University of Vermont

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Incentives and Health

    The topic of incentives and health is a major research priority of the Human Behavioral Pharmacology Research Unit.  Drs Higgins, Heil and Sigmon have extensive experience researching the use of incentives to promote healthy behavior change and is described further below are Principal Investigators on numerous NIH-funded research projects on this topic.

    As we settle into the 21st century, the main challenges to public health are from chronic health conditions rather than infectious disease.  These chronic health conditions contribute the majority of the global burden of disease in the form of addiction, cardiovascular disease, various site-specific cancers, obesity, and type 2 diabetes, among other diseases (Strong et al., 2005).  A central contributor to these chronic health conditions is lifestyle:  excessive use of substances, excessive eating and poor food choices, physical inactivity, risky sex, and medication non-compliance and failure to comply with other medical regimens to treat and prevent injury and disease are at the heart of this public health challenge (Valliant & Mukamal, 2001; Schoeni et al., 2008).  What has also become clear is that primary reliance on treatment of the disease outcomes associated with unhealthy lifestyles is no longer economically feasible.  They are simply too costly and are overwhelming the health care system in the US and abroad (Bland et al., 2009; Schneider et al., 2009). 

    There is growing recognition of the need for effective interventions to promote healthy behavior, interventions directed at promoting behavior change among those who already engage in a risky lifestyle as well as interventions to prevent the acquisition of unhealthy behaviors.  A broad range of different treatment and prevention strategies will be necessary to effectively promote healthy behavior.  The strategy that our group has been investigating and that is gaining increasing levels of empirical support for its efficacy in the promotion of healthy behavior is the systematic use of financial or other material incentives, an area often referred to as contingency management (CM; see Higgins et al., 2008).

    The problem area for which CM has received the most extensive investigation as a treatment for chronic health conditions is drug dependence, especially dependence on illicit drugs like cocaine (Higgins et al., 2008).  Indeed, the treatment approach gained broad recognition during the U.S. cocaine epidemic of the 1980s and 90s when from an extensive array of different behavioral and pharmacological treatments that were examined, voucher-based CM was demonstrated by Dr. Higgins and colleagues at the University of Vermont to be the only approach that could reliably increase cocaine abstinence in randomized controlled trials, which remains the case today.  That success promoted broad interest in investigating the efficacy of CM for treatment of other types of addiction and special populations of addicted individuals (pregnant women, those with co-occurring serious mental illness).  For example, our group conducted a randomized controlled trial demonstrating voucher-based CM’s efficacy in promoting cessation of cigarette smoking among educationally disadvantaged pregnant women while also increasing fetal growth, birth weight, and breastfeeding duration (Heil et al., 2008; Higgins et al., 2010; Higgins et al., in press).  Meta-analyses have now provided compelling evidence in support of the efficacy of voucher-based CM as a treatment for SUDs (Lussier et al., 2006).  Indeed, the evidence is sufficiently robust that the National Institute of Clinical Evidence recently recommended adoption of voucher-based CM for treatment of substance use disorders throughout the United Kingdom (Pilling et al., 2007). 

    The success of CM in treating addiction, especially certain recalcitrant forms and populations such as cocaine dependent outpatients and pregnant cigarette smokers, has helped kindle interest in examining or in some cases re-examining its efficacy in promoting other healthy behavior.  For example, controlled trials have recently been reported where CM successfully promoted weight reductions among obese adults and increased physical activity among sedentary elders (Finkeldtein et al., 2008; Volpp et al., 2008).  Studies examining the efficacy of CM to promote healthy behavior change across a range of different health-related behaviors and risk groups are underway.  Included among those efforts are the antipoverty conditional cash transfer initiatives that are ongoing throughout much of Latin America and elsewhere, which utilize the same behavioral principles just within an economic rather than a psychological conceptual framework (Lagarde et al., 2007).

