Electronic Letters to:
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eLetters: Electronic letters published:
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Contingency management treatment
- Ian G Bronks (9 August 2006)
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Ian G Bronks, consultant psychiatrist
Send letter to journal:
igb{at}bronks.plus.com Ian G Bronks
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Petry summarises evidence from studies conducted in the USA indicating that "contingency management treatment"- in other words, money- is efficacious in enhancing the duration of abstinence in drug and alcohol misusers. Unsurprisingly it appears that the more the individuals concerned are paid, the more likely they are to abstain. It is obvious that those who abstain from drugs or alcohol in the hope or expectation of material reward could have done so without such rewards, had they wished to. Most people will feel a natural sense of repugnance at the idea of paying people to refrain from antisocial or even criminal behaviour such as drug or alcohol misuse. Such a procedure, with its appeal to naked greed,is as Petry suggests, doubtless consistent with the values embedded in present day American society, and indeed our own. That it should be dignified with the respectable sounding title of "contingency management treatment" is equally distasteful. Where is the line to be drawn? Should we pay paedophiles if they refrain from molesting children, or thieves if they stop stealing? Contrary to what Petry seems to believe, the end does not always justify the means. We do need a serious debate, both within the psychiatric profession and more widely, about the extent to which those who choose to misuse drugs and other substances should be regarded as patients, requiring treatment,coupled with an objective evaluation of the extent to which society benefits from the vast sums of money poured into services for drug and alcohol misusers. If Petry's editorial helps to trigger such a debate it will have served a useful purpose. Yours faithfully Ian G Bronks F.R.C.P.(Ed.), F.R.C.Psych. 64 Broadway Duffield Derbyshire DE56 4BU Tel: 01332 841438 Fax: 01332 843660 |
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