Social Science

Can Marijuana Laws Reduce Prescription Drug Overdoses?

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Image result for marijuana laws

According to a 2015 study,

Drug overdoses are the leading cause of death from injuries in the United States today, exceeding deaths from suicide, gunshots and motor vehicle accidents (Murphy et al., 2013). They are also a prime contributor to the recent rise in mortality among middle-aged white Americans (Case and Deaton 2015). In 2010, 16,651 deaths were caused by a prescription opioid overdose, representing nearly 60% of all drug overdose deaths, and exceeding overdose deaths from heroin and cocaine combined (Jones, Mack and Paulozzi, 2013). While a modest decline in opioid overdose deaths has occurred since 2012, more than 16,000 lives are lost annually to prescription opioids (NCHS, 2014).

These numbers are the result of a dramatic rise in morbidity and mortality associated with prescription opioid abuse over the past two decades. The number of fatal poisonings due to prescription pain medications quadrupled between 1999 and 2010. Over the same period, the distribution of opioid pain medications also quadrupled, demonstrating a parallel rise between the distribution of opioid pain medication and its abuse nationally (CDC, 2011). Treatment admissions grew at an even faster rate, increasing nearly six-fold between 1999 and 2009 (CDC, 2011b). Opioid-related emergency department (ED) visits more than doubled from 21.6 per 100,000 in 2004 to 54.9 per 100,000 in 2011, for a total of 1.24 million ED visits involving nonmedical use of pharmaceuticals and pain relievers in 2011 (SAMHSA, 2013a). It is these trends that led the Centers for Disease Control to deem the misuse of prescription opioids in the United States an “epidemic” (pg. 2).

The researchers conclude,

Considerable attention has been paid in the literature to the potential unintended consequences of medical marijuana laws, with people examining impacts of these policies on youth initiation, recreational marijuana use and abuse as well as drunk driving (Wen et al., 2015; Choi, 2014; Lynne-Landsman et al., 2013; Anderson, Hanson and Rees, 2012 & 2013; Pacula et al., 2013). In this paper we consider a potential unintended benefit of these laws: a reduction in the misuse of prescription opiates.

Our results are intriguing in that we find fairly strong and consistent evidence using difference-in-differences, event study, and synthetic control group methods that states providing legal access to marijuana through dispensaries experience lower treatment admissions for addiction to pain medications. We provide complementary evidence that dispensary provisions also reduce deaths due to opioid overdoses. We estimate even larger effects in states that have both legally protected and active dispensaries.

…The fact that opioid harms decline in response to medical marijuana dispensaries raises some interesting questions as to whether marijuana liberalization may be beneficial for public health. Marijuana is a far less addictive substance than opioids and the potential for overdosing is nearly zero (Hall and Pacula, 2003). However, it remains unclear from our current analysis whether the findings we observe are short term or persist. In addition, we ultimately need to weigh any potential indirect benefits from medical marijuana dispensary provisions in terms of its implied reductions in opiate misuse (or other positive outcomes) against any potential negative impacts of these provisions on other factors, such as tobacco use and drugged driving. At a minimum, however, our results suggest a potential overlooked positive effect of dispensary enabling medical marijuana laws (pgs. 21-22).

Fighting Poverty with the EITC

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“The Earned Income Tax Credit isn’t super well-known,” writes Vox,

but it’s one of the best tools the federal government has for fighting poverty. It functions as a wage subsidy for the working poor, providing an average of $2,982 a year to families with children come tax season. The results are impressive. According to the Census Bureau, refundable tax credits like the EITC and the similarly structured Child Tax Credit cut the poverty rate (correctly measured) by 3 percentage points in 2013 — that’s 9.4 million people kept out of poverty.

But a [2015] study suggests that even that is an underestimate. UC Berkeley economist Hilary Hoynes and the Treasury Department’s Ankur Patel find that the EITC might be twice as effective at fighting poverty as the census estimate suggests.