Literature Cited

  1. Bland, P.C., An, L., Foldes, S.S., Garrett, N., & Alesci, N.L. (2009).  Modifiable health behaviors and short-term medical costs among health plan members.  American Journal of Health Promotion, 23, 265-273.  PMID: 19288848
  2. Finkelstein, E.A., Brown, D.S., Brown, D.R., & Buchner, D.M. (2008).  A randomized study of financial incentives to increase physical activity among sedentary older adults.  Preventive Medicine, 47, 182-187.  PMID: 18571226
  3. Heil S.H., Higgins, S.T., Bernstein, I.M., Solomon, L.J., Rogers, R.E., Thomas, C.S., Badger, G.J., & Lynch, M.E. (2008).  Effects of voucher-based incentives on abstinence from cigarette smoking and fetal growth among pregnant women.  Addictions, 103, 109-118.  PMID: 18482424
  4. Higgins, S.T., Bernstein, I.M., Washio, Y., Heil, S.H., Badger, G.J., Skelly, J.M., Higgins, T.M., & Solomon, L.J. (in press). Effects of smoking cessation with voucher-based contingency management on birth outcomes.  Addiction.
  5. Higgins, T.M., Higgins, S.T., Heil, S.H., Badger GJ, Skelly, J.M., Bernstein, I.M., Solomon, L.J., & Washio Y.  (2010).  Effects of cigarette smoking cessation on breastfeeding duration.  Nicotine & Tobacco Research, 12, 483-488. PMID: 20339141
  6. Higgins, S.T., Silverman, K., & Heil, S.H. (2008).  Contingency management in substance abuse treatment.  NY, NY: The Guilford Press. 
  7. Lagarde, M., Haines, A., & Palmer, N. (2007).  Conditional cash transfers for improving uptake and health interventions in low- and middle-income countries: A systematic review.  JAMA, 24, 1900-1910.  PMID: 17954541
  8. Lussier, J.P., Heil, S.H., Mongeon, J.A., Badger, G.J., & Higgins, S.T. (2006).  A meta-analysis of voucher-based reinforcement therapy for substance use disorders.  Addiction, 101, 192-203.  PMID: 16445548
  9. Pilling, S., Strang, J., & Gerada, C. (2007).  Psychosocial interventions and opioid detoxification for drug misuse: Summary of NICE guidelines.  BMJ, 335, 203-205.  PMID: 17656545
  10. Schneider, M., Bradshaw, D., Steyn, K., Norman, M., & Laubscher, R. (2009).  Poverty and non-communicable diseases in South Africa.  Scandinavian Journal of Public Health, 37, 176-186.  PMID: 19164428
  11. Schoeni, R.F., House, J.S., Kaplan, G.A., & Pollack, H.  (2008).  Making American’s healthier: Social and Economic policy as Health policy.  NY, NY:  Russell Sage Foundation. 
  12. Strong, K., Mathers, C., Leeder, S., & Beaglehole, R. (2005).  Preventing chronic diseases: How many lives can we save.  Lancet, 366, 1578-1582.  PMID: 16257345
  13. Vaillant, G.E. & Mukamal, K. (2001).  Successful aging.  American Journal of Psychiatry, 158, 838-847. 
  14. Volpp, K.G., John, L.K., Troxel, A.B., Norton, L., Fassbender, J., Loewenstein, G. (2008). Financial incentive-based approaches for weight loss” A randomized trial.  JAMA, 300, 2631-2637.  PMID: 19066383

University of Vermont Research Projects on Incentives and Health

Treating Cocaine Abuse:  A Behavioral Approach, R01DA009378, 9/30/94-3/31/2013
Funding Agency:  NIH/NIDA
This is a project that Dr. Higgins is leading.  Treatment development for cocaine dependence often proceeds without effort to adapt treatment parameters to patient characteristics, including the value of incentives used.  Such a one-size-fits-all approach is problematic because of the heterogeneity of the clinical population.  Additionally, the approach is often subject to opposing biases either towards constraining costs or maximizing efficacy.  Studies in this project using the CRA + Vouchers treatment for cocaine dependence that was developed at the University of Vermont are designed to explore matching incentive value and other treatment parameters to patient baseline characteristics known to moderate treatment response in an effort to strike a balance between those biases and thereby facilitate cost containment without compromising efficacy, especially among more severe patients.

Voucher-Based Incentives to Treat Pregnant Smokers, R01DA14028, 4/30/01-5/31/11
Funding Agency:  NIH/NIDA
This is a project that Dr. Higgins is leading.  The major goal of this project is to examine the efficacy of a voucher-based incentive program for promoting smoking cessation and preventing relapse during pregnancy and postpartum.  Smoking during pregnancy is the leading preventable cause of poor pregnancy outcomes in the U.S. and contributed to many adverse effects in mothers and offspring.  Efficacious treatments to increase cessation are sorely needed.  Voucher-based CM is producing excellent outcomes in promoting cessation in controlled trials and in improving fetal growth, birth outcomes, breastfeeding duration, and other outcome measures. 

