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Monday, August 19, 2019

Equal opportunity

From Wikipedia, the free encyclopedia

A sprinter at the starting block
The metaphor of a race is often used to describe equality of opportunity
 
Equal opportunity is a state of fairness in which job applicants are treated similarly, unhampered by artificial barriers or prejudices or preferences, except when particular distinctions can be explicitly justified. According to this often complex and contested concept, the intent is that the important jobs in an organization should go to the people who are most qualified – persons most likely to perform ably in a given task – and not go to persons for reasons deemed arbitrary or irrelevant, such as circumstances of birth, upbringing, having well-connected relatives or friends, religion, sex, ethnicity, race, caste, or involuntary personal attributes such as disability, age, gender identity, or sexual orientation.

Chances for advancement should be open to everybody interested, such that they have "an equal chance to compete within the framework of goals and the structure of rules established". The idea is to remove arbitrariness from the selection process and base it on some "pre-agreed basis of fairness, with the assessment process being related to the type of position" and emphasizing procedural and legal means. Individuals should succeed or fail based on their own efforts and not extraneous circumstances such as having well-connected parents. It is opposed to nepotism and plays a role in whether a social structure is seen as legitimate. The concept is applicable in areas of public life in which benefits are earned and received such as employment and education, although it can apply to many other areas as well. Equal opportunity is central to the concept of meritocracy.

Differing political viewpoints

Equal opportunity for all: "We fight God when our Social System dooms the brilliant clever child of a poor man to the same level as his father", Admiral "Jacky" Fisher, Records (1919)
 
People with differing political viewpoints often view the concept differently. The meaning of equal opportunity is debated in fields such as political philosophy, sociology and psychology. It is being applied to increasingly wider areas beyond employment, including lending, housing, college admissions, voting rights and elsewhere. In the classical sense, equality of opportunity is closely aligned with the concept of equality before the law and ideas of meritocracy.

Generally, the terms equality of opportunity and equal opportunity are interchangeable, with occasional slight variations; the former has more of a sense of being an abstract political concept while "equal opportunity" is sometimes used as an adjective, usually in the context of employment regulations, to identify an employer, a hiring approach, or law. Equal opportunity provisions have been written into regulations and have been debated in courtrooms. It is sometimes conceived as a legal right against discrimination. It is an ideal which has become increasingly widespread in Western nations during the last several centuries and is intertwined with social mobility, most often with upward mobility and with rags to riches stories:
The coming President of France is the grandson of a shoemaker. The actual President is a peasant's son. His predecessor again began life in a humble way in the shipping business. There is surely equality of opportunity under the new order in the old nation.

Theory

Outline of the concept

In a factory setting, equality of opportunity is often seen as a procedural fairness along the lines of "if you assemble twice as many lamps, you'll be paid double" and in this sense the concept is in contrast to the concept of equality of outcome, which might require that all workers be paid similarly regardless of how many lamps they made
 
According to the Stanford Encyclopedia of Philosophy, the concept assumes that society is stratified with a diverse range of roles, some of which are more desirable than others. The benefit of equality of opportunity is to bring fairness to the selection process for coveted roles in corporations, associations, nonprofits, universities and elsewhere. According to one view, there is no "formal linking" between equality of opportunity and political structure, in the sense that there can be equality of opportunity in democracies, autocracies and in communist nations, although it is primarily associated with a competitive market economy and embedded within the legal frameworks of democratic societies. People with different political perspectives see equality of opportunity differently: liberals disagree about which conditions are needed to ensure it and many "old-style" conservatives see inequality and hierarchy in general as beneficial out of a respect for tradition. It can apply to a specific hiring decision, or to all hiring decisions by a specific company, or rules governing hiring decisions for an entire nation. The scope of equal opportunity has expanded to cover more than issues regarding the rights of minority groups, but covers practices regarding "recruitment, hiring, training, layoffs, discharge, recall, promotions, responsibility, wages, sick leave, vacation, overtime, insurance, retirement, pensions, and various other benefits".

The concept has been applied to numerous aspects of public life, including accessibility of polling stations, care provided to HIV patients, whether men and women have equal opportunities to travel on a spaceship, bilingual education, skin color of models in Brazil, television time for political candidates, army promotions, admittance to universities and ethnicity in the United States. The term is interrelated with and often contrasted with other conceptions of equality such as equality of outcome and equality of autonomy. Equal opportunity emphasizes the personal ambition and talent and abilities of the individual, rather than his or her qualities based on membership in a group, such as a social class or race or extended family. Further, it is seen as unfair if external factors that are viewed as being beyond the control of a person significantly influence what happens to him or her. Equal opportunity then emphasizes a fair process whereas in contrast equality of outcome emphasizes a fair outcome. In sociological analysis, equal opportunity is seen as a factor correlating positively with social mobility, in the sense that it can benefit society overall by maximizing well-being.

Different types

There are different concepts lumped under equality of opportunity.

Formal equality of opportunity is a lack of (unfair) direct discrimination. It requires that deliberate discrimination be relevant and meritocratic. For instance, job interviews should only discriminate against applicants for job incompetence. Universities should not accept a less-capable applicant instead of a more-capable applicant who can't pay tuition. 

Substantive equality of opportunity is absence of indirect discrimination. It requires that society be fair and meritocratic. For instance, a person should not be more likely to die at work because they were born in a country with corrupt labor law enforcement. No one should have to drop out of school because their family needs of a full-time carer or wage earner. 

Formal equality of opportunity does not imply substantive equality of opportunity. Firing any employee who gets pregnant is formally equal, but substantively it hurts women more. 

Substantive inequality is often more difficult to address. A political party that formally allows anyone to join, but meets in a non-wheelchair-accessible building far from public transit, substantively discriminates against both young and old members as they are less likely to be able-bodied car-owners. However, if the party raises membership dues in order to afford a better building, it discourages poor members instead. A workplace in which it is difficult for persons with special needs and disabilities to perform can considered as a type of substantive inequality, although job restructuring activities can be done to make it easier for disabled persons to succeed. Grade-cutoff university admission is formally fair, but if in practice it overwhelmingly picks women and graduates of expensive user-fee schools, it is substantively unfair to men and the poor. The unfairness has already taken place and the university can choose to try to counterbalance it, but it likely can not single-handedly make pre-university opportunities equal. Social mobility and the Great Gatsby curve are often used as an indicator of substantive equality of opportunity.

Both equality concepts say that it is unfair and inefficient if extraneous factors rule people's lives. Both accept as fair inequality based on relevant, meritocratic factors. They differ in the scope of the methods used to promote them.

