinforcement. Increasing reinforcement magnitude can increase the proportion of individuals that respond to abstinence reinforcement, arranging long-term exposure to abstinence reinforcement can prevent relapse, and arranging abstinence reinforcement sequentially across drugs can promote abstinence from multiple drugs. Distal interventions reduce risk factors that underlie poor health and may have an indirect beneficial effect on health. In the case of poverty, distal interventions seek to move people out of poverty. The therapeutic workplace includes both proximal and distal interventions to treat drug addiction and poverty. In the therapeutic workplace, participants earn stipends or wages to work. The therapeutic workplace uses employment-based reinforcement in which participants are required to provide drug-free urine samples or take scheduled doses of addiction medications to work and/or maintain maximum pay. The therapeutic workplace has two phases, a training and an employment phase. Special contingencies appear required to promote skill development during the training phase, employment-based reinforcement can promote abstinence from heroin and cocaine and adherence to naltrexone, and the therapeutic workplace can increase employment. Behavior analysts are well-suited to address both poverty and drug addiction using operant interventions like the therapeutic workplace.

Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial

“…The development of interventions that can address the inter-related problems of substance use and poverty is among the most important challenges in substance abuse treatment research. The therapeutic workplace could be an ideal intervention for individuals with substance use disorders who live in poverty because it includes both a proximal intervention to promote drug abstinence and a distal intervention to promote employment 1 40. It also provides an opportunity to arrange special contingencies that may be needed to promote skill development, job search behaviours and employment in this population.…”

“…Substance use disorders, like many health problems, are associated with poverty 1. Heroin and cocaine use is an important example.…”

“…Two broad approaches could be used to address poverty-related health disparities like substance use disorders: proximal interventions that seek to promote health behaviours in low-income populations and distal interventions that seek to move low-income people out of poverty 1. The therapeutic workplace could be an ideal intervention for individuals with substance use disorders who live in poverty because it includes both a proximal intervention to promote drug abstinence and a distal intervention to promote employment.…”

Editorial: Emerging Cultural and Behavioral Systems Science

“…Others still have focused their efforts on systems and cultures with less clear boundaries than those found in traditional organizations-the community (e.g., Biglan 1995;Mattaini 2013), which is sometimes manifested in the efforts of community behavioral psychologists (e.g., Fawcett 1991;Watson-Thompson 2018;Watson-Thompson et al 2017). Often grounded in efforts toward social justice and mitigating systemic challenges such as addictions (Biglan and Ryzin 2019;Silverman et al 2019), violence (e.g., Aspholm and Mattaini 2017;Mattaini 2013), sustainability (e.g., Chance and Heward 2010;Grant 2011;Kaplan et al 2018), and poverty (e.g., Brady and Burton 2016; Fava and Vasconcelos 2017;Valderlon and Elias 2019), the work in this area frequently considers the impact of intervening on one part of a system on the other parts of the system or the system as a whole (or the interdependencies between and across sectors; see Biglan 1995;Mattaini 2013).…”

Audaciously under the Dome: Behavior Science in Systems and Society

“…). The recent pages of PoBS are filled with articles taking on topics under the dome such as incarceration(Apel and Diller 2017), consumer behavior(Foxall 2017), higher education(Brodsky and Fienup 2018), progressive political movements(Mattaini and Aspholm 2016), narrative (Hineline 2018), leadership(Houmanfar and Mattaini 2016), the "replication crisis"(Laraway et al 2019), connectionist models of human and computer learning(Ninness et al 2018), healthy eating(Rafacz 2019;Sigurdsson et al 2017), poverty(Silverman et al 2019), conditioning plants (Adelman 2018), understanding concepts(Layng 2019), flirtation(Wade 2018), and maternal health(Washio and Humphreys 2018).…”