Modeling Initial Smoking Abstinence and Relapse Risk, R01DA008076, 2/01/93-2/28/11
Funding Agency:  NIH/NIDA
Dr. Higgins is leading this project.  The overarching aim of the project is to conduct a detailed experimental analysis of whether and how varying amounts of initial smoking abstinence decrease relapse risk.  Sustaining abstinence through the initial high-risk period of a cessation effort is associated with a striking and precipitous decline in relapse risk.  A contingency management model is being used to overcome the methodological obstacle of gaining experimental control over the amount of initial abstinence attained, allowing experimental analysis of changes in the relative reinforcing effects of cigarette smoking.

Financial Incentives for Increasing Breastfeeding, HHSP233200900549P, 8/26/2009-8/25/2010
Funding Agency: NIH/Office of Research on Women’s Health
Dr. Higgins is leading this project.  Inadequate breastfeeding has potential adverse effects on maternal and infant health.  The purpose of this project is to conduct a pilot study examining whether voucher-based CM is effective at increasing breastfeeding through 6-months postpartum among educationally disadvantaged women, a group that is at increased risk for inadequate breastfeeding. 

Incentive-based smoking cessation for methadone patients R01DA019550, 06/01/07-05/31/12
Funding Agency: NIH/NIDA
Dr. Sigmon is leading this project.  The aim of the project is to programmatically develop and test the efficacy of a voucher-based smoking cessation intervention in methadone-maintained cigarette smokers.  The intervention uses intensive monitoring via breath carbon monoxide and urinary cotinine, voucher-based contingency management, and bupropion to promote smoking abstinence in this challenging population.  This project will culminate in an effective behavioral intervention for reducing cigarette smoking among methadone-maintained patients, a population in whom prevalence of cigarette smoking is three-fold that of the general population.

Characterizing Nicotine Withdrawal in Pregnant Smokers R01DA002491, 05/01/08-02/28/11
Funding Agency: NIH/NIDA
Dr. Heil is leading this project.  The major goal of the project is to conduct a a study of pregnant cigarette smokers to comprehensively and rigorously characterize nicotine withdrawal, including the incidence, magnitude and time-course of individual nicotine withdrawal symptoms, in this special population.  The study uses voucher-based CM to promote abstinence so that withdrawal can be examined. 

Human Behavioral Pharmacology Laboratory’s Publications on Incentives and Health

Books/Manuals

  1. Higgins, S.T., and Silverman, K. (Eds.). (1999).  Motivating behavior change in illicit-drug abusers: Contemporary research on contingency-management interventions.  Washington, DC: American Psychological Association. 
  2. Higgins, S.T., Silverman, K. & Heil, S.H. (Eds.). (2008). Contingency management in substance abuse treatment. New York, NY: The Guilford Press.
  3. Budney, A.J., and Higgins, S.T. (1998).  Treating cocaine dependence: A community reinforcement plus vouchers approach.  Rockville, MD: National Institute on Drug Abuse.