How so?:

Hoynes and Patel focus on the credit’s effect on single women with children, the single biggest group of recipients. It’s well-known that the EITC encourages nonworking single moms and dads to enter the workforce; an analysis by the Center on Budget and Policy Priorities found that EITC brought more single mothers into the workforce in the 1990s than welfare reform did. That means that it boosts income not just by giving people money, but by getting people to work more and bring in more in wages. These increased wages can reduce income in other ways, such as by making people ineligible for programs like food stamps, but on the whole it boosts pay.

Hoynes and Patel find that bringing this effect into the analysis doubles the number of people lifted out of poverty by the EITC. The expansion of the EITC included in Bill Clinton’s 1993 budget reduced the share of people under the poverty line by 7.9 percent. That’s much more than you’d find in an analysis that doesn’t take the EITC’s effect on employment into account.

 

Hoynes nicely summarizes these findings in a 2016 policy brief. In short,

  • “The EITC is the cornerstone of U.S. anti-poverty policy. It is the largest anti-poverty program for children in the US. Together with the Child Tax Credit (CTC), the EITC removed 4.8 million children from poverty in 2015. It is also the second largest anti-poverty program for the population as a whole. Together with the CTC, the EITC lifted a total of 9.2 million people out of poverty in 2015. Only Social Security removes more people from poverty” (pgs. 2-3).
  • The EITC “lowered mother’s risk of cardiovascular disease, metabolic disorder and inflammations, and improved their mental health. The expansion also led to a reduction in smoking among single mothers with children” (pg. 4).
  • The EITC also “reduced the incidence of low birth weight…and increased mean birth weight” (pg. 4).
  • “The EITC raises both math and reading test scores in elementary and secondary schooling” (pg. 5).
  • “The EITC is associated with higher rates of high school completion (or GED) and also higher college attendance rates. This in turn translates into better employment outcomes and higher earnings” (pg. 5).

Worth looking at.

Still Think There’s a Threat?: Immigrant-Linked Terrorism

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I’ve written before about the (un)likelihood of dying at the hands of a foreign terrorist here on American soil. But for kicks, let’s drive the point home a little more. As Vox reports,

To put [the Cato Institute’s numbers] in perspective, I’ve produced the following chart, which compares the average annual likelihood of American pedestrians being hit by a railway vehicle, dying due to their own clothes melting or lighting on fire, and being killed in a terrorist attack perpetrated by an immigrant. It’s quite revealing:

Image result for Relative odds of death, immigrant-linked terrorism and other rare events

Even better, you have a higher chance of winning the lottery or being struck by lightning than being killed by a refugee in a terrorist attack:

Here’s hoping we can all get a grip.[ref]Unfortunately, Trump’s Chief Strategist Steve Bannon doesn’t just dislike illegal immigration, but legal immigration. I imagine the restrictions will continue to be ratcheted up.[/ref]

The Return of the Anti-War Left?: The Carnage of Drone Warfare

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As a friend of mine said in response to this Tweet, “The left is anti-drone bombing once again. Welcome home after 8 years.” Now, if you think his quip is unfair, it should be noted that it’s based on sound social science: the majority of anti-war Democrats of the Bush years weren’t really all that anti-war as much as they were anti-Bush. As soon as Obama took office, the opposition dropped considerably.

But to wake people up to the reality of the continued violence, here are the estimates of total bombs dropped by the U.S. in 2016:

In President Obama’s last year in office, the United States dropped 26,172 bombs in seven countries. This estimate is undoubtedly low, considering reliable data is only available for airstrikes in Pakistan, Yemen, Somalia, and Libya, and a single “strike,” according to the Pentagon’s definition, can involve multiple bombs or munitions. In 2016, the United States dropped 3,028 more bombs—and in one more country, Libya—than in 2015.

Most (24,287) were dropped in Iraq and Syria. This number is based on the percentage of total coalition airstrikes carried out in 2016 by the United States in Operation Inherent Resolve (OIR), the counter-Islamic State campaign. The Pentagon publishes a running count of bombs dropped by the United States and its partners, and we found data for 2016 using OIR public strike releases and this handy tool.* Using this data, we found that in 2016, the United States conducted about 79 percent (5,904) of the coalition airstrikes in Iraq and Syria, which together total 7,473. Of the total 30,743 bombs that the coalition dropped, then, the United States dropped 24,287 (79 percent of 30,743).