Formal equality of opportunity

Formal equality of opportunity
 
Formal equality of opportunity is sometimes referred to as the nondiscrimination principle or described as the absence of direct discrimination, or described in the narrow sense as equality of access. It is characterized by:
  1. Open call. Positions bringing superior advantages should be open to all applicants and job openings should be publicized in advance giving applicants a "reasonable opportunity" to apply. Further, all applications should be accepted.
  2. Fair judging. Applications should be judged on their merits, with procedures designed to identify those best-qualified. The evaluation of the applicant should be in accord with the duties of the position and for the job opening of choir director, for example, the evaluation may judge applicants based on musical knowledge rather than some arbitrary criterion such as hair color.
  3. An application is chosen. The applicant judged as "most qualified" is offered the position while others are not. There is agreement that the result of the process is again unequal, in the sense that one person has the position while another does not, but that this outcome is deemed fair on procedural grounds.
The formal approach is seen as a somewhat basic "no frills" or "narrow" approach to equality of opportunity, a minimal standard of sorts, limited to the public sphere as opposed to private areas such as the family, marriage, or religion. What is considered "fair" and "unfair" is spelled out in advance. An expression of this version appeared in The New York Times: "There should be an equal opportunity for all. Each and every person should have as great or as small an opportunity as the next one. There should not be the unfair, unequal, superior opportunity of one individual over another."

The formal conception focuses on procedural fairness during the competition: are the hurdles the same height? (photo: athletes Ulrike Urbansky and Michelle Carey in Osaka)
 
This sense was also expressed by economists Milton and Rose Friedman in their 1980 book Free to Choose. The Friedmans explained that equality of opportunity was "not to be interpreted literally" since some children are born blind while others are born sighted, but that "its real meaning is ... a career open to the talents". This means that there should be "no arbitrary obstacles" blocking a person from realizing their ambitions: "Not birth, nationality, color, religion, sex, nor any other irrelevant characteristic should determine the opportunities that are open to a person – only his abilities".

A somewhat different view was expressed by John Roemer, who used the term nondiscrimination principle to mean that "all individuals who possess the attributes relevant for the performance of the duties of the position in question be included in the pool of eligible candidates, and that an individual's possible occupancy of the position be judged only with respect to those relevant attributes". Matt Cavanagh argued that race and sex should not matter when getting a job, but that the sense of equality of opportunity should not extend much further than preventing straightforward discrimination.

It is a relatively straightforward task for legislators to ban blatant efforts to favor one group over another and encourage equality of opportunity as a result. Japan banned gender-specific job descriptions in advertising as well as sexual discrimination in employment as well as other practices deemed unfair, although a subsequent report suggested that the law was having minimal effect in securing Japanese women high positions in management. In the United States, the Equal Employment Opportunity Commission sued a private test preparation firm, Kaplan, for unfairly using credit histories to discriminate against African Americans in terms of hiring decisions. According to one analysis, it is possible to imagine a democracy which meets the formal criteria (1 through 3), but which still favors wealthy candidates who are selected in free and fair elections.

Substantive equality of opportunity

Substantive equality of opportunity
 
The Great Gatsby Curve shows that countries with more equality of wealth also have more social mobility, which indicates that equality of wealth and equality of opportunity go together:
If higher inequality makes intergenerational mobility more difficult, it is likely because opportunities for economic advancement are more unequally distributed among children.
Substantive equality of opportunity, sometimes called fair equality of opportunity, is a somewhat broader and more expansive concept than the more limiting formal equality of opportunity and it deals with what is sometimes described as indirect discrimination. It goes farther and is more controversial than the formal variant; and has been thought to be much harder to achieve, with greater disagreement about how to achieve greater equality; and has been described as "unstable", particularly if the society in question is unequal to begin with in terms of great disparity of wealth. It has been identified as more of a left-leaning political position, but this is not a hard-and-fast rule. The substantive model is advocated by people who see limitations in the formal model:
Therein lies the problem with the idea of equal opportunity for all. Some people are simply better placed to take advantage of opportunity.
— Deborah Orr in The Guardian, 2009
There is little income mobility – the notion of America as a land of opportunity is a myth.
— Joseph E. Stiglitz, 2012
In the substantive approach, the starting point before the race begins is unfair since people have had differing experiences before even approaching the competition. The substantive approach examines the applicants themselves before applying for a position and judges whether they have equal abilities or talents; and if not, then it suggests that authorities (usually the government) take steps to make applicants more equal before they get to the point where they compete for a position and fixing the before-the-starting-point issues has sometimes been described as working towards "fair access to qualifications". It seeks to remedy inequalities perhaps because of an "unfair disadvantage" based sometimes on "prejudice in the past".

According to John Hills, children of wealthy and well-connected parents usually have a decisive advantage over other types of children and he notes that "advantage and disadvantage reinforce themselves over the life cycle, and often on to the next generation" so that successful parents pass along their wealth and education to succeeding generations, making it difficult for others to climb up a social ladder. However, so-called positive action efforts to bring an underprivileged person up to speed before a competition begins are limited to the period of time before the evaluation begins. At that point, the "final selection for posts must be made according to the principle the best person for the job", that is, a less qualified applicant should not be chosen over a more qualified applicant. There are also nuanced views too: one position suggested that the unequal results following a competition were unjust if caused by bad luck, but just if chosen by the individual and that weighing matters such as personal responsibility was important. This variant of the substantive model has sometimes been called luck egalitarianism. Regardless of the nuances, the overall idea is still to give children from less fortunate backgrounds more of a chance, or to achieve at the beginning what some theorists call equality of condition. Writer Ha-Joon Chang expressed this view:
We can accept the outcome of a competitive process as fair only when the participants have equality in basic capabilities; the fact that no one is allowed to have a head start does not make the race fair if some contestants have only one leg.
Issues about equal opportunity have been raised about the skin color of runway models at the São Paulo Fashion Week and in 2009 quotas requiring that at least 10 percent of models be "black or indigenous" were imposed as a substantive way to counteract a "bias towards white models", according to one account
 
In a sense, substantive equality of opportunity moves the "starting point" further back in time. Sometimes it entails the use of affirmative action policies to help all contenders become equal before they get to the starting point, perhaps with greater training, or sometimes redistributing resources via restitution or taxation to make the contenders more equal. It holds that all who have a "genuine opportunity to become qualified" be given a chance to do so and it is sometimes based on a recognition that unfairness exists, hindering social mobility, combined with a sense that the unfairness should not exist or should be lessened in some manner. One example postulated was that a warrior society could provide special nutritional supplements to poor children, offer scholarships to military academies and dispatch "warrior skills coaches" to every village as a way to make opportunity substantively more fair. The idea is to give every ambitious and talented youth a chance to compete for prize positions regardless of their circumstances of birth.

The substantive approach tends to have a broader definition of extraneous circumstances which should be kept out of a hiring decision. One editorial writer suggested that among the many types of extraneous circumstances which should be kept out of hiring decisions was personal beauty, sometimes termed "lookism":
Lookism judges individuals by their physical allure rather than abilities or merit. This naturally works to the advantage of people perceived to rank higher in the looks department. They get preferential treatment at the cost of others. Which fair, democratic system can justify this? If anything, lookism is as insidious as any other form of bias based on caste, creed, gender and race that society buys into. It goes against the principle of equality of opportunity.
The substantive position was advocated by Bhikhu Parekh in 2000 in Rethinking Multiculturalism, in which he wrote that "all citizens should enjoy equal opportunities to acquire the capacities and skills needed to function in society and to pursue their self-chosen goals equally effectively" and that "equalising measures are justified on grounds of justice as well as social integration and harmony". Parekh argued that equal opportunities included so-called cultural rights which are "ensured by the politics of recognition".