Original Experimental Studies in Peer-Reviewed Journals

  1. Higgins, S.T., Stitzer, M.L., Bigelow, G.E., & Liebson, I.A.  (1986).  Contingent methadone delivery:  effects on illicit opiate use.  Drug and Alcohol Dependence, 17, 311-322. PMID: 3757767
  2. Budney, A.J., Higgins, S.T., Delaney, D.D., Kent, T., & Bickel, W.K.  (1991).  Contingent reinforcement of abstinence with individuals abusing cocaine and marijuana.  Journal of Applied Behavior Analysis, 24, 657-665. PMCID: PMC1279622
  3. Higgins, S.T., Delaney, D.D., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, F., & Fenwick, J.W.  (1991).  A behavioral approach to achieving initial cocaine abstinence.  The American Journal of Psychiatry, 148, 1218-1224. PMID: 1883001
  4. Higgins, S.T., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, F., & Badger, G.  (1993).  Achieving cocaine abstinence with a behavioral approach.  American Journal of Psychiatry, 150, 763-769. PMID: 8480823
  5. Higgins, S.T., Budney, A.J., Bickel, W.K., Foerg, F.E., Donham, R., & Badger, G.J. (1994).  Incentives improve outcome in outpatient behavioral treatment of cocaine dependence.  Archives of General Psychiatry, 51, 568-576. PMID: 8031230
  6. Silverman, K., Higgins, S.T., Brooner, R.K., Montoya, I.D., Cone, E.J., Schuster, C.R., & Preston, K.L.  (1996).  Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy.  Archives of General Psychiatry, 53, 409-415. PMID: 8624184
  7. Silverman, K., Wong, C.J., Higgins, S.T., Brooner, R.K., Montoya, I.D., Contoreggi, C., Umbricht-Schneiter, A., Schuster, C.R., & Preston, K.L.  (1996).  Increasing opiate abstinence through voucher-based reinforcement therapy.  Drug and Alcohol Dependence, 41, 157-165. PMID: 8809505
  8. Bickel, W.K., Amass, L., Higgins, S.T., Badger, G.J., & Esch, R.A.  (1997).  Effects of adding behavioral treatment to opioid detoxification with buprenorphine.  Journal of Consulting and Clinical Psychology, 65, 803-810. PMID: 9337499
  9. Roll, J.M., Higgins, S.T., Steingard, S., & McGinley, M.  (1998).  Use of monetary reinforcement to reduce the cigarette-smoking of persons with schizophrenia: A feasibility study.  Experimental and Clinical Psychopharmacology, 6, 157-161. PMID: 9608347
  10. Budney, A.J., Higgins, S.T., Radonovich, K.J. & Novy, P.L.  (2000).  Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence.  Journal of Consulting and Clinical Psychology, 68, 1051-1061. PMID: 11142539
  11. Higgins, S.T., Wong, C.J., Badger, G.J., Ogden, D.E., & Dantona, R.L.  (2000).  Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up.  Journal of Consulting and Clinical Psychology, 68, 64-72. PMID: 10710841
  12. Roll, J.M., & Higgins, S.T. (2000).  A within-subject comparison of three different schedules of reinforcement of drug abstinence using cigarette smoking as an exemplar. Drug and Alcohol Dependence, 58,103-109. PMID: 10669060
  13. Sigmon, S.C., Steingard, S., Badger, G.J., Anthony, S.L., & Higgins, S.T.  (2000).  Contingent reinforcement of marijuana abstinence among individuals with serious mental illness: A feasibility study.  Experimental and Clinical Psychopharmacology, 8, 509-517. PMID: 11127422
  14. Tidey, J.W., O Neill, S. C., & Higgins, S. T. (2002).  Contingent monetary reinforcement of smoking reductions, with and without transdermal nicotine, in outpatients with schizophrenia. Experimental and Clinical Psychopharmacology, 10, 241-247.  PMID: 12233984
  15. Heil, S.H., Tidey, J.W., Holmes, H.W., Badger, G.J., & Higgins, S.T. (2003). A contingent payment model of smoking cessation: Effects on abstinence and withdrawal.  Nicotine and Tobacco Research, 5, 205-213.  PMID: 12745493
  16. Alessi, S.M., Badger, G.J., & Higgins, S.T., (2004).  An experimental examination of the initial weeks of abstinence in cigarette smokers. Experimental and Clinical Psychopharmacology, 12, 276-287.  PMID: 15571445
