Stimulation of future thinking in stimulant–depending patients using questionnaire–based structured interview

INTRODUCTION: Impaired future thinking (FT) a human ability to imagine and comprehend images and scenarios of the personal future may contribute to the severity of psychoactive substance dependence. Spontaneous mental images of the impacts of using psychoactive substances and/or of one’s own death (‘flash-forwards’), as well as impaired arbitrary modeling of future images (for example, overgeneralization and lack of reflection) interfere with adherence to treatment and stability of remission in addictions.

AIM: To evaluate the influence of FT-activating intervention on treatment outcomes in patients with narcotic psychostimulant dependence.

MATERIALS AND METHODS: A randomized prospective controlled clinical trial conducted in 2021–2023 involved 112 inpatients with stimulant dependence (F15.2). Of them, the main group consisted of 56 patients (age 24.0 [21.0; 27.0] years; 30.4% of men), who underwent FT stimulation in the form of semi-structured interview based on the Russian pilot version of the Impact of Future Events Scale (IFES). The control group consisted of 56 patients (age 23.5 [22.0; 26.0] years; 39.3% of men) who received a standard drug addiction conversation of equal duration. The treatment result parameters included the score on the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES); duration of remission, participation in long-term therapy, in outpatient rehabilitation, inpatient rehabilitation, confirmation of the fact of prescheduled discharge, infringement of regime, incarcerations. The test was conducted upon admission and after discharge. Hospitals stay period — 21 days, follow-up period — 6 months.

RESULTS: At the hospitalization stage, the groups did not differ in socio-demographic and main clinical parameters (p > 0.05). SOCRATES scores were higher in the control group 49.0 [47.0; 49.0] versus 48.0 [47.0; 49.0] (p = 0.040). At the stage of re-test before discharge, the main group showed an improvement in motivation according to SOCRATES and significantly outperformed the control group: 67.0 [65.3; 68.0] versus 50.0 [48.0; 53.8] points (p < 0.001). The main group had a longer duration of remission — 3.3 [0.5; 5.4] months versus 0.5 [0.4; 1.0] months (p = 0.001); fewer prescheduled discharges — 12.5% versus 50.0% (p = 0.001); more frequent visits to long-term therapy — 30.4% versus 8.9% (p = 0.01) and outpatient rehabilitation — 21.4% versus 1.8% (p = 0.001) respectively.

CONCLUSIONS: FT-activating intervention directed to stimulating reflection of anxious and positive aspects of the personal future, contributes to increase in duration of remission in the catamnesis, increases motivation and adherence to treatment in patients with addiction to narcotic psychostimulants.