Substance use disorders (SUDs) are associated with impulsive behavior and risky decision making (Amlung et al., 2017, Ariesen et al., 2023, Finn, 2002, Verdejo-Garcia and Albein-Urios, 2021). Furthermore, impulsivity is associated with more severe alcohol problems (Coskunpinar et al., 2013, Gunn et al., 2013). SUDs, including alcohol use disorder (AUD), are associated with increased discounting of future monetary rewards in favor of smaller, immediate monetary rewards, a quintessential feature of impulsive decision making (Bailey et al., 2018, Bobova et al., 2009, Field et al., 2007, Gerst et al., 2017, Johnson et al., 2007, Petry, 2001). This general pattern of increased discounting of future reward value is thought to be reflected in AUD as a tendency to place greater weight on alcohol’s immediate reinforcing properties rather than the rewarding aspects of delayed and more adaptive and constructive rewards, such as academic, professional, interpersonal, and long-term health (Bickel et al., 2014, Finn, 2002). In fact, decision making studies suggest that AUD is associated with placing greater value (or demand) on alcohol compared with natural rewards (Hardy and Hogarth, 2017, Hogarth and Hardy, 2018) and during alcohol purchase tasks (Amlung et al., 2012, Murphy et al., 2014).

Available treatments for AUD include pharmacotherapies (e.g., acamprosate, naltrexone, disulfiram) which target components of alcohol-related reinforcement, motivation, and withdrawal, as well as psychosocial and behavioral interventions, including a number of brief motivational interventions such as BASICS (Baer et al., 2001, Dimeff et al., 1999), cognitive behavioral therapy, mindfulness, contingency management, couples/family counseling, and 12-step programs (Davis et al., 2016, Koob, 2024, Ray et al., 2019, Wackernah et al., 2014). BASICS as well as similar brief motivational interventions (BMIs) typically involve a single session with a motivational interviewing (MI) focus on individual drinking habits, alcohol expectancies, and misperceptions of social norms for drinking. BASICS and other BMIs are generally effective in reducing drinking in college students, although less so for heavy drinkers and other risk groups (Carey, Scott-Sheldon, Carey & DeMartini, 2007). Heavier drinking young adults who generally engage in risky, impulsive decisions regarding drinking often have poor self-control in general and difficulty regulating their behavior in certain contexts (Finn, 2002, Finn et al., 2017) and likely need more than a single MI focused session to see behavioral change. While BASICS is quite effective in reducing drinking in young adults who do not yet have a severe drinking problem, heavier drinkers, especially those who show poor self-control and risky, impulsive decision-making, likely need an intervention that more directly targets decision mechanisms, such as Impulsive Decision Reduction Training, that is presented in this paper. Furthermore, recent research highlights the fact that the majority of individuals with a SUD, especially young adults, do not get treatment (SAMSHA, 2023). A major issue is that only a very small percentage of people who need treatment actually perceive that they need treatment, leading to a low rate of treatment seeking (SAMSHA, 2023). We address this issue with IDRT by advertising for participants who want to make better decisions about drinking rather than for people seeking treatment for their alcohol problem per se. This likely increases the likelihood of people with AUD engaging in treatment for an aspect of their problem (their maladaptive decisions). AUD/SUDs are notoriously chronic conditions (Dennis et al., 2005, Ray et al., 2019), and a substantial portion of individuals with AUD have unmet treatment needs, given the existing provider workforce shortages (Koob, 2024, SAMSHA, 2023) and the modest effect size of existing treatments (Imel et al., 2008, Klemperer et al., 2018). The AUD field continues to call for the development of novel effective interventions (Koob, 2024, Ray et al., 2019).

As decision making plays a central role in heavy drinking, specific features, or mechanisms, associated with impulsive decision making in those with an AUD have been proposed as treatment targets, including delay discounting (Bickel et al., 2023, Weber et al., 2007), working memory processes (Finn et al., 2022, Gunn et al., 2018b), and attention (Gunn, Gerst, Lake, & Finn, 2018a). In particular, the association between excessive drinking and increased delay discounting, as well as the findings of Weber and colleagues (2007), has spurred new interventions targeting reduction of impulsive decision-making (measured as discounting of the future) as a means of reducing excessive drinking (Atance and O'Neill, 2001, Bulley and Gullo, 2017, Snider et al., 2016). Interventions such as Episodic Future Thinking (EFT; Atance & O'Neill, 2001) or using a virtual reality representation of one’s future self (VR-FS; Shen, Nelson & Oberlin, 2022) are designed to reduce the tendency to discount the future by orienting the decision maker’s attention toward future events. EFT has been associated with reduced delay discounting (Bulley and Gullo, 2017, Patel and Amlung, 2020, Snider et al., 2016), with reduced initial demand for alcohol on an Alcohol Purchase Task (Bulley and Gullo, 2017, Patel and Amlung, 2020, Snider et al., 2016, Voss et al., 2022), and in one study, with a reduction in alcohol consumption in heavy-drinking college students (Voss et al., 2022). Similarly, Shen and colleagues (2022) found that VR-FS that involved interacting with a VR version of a “recovered self” and a “substance using self” (presented 15 years in the future) was associated with reduced delay discounting and reduced drug craving. These promising studies suggest that enhancing future orientation (toward future events/selves) can reduce discounting of the future (on delay discounting decision tasks) and that this may reduce the perceived value of drinking alcohol, at least in the short term. We have developed a new intervention, called Impulsive Decision Reduction Training (IDRT), that extends the breadth of EFT and VR-FS by directly targeting the decision-making processes (noted above) involved in drinking decisions as well as promoting future orientation.

IDRT is based on our “process model” of decision making (Busemeyer and Townsend, 1993, Finn, 2002, Stout et al., 2005) which identifies four critical components in the multi-step decision process: (1) attending to choice options, (2) deliberation about those options and associated future outcomes, considering the future, and establishing a choice preference (also referred to as the decision drift process), (3) decision execution, and (4) post-decision processing and evaluation of decision outcomes (Busemeyer and Townsend, 1993, Stout et al., 2005, Ernst and Paulus, 2005, Finn, 2002). IDRT was designed to enhance a participant’s understanding of the decision-making process (psychoeducation), enhance future orientation, and enhance drinking decision-making skills such as deliberation post-decision processing. IDRT is described in detail in the manual (available online at: https://drive.google.com/file/d/1SGXAyCanE9ei3Wr6BRERA_-vRmo0k2fG/view?usp = sharing) and in the methods section below.

The purpose of this paper is to introduce IDRT and report its impact on drinking levels, delay discounting rates, and future orientation in a pilot study with binge drinking college students. In a case report, we showed that a version of IDRT, adapted for youth, was associated with reductions in impulsivity, substance use, and externalizing problems (Adams et al, 2024). We hypothesize that IDRT will reduce binge drinking (overall consumption) and delay discounting rates and increase future orientation.