  17. Heil, S.H., Alessi, S.M., Lussier, J.P., Badger, G.J. & Higgins, S.T. (2004). An experimental test of the influence of prior cigarette smoking abstinence on future abstinence. Nicotine and Tobacco Research, 6, 471-479.  PMID:  15203781
  18. Higgins, S.T., Sigmon, S.C., Wong, C.J., Heil, S.H., Badger, G.J., Donham, R., Dantona, R.L., & Anthony, S. (2003).  Community reinforcement therapy for cocaine-dependent outpatients. Archives of General Psychiatry, 60, 1043-1052. PMID: 14557150
  19. Higgins, S.T., Heil, S.H., Solomon, Bernstein, I.M., L.J., Lussier, J.P., Abel, R.L., Lynch, M.E. & Badger, G.J. (2004).  A pilot study on voucher-based incentives to promote abstinence from cigarette smoking during pregnancy and postpartum. Nicotine & Tobacco Research, 6, 1015-1020.  PMID:  15801574
  20. Lussier, J.P., Higgins, S.T., & Badger, G.J. (2005).  Influence of the duration of abstinence on the relative reinforcing effects of cigarette smoking.  Psychopharmacology, 181, 486-495.  PMID:  16034556
  21. Sigmon, S. C. & Higgins, S.T., (2006). Voucher-based contingent reinforcement of marijuana abstinence among individuals with serious mental illness.  Journal of Substance Abuse Treatment, 30, 291-295. PMID: 16716843
  22. Budney, A.J., Moore, B.A., Rocha, H.L., & Higgins, S.T. (2006). Clinical trial of abstinence-based vouchers and cognitive-behavioral therapy for cannabis dependence. Journal of Consulting and Clinical Psychology, 74, 307-316. PMID: 16649875
  23. Higgins, S.T., Heil, S.H., Dantona, R., Donham, R., Matthews, M., & Badger, G.J. (2007). Effects of varying the monetary value of voucher-based incentives on abstinence achieved during and following treatment among cocaine-dependent outpatients. Addiction, 102, 271-281.  PMID:  17222282
  24. Secades-Villa, R., Garcia-Rodriguez, O., Higgins, S.T., Fernandez-Hermida, J.R. & Carballo, J.L. (2007). Community reinforcement approach plus vouchers for cocaine dependence in a community setting in Spain: Six-month outcomes. Journal of Substance Abuse Treatment, 34, 202-207. PMID: 17512158
  25. Chivers, L.L., Higgins, S.T., Heil, S.H., Proskin, R.W. & Thomas, C.S. (2008).  Effects of initial abstinence and programmed lapses on the relative reinforcing effects of cigarette smoking. Journal of Applied Behavior Analysis, 41, 481-497. PMID: 19192854, PMCID: PMC2606599
  26. Dunn, K.E., Sigmon, S.C., Thomas, C.S., Heil, S. & Higgins, S.T.  (2008).  Voucher-based contingent reinforcement of smoking abstinence among methadone-maintained patients: A pilot study.  Journal of Applied Behavior Analysis. 41, 527-538. PMID: 19192857, PMCID: PMC2606604
  27. Heil, S.H., Higgins, S.T., Bernstein, I.M., Solomon, L.J., Thomas, C.S., Badger, G.J., Lynch, M.E. (2008). Effects of voucher-based incentives on abstinence from cigarette smoking and fetal growth among pregnant women. Addiction, 103, 1009-1018.  PMID: 18482424, PMCID: PMC2731575
  28. Dunn, K.E., Sigmon, S.C., Reimann, E., Heil, S.H., & Higgins, S.T. (2009). Effects of smoking cessation on illicit drug use among opioid maintenance patients. Journal of Drug Issues, Vol. 39(2), 313-328. PMID: 20401340
  29. Garcia-Rodriguez, O. Secades-Villa, R., Higgins, S.T., Carballo, J.L., Díaz. S.A., Errasti Perez, J.M. and Fernandez-Hermida, J.  R.  (2009).  Effects of voucher-based intervention on abstinence and retention in an outpatient treatment for cocaine addiction: A randomized controlled trial.  Experimental and Clinical Psychopharmacology, 17, 131-138.  PMID: 19586227
  30. Dunn, K.E., Sigmon, S.C., Reimann, E.F., Badger, G.J., Heil, S.H. & Higgins, S.T. (2010).  A contingency-management intervention to promote initial smoking cessation among opioid-maintained patients.  Experimental and Clinical Psychopharmacology, 18, 37-50. PMID: 20158293

