The goal of this study is to examine the effectiveness of a brief, episodic future
thinking (EFT) intervention in a substance use treatment setting serving returning
citizens with substance use disorders (SUD).

The main questions it aims to answer are:

  1. Determine preliminary implementation potential of the EFT intervention, including
     acceptability and feasibility of conducting the intervention.

  2. Examine the preliminary effectiveness of this approach, with a specific focus on
     patient outcomes, including changes in delay discounting, treatment retention,
     treatment motivation, and substance use.

Participants will be asked to participant in pre and post assessment questionnaires,
participate in a single-episode brief intervention followed by tailored phone call
follow-ups.

Peer-Delivered Episodic Future Thinking for Returning Citizens

Behavior, Health

Returning citizens with substance use disorders (SUD) are at the greatest risk for
overdose in the first two weeks following the transition from incarceration. Thus, the
reentry period is of specific importance for ensuring individuals are engaged and
retained in specialized intervention services. Individuals also face numerous, and highly
impactful, decisions during this period. They are required to navigate complex tasks
(finding employment, securing housing), often with limited financial and social supports.
Of particular concern, recent research suggests that the reentry period, often
characterized by instability and limited resources, may reinforce a decision-making
approach that favors meeting immediate needs relative to engaging in long-term planning.
This focus on attaining smaller but immediately available rewards relative to larger,
delayed, rewards (known as delay discounting), in turn, has been associated with a number
of negative health outcomes, including substance use and poor treatment outcomes (higher
dropout and lower motivation). In other words, the reentry context may create an
environment which reinforces individuals' tendencies to engage in short-term,
reward-seeking behaviors (e.g. substance use, skipping treatment appointments) at a time
when their decisions have highly significant consequences (relapse, recidivism). This
study will examine the efficacy of implementing a low-cost, brief intervention (Episodic
Future Thinking) targeting the reduction of delay discounting with the reentry population
to inform broader public health efforts aimed at reducing substance misuse and
improvements in treatment outcomes.

Elongating Time HOrizons for Reentry (ETHoR)

Standardized Episodic Thinking (SET)

Peer Delivered Episodic Future Thinking to Improve MOUD Treatment Engagement Among Returning Citizens - A Randomized Controlled Trial

The computer based adjusting amount discounting task uses an adjusting algorithm to
determine the amount of immediately available money that is equivalent to a large sum
that is delayed by seven discrete durations of time presented in a randomized order
(i.e., 1 day, 1 week, 1 month, 6 months, 1 year, 5 years, and 25 years). At each delay, a
choice is first presented between the delayed larger sum and a smaller sum available
immediately. For each trial, the position of the delayed and immediate amounts are
randomly assigned and the participant chooses the preferred option by pressing the
corresponding response button.

The Consideration of Future Consequences Scale1 (CFCS-14) is a 14-item self-report
questionnaire that assesses active consideration of longer-term implications of an
individual's actions. Lower scores on the CFCS-14 are associated with a greater focus on
immediate needs and have been found to be associated with less engagement in health
behaviors1819 and greater substance use. The measure has been used extensively among
adult samples and demonstrates strong reliability and validity. Research suggests modest
but significant correlations with the MCQ.

Principal Investigator

The SMAST is a brief questionnaire consisting of 13 items. It can be completed in just a
few minutes and is designed for individuals with a reading level equivalent to that of a
7th grader. This assessment tool was derived from the Michigan Alcoholism Screening Test
and has been found to be a reliable diagnostic tool to detect at-risk alcohol use,
alcohol abuse, or alcoholism. The evaluation data suggests its effectiveness, with no
notable occurrence of false positives.

The DAST offer a concise self-report tool for screening populations, identifying clinical
cases, and researching treatment effectiveness related to drug abuse. It is applicable
for use with both adults and older adolescents. The DAST-10 provides a numerical gauge of
the extent of drug abuse-related consequences. Administering the assessment takes around
5 minutes Condensed from its longer counterpart of 28 items, the DAST-10 comprises 10
self-report items.

Episodic Future Thinking (EFT) utilizes participant-generated descriptions of future
events to elongate an individual's temporal horizon. In EFT paradigms, the participant is
asked to create and envision vivid descriptions of specific, positively valanced, events
that could happen in the future. Recent research suggests that directing EFTs to focus on
specific goals (i.e. evoking images of oneself engaging in activities consistent with a
desired future outcome) are associated with stronger decreases in undesirable health
behaviors. Thus, as part of the ETHoR condition, participants will be asked to verbally
describe and imagine four specific events reflecting positive activities in which the
participant engages in substance and incarceration-free activities, corresponding to
predetermined future timepoints. The PRC will encourage participants to include as many
contextual and emotional details as possible.

Individuals in the control group utilizes SET; an approach that controls for activation
of episodic thinking but does not engage prospection (the hypothesized mechanism of
episodic future thinking, future outcome) are associated with stronger decreases in
undesirable health behaviors. Thus, as part of the SET condition, participants will be
asked to verbally describe and imagine four current events reflecting positive activities
in which the participant engages in substance and incarceration-free activities,
corresponding to current experiences. The PRC will encourage participants to include as
many contextual and emotional details as possible.

Peer-Delivered Episodic Future Thinking for Returning Citizens

About this trial

Study ID

Status

Type

Phase

Placebo

Accepting

Trial Timing

What is this trial about?

What are the participation requirements?