Monitor on Psychology - November 2011 - (Page 39)

scIence Watch t was a chilly February day in Concord, N.H., and the audience of a hundred judges, prosecutors and probation officers facing psychologist Douglas Marlowe, JD, PhD, was perhaps even chillier. They’d invited him to speak because newly enacted legislation made it tough to incarcerate nonviolent addicted and mentally ill offenders. Instead, the criminal justice system would provide alternative programs, including drug courts that reward good behavior and punish missteps — a system that many of Marlowe’s audience members viewed skeptically. “I know what a lot of you are thinking right now: ‘You want me to take these high-risk antisocial, addicted individuals and give them,” — Marlowe switches to a mocking voice — “positive reinforcement.” You’re thinking, ‘Why should I give them rewards for doing what the rest of us are legally, ethically and morally required to do anyway? Who rewards me for not breaking the law? Who rewards me for not doing drugs?’ But you have to remember there was a time in all your lives when people did reward you for doing simple, basic things. People applauded when you went poopie in the potty. ... Your families did an extraordinarily good job of socializing you, and that is why you are all judges and lawyers and corrections officers today.” It’s a talk Marlowe has given many times as chief of science, policy and law for the National Association of Drug Court Professionals. And it works, he says. If you remind people of their own learning histories, they become more receptive to the idea that even hardened criminals can change. Then, he tells them how to use psychology’s fundamental laws of reinforcement to help drug-addicted offenders quit — the technique psychologists call contingency management. For example, some judges send offenders to jail the first time they fail a urine test. But research shows that it’s more effective to have gradually escalating penalties. Positive reinforcement — in the form of token gifts and pep-talks from judges — also improves abstinence and recidivism rates. But perhaps the most important quality of a good drug court is regular drug testing and swift consequences, Marlowe says. “The courtroom is the perfect place to deliver a contingency management intervention,” says Marlowe. “I think Skinner himself would have loved a courtroom where punishment and reward were delivered systematically.” n ov e M b e r 2 0 1 1 • M o n i to r o n p s yc h o l o g y I The courtroom, however, is just one of many venues where psychologists are applying contingency management on a larger scale than ever before. After spending the better part of a century germinating in psychology labs, psychologist-designed programs are finally taking root in the wider world, especially in drug treatment programs and company wellness initiatives. The results, so far, are nothing short of staggering: Homeless people with HIV are remembering to take their medications, cocaine addicts are showing up to work on time and drug-free, and already healthy workers are becoming even healthier, by increasing their gym attendance and refilling prescriptions on time. As for drug courts, those that faithfully apply principles pioneered by B.F. Skinner are reducing recidivism by upward of 35 percent, according to a research review by Marlowe (in the Chapman Journal of Criminal Justice). That success has spurred a huge uptick in drug court participation nationwide, to the point that every state now offers drug courts, says Marlowe. In essence, Skinner is scaling up. “We’re on the cusp of a new generation of contingency management,” says Joshua Klapow, PhD, a public health professor and contingency management researcher at the University of Alabama at Birmingham. “We’re taking momand-pop projects, designed for a few hundred people at most, and learning how to apply them to whole populations.” Pay to play Contingency management programs are often deceptively simple. Most reinforce good behavior by giving people cash or vouchers. For example, a program developed by James Sorensen, PhD, a University of California, San Francisco, psychology professor, paid HIV-positive methadone patients for taking their antiretroviral medication. By giving 66 participants vouchers worth an average of $5 per day, Sorensen and his colleagues increased pill taking from 56 percent to 78 percent, according to a study published in Drug and Alcohol Dependence (Vol. 88, No. 1). Getting people to take lifesaving medications may not seem like a major accomplishment, but many of the study’s participants were homeless, which makes keeping track of medications — not to mention refrigerating them — difficult, 39

Table of Contents for the Digital Edition of Monitor on Psychology - November 2011

Monitor on Psychology - November 2011
Letters
President’s Column
Contents
Guest Column
‘Grand Challenges’ offers blueprint for mental health research
Documentary seeks to reach parents of LGBT kids
Treating veterans will cost at least $5 billion by 2020
Selfless volunteering might lengthen your life
Combat and stress up among U.S. military in Afghanistan
South Africa to host international psychology conference
Study uncovers a reason behind sex differences in mental illness
Navy psychologist gives a voice to combat trauma
In Brief
Psychologist suicide
On Your Behalf
Journey back to Heart Mountain
Psychology is key to pain management, report finds
ACT goes international
Judicial Notebook
Random Sample
Time Capsule
Questionnaire
Science Watch
Behavior change in 15-minute sessions?
Health-care reform 2.0
Perspective on Practice
Giving a heads up on concussion
Practice Profile
Searching for meaning
Inspiring young researchers
Aging, with grace
Public Interest
Thank you!
APA News
Division Spotlight
American Psychological Foundation
The man who gave Head Start a start
Personalities

Monitor on Psychology - November 2011