Affirmative action programs usually fall under the substantive category. The idea is to help disadvantaged groups get back to a normal starting position after a long period of discrimination. The programs involve government action, sometimes with resources being transferred from an advantaged group to a disadvantaged one and these programs have been justified on the grounds that imposing quotas counterbalances the past discrimination as well as being a "compelling state interest" in diversity in society. For example, there was a case in São Paulo in Brazil of a quota imposed on the São Paulo Fashion Week to require that "at least 10 percent of the models to be black or indigenous" as a coercive measure to counteract a "longstanding bias towards white models". It does not have to be accomplished via government action: for example, in the 1980s in the United States, President Ronald Reagan dismantled parts of affirmative action, but one report in the Chicago Tribune suggested that companies remained committed to the principle of equal opportunity regardless of government requirements. In another instance, upper-middle-class students taking the Scholastic Aptitude Test in the United States performed better since they had had more "economic and educational resources to prepare for these test than others". The test itself was seen as fair in a formal sense, but the overall result was seen as nevertheless unfair. In India, the Indian Institutes of Technology found that to achieve substantive equality of opportunity the school had to reserve 22.5 percent of seats for applicants from "historically disadvantaged schedule castes and tribes". Elite universities in France began a special "entrance program" to help applicants from "impoverished suburbs".

Equality of fair opportunity

Philosopher John Rawls offered this variant of substantive equality of opportunity and explained that it happens when individuals with the same "native talent and the same ambition" have the same prospects of success in competitions. Gordon Marshall offers a similar view with the words "positions are to be open to all under conditions in which persons of similar abilities have equal access to office". An example was given that if two persons X and Y have identical talent, but X is from a poor family while Y is from a rich one, then equality of fair opportunity is in effect when both X and Y have the same chance of winning the job. It suggests the ideal society is "classless" without a social hierarchy being passed from generation to generation, although parents can still pass along advantages to their children by genetics and socialization skills. One view suggests that this approach might advocate "invasive interference in family life". Marshall posed this question:
Does it demand that, however unequal their abilities, people should be equally empowered to achieve their goals? This would imply that the unmusical individual who wants to be a concert pianist should receive more training than the child prodigy.
Economist Paul Krugman agrees mostly with the Rawlsian approach in that he would like to "create the society each of us would want if we didn’t know in advance who we’d be". Krugman elaborated: "If you admit that life is unfair, and that there's only so much you can do about that at the starting line, then you can try to ameliorate the consequences of that unfairness".

Level playing field

The match's outcome is deemed legitimate if there is a level playing field and rules do not favor either player or team arbitrarily (photo: Cesc Fàbregas duels with Anderson in a football match in 2008)
 
Some theorists have posed a level playing field conception of equality of opportunity, similar in many respects to the substantive principle (although it has been used in different contexts to describe formal equality of opportunity) and it is a core idea regarding the subject of distributive justice espoused by John Roemer and Ronald Dworkin and others. Like the substantive notion, the level playing field conception goes farther than the usual formal approach. The idea is that initial "unchosen inequalities" – prior circumstances over which an individual had no control, but which impact his or her success in a given competition for a particular post – these unchosen inequalities should be eliminated as much as possible, according to this conception. According to Roemer, society should "do what it can to level the playing field so that all those with relevant potential will eventually be admissible to pools of candidates competing for positions". Afterwards, when an individual competes for a specific post, he or she might make specific choices which cause future inequalities – and these inequalities are deemed acceptable because of the previous presumption of fairness. This system helps undergird the legitimacy of a society's divvying up of roles as a result in the sense that it makes certain achieved inequalities "morally acceptable", according to persons who advocate this approach. This conception has been contrasted to the substantive version among some thinkers and it usually has ramifications for how society treats young persons in such areas as education and socialization and health care, but this conception has been criticized as well. John Rawls postulated the difference principle which argued that "inequalities are justified only if needed to improve the lot of the worst off, for example by giving the talented an incentive to create wealth".

Meritocracy

There is some overlap among these different conceptions with the term meritocracy which describes an administrative system which rewards such factors as individual intelligence, credentials, education, morality, knowledge or other criteria believed to confer merit. Equality of opportunity is often seen as a major aspect of a meritocracy. One view was that equality of opportunity was more focused on what happens before the race begins while meritocracy is more focused on fairness at the competition stage. The term meritocracy can also be used in a negative sense to refer to a system in which an elite hold themselves in power by controlling access to merit (via access to education, experience, or bias in assessment or judgment).

Moral senses

There is general agreement that equality of opportunity is good for society, although there are diverse views about how it is good since it is a value judgement. It is generally viewed as a positive political ideal in the abstract sense. In nations where equality of opportunity is absent, it can negatively impact economic growth, according to some views and one report in Al Jazeera suggested that Egypt, Tunisia and other Middle Eastern nations were stagnating economically in part because of a dearth of equal opportunity. The principle of equal opportunity can conflict with notions of meritocracy in circumstances in which individual differences in human abilities are believed to be determined mostly by genetics as in such circumstances there can be conflict about how to achieve fairness in such situations.

Practical considerations

Difficulties with implementation

There is general agreement that programs to bring about certain types of equality of opportunity can be difficult and that efforts to cause one result often have unintended consequences or cause other problems. There is agreement that the formal approach is easier to implement than the others, although there are difficulties there too. 

A government policy that requires equal treatment can pose problems for lawmakers. A requirement for government to provide equal health care services for all citizens can be prohibitively expensive. If government seeks equality of opportunity for citizens to get health care by rationing services using a maximization model to try to save money, new difficulties might emerge. For example, trying to ration health care by maximizing the "quality-adjusted years of life" might steer monies away from disabled persons even though they may be more deserving, according to one analysis. In another instance, BBC News questioned whether it was wise to ask female army recruits to undergo the same strenuous tests as their male counterparts since many women were being injured as a result.

Age discrimination can present vexing challenges for policymakers trying to implement equal opportunity. According to several studies, attempts to be equally fair to both a young and an old person are problematic because the older person has presumably fewer years left to live and it may make more sense for a society to invest greater resources in a younger person's health. Treating both persons equally while following the letter of the equality of opportunity seems unfair from a different perspective. 

Efforts to achieve equal opportunity along one dimension can exacerbate unfairness in other dimensions. For example, take public bathrooms: if for the sake of fairness the physical area of men's and women's bathrooms is equal, the overall result may be unfair since men can use urinals, which require less physical space. In other words, a more fair arrangement may be to allot more physical space for women's restrooms. The sociologist Harvey Holotch explained: "By creating men's and women's rooms of the same size, society guarantees that individual women will be worse off than individual men."

Another difficulty is that it is hard for a society to bring substantive equality of opportunity to every type of position or industry. If a nation focuses efforts on some industries or positions, then people with other talents may be left out. For example, in an example in the Stanford Encyclopedia of Philosophy, a warrior society might provide equal opportunity for all kinds of people to achieve military success through fair competition, but people with non-military skills such as farming may be left out.

