Episodic future thinking decreases cocaine consumption among individuals with cocaine use disorder

Psychosocial treatments remain the standard approach for cocaine use disorder (CUD). However, high dropout rates and a lack of significant response to these treatments are commonly observed, highlighting the need for novel, scalable interventions to support recovery from CUD. Episodic future thinking (EFT) is a scalable intervention that has been shown to decrease delay (DD) discounting and cocaine valuation after a single exposure among individuals with CUD. Expanding on those findings, we conducted a pilot clinical trial in a CUD sample to evaluate the: 1) feasibility of prolonged EFT exposure and remote monitoring of cocaine consumption; 2) efficacy of prolonged exposure to EFT in decreasing DD and cocaine consumption; and 3) efficacy of prolonged exposure to EFT in decreasing hypothetical demand for cocaine. Participants were randomized to EFT (n = 41) or control episodic thinking (n = 39) and completed a five-week study, during which they completed four cue generation sessions, received cue reminders twice daily, and reported daily cocaine consumption. Results indicated that prolonged exposure to daily EFT reminders and daily consumption reporting was feasible, with more than 70% of participants in both groups completing the entire study and daily submissions above 80% for both groups. Consistent with our hypotheses, significant decreases in DD and amount of cocaine consumption were observed for participants in the EFT group, but not in CET. However, contrary to our hypothesis, robust effects of EFT on hypothetical demand were not observed.