The Effect of Cue-Exposure Combined with Episodic Future Thinking (CIREF) Intervention on Craving and Delay Discounting in Opioid Users Receiving Methadone Maintenance Treatment: A Pilot Study

The current study aimed to investigate the efficacy of drug cue-exposure combined with episodic future thinking (CIREF) on craving and Delay Discounting in a sample of individuals with opioid use history receiving Methadone Maintenance Treatment (MMT).

A randomized, double blinded clinical trial with a two arm parallel group designed of 28 Participants. Applying Python for the randomization.

This study will be performed in 4 one-hour sessions for four weeks with 28 subjects in one of the outpatient clinics for addiction treatment. After Initial and second screening, eligible individuals will be randomly allocated to trial and control groups. In the first session, momentary craving, craving in the past and delay discounting will be measured. Then, Individuals will be asked to generate opioid-related cues for 6 time intervals and rate each of them. (trial: 1 week, 1, 3, 6 months, and 1 year in future Control: 9,7,5 , Last 3, 1 and 11 days in the past). Cues which will receive normal score in arousal, valence, and vividness will be applied in the intervention. In second sessions, the cues will be presented again and 4 stages of EFT including simulation, prediction, Intention and Plan will be executed. At the end, the amount of craving and the value of procrastination will be measured again.

Inclusion Criteria: Individuals with a history of opioid use currently receiving Methadone maintenance treatment ≤ 150 mg Acquire normal score on the Beck Depression Inventory, Snaith-Hamilton Pleasure Scale and Montreal Cognitive Assessment in the initial Screening Ability to generate the opioid-related cues in the second screening Exclusion Criteria: Not having the mentioned criteria above

Episodic Future Thinking

Momentary Craving Craving in the past time frame Delay Discounting

After screening, participants meeting the required inclusion criteria will be randomly allocated to the intervention and the active control group through block randomization. The randomization list will be created using Python. In block randomization, there would be only six conditions in which two cells get “C” control and two cells get “T” trial for a block of four cells. As a result, the 6 outcomes will be as follows: 1: CCTT, 2: TTCC, 3: CTCT, 4: TCTC, 5: TCCT, 6: CTTC. Also, a number will be randomly assigned to each participant.

In the present study, after screening and randomization, individuals will be officially included in the study. In the first session of the intervention, a brief description of the study process by the examiner will be provided to the participant. They will then be given an informed consent form. The information contained in the informed consent form and how to spend the study will be fully explained to the participants. In the process of conducting the study, participants will be blind to the intervention received. It should be noted that the staff present at the outpatient clinic will be blind to the whole intervention process. These people are: nurse, psychologist, assistant and also the technical manager of the clinic. All data recorded during the intervention sessions will be stored in the computer of the outpatient clinic (the venue of the intervention sessions) in an encrypted folder that only the researcher has access to, and will be deleted after the intervention and follow-up sessions. At the end of the intervention sessions, only the data obtained from the questionnaires will be provided to the data analyzer.