A lot of what I’ve written over the years here concerns the tension between the research economists and psychologists, who say that human behavior is pretty easy to change with incentives, and politicians who say that human behavior won’t be affected by incentives (e.g., Book Review: The Redistribution Recession looks at what happened when politicians offered to give Americans free houses, food, and health care on condition that they not take a W-2 job; Real World Divorce looks at the extent to which Americans will fight for custody of children who yield more cash than going to college and working).
“A Simple Fix for Drunken Driving” is a WSJ article on the same general theme. Psychologists who get paid to treat alcoholics believe that straightforward incentives (not involving paychecks to therapists) won’t affect their behavior:
Among the most enduring of these myths is the idea that no one can recover from a drinking problem without our help. Treatment professionals save many lives that would otherwise be lost to addiction, but we are not the sole pathway to recovery. National research surveys have shown repeatedly that most people who resolve a drinking problem never work with a professional.
Some members of the addiction field can also be faulted for spreading an extreme version of the theory that addiction is a “brain disease,” which rules out the possibility that rewards and penalties can change drinking behavior. Addiction is a legitimate disorder, in which the brain is centrally involved, but as Dr. Higgins notes, “it is not akin to a reflex or rigidity in a Parkinson’s patient.”
In their haste to ensure that people who suffer from substance-abuse disorders are not stigmatized, some well-meaning addiction professionals insist that their patients have no capacity for self-control. Most people with alcohol problems do indeed struggle to make good choices, but that just means they need an environment that more strongly reinforces a standard of abstinence.
This belief has persisted for roughly 25 years after a 1991 paper showing that cocaine users could be “induced to refrain from it when promised a small reward, like $10 for a negative urine test.”
Related:
- American Economic Association Meeting in Boston (summarizes all kinds of papers regarding incentives)
If changing behavior was easy, then psychologists would have gone out of business long ago. Like Woody Allen said in his movie “Sleeper” after being cryogenically frozen for two centuries: “I haven’t seen my analyst in 200 years. He was a strict Freudian. If I’d been going all this time, I’d probably *almost* be cured by now.”
“Psychologists who get paid to treat alcoholics” is another cash cow/scam. The founder of alcoholics anonymous cured his alcoholism not via their program (requiring years of cult-like commitment yet <10% success), but by taking a couple doses of LSD:
http://www.hightimes.com/read/aa-founder-believed-lsd-could-cure-alcoholism
Alcoholics Anonymous, more than anyone else, promotes the idea that alcohol makes people helpless. It is taught like a religion.
Two points: incentives better be well though through, because people might do ‘what it takes’, not ‘what we would like’, to get what is promised (a druggie could ask his lil’ sister to provide the urine sample while still shooting up). Poorly designed incentives, as shown in your divorce work seem to cause more problems than they solve.
Second, there is ample work by Bruce Alexander showing that addiction is basically extreme self medication, in order to cope with situations that are over and above the carrying capacity of the addict (ever noticed how many druggies come from ‘difficult backgrounds’?).
I have personal experience on this topic, and while I can’t claim to agree 100% with AA…the support group it offers is amazing! I suspect many of the people who go there are not true “alcoholics”, but the support group still provides a ton of value. And they are the last line of support for people who lost everything in life. You can say the same about religion I guess. I happen to have the Big Book and I kinda agree with all of it.
I have read articles that suggest that Buddhist monks are extremely self-aware and can withstand conditions that would kill almost any “normal” human being. I have also read that to become one of those monks, refraining from alcohol is paramount. Who is right at the end of the day?
PS. I *do* drink alcohol.
Ok so how do we also prevent distracted driving by people who are addicted to their cellphones?
Can we throw them in the slammer for 12 hours so they can think about how they could have killed somebody?
California Judges seem to have come up with similar conclusions independently. They set up drug courts, where offenders get less or no jail time. While on probation, they are subject to random testing – one phone call and its off to get your urine tested. Fail the test, go to jail. Since the offender is on probation there is no due process involved. Such simple but severe polices are surprising good at keeping people off drugs.
People seem to have wildly different affinities for drugs. (I have smoked a few cigars, but it never really “hooked” for instance) I’m sure that there are people that would be happy to abstain from cocaine for $10/week, but there are also people who will do absolutely life-wrecking things to get and use cocaine. Clearly there’s no one size fits all model that will work.
The DUI system sure is interesting. You’re assumed to have a drinking problem, which is probably a fair assumption. You pay fines in the $1500-5000 range, legal costs, to tow your car, $500 to go through a DUI program, can’t drive for 3 months to a year, etc.
This is plausible for a wealthier person to get through, but its completely life destroying for people in the lower two thirds of the earning curve. If you had a drinking problem, this is not going to help you solve it.
Given that people will often get 2, 3 or more of these, it also doesn’t seem to act as a deterrent. Its also interesting that in California (where I live) at no point in this process does anything happen that looks at or tries to help you with whatever might be the root cause of your drinking problem.
Psychologists? I honestly have no idea what value they add to anything at all.