Micah Zenko of the Council on Foreign Relations points out,

As Donald Trump assumes office today, he inherits a targeted killing program that has been the cornerstone of U.S. counterterrorism strategy over the past eight years. On January 23, 2009, just three days into his presidency, President Obama authorized his first kinetic military action: two drone strikes, three hours apart, in Waziristan, Pakistan, that killed as many as twenty civilians. Two terms and 540 strikes later, Obama leaves the White House after having vastly expanding and normalizing the use of armed drones for counterterrorism and close air support operations in non-battlefield settings—namely Yemen, Pakistan, and Somalia.

…Less than two weeks ago, the United States conducted a drone strike over central Yemen, killing one al-Qaeda operative. The strike was the last under Obama (that we know of). The 542 drone strikes that Obama authorized killed an estimated 3,797 people, including 324 civilians. As he reportedly told senior aides in 2011: “Turns out I’m really good at killing people. Didn’t know that was gonna be a strong suit of mine.”

This is what leads Nathan Robinson at Current Affairs to chastise his fellow leftists:

The newspaper headlines today all blare shocking reports about Trump’s continued bigotry. But further down the page, a different story about Muslim lives is receiving far less attention: the U.S. bombing of Syria, and its increasing numbers of civilian casualties. While Trump says racist things about Muslims, U.S. warplanes are actually killing them, something far less discussed even though (or perhaps because) it morally implicates Democrats.

The U.S. has also been accused of concealing the true death toll…[But i]t’s also important to remember that death tolls themselves only begin to capture the scale of a bombing’s impact. The numbers of injuries are often far higher (and frequently unreported). “Injuries” can mean lost limbs, blindness, and paralysis. They can mean permanent disfigurement. They can mean that a person will never work again, and will suffer from depression and PTSD, or will require medical care for the rest of their lives. Furthermore, even those who are not “injured” can experience deep and lasting trauma, after seeing loved ones or even strangers torn to shreds before their eyes. The actual pain of a mother realizing her child has been blinded, or a brother watching his sister die, is absent from death toll statistics.

The complaint of human rights advocates has centered around the fact that the United States is downplaying and concealing casualties, and that the deaths are growing in frequency without any justification…All of this occurred under a Democratic president. So while the organizers of the Democratic National Convention where proudly presenting the Khan family as evidence of their superior devotion to Muslim lives (and while DNC attendees were chanting “USA, USA, USA” as if they were frenzied 2004-era Bush Republicans), the Obama administration was directly responsible for killing scores of living, breathing Muslim civilians. While Democrats were voicing their outrage that Donald Trump had said yet another despicable racist thing, the party was speaking up in defense of a candidate who had decimated a Muslim country, and who had actually voted for the senseless war that killed Cap. Kahn in the first place.

Rhetorical attacks on Muslims are indefensible. But physical attacks on Muslims, using tanks and gunships, are even more horrific. Democrats might not want to be so certain that they have the moral high ground when it comes to valuing Muslim lives.

Of course, this by no means lets Republicans off the hook. Nor does it equate Obama and Trump (or the GOP) or fail to recognize the nuances of war. It shouldn’t dampen our optimism about the decline of war and violence in the modern era either. But it does call for some consistency; to minimize selective outrage. If we treated all administrations like public servants accountable to us instead of celebrities on our favorite football team, some of this might have been avoided.[ref]Unfortunately, I don’t have all that much faith in the general electorate to oppose bad policies.[/ref]

By Riley Yates

Immigration and Prosperity

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According to The New York Times,

President Trump on Wednesday began a sweeping crackdown on illegal immigration, ordering the immediate construction of a border wall with Mexico and aggressive efforts to find and deport unauthorized immigrants. He planned additional actions to cut back on legal immigration, including barring Syrian refugees from entering the United States.

