PROJECT SUMMARY / ABSTRACT We propose testing the ability of high-intensity future image cues to enhance future orientation, delayed reward preference, recovery self-efficacy, and elicit brain responses in persons in early recovery from alcohol use disorder (AUD). Impaired future orientation and delay-of-reward appear to be a behavioral endophenotype for AUD and other addictions. AUD also corresponds with increased sensation seeking (SS); that is, the need for stimuli that elicit arousal and are high in intensity, emotional salience, and novelty. With recovery attempts failing more often than succeeding within 6 months of treatment, there is considerable room for improved efficacy. Converging evidence indicates that impaired future visualization and planning is a hallmark of AUD, reflected experimentally as a greater devaluation of delayed rewards. By focusing attention on the exciting aspects of a personalized future, we will reorient decision-making to delayed outcomes and future prosocial rewards. Extending prior promising work on episodic future thinking, we will optimize the power of future cues by presenting personally relevant high-intensity cues. Our preliminary data strongly supports the power of a high-intensity intervention for shifting preference toward future outcomes. Further, the SS trait predicts responsiveness to high-intensity interventions and success in abstinence from alcohol/drugs. Episodic future thinking manipulations typically comprise references to anticipated events being presented during behavioral testing—often with sensory elaboration preceding the test. Here, we will explicitly test the efficacy of visual cues representing high-intensity future events, compared to control cues invoking low-intensity future events in a parallel trial. All cues will be elaborated with sensory elements, and presented during delay-of-reward decision-making to directly test their effects on temporal decision-making behavior. Aim 1 will test the effectiveness of high-intensity cues for increasing future reward preference, the association of the SS trait with recovery self-efficacy, and correlations of SS trait with the capacity for increased future reward preference. Aim 2 will demonstrate brain target engagement by showing greater midline and lateral default mode network involvement during delayed reward choice. To determine brain activation during an actual SS choice, we will test for reward activation in a novel behavioral SS task using odorant stimuli in real-time. We will additionally assess if functional connectivity between prospective and reward regions relates to behavioral SS. Brain activation will provide a neural signal that could be used as a predictive marker for treatment responders. We will also perform exploratory tests of the effects of SS and other impulsivity measures for moderation of episodic future thinking effects on temporal decision-making. Our major goals are to discover whether intensity is an ‘active ingredient’ for the episodic future thinking intervention, and how intensity effects can be leveraged to enhance positive outcomes in early AUD recovery. The potential impact of this knowledge is large, considering how it could inform interventions in the clinic for better outcomes.

PROJECT NARRATIVE The goal of this project is to use high-intensity visual cues to increase future orientation, increase delayed reward preference, and increase recovery self-efficacy by invoking highly salient anticipated future events in people in early recovery from alcohol use disorder—who tend to be high sensation seekers. By increasing future orientation, the intervention targets enhanced brain activation related to beneficial decision-making and positive future outcomes. The results of this study will provide vital information on the effectiveness and brain mechanisms of this intervention approach intended to facilitate better outcomes in early recovery from alcohol use disorder.