Peer-Delivered Episodic Future Thinking for Returning Citizens

Henry Ford Health

Status: Enrolling

Conditions: Behavior, Health

Treatments: Behavioral: Standardized Episodic Thinking (SET); Behavioral: Elongating Time HOrizons for Reentry (ETHoR)

Study type: Interventional

Funder types: Other

Identifiers

NCT06119503

JRCT: 16686-01

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 50 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. At least 18 years of age
2. Experience in an incarceration setting within 12 months
3. Identify as an individual in substance use recovery
4. Willing to participate in the study
5. Able to participate in written assessments and an intervention conducted in English
6. Willing to receive brief bi-weekly check-in calls for one month, email, and other phone messages related to study participation including SMS/text messages as needed

Exclusion criteria

1. Individuals' ineligible or unwilling to participate in study activities and assessments
2. Self-reporting of active and untreated psychosis

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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50 participants in 2 patient groups

Elongating Time HOrizons for Reentry (ETHoR)

Experimental group

Description:

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.

Treatment:

Behavioral: Elongating Time HOrizons for Reentry (ETHoR)

Standardized Recent Thinking (ERT)

Active Comparator group

Description:

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.

Treatment:

Behavioral: Standardized Episodic Thinking (SET)