Stress and Episodic Future Thinking: Effects on Temporal Window and Alcohol Demand

Stress is a key factor maintaining problematic alcohol use, but it is unclear how stress contributes to problematic use and how to intervene in the stress-alcohol relationship. This study views the stress-alcohol relationship through the lens of behavioral economics, or the study of how individuals make decisions. Reinforcer Pathology Theory explains the stress-alcohol relationship by positing that stress-related increases in preference for immediate rewards directly contribute to overvaluation of alcohol. This study tested the relationships between stress, preference for immediate rewards, and alcohol valuation. Further, this study tested if episodic future thinking (EFT), which involves vividly imagining personal future events, disrupts the link between stress and alcohol by increasing future-focus. Our hypotheses were: (1) the effect of self-reported stress on alcohol demand would be mediated by greater preference for immediate rewards; (2) EFT, as compared to an episodic recent thinking (ERT) condition, would decrease alcohol demand by increasing preferences for delayed rewards; and (3) EFT, as compared to ERT, would ameliorate the effect of stress on alcohol demand by increasing preferences for delayed rewards. 139 adults with problematic alcohol use completed an online survey assessing past month stress and in-the-moment stress. Each participant was randomly assigned to complete an EFT or ERT procedure. Then participants completed a delay-discounting task with EFT/ERT cue exposure to measure preference for immediate rewards and an alcohol purchase task to measure alcohol demand. Results indicate that past month stress was not associated with alcohol demand, either directly or indirectly via changes in preference for immediate rewards. However, higher in-the-moment stress was related to increased preference for immediate rewards, which contributed to higher alcohol demand. EFT increased preference for delayed rewards, which contributed to decreased alcohol demand. However, EFT did not reduce the effect of stress on preference for immediate rewards or buffer the indirect effect of stress on alcohol demand. Thus, EFT is unlikely to be uniquely effective for disrupting the stress-alcohol relationship, but equally, EFT’s efficacy in reducing alcohol demand appears unaffected by presence of stress. Findings emphasize independent, opposing roles of state stress and EFT in the behavioral economics underlying problematic alcohol use.