Vox reports,

The four remaining draft orders obtained by Vox focus on immigration, terrorism, and refugee policy. They wouldn’t ban all Muslim immigration to the US, breaking a Trump promise from early in his campaign, but they would temporarily ban entries from seven majority-Muslim countries and bar all refugees from coming to the US for several months. They would make it harder for immigrants to come to the US to work, make it easier to deport them if they use public services, and put an end to the Obama administration program that protected young “DREAMer” immigrants from deportation.

In all, the combined documents would represent one of the harshest crackdowns on immigrants — both those here and those who want to come here — in memory.

Much like trade, I’ve spent the last year writing about the economics of immigration. Some of my findings are:

Sure enough, more evidence comes rolling in. A new IMF study finds

that migrants help increase per capita income levels in host advanced economies, and this effect is both statistically and economically significant. Our estimates suggest that a one percentage point increase in the share of migrants in the adult population (the average annual increase is 0.2 percentage point) can raise GDP per capita by up to 2% in the long run. Moreover, this effect comes mainly through an increase in labour productivity and, to a lesser extent, through the more standard channel of an increase in the ratio of working-age to total population.

The result survives a number of robustness checks, which include controlling for other determinants of income per capita (trade openness, the level of technology, the education level, and age structure of the host population, and policy variables); excluding from the sample countries that were created through migration and have high income levels (USA, Canada, Australia, and New Zealand); and using alternative gravity model-based instruments.

We find that both high- and low-skill migrants raise labour productivity. There is no evidence of major physical or human capital dilution, as investment adjusts over time to the larger pool of workers, and migrants are increasingly high-skilled. Instead, our results suggest that the complementarities that earlier analyses uncovered mostly at the micro level are also relevant at the macro level. The evidence from the microeconomic literature suggests that the positive productivity effects come from increased TFP and human capital. High-skilled migrants contribute to productivity directly, including through innovation, and indirectly through their positive spillovers on native workers. Low- and medium-skilled migrants can also contribute to aggregate productivity, to the extent that their skills are complementary to those of natives, promoting occupational reallocation and task specialisation.

…Our analysis finds…that the gains from immigration are broadly shared across the population. Migration increases the average income per capita of both the bottom 90% and the top 10% of earners, even though high-skilled migration benefits more top earners — possibly because of a stronger synergy between migrants and natives with high skills. Moreover, the Gini coefficient — a broad measure of income inequality within the bottom 90% of earners — is not affected by the migrant share.

Let them come.

Education Levels, Not Income, Led to Trump

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With it being Trump’s inauguration today, I thought I’d highlight an article from November by Nate Silver. Where did Clinton do well and where did she falter?:

I took a list of all 981 U.S. counties with 50,000 or more people and sorted it by the share of the population that had completed at least a four-year college degree. Hillary Clinton improved on President Obama’s 2012 performance in 48 of the country’s 50 most-well-educated counties. And on average, she improved on Obama’s margin of victory in these countries by almost 9 percentage points, even though Obama had done pretty well in them to begin with.

Yet, when he looks at “50 counties (minimum population of 50,000) where the smallest share of the population has bachelor’s degrees,” the tune changes considerably:

These results are every bit as striking: Clinton lost ground relative to Obama in 47 of the 50 counties — she did an average of 11 percentage points worse, in fact. These are really the places that won Donald Trump the presidency, especially given that a fair number of them are in swing states such as Ohio and North Carolina. He improved on Mitt Romney’s margin by more than 30 points (!) in Ashtabula County, Ohio, for example, an industrial county along Lake Erie that hadn’t voted Republican since 1984.

Silver continues by showing just how important education was in determining Trump/Clinton support:

  • High-education, medium-income white counties shifted to Clinton.
  • High-income, medium-education white counties shifted to Trump.
  • Highly educated majority-minority counties shifted toward Clinton.
  • Low-education majority-minority counties shifted toward Trump.

Silver concludes,

In short, it appears as though educational levels are the critical factor in predicting shifts in the vote between 2012 and 2016. You can come to that conclusion with a relatively simple analysis, like the one I’ve conducted above, or by using fancier methods. In a regression analysis at the county level, for instance, lower-income counties were no more likely to shift to Trump once you control for education levels. And although there’s more work to be done, these conclusions also appear to hold if you examine the data at a more granular level, like by precinct or among individual voters in panel surveys.

