Te selection of a suitable reward is a key
element in a successful CM intervention. In CM parlance, the reward, or positive reinforcer, must be of sufficiently high “magnitude” to change the target behavior. In terms of substance use, this means the reward must be atractive enough to compete favorably with a psychoactive substance, a substance that is used and repeatedly abused for its intrinsic reward value. Te DOT return-to-duty process rewards abstinence by granting eligibility to engage in a process that can lead to regaining or gaining employment, and it punishes substance use by removing the individual from the process. Te success rates of the DOT process demonstrate that the reward magnitude of a well-structured opportunity to restore a livelihood is quite oſten powerful enough to usurp substance use and change behavior. Te structure of a reward system is
known as a “reinforcement schedule.” A reinforcement schedule manages the delivery of rewards and punishments. A reward is most effective when there is a timely pairing of behavior and consequence, i.e., the shorter the interval between behavior and consequence, the more powerful the intervention. Te DOT process quickly
supplies consequences to prohibited substance use by requiring immediate suspension or termination of safety-sensitive employment. Abstinence is rewarded by providing access to a process that ultimately rewards long-term compliance with eligibility to regain or gain a safety-sensitive job. If an individual who is matriculating in the process violates the requirement of abstinence, they are immediately removed from it. Tey are discharged from the process, but may choose to re-enter it by starting-over with a new initial SAP evaluation and complying with SAP recommendations. Tis is the DOT version of the proverbial “going back to GO, but not collecting $200.” A reinforcement schedule is also
most effective when it is long enough to promote behavior change. Substance use treatment research supports the notion that longer treatment is usually the most effective treatment. Today’s emphasis on “continuing care” reflects this idea. To this important point, the DOT return-to-duty process allows for a treatment follow-up period that must extend, at minimum, for at least one year after the individual has been returned to safety-sensitive duties. The follow- up period can extend up to 5 years at the clinical discretion of the SAP. The DOT requirement for the follow-up phase of the care continuum includes an unannounced testing schedule designed by the SAP that calls for at least six tests during the first year of follow-up. The SAP may also recommend verifiable counseling and verifiable community support group attendance. A hallmark of a successful CM
intervention is that its benefits extend beyond the term of active treatment. In behavioral terminology, a CM intervention that accomplishes this activates a phenomenon called “response generalization.” Tis means that, as desirable behavior is rewarded and practiced, new rewards become associated
10 datia focus
with the healthy choices the person makes and the new rewards invigorate and perpetuate the new behaviors. In terms of the DOT process, the recovering individual’s abstinence is rewarded by more than just gaining or re-gaining a job. Yes, employment is restored, but so are relationships, families, health, energy and a positive outlook on life. A life is not just saved, it’s enriched. Te benefits do not stop here. Te lives our employees save are not limited to the one life that is going through the DOT return-to-duty process. Te other saved lives belong to pedestrians, automobile drivers and passengers on buses, trains, planes and boats. Tese are among the beneficiaries of life changing behaviors that pay life saving dividends! ❚
References
McKay, J.R. (2009). Continuing care research: what we have learned and where we are going. Journal of Substance Abuse Treatment 36 , 131–145.
Morrison, R. & DuPont, R. (2013). The new paradigm and the dot/sap process. Journal of Employee Assistance, 43 (1), pp. 26–28.
Morrison, R. (2008). What is sap treatment? DATIA Focus,1(3), pp. 32–33.
Silverman, K., Holtyn, K. & Morrison, R. (2015) The therapeutic utility of employment in treating drug addiction: science to application. Update. Partnership for a Drug-Free New Jersey. No. 74, Spring 2015.
Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS): 2011. Discharges from Substance Abuse Treatment Services. BHSIS Series S-70, HHS Publication No. (SMA) 14-4846. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
U.S. Department of Transportation. Title 49 PART 40— Procedures for Transportation Workplace Drug and Alcohol Testing Programs (Updated September 27, 2011)
Reed A. Morrison, PhD is president and CEO of American Substance Abuse Professionals (ASAP), a national provider of drug free workplace services. Dr. Morrison is a qualified Substance Abuse Professional (SAP) and a qualified Substance Abuse Expert (SAE). He holds the American Psychological Association’s Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substances and the American Academy of Healthcare Providers in the Addictive Disorders’ Certified Addiction Specialist (CAS) credential.
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