The Science of Future Thinking and its Role in Recovery

Would you prefer a delicious piece of chocolate now or a whole chocolate bar tomorrow? A 3-day vacation now or a 7-day vacation in 5 months? To spend an extra/bonus $500 now, or put it in a savings account to accrue interest? Most people prefer immediate rewards over delayed ones. However, people with substance use challenges tend to find it especially difficult to imagine their futures and delay rewards. Research indicates that people with substance use disorders have a narrower “temporal window,” meaning their attention is focused on gaining near-future rewards, such as the next drink or next drug use opportunity. For example, studies show that when asked about their own future, the typical individual reports goals and activities about 5 years in the future. In stark contrast, people with heroin use disorders offered reports that extended only 9 days in the future, on average (Patel & Amlen, 2020).
 
Delay discounting is the term used to describe the rate at which future rewards are less valued over time. Higher rates of delay discounting are related to impulsivity and risky behaviors like drug and alcohol use. Research in Episodic Future Thinking (EFT) suggests that helping people to vividly imagine personally salient future events could help them learn to delay rewards in order to get a bigger payoff in the longer term (Bulley & Gullo, 2017). Applied to a treatment court context, clients could learn to forgo short term rewards such as relief from craving or feeling euphoric, in favor of long-term goals, like graduating from the program, freedom from probation, and regaining custody of children.
 
Several promising studies of EFT with people with alcohol dependence show positive results. For example, Snider, LaConte & Bickel, (2016) encouraged participants to expand their temporal windows by thinking about personally relevant future events and describing them in salient detail. Participants reported the most positive event that could realistically happen at each of 5 points in the future (1 day, 1 week, 1 month, 3 months, and 1 year). Researchers then probed: “What will you be doing?” “Whom will you be with?” “Where will you be?” “How will you be feeling?” “What will you be seeing?” “What will you be hearing?” “What will you be tasting?” “What will you be smelling?” (pp. 1160-1161). They also asked a comparison group of people with alcohol dependence to imagine PAST events in the same timeframes, with similarly worded probes. This method allowed researchers to assess the unique contribution of a future time orientation.
 
Each participant’s future or past personalized account was then integrated into a task in which they chose between hypothetical gains in money received now or after some delay (e.g., “Would you like $50 now or $100 in a year?” They also administered measures of alcohol use.  They found that over time, people in the future-thinking/EFT group came to value future monetary rewards more highly and reduced their alcohol consumption. These improvements were also found in a study that involved a one-week, 4-session/practice protocol with people with alcohol dependence (Patel & Amlen, 2020). In addition to decreases in alcohol demands and delay discounting rates (i.e., they were more able to delay rewards), participants who had engaged in even 1 session also showed significant increases in mindfulness—an essential tool in supporting recovery.
 
More research is needed to determine whether EFT can effectively contribute to treatment of substance use disorders. But treatment court personnel and providers can easily incorporate these highly targeted, future-thinking questions to help clients visualize a future self that is healthier and more fulfilled. Repeated practice is essential to change, and the frequent contacts afforded to treatment court clients could provide ideal opportunities to engage them in this line of thinking.
 

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References: 

Bulley A, Gullo MJ. (2017). The influence of episodic foresight on delay discounting and demand for alcohol. Addictive Behaviors, 66, 1-6. doi: 10.1016/j.addbeh.2016.11.003. Epub 2016 Nov 3. PMID: 27837662.
 
Patel, H. & Amlung, M. (2020). Acute and extended exposure to episodic future thinking in a treatment seeking addiction sample: A pilot study. Journal of Substance Abuse Treatment, 116, ISSN 0740-5472, https://doi.org/10.1016/j.jsat.2020.108046.
 
Snider SE, LaConte SM, Bickel WK. (2016). Episodic Future Thinking: Expansion of the temporal window in individuals with Alcohol Dependence. Alcoholism: Clinical & Experimental Research, 40(7), 1558-1566. doi: 10.1111/acer.13112. Epub 2016 Jun 1. PMID: 27246691; PMCID: PMC5497459.
 
 
 

Written by Sally MacKain, Ph.D., LP

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