Lawmakers have run into problems trying to implement equality of opportunity. In 2010 in Britain, a legal requirement "forcing public bodies to try to reduce inequalities caused by class disadvantage" was scrapped after much debate and replaced by a hope that organizations would try to focus more on "fairness" than "equality" as fairness is generally seen as a much vaguer concept than equality, but easier for politicians to manage if they are seeking to avoid fractious debate. In New York City, mayor Ed Koch tried to find ways to maintain the "principle of equal treatment" while arguing against more substantive and abrupt transfer payments called minority set-asides.

Equal opportunity issues are discussed at an army roundtable in Alabama
 
Many countries have specific bodies tasked with looking at equality of opportunity issues. In the United States, for example, it is the Equal Employment Opportunity Commission; in Britain, there is the Equality of Opportunity Committee as well as the Equality and Human Rights Commission; in Canada, the Royal Commission on the Status of Women has "equal opportunity as its precept"; and in China, the Equal Opportunities Commission handles matters regarding ethnic prejudice. In addition, there have been political movements pushing for equal treatment, such as the Women's Equal Opportunity League which in the early decades of the twentieth century, pushed for fair treatment by employers in the United States. One of the group's members explained:
I am not asking for sympathy but for an equal right with men to earn my own living in the best way open and under the most favorable conditions that I could choose for myself.

Difficulties with measurement

The consensus view is that trying to measure equality of opportunity is difficult whether examining a single hiring decision or looking at groups over time.
  • Single instance. It is possible to reexamine the procedures governing a specific hiring decision, see if they were followed and re-evaluate the selection by asking questions such as "Was it fair? Were fair procedures followed? Was the best applicant selected?". This is a judgment call and it is possible that biases may enter into the minds of decision-makers. The determination of equality of opportunity in such an instance is based on mathematical probability: if equality of opportunity is in effect, then it is seen as fair if each of two applicants has a 50 per cent chance of winning the job, that is, they both have equal chances to succeed (assuming of course that the person making the probability assessment is unaware of all variables – including valid ones such as talent or skill as well as arbitrary ones such as race or gender). However, it is hard to measure whether each applicant had in fact a 50 per cent chance based on the outcome.
  • Groups. When assessing equal opportunity for a type of job or company or industry or nation, then statistical analysis is often done by looking at patterns and abnormalities, typically comparing subgroups with larger groups on a percentage basis. If equality of opportunity is violated, perhaps by discrimination which affects a subgroup or population over time, it is possible to make this determination using statistical analysis, but there are numerous difficulties involved. Nevertheless, entities such as city governments and universities have hired full-time professionals with knowledge of statistics to ensure compliance with equal opportunity regulations. For example, Colorado State University requires their director of its Office of Equal Opportunity to maintain extensive statistics on its employees by job category as well as minorities and gender. In Britain, Aberystwyth University collects information including the "representation of women, men, members of racial or ethnic minorities and people with disabilities amongst applicants for posts, candidates interviewed, new appointments, current staff, promotions and holders of discretionary awards" to comply with equal opportunity laws.
It is difficult to prove unequal treatment although statistical analysis can provide indications of problems, but it is subject to conflicts over interpretation and methodological issues. For example, a study in 2007 by the University of Washington examined its own treatment of women. Researchers collected statistics about female participation in numerous aspects of university life, including percentages of women with full professorships (23 per cent), enrollment in programs such as nursing (90 per cent) and engineering (18 per cent). There is wide variation in how these statistics might be interpreted. For example, the 23 per cent figure for women with full professorships could be compared to the total population of women (presumably 50 per cent) perhaps using census data, or it might be compared to the percentage of women with full professorships at competing universities. It might be used in an analysis of how many women applied for the position of full professor compared to how many women attained this position. Further, the 23 per cent figure could be used as a benchmark or baseline figure as part of an ongoing longitudinal analysis to be compared with future surveys to track progress over time. In addition, the strength of the conclusions is subject to statistical issues such as sample size and bias. For reasons such as these, there is considerable difficulty with most forms of statistical interpretation. 

A computerized statistical analysis suggested nepotism and a practice of unequal opportunity within Italy's academic community (photo: University of Bari)
 
Statistical analysis of equal opportunity has been done using sophisticated examinations of computer databases. An analysis in 2011 by University of Chicago researcher Stefano Allesina examined 61,000 names of Italian professors by looking at the "frequency of last names", doing one million random drawings and he suggested that Italian academia was characterized by violations of equal opportunity practices as a result of these investigations. The last names of Italian professors tended to be similar more often than predicted by random chance. The study suggested that newspaper accounts showing that "nine relatives from three generations of a single family (were) on the economics faculty" at the University of Bari were not aberrations, but indicated a pattern of nepotism throughout Italian academia.

There is support for the view that often equality of opportunity is measured by the criteria of equality of outcome, although with difficulty. In one example, an analysis of relative equality of opportunity was done based on outcomes, such as a case to see whether hiring decisions were fair regarding men versus women—the analysis was done using statistics based on average salaries for different groups. In another instance, a cross-sectional statistical analysis was conducted to see whether social class affected participation in the United States Armed Forces during the Vietnam War: a report in Time by the Massachusetts Institute of Technology suggested that soldiers came from a variety of social classes and that the principle of equal opportunity had worked, possibly because soldiers had been chosen by a lottery process for conscription. In college admissions, equality of outcome can be measured directly by comparing offers of admission given to different groups of applicants: for example, there have been reports in newspapers of discrimination against Asian Americans regarding college admissions in the United States which suggest that Asian American applicants need higher grades and test scores to win admission to prestigious universities than other ethnic groups.

Marketplace considerations

Equal opportunity has been described as a fundamental basic notion in business and commerce and described by economist Adam Smith as a basic economic precept. There has been research suggesting that "competitive markets will tend to drive out such discrimination" since employers or institutions which hire based on arbitrary criteria will be weaker as a result and not perform as well as firms which embrace equality of opportunity. Firms competing for overseas contracts have sometimes argued in the press for equal chances during the bidding process, such as when American oil corporations wanted equal shots at developing oil fields in Sumatra; and firms, seeing how fairness is beneficial while competing for contracts, can apply the lesson to other areas such as internal hiring and promotion decisions. A report in USA Today suggested that the goal of equal opportunity was "being achieved throughout most of the business and government labor markets because major employers pay based on potential and actual productivity".

Fair opportunity practices include measures taken by an organization to ensure fairness in the employment process. A basic definition of equality is the idea of equal treatment and respect. In job advertisements and descriptions, the fact that the employer is an equal opportunity employer is sometimes indicated by the abbreviations EOE or MFDV, which stands for Minority, Female, Disabled, Veteran. Analyst Ross Douthat in The New York Times suggested that equality of opportunity depends on a rising economy which brings new chances for upward mobility and he suggested that greater equality of opportunity is more easily achieved during "times of plenty". Efforts to achieve equal opportunity can rise and recede, sometimes as a result of economic conditions or political choices.