So it wasn’t necessarily the economically destitute that voted for Trump. A 2016 Gallup study found

that Americans who live in places where employment in manufacturing has declined since 1990 are not more favorable to Trump. Rothwell [the author] did not find a relationship when he focused only on white respondents, either, or even specifically on white Republicans. Trump’s supporters have many other traits in common with the factory workers whose economic prospects have been negatively affected by automation and global trade. They tend to be less educated men who hold blue-collar occupations. Yet those two broad trends in factory work do not account for Trump’s appeal, Rothwell’s analysis suggests. In fact, among those who share other traits, those who live in districts with more manufacturing are less favorably disposed toward Trump.

However, Silver offers a few “competing hypotheses” to the straightforward interpretation above:

  • Education levels may be a proxy for cultural hegemony. Academia, the news media and the arts and entertainment sectors are increasingly dominated by people with a liberal, multicultural worldview, and jobs in these sectors also almost always require college degrees. Trump’s campaign may have represented a backlash against these cultural elites.[ref]I’m partial to this explanation.[/ref]
  • Educational attainment may be a better indicator of long-term economic well-being than household incomes. Unionized jobs in the auto industry often pay reasonably well even if they don’t require college degrees, for instance, but they’re also potentially at risk of being shipped overseas or automated.
  • Education levels probably have some relationship with racial resentment, although the causality isn’t clear. The act of having attended college itself may be important, insofar as colleges and universities are often more diverse places than students’ hometowns. There’s more research to be done on how exposure to racial minorities affected white voters. For instance, did white voters who live in counties with large Hispanic populations shift toward Clinton or toward Trump?
  • Education levels have strong relationships with media-consumption habits, which may have been instrumental in deciding people’s votes, especially given the overall decline in trust in the news media.
  • Trump’s approach to the campaign — relying on emotional appeals while glossing over policy details — may have resonated more among people with lower education levels as compared with Clinton’s wonkier and more cerebral approach.

So with that, enjoy Inauguration Day.

2016: Best Year Ever

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Image result for 2016 burning dumpster

Here’s a bit of optimism after the train wreck that was 2016:

By conventional wisdom, 2016 has been a horrible year. Only someone living in a cave could have missed the flood of disheartening headlines. However, if 2016 continues the global trends of previous years, it may turn out to have been one of the best years for humanity as a whole.

Those of us who live in the world of poverty research and rigorous measurement have watched many global indicators improve consistently for the past few decades. Between 1990 and 2013 (the last year for which there is good data), the number of people living in extreme poverty dropped by more than half, from 1.85 billion to 770 million. As the University of Oxford’s Max Roser recently put it, the top headline every day for the past two decades should have been: “Number of people in extreme poverty fell by 130,000 since yesterday.” At the same time, child mortality has dropped by nearly half, while literacy, vaccinations and the number of people living in democracy have all increased.[ref]Similar to last year.[/ref]

The authors point to four things that can make 2017 even better for the poor and destitute:

