giovedì 28 luglio 2016

The Price of Cold Turkey

Contingency management (CM) is a strategy used in alcohol and other drug (AOD) abuse treatment to encourage positive behavior change (e.g., abstinence) in patients by providing reinforcing consequences when patients meet treatment goals and by withholding those consequences or providing punitive measures when patients engage in the undesired behavior (e.g., drinking). For example, positive consequences for abstinence may include receipt of vouchers that are exchangeable for retail goods, whereas negative consequences for drinking may include withholding of vouchers or an unfavorable report to a parole officer.

I wish they chose a more transparent name, but the results of this well-developed literature are striking even to me. There have been lots of good experiments where addicts are randomly assigned to either the experimental group, where they getconditional rewards for abstinence, and a control group, where they get unconditionalrewards. Paying people to ditch their favorite vice is amazingly effective

Economists have done a number of studies showing that the demand for drugs usually considered highly addictive is still fairly elastic. The CM literature goes a bit further: Instead of estimating elasticity, it estimates the total consumer's surplus of the marginal addict, by seeing how much you have to pay people to reduce their consumption to zero.

As might be expected, psychiatrists look at these results and see only another tool for "helping" people who probably don't want to be helped in the first place. In contrast, I look at these results and see further evidence that addiction is not a "disease," but a free choice.