History

According to professor David Christian of Macquarie University, an underlying Big History trend has been a shift from seeing people as resources to exploit towards a perspective of seeing people as individuals to empower. According to Christian, in many ancient agrarian civilizations, roughly nine of every ten persons was a peasant exploited by a ruling class. In the past thousand years, there has been a gradual movement in the direction of greater respect for equal opportunity as political structures based on generational hierarchies and feudalism broke down during the late Middle Ages and new structures emerged during the Renaissance. Monarchies were replaced by democracies: kings were replaced by parliaments and congresses. Slavery was also abolished generally. The new entity of the nation state emerged with highly specialized parts, including corporations, laws and new ideas about citizenship as well as values about individual rights found expression in constitutions, laws and statutes.

African-American civil rights lawyer Thurgood Marshall fought numerous battles in the courts for equal opportunity for all races in the United States; argued the 1954 Brown v. Board of Education case and won; and in 1967 was appointed to the Supreme Court
 
In the United States, one legal analyst suggested that the real beginning of the modern sense of equal opportunity was in the Fourteenth Amendment which provided "equal protection under the law". The amendment did not mention equal opportunity directly, but it helped undergird a series of later rulings which dealt with legal struggles, particularly by African Americans and later women, seeking greater political and economic power in the growing republic. In 1933, a congressional "Unemployment Relief Act" forbade discrimination "on the basis of race, color, or creed". The Supreme Court's 1954 Brown v. Board of Education decision furthered government initiatives to end discrimination.

In 1961, President John F. Kennedy signed Executive Order 10925 which enabled a presidential committee on equal opportunity, which was soon followed by President Lyndon B. Johnson's Executive Order 11246. The Civil Rights Act of 1964 became the legal underpinning of equal opportunity in employment. Businesses and other organizations learned to comply with the rulings by specifying fair hiring and promoting practices and posting these policy notices on bulletin boards, employee handbooks and manuals as well as training sessions and films. Courts dealt with issues about equal opportunity, such as the 1989 Wards Cove decision, the Supreme Court ruled that statistical evidence by itself was insufficient to prove racial discrimination. The Equal Employment Opportunity Commission was established, sometimes reviewing charges of discrimination cases which numbered in the tens of thousands annually during the 1990s. Some law practices specialized in employment law. Conflict between formal and substantive approaches manifested itself in backlashes, sometimes described as reverse discrimination, such as the Bakke case when a white male applicant to medical school sued on the basis of being denied admission because of a quota system preferring minority applicants. In 1990, the Americans with Disabilities Act prohibited discrimination against disabled persons, including cases of equal opportunity. In 2008, the Genetic Information Nondiscrimination Act prevents employers from using genetic information when hiring, firing, or promoting employees.

Measures

Many economists measure the degree of equal opportunity with measures of economic mobility. For instance, Joseph Stiglitz asserts that with five economic divisions and full equality of opportunity, "20 percent of those in the bottom fifth would see their children in the bottom fifth. Denmark almost achieves that – 25 percent are stuck there. Britain, supposedly notorious for its class divisions, does only a little worse (30 percent). That means they have a 70 percent chance of moving up. The chances of moving up in America, though, are markedly smaller (only 58 percent of children born to the bottom group make it out), and when they do move up, they tend to move up only a little". Similar analyses can be performed for each economic division and overall. They all show how far from the ideal all industrialized nations are and how correlated measures of equal opportunity are with income inequality and wealth inequality. Equal opportunity has ramifications beyond income; the American Human Development Index, rooted in the capabilities approach pioneered by Amartya Sen, is used to measure opportunity across geographies in the U.S. using health, education and standard of living outcomes.

Criticism

There is agreement that the concept of equal opportunity lacks a precise definition. While it generally describes "open and fair competition" with equal chances for achieving sought-after jobs or positions as well as an absence of discrimination, the concept is elusive with a "wide range of meanings". It is hard to measure, and implementation poses problems as well as disagreements about what to do.

There have been various criticisms directed at both the substantive and formal approach. One account suggests that left-leaning thinkers who advocate equality of outcome fault even formal equality of opportunity on the grounds that it "legitimates inequalities of wealth and income". John W. Gardner suggested several views: (1) that inequalities will always exist regardless of trying to erase them; (2) that bringing everyone "fairly to the starting line" without dealing with the "destructive competitiveness that follows"; (3) any equalities achieved will entail future inequalities. Substantive equality of opportunity has led to concerns that efforts to improve fairness "ultimately collapses into the different one of equality of outcome or condition".

Economist Larry Summers advocated an approach of focusing on equality of opportunity and not equality of outcomes and that the way to strengthen equal opportunity was to bolster public education. A contrasting report in The Economist criticized efforts to contrast equality of opportunity and equality of outcome as being opposite poles on a hypothetical ethical scale, such that equality of opportunity should be the "highest ideal" while equality of outcome was "evil". Rather, the report argued that any difference between the two types of equality was illusory and that both terms were highly interconnected. According to this argument, wealthier people have greater opportunities – wealth itself can be considered as "distilled opportunity" – and children of wealthier parents have access to better schools, health care, nutrition and so forth. Accordingly, people who endorse equality of opportunity may like the idea of it in principle, yet at the same time they would be unwilling to take the extreme steps or "titanic interventions" necessary to achieve real intergenerational equality. A slightly different view in The Guardian suggested that equality of opportunity was merely a "buzzword" to sidestep the thornier political question of income inequality.

There is speculation that since equality of opportunity is only one of sometimes competing "justice norms", there is a risk that following equality of opportunity too strictly might cause problems in other areas. A hypothetical example was suggested: suppose wealthier people gave excessive amounts of campaign contributions; suppose further that these contributions resulted in better regulations; and then laws limiting such contributions on the basis of equal opportunity for all political participants may have the unintended long term consequence of making political decision-making lackluster and possibly hurting the groups that it was trying to protect. Philosopher John Kekes makes a similar point in his book The Art of Politics in which he suggests that there is a danger to elevating any one particular political good – including equality of opportunity – without balancing competing goods such as justice, property rights and others. Kekes advocated having a balanced perspective, including a continuing dialog between cautionary elements and reform elements. A similar view was expressed by Ronald Dworkin in The Economist:
It strikes us as wrong – or not obviously right – that some people starve while others have private jets. We are uncomfortable when university professors earn less, for example, than junior lawyers. But equality appears to pull against other important ideals such as liberty and efficiency.
Economist Paul Krugman sees equality of opportunity as a "non-Utopian compromise" which works and is a "pretty decent arrangement" which varies from country to country. However, there are differing views, such as by Matt Cavanagh, who criticised equality of opportunity in his 2002 book Against Equality of Opportunity. Cavanagh favored a limited approach of opposing specific kinds of discrimination as steps to help people get greater control over their lives.