  1. “First, give the poor cash. Studies in Kenya and elsewhere show that the simplest way to help is also quite effective. We also know that if we give cash, the poor won’t smoke or drink it away. In fact, a recent look at 19 studies across three continents shows that when the poor are given money, they are less likely to spend it on “temptation goods” such as alcohol and tobacco. More and more research shows that when the poor come into a windfall, they spend it on productive things — sending their children to school, fixing the roof that’s letting in the harsh weather or investing in a business.”[ref]This is perhaps more evidence in favor of a basic income.[/ref]
  2. “Second, innovative health-care delivery can dramatically improve outcomes…The nongovernmental organizations Living Goods and BRAC Uganda have been training women in Uganda to make a living by going door-to-door selling over-the-counter medications and health products. They function as franchisees in an “Avon lady”-style business. But these small-business owners also perform basic health checks for children to look for symptoms that warrant getting the child to a clinic. One randomized evaluation released this year concluded that taking this health care to people’s homes reduced child mortality (for those younger than 5) by an astounding 27 percent and infant mortality (less than a year old) by 33 percent.”
  3. “Third, access to mobile money may lift people out of poverty in large numbers…In Kenya, the M-Pesa mobile money system, introduced in 2007, allows anybody with a mobile phone to transfer money through a text message. Research from this year shows that as M-Pesa became more available in a local area, households became less poor — particularly households run by women. The study estimates that 185,000 women changed professions from subsistence agriculture to business and retail and that 194,000 households were lifted out of extreme poverty.”
  4. “Finally, mobile phone technologies are leapfrogging the reach of traditional telecom infrastructure, and text message reminders are proving to be effective at helping people follow through on things they want to do. One study found that they helped the poor save money. Another in Ghana aimed at combating drug resistance found that such reminders helped people to finish all of their antimalarial drugs. Researchers in Ghana also found that text message quizzes improved girls’ understanding of reproductive health, resulting in fewer reported pregnancies. In Kenya, another interactive text message system offering support for teachers helped reduce student dropouts by 50 percent.”[ref]The importance of mobile phone technologies is underappreciated.[/ref]

2017 is looking up.

 

Nation Building From the Ground Up

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I’ve written on the social science of military intervention before, noting that they rarely achieve the democratic goals of those intervening. A new study distinguishes between top-down and bottom-up approaches to foreign intervention: “Top-down approaches to foreign intervention emphasise gaining citizen compliance by making it costly for citizens to oppose the state, whereas bottom-up approaches aim to increase the benefits of supporting the state by providing public goods, economic aid, and political opportunities.” Drawing on evidence from the Vietnam War, the researchers find (perhaps unsurprisingly),

Image result for vietnam warEstimates document that the bombing of South Vietnamese population centres backfired, leading more Vietnamese to participate in Viet Cong (VC) military and political activities and increasing VC attacks on troops and civilians. The initial deterioration in security entered the next quarter’s security score, increasing the probability of future bombing and hence leading to sustained increases in VC activity. Moreover, while US intervention aimed to build a strong state and engaged civic society that would provide a bulwark against communism after US withdrawal, bombing instead reduced the probability that the local government collected taxes, decreased access to primary schools, and reduced participation in civic organisations. To the extent that spillover effects of bombing on other locations exist, the impacts tend to go in the same direction as the effects on the locations that were bombed.

Interviews of VC prisoners and defectors provide a potential explanation for why bombing increased VC activity. Grievances against the government – particularly in cases where a civilian family member was killed in US or South Vietnamese attacks – were strong motivators for joining the VC (Denton 1968). Civilian casualties and property damage are plausibly particularly harmful to the trust between government and citizens that underlies an effective social contract.

In order to compare the two strategies, the authors explored

the boundary between Military Region I – commanded by the US Marine Corps (USMC) – and Military Region II – commanded by the US Army. The Marines emphasised providing security by embedding soldiers in communities and winning hearts and minds through development programmes (USMC 2009). Their approach was motivated by the view that “in small wars the goal is to gain decisive results with the least application of force… the end aim is the social, economic, and political development of the people” (USMC 1940). In contrast, the Army relied on overwhelming firepower deployed through search and destroy raids (Krepinevich 1986, Long 2016). Evidence points to this difference in counterinsurgency strategies as a central distinction between the Army and Marines.

Hamlets just to the USMC side of the boundary were less likely to have a VC presence than those just to the Army side, and public opinion data document that citizens in the USMC region reported less anti-Americanism and more positive attitudes towards all levels of South Vietnamese government than did citizens in the Army region. Pre-period VC attacks, pre-characteristics, and soldier characteristics – including Armed Forces Qualifying Test scores – are all relatively balanced across the boundary, suggesting that the effects are driven by differences in military strategy and not by omitted factors.

Civility, trust, and community work better than violence. Fancy that.

AEA Meeting: Minimum Wage Research

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The New York Times has a recent article discussing new research on the minimum wage presented at the annual meeting of the American Economic Association:

Image result for minimum wageJohn Horton of New York University conducted an experiment on an online platform where employers post discrete jobs — including customer service support, data entry, and graphic design — and workers submit a proposed hourly wage for completing them.

