Rate‐dependent effects of narrative interventions in a longitudinal study of individuals who use alcohol

• Published in: Alcohol, clinical & experimental research clinical & experimental research, 2023-03, Vol.47 (3), p.566-576
• Main Authors: Craft, William H., Dwyer, Candice L., Tomlinson, Devin C., Yeh, Yu‐Hua, Tegge, Allison N., Bickel, Warren K.
• Format: Article
• Language: English
• Subjects: alcohol; Alcohol use; Alcoholism; delay discounting; episodic future thinking; Intervention; longitudinal; Longitudinal studies; rate dependence; Substance use
• ISSN: 0145-6008; 2993-7175; 1530-0277; 2993-7175
• DOI: 10.1111/acer.15020

Background Delay discounting (DD), the decrease in reward valuation as a function of delay to receipt, is a key process undergirding alcohol use. Narrative interventions, including episodic future thinking (EFT), have decreased delay discounting and demand for alcohol. Rate dependence, the relationship between a baseline rate and change in that rate after an intervention, has been evidenced as a marker of efficacious substance use treatment, but whether narrative interventions have rate‐dependent effects needs to be better understood. We investigated the effects of narrative interventions on delay discounting and hypothetical demand for alcohol in this longitudinal, online study. Methods Individuals (n = 696) reporting high‐ or low‐risk alcohol use were recruited for a longitudinal 3‐week survey via Amazon Mechanical Turk. Delay discounting and alcohol demand breakpoint were assessed at baseline. Individuals returned at weeks 2 and 3 and were randomized into the EFT or scarcity narrative interventions and again completed the delay discounting tasks and alcohol breakpoint task. Oldham's correlation was used to explore the rate‐dependent effects of narrative interventions. Study attrition as a function of delay discounting was assessed. Results Episodic future thinking significantly decreased, while scarcity significantly increased delay discounting relative to baseline. No effects of EFT or scarcity on the alcohol demand breakpoint were observed. Significant rate‐dependent effects were observed for both narrative intervention types. Higher delay discounting rates were associated with a greater likelihood of attrition from the study. Conclusion The evidence of a rate‐dependent effect of EFT on delay discounting rates offers a more nuanced, mechanistic understanding of this novel therapeutic intervention and can allow more precise treatment targeting by demonstrating who is likely to receive the most benefit from it. Rate‐dependence has been well characterized in pharmacological studies but whether behavioral interventions have rate‐dependent effects is less well understood. We report a rate‐dependent effect of episodic future thinking (EFT) on delay discounting such that individuals with the highest baseline discounting rate saw the greatest change in discounting post‐EFT. This finding provides a more mechanistic understanding of the EFT intervention and helps to identify individuals who may receive the most benefit from this novel therapeutic.