Follow-up Studies/Reviews/Book Chapters

  1. Higgins, S.T., Budney, A.J., & Delaney, D.D.  (1992).  Behavior analysis in the treatment of cocaine dependence.  In J. Cohen - Y'Nez, J.L. Amezcua-Gaste'Lum, J. Villarreal, and L. Salazar Zayala (Eds.), International symposium on drug dependence: From the molecular to the social level, (pp. 327-334). Elsevier.
  2. Grabowski, J., Higgins, S.T., & Kirby, K.C.  (1993).  Behavioral treatments of cocaine dependence.  In F.M. Timms and C.G. Leukefeld (Eds.), NIDA Research Monograph No.135: Cocaine treatment: Research and clinical perspectives, (pp. 133-149). Rockville, MD: National Institute on Drug Abuse.
  3. Higgins, S.T., & Budney, A.J.  (1993).  Treatment of cocaine dependence via the principles of behavior analysis and behavioral pharmacology.  In L.S. Onken, J.D. Blaine, and J.J. Boren (Eds.), NIDA research monograph 137: Behavioral treatments for drug abuse and dependence, (pp. 97-121). Rockville, MD: National Institute on Drug Abuse.
  4. Higgins, S.T., Budney, A.J., & Bickel, W.K.  (1994).  Applying behavioral concepts and principles to the treatment of cocaine dependence.  Drug and Alcohol Dependence, 34, 87-97. PMID: 8026305
  5. Budney, A. J., & Higgins, S.T.  (1995).  Psychological treatment for cocaine dependence.  In J.H. Jaffe (Ed.), Encyclopedia of drug and alcohol.  New York, NY: Simon and Schuster Macmillan Library Reference, pp. 1095-1101.
  6. Higgins, S.T., & Budney, A.J.  (1995).  Contingency contracts in the treatment of drug dependence.  In J. Jaffe (Ed.), Encyclopedia of drug and alcohol.  New York, NY: Simon and Schuster Macmillan Library Reference, pp. 317-319.
  7. Higgins, S.T., & Budney, A.J.  (1995).  Behavior modification in the treatment of drug dependence.  In J. Jaffe (Ed.), Encyclopedia of drug and alcohol.  New York, NY: Simon and Schuster Macmillan Library Reference, pp. 1146-1149.
  8. Higgins, S.T., Budney, A.J., Bickel, W.K., Badger, G.J., Foerg, F.E., & Ogden, D.  (1995).  Outpatient behavioral treatment for cocaine dependence: One-year outcome. Experimental and Clinical Psychopharmacology, 3, 205-212.
  9. Higgins, S.T.  (1996).  Some potential contributions of reinforcement and consumer-demand theory to reducing cocaine use.  Addictive Behaviors, 21, 803-816. PMID: 8904945
  10. Higgins, S.T.  (1997).  The influence of alternative reinforcers on cocaine use and abuse. A brief review. Pharmacology Biochemistry & Behavior, 57, 419-427. PMID: 9218266
  11. Higgins, S.T.  (1997).  Behavioral choice theory can enhance our understanding of drug dependence and other behavioral disorders.  Behavioral and Brain Sciences, 19, 579-580.
  12. Higgins, S.T., & Budney, A.J. (1997).  From the initial clinic contact to aftercare: A brief review of effective strategies for retaining cocaine abusers in treatment.  In L.S. Onken, J.D. Blaine, and J.J. Boren (Eds.), NIDA Research Monograph: No.165, Beyond the therapeutic alliance: Keeping drug-dependent individuals in treatment, pp. 25-43. Rockville, MD: National Institute on Drug Abuse.
  13. Higgins, S.T., Tidey, J.W., & Stitzer, M.L.  (1998).  Community reinforcement and contingency management in the treatment of alcohol, cocaine, and opioid dependence.  In A.W. Graham and T.K. Schultz (Eds.), ASAM principles of addiction medicine, 2nd Edition, pp. 675-690.
  14. Preston, K.L., Silverman, K., Higgins, S.T., Brooner, R.K., Montoya, I., Schuster, C.R., & Cone, E.J.  (1998).  Cocaine use early in treatment predicts outcome in a behavioral treatment program.  Journal of Consulting and Clinical Psychology, 66, 691-696. PMID: 9735588
  15. Higgins, S.T.  (1999).  Applying behavioral economics to the challenge of reducing cocaine abuse.  In F.J. Chaloupka, M. Grossman, W.K. Bickel, and H. Saffer (Eds.), Proceedings of the economic analysis of substance use and abuse: An integration of economic and behavioral economic research, pp. 157-174. Chicago, IL: University of Chicago Press.
