Episodic Future Thinking for Cocaine Use Disorder

Overseen By Kirstin Gatchalian

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Virginia Polytechnic Institute and State University

Disqualifiers: Opioid use disorder, Psychotic disorder, Seizure disorders, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 13

100 Participants Needed

Trial Summary

What is the purpose of this trial?

The primary objective is to test the theory of Reinforcer Pathology via manipulation of the temporal window with successive Episodic Future Thinking generation in individuals with cocaine use disorder.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Episodic Future Thinking for Cocaine Use Disorder?

Research shows that Episodic Future Thinking (EFT), which involves imagining oneself in future situations, can help reduce impulsive decision-making in people with cocaine use disorder. Studies found that when individuals used EFT, they were less likely to choose immediate smaller rewards over larger future rewards, suggesting EFT may help in making better long-term decisions. ^{1 2 3 4 5}

Is episodic future thinking (EFT) safe for humans?

The studies reviewed do not report any safety concerns related to episodic future thinking (EFT) in humans, suggesting it is generally safe to use. ^{1 2 3 4 5}

How is the treatment Episodic Future Thinking (EFT) different from other treatments for cocaine use disorder?

Episodic Future Thinking (EFT) is unique because it involves imagining positive future events to help reduce impulsive decision-making and the desire for immediate rewards, which can support long-term recovery from cocaine use disorder. Unlike traditional treatments, EFT focuses on enhancing future-oriented thinking to decrease the appeal of immediate drug use. ^{1 2 3 4 5}

Research Team

Stephen LaConte, PhD

Principal Investigator

Virginia Polytechnic and State University

Eligibility Criteria

This trial is for adults over 18 with Cocaine Use Disorder (CUD) who have used cocaine recently and want to reduce their use but aren't planning to enter treatment soon. It's not for those with MRI contraindications, psychotic disorders, severe opioid use disorder, or a history of seizures or brain injury.

Inclusion Criteria

Demonstrate recent cocaine use and CUD (use in the last month, DSM-5 for CUD > 4)

I am 18 years old or older.

I want to reduce or stop my cocaine use but don't plan to seek treatment for it soon.

Exclusion Criteria

Meeting moderate to severe DSM-5 criteria for opioid use disorder

I have been diagnosed with a psychotic disorder.

I have had seizures or a serious head injury in the past.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline

Participants undergo initial assessments and randomization to either EFT or CET groups, including neuroimaging procedures

1 session

1 visit (in-person)

Intervention

Participants engage in episodic future thinking (EFT) or control episodic thinking (CET) over a 4-week period with thrice-weekly lab visits for event generation and stress probe exposure

4 weeks

12 visits (in-person)

Follow-up

Participants are monitored for changes in delay discounting, neural activation, cocaine urinalysis, cocaine demand, and craving

4 weeks

Treatment Details

Interventions

• Control Episodic Thinking
• Episodic Future Thinking (EFT)

Trial Overview The study tests how changing the way people think about the future affects their cocaine use. Participants will either engage in Episodic Future Thinking (EFT), imagining future events, or they'll be part of a control group focusing on general thoughts.

Participant Groups

Group I: Episodic Future Thinking (EFT) Experimental Treatment 1 Intervention

Participants will generate positive future events they are looking forward to at several time points in the future (e.g., 2 weeks, 1 month, 3 months, 1 year, and 5 years). Participants will be reminded of these events using cues throughout the study and instructed to think about these cues as they make their decisions. This intervention will be tested in both the presence and absence of stress probes.

Group II: Control Episodic Thinking (CET) Placebo Group 1 Intervention

Participants will generate positive recent past events that have happened to them at several time points in the previous day (e.g., 7pm-10pm, 4pm-7pm, 1pm-4pm, 10am-1pm, and 7am-10am). Participants will be reminded of these events using cues throughout the study and instructed to think about these cues as they make their decisions. This intervention will be tested in both the presence and absence of stress probes.

Who Is Running the Clinical Trial?

Virginia Polytechnic Institute and State University

Lead Sponsor

Trials

162

Recruited

26,900+

Carilion Clinic

Collaborator

Trials

85

Recruited

15,400+

Arizona State University

Collaborator

Trials

311

Recruited

109,000+

Findings from Research

Episodic future thinking (EFT) was successfully applied in a pilot study with 18 individuals seeking treatment for cocaine use disorder, showing that it can help reduce impulsive decision-making by decreasing the discounting of future rewards.

Participants who engaged in EFT by envisioning future positive events demonstrated a significant reduction in discounting behavior compared to standard conditions, indicating that EFT may have therapeutic potential for improving future-oriented decision-making in substance use recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating effects of episodic future thinking on valuation of delayed reward in cocaine use disorder: a pilot study. Forster, SE., Steinhauer, SR., Ortiz, A., et al.[2022]

Episodic future thinking (EFT) shows promise as an intervention for reducing problematic substance use and substance use disorders, based on a systematic review of 16 studies that demonstrated benefits in self-reported and task-based outcomes.

The review highlights the need for further research to assess the feasibility, generalizability, and long-term effects of EFT, as well as to identify factors that influence its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Imagining the future can shape the present: A systematic review of the impact of episodic future thinking on substance use outcomes. Collado, A., Stokes, A.[2023]

In a study involving 35 individuals with cocaine use disorder, personalized event cues used to prompt episodic future thinking (EFT) significantly reduced impulsive decision-making related to delayed rewards, indicating that EFT can help individuals make better choices about future rewards.

The effectiveness of EFT in reducing discounting behavior was consistent regardless of whether participants had a significant history of incarceration, suggesting that EFT-based interventions could benefit both groups in improving outcomes related to substance use and reducing the risk of future criminal behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patients with cocaine use disorder exhibit reductions in delay discounting with episodic future thinking cues regardless of incarceration history. Torres, TM., Steinhauer, SR., Forman, SD., et al.[2023]

Individuals with alcohol dependence demonstrated significantly better episodic future thinking abilities compared to those with opiate use disorders, based on a study involving 31 opiate users, 21 alcohol-dependent individuals, and 23 healthy controls.

These findings suggest that rehabilitation programs for substance use disorders may need to be customized to address the varying capabilities of self-projection and future thinking among different substance use groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Not all drugs are created equal: impaired future thinking in opiate, but not alcohol, users. Moustafa, AA., Morris, AN., Nandrino, JL., et al.[2019]

A 1-week episodic future thinking (EFT) protocol was tested on 28 individuals in treatment for alcohol use disorder, showing promise in reducing impulsive decision-making and alcohol motivation.

Participants exhibited decreased alcohol demand and delay discounting rates, along with increased mindfulness, suggesting that EFT could be a beneficial supplement to traditional addiction treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute and extended exposure to episodic future thinking in a treatment seeking addiction sample: A pilot study. Patel, H., Amlung, M.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Evaluating effects of episodic future thinking on valuation of delayed reward in cocaine use disorder: a pilot study. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Imagining the future can shape the present: A systematic review of the impact of episodic future thinking on substance use outcomes. [2023]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Patients with cocaine use disorder exhibit reductions in delay discounting with episodic future thinking cues regardless of incarceration history. [2023]

4. Germany pubmed.ncbi.nlm.nih.gov

Not all drugs are created equal: impaired future thinking in opiate, but not alcohol, users. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Acute and extended exposure to episodic future thinking in a treatment seeking addiction sample: A pilot study. [2022]