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Application of Operant Conditioning to Address the Interrelated Problems of Poverty and Drug Addiction

July 23, 2012

Kenneth Silverman, PhD
Professor of Psychiatry & Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine

About the Presentation: Laboratory and clinical research suggests that drug addiction can be viewed as operant behavior and effectively treated through the direct application of operant conditioning. Abstinence reinforcement, in which patients receive desirable consequences contingent on providing objective evidence of abstinence, can promote abstinence from commonly abused drugs, but they must employ high magnitude reinforcement to promote abstinence in treatment-refractory patients and they must be maintained over time to prevent elapse. The therapeutic workplace was developed to provide a practical way to arrange high magnitude and long duration abstinence reinforcement. Under the therapeutic workplace, individuals are hired and paid to work. To reinforce abstinence, participants are required to provide objective evidence of drug abstinence to maintain access to the workplace. In this way, participants can work and earn wages, but only as long as they remain drug abstinent. Because many poor individuals lack adequate job skills, the therapeutic workplace offers a training phase before formal employment. During the training phase, participants receive stipend-supported education and job skills training to establish skills needed for employment. In the employment phase, participants perform work in an income-producing business. Controlled studies have shown that the therapeutic workplace’s stipend-supported education can retain low-income unemployed adult in training and promote the development of job skills. Randomized controlled clinical trials have also shown that the therapeutic workplace and employment-based reinforcement can initiate and maintain abstinence from heroin and cocaine over extended periods of time and promote adherence to addiction medications in poor and chronically unemployed adults. This research suggests that the therapeutic workplace could be used as a long-term treatment for drug addiction and chronic unemployment in adults living in poverty.

Supported by NIDA grants R01DA09426, R01DA12564, R01DA13107, R01DA019386, R01DA019497 and R01DA023864.

About the Presenter: Kenneth Silverman received his doctorate in Developmental and Child Psychology from the University of Kansas in 1984. His doctoral training focused in the areas operant conditioning and behavior analysis. He completed a postdoctoral research fellowship in Behavioral Pharmacology at the Johns Hopkins University School of Medicine in 1991, and served as a staff fellow in the Clinical Trials Section in the National Institute on Drug Abuse’s Addiction Research Center from 1991-1993. He has maintained a faculty appointment in the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine since 1991, and is currently Professor of Psychiatry and Behavioral Sciences. Dr. Silverman’s research has focused on developing operant treatments to address the interrelated problems of poverty and drug addiction. His primary research has focused on the development and evaluation of abstinence reinforcement interventions for heroin and cocaine addiction in low-income, inner city adults; the integration of abstinence reinforcement contingencies into model employment settings; the use of employment-based reinforcement in the long-term maintenance of drug abstinence and adherence to addiction treatment medications; and the development of computer-based training to establish critical academic and job skills that chronically unemployed adults need to gain and maintain employment and escape poverty.