Contingent reinforcement of lowered blood-alcohol levels in an outpatient chronic alcoholic

Recently. the proposition that alcohol abuse is an operant behavior and thus functionally related to its consequences has been investigated under experimental conditions. In controlled laboratory settings, in which inpatient chronic alcoholics are allowed access to alcoholic beverages, alcohol consumption has been markedly altered via operant strategies. Monetary rewards (Cohen et al., 1971), the opportunity to participate in an enriched environment (Cohen et al., 1971). and visits to a girlfriend (Bigelow et al., 1973) have been used as reinforcers for decreased drinking.Other investigators (Sulzer, 1965; Miller, 1972: Hunt and Azrin, 1973) have successfully applied similar contingency management techniques to alcoholics in the natural environment. However, failure to control for the influence of extraneous therapeutic variables (e.g., attention-placebo factors, job counseling) together with reliance on self-report measures of drinking behavior seriously limit the conclusiveness of these results. Objective assessment is particularly essential with operant techniques since consequent events must be systematically scheduled upon the occurrence or non-occurrence of drinking. Documentation of drinking in the natural environment is a difficult task since the alcoholic frequently consumes alcohol when he is alone. In lieu of direct observation, blood alcohol concentrations are an obvious means of objective assessment. Such data are most conveniently obtained via breath tests similar to the ones that law enforcement officers utilize to identify intoxicated motorists.The purpose of the present study was to investigate the influence of reinforcement contingencies on lowering blood alcohol concentrations obtained in an alcoholic's natural environment.     

Behavioural aspects of the management of diabetes mellitus: Education,self-care and metabolic control

A review is presented of factors relevant to the level of the knowledge, self-care and metabolic control of diabetic patients. Methods of assessing each of these are described, and ways of improving them reviewed. Recommendations are made for further work in this field.It is suggested that traditional education programmes have little clinical value beyond improving knowledge about diabetes. Among the recommendations made are approaches to the assessment and change of relevant health beliefs, and the use of behavioural methods of self-regulation, to improve the quality of self-care. The difficulties created by the variety of factors influencing metabolic control are discussed, with particular attention to the relevance of emotional stress.     

Educational and careers guidance services for adults: II. A review of current provision

The similarities and differences between existing educational and careers guidance services for adults are analysed in terms of five dimensions: the roles with which the services are primarily concerned, their target groups, their guidance junctions, their staffing policy, and their organisational base. A brief discussion of 'distance-guidance' services is added.     

Careers education in higher education: Principles and practice

It is argued that careers education represents a distinctive new approach in careers guidance within higher education. A detailed analysis is presented of American and British experiments to date, dividing them into three groups: unit courses leading to credit, courses not leading to credit, and intensive experiences. Attention is also paid to the need to integrate formal group work of these kinds with other formal and informal learning experiences. Finally, an attempt is made to identify some crucial dilemmas and issues which need to be addressed if careers education is to be structured into the British higher education system.     

Trends in community mental health programming

One hundred-seventy-three mental health centers responded to a survey inquiring about allocation of staff time for mental health services and about the availability of an array of services at present, 3 years previous, and 3 years hence. The data reflect an emphasis upon reactive services as opposed to those considered proactive, and on services directed to individuals as opposed to other groups. However, this emphasis seems to be changing. Future projections call for a de-emphasis on individual reactive programs and increased emphasis on programs directed toward families and small groups, and toward proactive programs directed to the communities-at-large. Data about specific programs and services further suggest de-emphasis of services that involve the mental health professional and the client in direct interaction, and continued growth in services that can be delivered by less formally trained mental health workers or volunteers.