Stephen Higgins, Ph.D.

(FEBRUARY 8, 2022) A contingency management program developed by psychologist Stephen Higgins, Ph.D., professor of psychiatry, to treat patients with addictions was mentioned in The Guardian. Carl Erik Fisher’s book The Urge: Our History of Addiction, a harrowing first-person account of his drinking, drug use, and eventual complete breakdown during his residency training, was excerpted in The Long Read in The Guardian under the title “Alcoholism and me: ‘I was an addicted doctor, the worst kind of patient.’” Today Fisher is an addiction physician, bioethicist, and assistant professor of clinical psychiatry at Columbia University who also maintains a private psychiatry practice focusing on complementary and integrative approaches to treating addiction. Fisher mentioned behavioral economics research that describes the psychological feature of “delay discounting,” in which smaller but more immediate rewards are favored over larger, delayed ones -- this process is universal to humankind, but more pronounced in addiction. In addition to counselling, Higgins used a voucher system that gave people small rewards, such as sports equipment and movie passes, for cocaine-negative urine samples, and gave them a bonus for longer stretches of abstinence. This strategy was highly successful. After decades’ more research, contingency management now has strong evidence in its favor, especially for stimulant problems, for which good medication treatments have not been found.