Conservative thinker Dinesh D'Souza criticized equality of opportunity on the basis that "it is an ideal that cannot and should not be realized through the actions of the government" and added that "for the state to enforce equal opportunity would be to contravene the true meaning of the Declaration and to subvert the principle of a free society". D'Souza described how his parenting undermined equality of opportunity:
I have a five-year-old daughter. Since she was born ... my wife and I have gone to great lengths in the Great Yuppie Parenting Race. ... My wife goes over her workbooks. I am teaching her chess. Why are we doing these things? We are, of course, trying to develop her abilities so that she can get the most out of life. The practical effect of our actions, however, is that we are working to give our daughter an edge – that is, a better chance to succeed than everybody else's children. Even though we might be embarrassed to think of it this way, we are doing our utmost to undermine equal opportunity. So are all the other parents who are trying to get their children into the best schools ...
Equal opportunity theorists generally agree that once the race begins, who wins is a function of talent, hard work and competitive drive (photo: runner Billy Mills crossing the finish line in the 1964 Olympics)
 
D'Souza argued that it was wrong for government to try to bring his daughter down, or to force him to raise up other people's children, but a counterargument is that there is a benefit to everybody, including D'Souza's daughter, to have a society with less anxiety about downward mobility, less class resentment and less possible violence.

An argument similar to D'Souza's was raised by Nozick in Anarchy, State, and Utopia, who wrote that the only way to achieve equality of opportunity was "directly worsening the situations of those more favored with opportunity, or by improving the situation of those less well-favored". Nozick gave an argument of two suitors competing to marry one "fair lady": X was plain while Y was better looking and more intelligent. If Y did not exist, then "fair lady" would have married X, but Y exists and so she marries Y. Nozick asks: "Does suitor X have a legitimate complaint against Y on the basis of unfairness since Y did not earn his good looks or intelligence?". Nozick suggests that there is no grounds for complaint. Nozick argued against equality of opportunity on the grounds that it violates the rights of property since the equal opportunity maxim interferes with an owner's right to do what he or she pleases with a property.

Property rights were a major component of the philosophy of John Locke and are sometimes referred to as "Lockean rights". The sense of the argument is along these lines: equal opportunity rules regarding, say, a hiring decision within a factory, made to bring about greater fairness, violate a factory owner's rights to run the factory as he or she sees best; it has been argued that a factory owner's right to property encompasses all decision-making within the factory as being part of those property rights. That some people's "natural assets" were unearned is irrelevant to the equation according to Nozick and he argued that people are nevertheless entitled to enjoy these assets and other things freely given by others.

Friedrich Hayek felt that luck was too much of a variable in economics, such that one can not devise a system with any kind of fairness when many market outcomes are unintended. By sheer chance or random circumstances, a person may become wealthy just by being in the right place and time and Hayek argued that it is impossible to devise a system to make opportunities equal without knowing how such interactions may play out. Hayek saw not only equality of opportunity, but all of social justice as a "mirage".

Some conceptions of equality of opportunity, particularly the substantive and level playing field variants, have been criticized on the basis that they make assumptions to the effect that people have similar genetic makeups. Other critics have suggested that social justice is more complex than mere equality of opportunity. Robert Nozick made the point that what happens in society can not always be reduced to competitions for a coveted position and in 1974 wrote that "life is not a race in which we all compete for a prize which someone has established", that there is "no unified race" and there is not some one person "judging swiftness".

Sunday, August 18, 2019

Addiction psychology

From Wikipedia, the free encyclopedia
 
Addiction psychology mostly comprises the clinical psychology and abnormal psychology disciplines and fosters the application of information obtained from research in an effort to appropriately diagnose, evaluate, treat, and support clients dealing with addiction. Throughout the treatment process addiction psychologists encourage behaviors that build wellness and emotional resilience to their physical, mental and emotional problems. 

The basis of addiction is controversial. Professionals view it as a disease or a choice. One model is referred to as the Disease model of addiction. The second model is the Choice model of addiction. Researches argue that the addiction process is like the disease model with a target organ being the brain, some type of defect, and symptoms of the disease. The addiction is like the choice model with a disorder of genes, a reward, memory, stress, and choice. Both models result in compulsive behavior.
Cognitive Behavioral Therapy, Dialectal Behavior Therapy and Behaviorism are widely used approaches for addressing Process Addictions and Substance Addictions. Less common approaches are Eclectic, Psychodynamic, Humanistic, and Expressive therapies. Substance addictions relate to drugs, alcohol, and smoking. Process addictions relate to non-substance related behaviors such as gambling, spending, sexual activity, gaming, internet, and food. 

Psychologists oldest definition of addiction is that the addict has a lack of self-control. The addicted party wants to abstain, but they can't resist the temptation. Addicts lose control over their actions. It is viewed that an addict battles with their addiction and wanting abstinence and gain control over their actions.

History

The word 'addiction' has successfully been traced to the 17th century. During this time period, addiction was defined as being compelled to act out any number of bad habits. Persons abusing narcotics were called opium and morphine 'eaters.' 'Drunkard' referred to abusers of alcohol. Medical textbooks categorized these 'bad habits' as dipsomania or alcoholism However, it wasn't until the 19th century when the diagnosis was first printed in medical literature. In the 1880s, Sigmund Freud and William Halsted began experimenting with users of cocaine. Unaware of the drug's powerful addictive qualities, they inadvertently became guinea pigs in their own research and, as a result, their contributions to psychology and medicine changed the world. 

While working in Vienna General Hospital (Vienna Krankenhaus), in Austria, cocaine took possession over Freud's life when he found cocaine to relieve his migraine. When the effect of cocaine decreased, the amount of cocaine Freud consumed increased. With information about the pain suppressing properties of cocaine, physicians began prescribing cocaine to their patients who required pain relief.

Unaware of Freud and Halsted's experiments with cocaine, American Physician W.H. Bentley was conducting his own similar experiments. The Index Medicus published his article describing how he successfully treated patients with cocaine who were addicted to opium and alcohol. In the late 1800s the use of cocaine as a recreational drug spread like a worldwide epidemic.

As cocaine continued to spread physicians began looking for ways to treat patients with opium, cocaine, and alcohol addictions. Physicians debated the existence of the label 'addictive personality' but believed the qualities Freud possessed (bold risk taking, emotional scar tissue, and psychic turmoil) were of those that fostered the 'addictive personality'.

Important contributors

Physician Sigmund Freud, born on May 6, 1856, in Freiberg, Moravia (an area now known as Pribor in the Czech Republic), was instrumental in the field of psychology. Dream interpretation and psychoanalysis (also known as talk therapy) are two of his well-known contributions. Psychoanalysis is used to treat a multitude of conditions including addictions. As one of the most influential thinkers in the 20th century, he altered the way we perceive ourselves and communicate about our perceptions as a number of his theories have been popularized and terms he created have entered into general language.

Theories on mental health, personality development and illness that Freud developed are considered highly controversial. According to Freud, people are endowed with three levels of awareness: conscious, preconscious, and unconscious, where conscious level refers to what we are fully appreciative of, preconscious is what people could be aware of if they became more attentive, and unconscious level includes facts that humans cannot be aware of. The aim of the therapy is to turn unconscious into conscious.

