Using Monetary Incentives to Reduce Drug Use and Improve Health
Stephen T. Higgins, University of Vermont
Dr. Higgins is a professor of psychiatry and psychology at the University of Vermont where he serves as vice chair of the Department of Psychiatry and director of the Department of Psychiatry's Center on Substance Abuse Research and Treatment, and co-director of their Human Behavioral Pharmacology Laboratory. He completed postdocotral training in behavioral pharmacology at The Johns Hopkins University School of Medicine from 1983-85, obtained his doctorate degree in child psychology and human development from the University of Kansas in 1983, a master's in counseling in 1977, and a bachelor's degree in psychology in 1975 from Shippensburg University. He has been the recipient of many national research awards, including a National Institutes of Health (NIH) MERIT Award for his development of an efficacious outpatient treatment for cocaine dependence. More recently, an incentive-based intervention that Dr. Higgins developed for smoking cessation among pregnant women has gained considerable national and international attention for its efficacy in producing high antepartum cessation rates and significant improvements in birth outcomes. Dr. Higgins has published approximately 250 articles, book chapters, and books; has served as president of two national scientific organizations and in other leadership positions in the areas of psychopharmacology and substance abuse; is on the editorial board of four peer-reviewed journals, including the well regarded international specialty journal Addiction; has served as the editor for behavioral pharmacology for the Journal of the Experimental Analysis of Behavior-a well-respected outlet for basic research on operant conditioning; and has served as a guest editor for special issues of different peer-reviewed specialty journals on selected topics in behavioral pharmacology and behavioral economics (e.g., Drug and Alcohol Dependence, Experimental and Clinical Psychopharmacology, Journal of Applied Behavior Analysis). He has served on various NIH study sections, including a 3-year term on the Training and Career Development Review Committee of the National Institute on Drug Abuse.
Abstract:There is growing recognition and concern that many individuals persist in behavior patterns (substance abuse, physical inactivity, unhealthy food choices, medication non-adherence) that are strikingly harmful to their long-term health and a staggering financial burden on the U.S. health care system. Indeed, unhealthy personal behavior patterns are estimated to contribute to 40% of all premature deaths in the U.S. annually, with cigarette smoking alone being responsible for approximately 435,000 deaths/year and physical inactivity and obesity contributing to another 365,000 deaths/year. These behavior patterns increase risk for numerous chronic diseases, including cardiovascular disease, stroke, site-specific cancers, and type-2 diabetes. Our group has been investigating the systematic use of financial incentives to promote behavior change among addicted individuals. This presentation will review a program of research conducted with pregnant women who are still smoking cigarettes upon entry into prenatal care. It will also review results from studies demonstrating that providing these women with vouchers exchangeable for retail items in the community contingent on objectively verified abstinence from recent smoking can significantly increase abstinence levels and improve birth outcomes. These positive results are congruent with a larger body of evidence demonstrating that financial incentives can be effective in promoting health-related behavior change and improving health outcomes.