  16. Higgins, S.T.  (1999).  Introduction.  In S.T. Higgins and K. Silverman (Eds.), Motivating behavior change among illicit-drug abusers: Research on contingency-management interventions,  Washington, DC: American Psychological Association, pp. 3-13.
  17. Higgins, S.T.  (1999).  Principles of learning in the study and treatment of drug dependence: The challenge of applying what we've learned.  In M. Galanter, and H.D. Kleber (Eds.), Textbook of substance abuse treatment, (2nd ed.), pp. 67-73. Washington, DC: American Psychiatric Press.
  18. Higgins, S.T.  (1999).  Potential contributions of the community reinforcement approach and contingency management to broadening the base of substance abuse treatment.  In J.A. Tucker, D.M. Donovan, and G.A. Marlatt (Eds.), Changing addictive behavior: Bridging clinical and public health strategies, pp. 283-306. New York: Guilford Publications, Inc.
  19. Higgins, S.T., & Petry, N.M.  (1999). Contingency management: Incentives for sobriety.  Alcohol Health & Research World, 23, 122-127. PMID: 10890806
  20. Higgins, S.T., Roll, J.M., Wong, C.J., & Tidey, J.W.  (1999).  Clinic and laboratory studies on the use of incentives to decrease cocaine and other substance use.  In S.T. Higgins and K. Silverman (Eds.), Motivating behavior change among illicit-drug abusers: Contemporary research on contingency-management interventions, pp. 35-56. Washington, DC: American Psychological Association.
  21. Heil, S.H., Wong, C.J., & Higgins, S.T.  (2000).  Community reinforcement approach combined with contingent vouchers for the treatment of cocaine dependence.  The Addictions Newsletter, Division 50 of the American Psychological Association, 7, 24-26.
  22. Higgins, S.T., Badger, G.J., & Budney, A.J.  (2000).  Initial abstinence and success in achieving longer-term cocaine abstinence.  Experimental and Clinical Psychopharmacology, 8, 377-386. PMID: 10975629
  23. Budney, A.J., Sigmon, S.C., & Higgins, S.T. (2001). Contingency management: Using science to motivate change. In R.H. Coombs (Ed.) Addiction recovery tools: A practical handbook (pp. 147-172). Thousand Oaks, CA: Sage Publications, Inc.
  24. Carroll, M.E., Bickel, W.K., & Higgins, S.T. (2001).  Nondrug incentives to treatment drug abuse: A promising strategy developed in animals and humans.  In M.E. Carroll and J.B. Overmier (Eds.), Linking animal research and human psychological health (pp. 139-154). Washington, DC: American Psychological Association.
  25. Higgins, S.T.  (2001).  A promising intervention for a daunting problem: Comments on Silverman and colleagues' therapeutic workplace for drug-dependent, pregnant women.  Experimental and Clinical Psychopharmacology, 9, 27-28. PMID: 11519630
  26. Higgins, S.T., & Abbott, P.  (2001).  Community reinforcement approach and treatment of cocaine and opioid dependence.  In R.J. Meyers and W.R. Miller (Eds.), A community reinforcement approach to addiction treatment (pp. 123-146). Cambridge, UK: Cambridge University Press.
  27. Higgins, S.T., Budney, A.J., & Sigmon, S.C. (2001).  Cocaine dependence.  In D.H. Barlow (Ed.), Clinical Handbook of Psychological Disorders, 3rd ed.  New York: Guilford Publications, Inc., pp. 434-469.
  28. Higgins, S.T., & Heil, S.  (2001).  Behavioral  treatments. In R.C. DeWitt  (Ed.), Encyclopedia of drugs, alcohol, and addictive behavior, 2nd Ed.  (pp. 1225-1227). New York: Macmillan Reference USA.
  29. Higgins, S.T., & Heil, S.  (2001).  Contingency management.  In R.C. DeWitt, (Ed.), Encyclopedia of drugs, alcohol, and addictive behavior, 2nd Ed.  (pp. 1231-1233). New York: Macmillan Reference, USA.
  30. Higgins, S.T., Alessi, S.M. & Dantona, R.L. (2002).  Voucher-based incentives. A substance abuse treatment innovation. Addictive Behaviors, 27, 887-910. PMID: 12369474
  31. Higgins, S.T., Sigmon, S.C., & Budney, A.J.  (2002).  Psychosocial treatment of cocaine dependence:  The community reinforcement plus vouchers approach.  In S.G. Hofmann and M.C. Tompson (Eds.), Handbook of psychosocial treatments for severe mental disorders (pp 296-313). New York: Guilford Publications, Inc.