William Halsted, born on September 23, 1852, in New York City, received his degree in medicine in 1877. Throughout his medical career as a surgeon he contributed surgical techniques that ultimately led to improvement of the patient's outcome following surgery. During Halsted's professional career, he (along with Freud) conducted experiments with the drug cocaine. While their research was in process they became guinea pigs for their own experiments when they became addicted to cocaine. In 1884 he became the first to describe how cocaine could be utilized as a localized anesthetic when injecting into the trunk of a sensory nerve, and how the localized ischemia prolonged the anesthetic properties of the drug.

G. Alan Marlatt was a pioneer in the field of addiction psychology. Born in Vancouver, British Columbia, in 1941, he spent his professional career as an addiction psychologist, researcher, and director of the University of Washington's Addictive Behaviors Research Center and professor in the Department of Psychology. Marlatt adopted the theory of harm reduction, and developed and scientifically tested ways to prevent an addict's slip from becoming a relapse. He understood that expecting immediate and complete abstinence from addicts often deterred addicts from seeking the help they needed and deserved. Marlatt died on March 14, 2011.

A. Thomas McLellan was born in 1949 in Staten Island, New York. He is a professor at the University of Pennsylvania School of Medicine at the Center for Studies of Addiction. McLellan serves or has served on editorial boards as a reviewer of medical and scientific journals, and as an advisor to government and non-profit organizations including the National Practice Laboratory of the American Psychiatric Association, and the World Health Organization. He is co-founder and chief executive officer of the Treatment Research Institute located in Philadelphia, Pennsylvania. McLellan has conducted decades of research for the efficacy of treatment for substance abuse patients, and is recognized both at the national and international level as an addiction psychologist. He is also known for the development of the Addiction Severity Index or ASI and serves as editor-in-chief of the Journal of Substance Abuse Treatment and the deputy officer of National Drug Control Policy, Research and Evaluation.

Arnold Washton has specialized in addiction since 1975 and is an addiction psychologist known for his work in the development of therapeutic approaches to the treatment of drug and alcohol abuse. He is the author of many books and professional journal articles on treatment and addiction. He is a lecturer, clinician, researcher, and has served on the advisory committee for the US Food and Drug Administration. Washton is the founder and executive director of Recovery Options, a private addiction treatment practice located in New York City and Princeton, New Jersey.

William L. White is a Senior Research Consultant at Chestnut Health Systems, an addiction counselor, researcher and writer in the field of addiction for over 45 years. He wrote over 400 papers and 18 books. He received awards from the National Association of Addiction Treatment Providers (NAATP), the National Council on Alcoholism and Drug Dependence, (NAADAC), the Association of Addiction Professionals and the American Society of Addiction Medicine (ASAM).

Addiction

Addiction is a progressive disease and psychiatric disorder that is defined by the American Society of Addiction Medicine as "a primary, chronic disease of brain reward, motivation, memory and related circuitry. It is characterized by the inability to control behavior, it creates a dysfunctional emotional response, and it affects the users ability to abstain from the substance or behavior consistently. Psychology Today defines addiction as "a state that can occur when a person either consumes a substance such as nicotine, cocaine, or, alcohol or engages in an activity such as gambling or shopping/spending."

When a non-addict takes a drug or performs a behavior for the first time he/she does not automatically become an addict. Over time the non-addict chooses to continue to engage in a behavior or ingest a substance because of the pleasure the non-addict receives. The now addict has lost the ability to choose or forego the behavior or substance and the behavior becomes a compulsive action. The change from non-addict to addict occurs largely from the effects of prolonged substance use and behavior activities on brain functioning. Addiction affects the brain circuits of reward and motivation, learning and memory, and the inhibitory control over behavior.

There are different schools of thought regarding the terms dependence and addiction when referring to drugs and behaviors. One adopted belief is that "drug dependence" equals "addiction." The second belief is that the two terms do not equal each other. According to the DSM, the clinical criteria for "drug dependence" (or what we refer to as addiction) include compulsive drug use despite harmful consequences; inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal

The latter reflects physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal). Physical dependence can happen with the chronic use of many drugs—including even appropriate, medically instructed use. Thus, physical dependence in and of itself does not constitute addiction, but often accompanies addiction. This distinction can be difficult to discern, particularly with prescribed pain medications, where the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction.

There are some characteristics of addiction that regardless of the type share commonalities. The behavior provides a rapid and potent means of altering mood, thoughts, and sensations of a person which occur because of physiology and learned expectations. The immediate precipitating factors of the relapse, the timing of the relapse and the rate of relapse following treatment is high.

American Psychological Association

The American Psychological Association (APA) is a professional psychological organization and is the largest association of psychologists in the United States. Over 100,000 researchers, educators, clinicians and students support the association through their membership. Their mission "is to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives."

APA supports 54 divisions, two of which pertain to addictions. Division 50, Society of Addiction Psychology promotes advances in research, professional training, and clinical practice within the range of addictive behaviors. Addictive behaviors include problematic use of alcohol, nicotine, and other drugs as well as disorders involving gambling, eating, spending, and sexual behavior. Division 28, Psychopharmacology and Substance Abuse promotes teaching, research, and dissemination of information regarding the effects of drugs on behavior.

The College of Professional Psychology (CPP), hosted by the American Psychological Association Practice Organization, previously offered a certificate to psychologists whom demonstrated proficiency in the psychological treatment of alcohol and other substance-related disorders. The CPP maintains the certificate of proficiency for persons who acquired it prior to 2011. The Society of Addiction Psychology certificate will be re-instated while the Society examines other avenues for credentialing professionals in addiction treatment.

Addiction as a Disease

It seems that wherever one finds intoxication, one likely will find addiction. Recently researchers have argued that the addiction process is like the disease model, with a target organ, a defect, and symptoms of the disease. In other accounts, addiction is a disorder of genes, reward, memory, stress, and choice.

The Disease Model in Addiction

According to the new disease model, rather than being a disease in the conventional sense, addiction is a disease of choice. That is, it is a disorder of the parts of the brain necessary to make proper decisions. As one becomes addicted to cocaine, the ventral tegmentum nucleus accumbens in the brain is the organ. The defect is stress-induced hedonic regulation. 

Understanding the impact that genes, reward, memory, stress, and choice have on an individual will begin to explain the Disease Model of Addiction 

Genetic

The genetic makeup of an individual determines how they respond to alcohol. What causes an individual to be more prone to addiction is their genetic makeup. For example, there are genetic differences in how people respond to methylphenidate (Ritalin) injections.

Reward

Increased dopamine is correlated with increased pleasure. For that reason, dopamine plays a significant role in reinforcing experiences. It tells the brain the drug is better than expected. When an individual uses a drug, there may be a surge of dopamine in the midbrain, which can result in the shifting of that individual's pleasure “threshold” (see figures one and two).

Memory

The neurochemical, glutamate is the most abundant neurochemical in the brain. It is critical in memory consolidation. When an addict discovers an addicting behavior, glutamate plays a role by creating the drug cues. It is the neurochemical in motivation which initiates the drug seeking, thus creating the addiction.

