Experimental Application of Reinforcement Principles to the Analysis and Treatment of Hospitalized Alcoholics

Abstract

As a pilot project to demonstrate that reinforcement techniques can be applied to change the behavior of alcoholics, a simulated "real world" economy was established in the Richmond State Hospital, Indiana. Points were paid to 17 nonvolunteer subjects for work on the hospital labor force (at 100 points per hour), and could be used to make compulsory purchases, such as room and board (800[long dash]2,400 points per week) or ground privileges (400 per week), and voluntary purchases, such as canteen tickets (300 per week), passes (800 per day), disulfiram tablets (15), Alcoholics Anonymous meetings (200) or group therapy (500). The patients were started in a closed ward with few comforts and little freedom and could then work their way through 5 levels, with a minimum of 1 week at each level, until they were in a comfortable open ward with ground privileges and leaves of absence. All but 3 of the 17 alcoholic subjects in the experiment remained in the project for 9 weeks or more, and their work output increased until all were working an average of 8 hours a day, in comparison to the other hospital patients'' 4-hr day. The voluntary purchases of the patients included recreation, canteen tickets, leaves of absence, and A. A. meetings; almost no patients purchased specialized treatment or vocational or hobby instruction, even though most patients had thousands of unspent points in their accounts. It is concluded that although the project had no therapeutic purpose, it demonstrated that simulated economies will control behavior and that the patients'' purchases can yield valuable evidence of their motivation. A more comprehensive program is outlined. Focalized neurotic symptomatologies have been successfully treated by such programs but a disorder as complex as alcoholism will be more difficult to treat. It is suggested that alcohol should be used in a reinforcement program with alcoholics so that their behavior can be more readily understood and controlled and perhaps to allow the alternative of moderate drinking.