…At first glance, the findings were consistent with the growing body of work on the minimum wage: While the workers saw their wages rise, there was little decline in hiring. But other results suggested that the minimum wage was having large effects. Most important, the hours a given worker spent on a given job fell substantially for jobs that typically pay a low wage — say, answering customer emails.

Mr. Horton concluded that when forced to pay more in wages, many employers were hiring more productive workers, so that the overall amount they spent on each job changed far less than the minimum-wage increase would have suggested…When the minimum wage increased, employers tended to hire workers who had earned higher wages in the past, suggesting that they were looking for a more productive work force. 

If the pattern Mr. Horton identified were to apply across the economy, it would raise questions about whether increasing the minimum wage is as helpful to those near the bottom of the income spectrum as some proponents assume. The higher minimum wage could cost low-skilled workers their jobs, as employers rush to replace them with somewhat more skilled workers.

Another study found that when the minimum wage increases, employers may be put out of business. After identifying the ratings of thousands of restaurants in the San Francisco area, the researchers

found that many poorly rated restaurants tend to go out of business after a minimum-wage increase takes effect. By contrast, highly rated restaurants appear to be largely unaffected by minimum-wage increases, and over all, there is no substantial rise in restaurant closings after a minimum-wage increase. 

The results are broadly consistent with a 2013 study…showing that a sizable minimum-wage increase in New Jersey resulted in many lost jobs as numerous businesses closed, but an almost offsetting number of new jobs as other businesses opened, which the authors argue were more productive. 

Just add this to the growing evidence of adverse effects of the minimum wage.

Why Therapy Works: Interview with Louis Cozolino

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This is part of the DR Book Collection.

Image result for why therapy worksI don’t think I’ve ever mentioned this before on here, but, as some of  you may have guessed, I go to therapy. I haven’t as of late for various reasons, but for a solid two years I went pretty much every other week. My interest in shame and vulnerability has been largely due to my personal work in therapy. This is why as soon as I heard of psychologist Louis Cozolino’s book Why Therapy Works: Using Our Minds to Change Our Brains, I immediately picked it up. Granted, like most of my books, it sat dormant for quite a while until I finally finished it up toward the end of last year.

Cozolino walks the reader through the findings of cognitive neuroscience, discussing the “fast” (i.e., “primitive systems, which are nonverbal and inaccessible to conscious reflection, [that] are referred to as implicit memory, the unconscious, or somatic memory”, pg. 5) and “slow” (i.e., “conscious awareness…[which] eventually gave rise to narratives, imagination, and abstract thought”, pg. 5) systems of the brain. Because of this “fast” system, we often have negative internalizations that we’re not even consciously aware of. This is what Cozolino calls “core shame”:

Core shame needs to be differentiated from appropriate shame and guilt that emerge later in childhood. Appropriate shame is an adaptation to social behavior required by the group. Core shame, on the other hand, is an instinctual judgment about the self, and it results in a sense of worthlessness, a fear of being found out, and a desperate striving for perfection. In essence, core shame is tied to our primitive instinct to be a worthy part of the tribe; it is a failure to internalize a deep sense of bonded belonging. As a result, people with core shame feel damaged, unlovable, and abandoned. Thus, core shame becomes a central factor in the perpetuation of insecure attachment and social status schema (pg. 10).

The brain, according to Cozolino, “is a social organ” and “we can leverage the power of human relationships to regulate anxiety and stimulate learning” (pg. xxii). This makes the relational nature of therapy all the more important and effective:

The reasons for our struggles often remain buried in networks of implicit memory, inaccessible to conscious reflection. Psychotherapy guides us in a safe exploration of our early experiences and helps us create a narrative that associates these early experiences with the ways in which our brains and minds distort our current lives. In the process, our symptoms come to be understood as forms of implicit memory instead of insanity, character pathology, or plain stupidity. This process can open the door to greater compassion for oneself, openness to others, and the possibility for healing (pg.9).

The book is comprehensive and excellent for both laypersons and scholars. You can see short interview clips with Cozolino below.