Stress

When under stress the brain is unable to achieve homeostasis. As a result, the brain reverts to allostasis, which in turn alters the brains ability to process pleasure, which is experienced at the hedonic “set point” (see figures one). Thus, previous pleasures may become no longer pleasurable. This is also known as anhedonia, or “pleasure deafness.” When stressed, the addict may experience extreme craving—an intense, emotional, obsessive experience.

Choice

An addict may incur damage to the orbitofrontal cortex (OFC), the anterior cingulate cortex (ACC), and the prefrontal cortex (PFC). This damage causes a tendency to choose small and immediate rewards over larger but delayed rewards, deficits in social responding due to decreased awareness of social cues, and a failure of executive function such as sensitivity to consequences.

Licensed Practitioners

Many degrees provide space for the treatment of addictions. The educational background that each professional obtains will contain similarities but the philosophy and the viewpoint from which the material is delivered may vary. The required amount of education prior to earning a certificate or degree also varies. A few of the more commonly recognized fields of study are included.
  • Psychologist
  • Psychiatrist
  • Licensed Counselor Social Worker
  • Licensed Social Worker
  • Licensed Professional Counselor
  • Paraprofessional

Recognized Certifications in the Field of Addiction Psychology

Many certifications are recognized in the field of addiction psychology. Each have their own requirements.
  • Certification for Alcohol and Drug Counselor Candidate.
  • Credentialed Alcoholism and Substance Abuse Counselor.
  • A Certified Chemical Dependency Counselor.
  • Substance Abuse Counselor/Certified Addiction Counselor.
  • The Certified Addiction Professional.
  • Certified Addiction Treatment Counselors.
  • Combined Certifications With Other Degrees.

Treatment

Both process addiction and behavioral addiction have many dimensions causing disarray in many aspects of the addicts' life. Treatment programs are not a one size fits all phenomenon, hence there are different modalities or levels of care. Effective treatment programs incorporate many components to address each dimension. The addict suffers from psychological dependence and some may suffer from physical dependence.

Helping an individual stop using drugs is not enough. Addiction treatment must also help the individual maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Addiction is a disease which alters the structure and function of the brain. The brain circuitry may take months or years to recover after the addict has recovered.

This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences. Research shows that most addicted individuals need a minimum of 3 months in treatment to significantly reduce or stop their drug use, however treatment in excess of 3 months has a greater success rate. Recovery from addiction is a longterm process.

Modalities of Care

The modality or level of care needed for a patient is decided by the treating professional in conjunction with the patient when feasible. As expected the patient receiving treatment will likely take steps forward and backward the level of care will likely to fluctuate. Common modalities are explained.

Detoxification and Medically Managed Withdrawal

The process when the body rids itself of drugs is referred to as detoxification, and is usually concurrent with the side effects of withdrawal which vary depending on the substance(s) and are often unpleasant and even fatal. Physicians may prescribe a medication that will help decrease the withdrawal symptoms while the addict is receiving care in an inpatient or outpatient setting. Detoxification is generally considered a precursor to or a first stage of treatment because it is designed to manage the acute and potentially dangerous physiological effects of stopping drug use.

Long-term Residential

Treatment is structured and operates 24 hours a day. Residents will remain in treatment from usually 6 to 12 months while developing accountability, responsibility and socialization skills. Activities are designed to help addicts recover from destructive behavior patterns while adopting positive behavioral patterns. Constructive methods of interacting with others and improving self-esteem are other areas of focus. The therapeutic community model is an example of one treatment approach. Many therapeutic communities provide a more comprehensive approach to include employment training and other support services.

Short-term Residential

Short-term residential programs are on average 3–6 weeks in a residential setting. The program is intensive followed by more extended outpatient treatment to include individual and/or group therapy, 12-step Anonymous programs, or other forms of support. Because of the short duration of this modality it is even more important for individuals to remain active in outpatient treatment programs to help decrease the risk of relapse following residential treatment.

Outpatient-treatment Programs

Outpatient treatment program vary regarding the services offered and the intensity. It's more affordable and may be more suitable for patients who are employed full-time and/or who have secured multiple social supports. Outpatient programs may include group and/or individual therapy, intensive outpatient program, and partial hospitalization. Some outpatient programs are also designed to treat patients with medical or other mental health problems in addition to their drug disorders.

Individualized Drug Counseling

Individualized drug counseling not only focuses on reducing or stopping illicit drug or alcohol use; it also addresses related areas of impaired functioning such as employment status, illegal activity, and family/social relations as well as the content and structure of the patient's recovery program. Through its emphasis on short-term behavioral goals, individualized counseling helps the patient develop coping strategies and tools to abstain from drug use and maintain abstinence. The addiction counselor encourages 12-step participation (at least one or two times per week) and makes referrals for needed supplemental medical, psychiatric, employment, and other services.

Group Counseling

An outpatient treatment option facilitated by a treatment provider and used to expand on the support system the patient already has. Groups foster a non-judgmental environment allowing patients to meet and discuss difficulties and successes of their addiction while providing on-going support that is needed to be successful with recovery.

Intensive Outpatient Program (IOP)

As the name implies this is an outpatient treatment option designed for addicts who for various reasons do not have the opportunity to attend an inpatient treatment program, yet who otherwise would not be able to receive the level of support needed to recover from their addiction. Programs vary in duration based on the patients need. Because of the lower level of support offered IOP is frequently used as a step down approach from patients leaving inpatient treatment but who are still in need of intensive therapy.

Prevention, Relapse & Recovery

Therapeutic Orientations & Approaches

In 1878 the Index Medicus published research conducted and written by American physician W.H. Bentley. Bentley's research described his success in treating patients addicted to the ‘opium habit’ w/cocaine. Two years later he reported success in treating both opium and alcohol abusers w/cocaine. Today, the swapping one addiction for another is referred to as crossover addiction.

A variety of treatment approaches are utilized by health professionals in order to provide their clients the highest possible level of success to overcome their addictions. There is no one specific approach and often therapists will use multiple techniques.
  • Behaviorism.
  • Humanistic Therapy.
  • Cognitive Behavioral Therapy (CBT).
  • Dialectical Behavioral Therapy (DBT).
  • Psychodynamic.
  • Expressive.
  • Integrative.
  • Harm Reduction.
  • Eclectic.
  • Animal Assisted Therapy.

Further reading

  • Integrative Therapy: 100 Key Points and Techniques; Maria Gilbert, Vanja Orlans books listed here that may be of interest but don't incl if they were already cited in article
  • Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; Anderson, J.; and Etheridge, R.M. Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4) 291-298, 1998.
  • Miller, M.M. Traditional approaches to the treatment of addiction. In: A.W. Graham and T.K. Schultz (eds.), Principles of Addiction Medicine (2nd ed.). Washington, D.C.: American Society of Addiction Medicine, 1998.
  • Simpson, D.D., and Brown, B.S. Treatment retention and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4) 294-307, 1998.
  • Institute of Medicine. Treating Drug Problems. Washington, D.C.: National Academy Press, 1990.

1947–1948 civil war in Mandatory Palestine

From Wikipedia, the free encyclopedia During the civil war, the Jewish and Arab communities of Palestine clashed (the latter supported b...