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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a method called Episodic Future Thinking (EFT) to help individuals with cocaine use disorder. Participants will envision positive future events to reduce cocaine use. The trial compares this method to a control group that reflects on recent positive events. Individuals who have recently used cocaine, have a cocaine use disorder, and wish to reduce their use might be suitable candidates.

As an unphased trial, this study provides a unique opportunity to explore a novel approach to reducing cocaine use.

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.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that Episodic Future Thinking (EFT) is generally safe. Studies have not identified any safety issues with EFT, indicating it is well-tolerated. EFT involves imagining positive future events and aims to reduce impulsive decisions, particularly in individuals with cocaine use disorder. Researchers have tested this method in various settings without harmful effects. Based on available evidence, EFT appears to be a safe treatment option. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Episodic Future Thinking (EFT) for cocaine use disorder because it focuses on helping individuals envision positive future events, which is a shift from traditional treatments like cognitive-behavioral therapy or medication-assisted treatments. Unlike standard methods that often address past behavior or manage cravings with medication, EFT encourages individuals to think about personal, positive milestones they aim to achieve in the future. This future-oriented approach could potentially enhance decision-making and motivation, offering a new way to reduce cocaine use by emphasizing long-term goals and aspirations.

What evidence suggests that Episodic Future Thinking might be an effective treatment for cocaine use disorder?

Research shows that Episodic Future Thinking (EFT), one of the interventions in this trial, can help people with cocaine use disorder by reducing impulsive decisions. Imagining positive future events may decrease the likelihood of making quick, rash choices, a common challenge for those with substance use disorders. Some studies suggest that EFT encourages individuals to wait for larger rewards rather than opting for smaller, immediate ones. This shift in thinking could support recovery by making it easier to resist the urge to use cocaine. Overall, EFT appears promising as a tool to improve decision-making for those struggling with cocaine use. Participants in this trial may also receive Control Episodic Thinking (CET), which involves recalling positive recent past events. ^{1 3 6 7 8}

Who Is on the Research Team?

Stephen LaConte, PhD

Principal Investigator

Virginia Polytechnic and State University

Are You a Good Fit for This Trial?

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 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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8062282/

Evaluating effects of episodic future thinking on valuation ...

These preliminary findings suggest that EFT can reduce impulsive decision-making in cocaine use disorder and may therefore have therapeutic value.

2.

sciencedirect.com

sciencedirect.com/science/article/pii/S2352853223000408

Patients with cocaine use disorder exhibit reductions in ...

Episodic future thinking (EFT) has been shown to reduce impulsive decision-making. · This EFT effect has previously been demonstrated in substance use disorders ...

3.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/33539190/

Evaluating effects of episodic future thinking on valuation ...

These preliminary findings suggest that EFT can reduce impulsive decision-making in cocaine use disorder and may therefore have therapeutic value.

4.

jsatjournal.com

jsatjournal.com/article/S2949-8759(23)00307-7/fulltext

Art-delivered episodic future thinking reduces delay ...

Lower rates of DD predict better treatment outcomes, and thus strategies that reduce DD may support SUD recovery. The process of vividly ...

5.

withpower.com

withpower.com/trial/phase-cocaine-use-disorders-9-2022-ee696

Episodic Future Thinking for Cocaine Use Disorder

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

6.

sciencedirect.com

sciencedirect.com/science/article/abs/pii/S0740547220303020

Acute and extended exposure to episodic future thinking in ...

These disorders are associated with substantial negative outcomes, including negative health consequences, interpersonal problems, legal problems, and negative ...

7.

researchgate.net

researchgate.net/publication/349057743_Evaluating_effects_of_episodic_future_thinking_on_valuation_of_delayed_reward_in_cocaine_use_disorder_a_pilot_study

Evaluating effects of episodic future thinking on valuation ...

Objectives: This pilot study aimed to (1) assess the feasibility of utilizing EFT methods in individuals with cocaine use disorder (CUD) and (2) ...

8.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC6538444/

Cognitive Dysfunction in Individuals With Cocaine Use ...

It is well-documented in the literature that individuals repeatedly exposed to cocaine exhibit cognitive impairment and that cognitive dysfunction is a risk ...