  32. Budney, A.J., Sigmon, S.C., & Higgins, S.T. (2003). Contingency management in the substance abuse treatment clinic.  In F. Rotgers, S.T. Walters and J. Morgenstern (Eds.), Treating substance abuse: Theory and technique (pp. 279-297). New York: Guilford Press.
  33. Higgins, S.T., & Heil, S.H. (2003). Urine the money: Voucher-based incentive scheme for drug treatment.  Drug Link, 18, 11-12.
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  39. Sigmon, S.C., Correia, C., & Stitzer, M.L. (2004).  Cocaine abstinence during methadone maintenance: Effects of repeated exposure to voucher-based reinforcement and predictive utility for response to abstinence incentive interventions. Experimental and Clinical Psychopharmacology, 12(4), 269-275. PMID: 15571444
  40. Correia, C.J., Sigmon, S.C., Silverman, K., Bigelow, G., & Stitzer, M.L. (2005). A comparison of voucher delivery schedules for the initiation of cocaine abstinence. Experimental and Clinical Psychopharmacology, 13, 253-258. PMID: 16173889
  41. Mueser, K.T., Drake, R.E., Sigmon, S.C., & Brunette, M.F. (2005). Psychosocial interventions for adults with severe mental illness and co-occurring substance use disorders: A review of specific interventions. Journal of Dual Diagnosis, 1(2), 57-82.
  42. Rosado, J., Sigmon, S.C., Jones, H., Chilsolm, C., & Stitzer, M.L. (2005).  Cash value of voucher reinforcers in pregnant drug-dependent women. Experimental and Clinical Psychopharmacology, 13, 41-47. PMID: 15727502
  43. Sigmon, S.C. & Stitzer, M.L. (2005). Use of a low-cost incentive intervention to improve counseling attendance among methadone-maintained patients. Journal of Substance Abuse Treatment, 29, 253-258. PMID: 16311177
  44. Budney, A.J., Moore, B.A., Sigmon, S.C. & Higgins, S.T. (2006).  Contingency-management interventions for cannabis dependence.   In R.A. Roffman and R.S. Stephens (Eds.) Cannabis dependence: Its nature, consequences, and treatment (pp. 154 - 176). United Kingdom: Cambridge University Press.
  45. Higgins, S.T. (2006). Extending contingency management to the treatment of methamphetamine use disorders.  American Journal of Psychiatry,163, 1870-1872.  PMID: 17074933
  46. Lussier, J.P., Heil, S.H, Mongeon, J.A., Badger, G.J. & Higgins, S.T. (2006). A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction, 101, 192-203. PMID:  16445548
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  49. Sigmon, S.C., Dunn, K., & Higgins, S.T. (2007). Brief history of the contingency management working group at the annual meeting of The College on Problems of Drug Dependence. Drug and Alcohol Dependence, 89, 314-316.
  50. Sigmon, S.C. & Stitzer, M.L. (2007). Low-cost incentives to improve counseling attendance. Counselor Magazine, 8(1), 32-38.
  51. Garcia-Rodriguez, O., Secades-Villa, R., Higgins, S.T., Fernandez-Hermida, J.R. and Carballo, J.L. (2008).  Financing a voucher program for cocaine abusers through community donations in Spain. Journal of Applied Behavior Analysis, 41, 623-628.  PMID: 19192866, PMCID: PMC2606591
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  58. Rogers, R. E., Higgins, S. T., Silverman, K, G., Thomas, C., Badger, _G. J., Stitzer, M., Bigelow, G.  (2008).  Abstinence-contingent reinforcement and engagement in non-drug related activities among illicit drug abusers. Psychology of Addictive Behaviors, 22, 544-50.   PMID: 19071979, PMCID: PMC2825151
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  64. Higgins, S.T., Bernstein, I.M. , Washio, Y., Heil, S.H., Badger, G.J., Skelly, J.M., Higgins, T.M., & Solomon, L.J. (in press).  Effects of smoking cessation with voucher-based contingency management on birth outcomes.  Addiction. NIHMSID # 207216
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  71. Saulsgiver, K., Sigmon, S.C., Dunn, K.E., Badger, G.J., Yoon, J., Bradstreet, M., Reimann, E., Heil. S.H. & Higgins, S.T.  (in preparation). Baseline delay discounting predicts response to a behavioral intervention for smoking cessation. 




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