Individuals returning to the community following incarceration (“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 application proposes to develop and test a brief (single-session) adapted version of Episodic Future Thinking, which has been shown to elongate individual’s time horizon and decrease delay discounting, leading to subsequent reductions in substance misuse and improvements in treatment outcomes. The modified intervention, Elongating Time HOrizons for Reentry (ETHoR), will be delivered by a peer recovery coach (PRC) with lived experience in substance use and justice involvement. Findings from this study will be disseminated to community partners and used to plan a large-scale intervention trial that will inform public health approaches to increasing successful reentry among individuals with SUD.
PI: Julia Felton, Ph.D.