Results from a Peer Recovery Coach-Delivered Future Orientation Intervention for Returning Citizens in Substance Use Treatment:  Feasibility and Preliminary Outcomes

Results from a Peer Recovery Coach-Delivered Future Orientation Intervention for Returning Citizens in Substance Use Treatment: Feasibility and Preliminary Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Results from a Peer Recovery Coach-Delivered Future Orientation Intervention for Returning Citizens in Substance Use Treatment: Feasibility and Preliminary Outcomes Salam Sulaiman, Richard Yi, Jennifer E. Johnson, Andre Johnson, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7983432/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Introduction: Returning citizens with substance use disorders (SUD) make numerous decisions that involve engaging in behaviors with short-term, immediate rewards (i.e. the pleasurable effects of returning to use) relative to those with longer-term, but delayed, benefits (i.e. engaging in treatment), often in the context of resource-poor and unstable environments. Successful navigation of the reentry period may require making future-oriented decisions; yet previous research suggests that incarcerated individuals and those with SUD evidence steeper rates of delay discounting, or tendency to devalue something as a function of the delay of its receipt. Episodic future thinking has been shown to reduce delay discounting and improve decision-making, suggesting it may be particularly well-suited to support healthy decision-making among justice-involved populations. The current study evaluated the implementation potential and preliminary effectiveness of an episodic future thinking intervention adapted for individuals during the reentry period to reduce delay discounting and improve related clinical outcomes. Method Returning citizens ( n = 40) who identified as in recovery from SUD and had experienced incarceration within 12 months prior to enrollment were recruited to participate in a randomized controlled trial. Participants received either a brief (60-minute) adapted episodic future thinking intervention or a control intervention that did not activate future thinking. Both interventions were administered by a peer recovery coach in a community setting. Participants then completed weekly check-ins for up to four weeks and were assessed one month after the intervention. Results Findings suggest that peer-delivered episodic future thinking was feasible and acceptable, and could be delivered with fidelity. Additionally, participants in the active condition experienced significant decreases in delay discounting, significant increases in considerations of future consequences, and increases in the presence of protective factors that may support longer-term recovery. Participants in the control condition did not experience changes in clinically-relevant outcomes. Conclusion Results of this study provide preliminary support for the implementation potential and effectiveness of brief, peer-delivered intervention focused on improving decision-making during the reentry period. Substance use Returning citizens Future orientation Treatment engagement Delay discounting Episodic Future Thinking Figures Figure 1 Introduction Prisons house nearly 1 million individuals at any given time in the United States (Zeng, 2019), the vast majority of whom will be released back into the community. Over half of these returning citizens meet criteria for a substance use disorder (SUD; (Karberg & James, 2005; Mumola & Karberg, 2006); yet, fewer than one-in-three formerly incarcerated individuals receives ongoing SUD treatment after release (Malik-Kane & Visher, 2008), placing them at higher risk for recidivism, relapse, overdose, and other poor health outcomes. Thus, there is a critical need to ensure that returning citizens who misuse substances make decisions that support effective navigation of the reentry environment, including engaging in appropriate, ongoing SUD services. The current study reports on a clinical trial that examined the implementation potential and preliminary effectiveness of a brief, scalable intervention for supporting healthy decision-making and (as an exploratory aim) retention in substance use treatment services during the reentry period. Decision-making during the reentry period. Returning citizens with SUD face several decisions that impact their ability to remain in recovery during the reentry period (the time directly following release from incarceration). Reentry is characterized by numerous demands, including finding housing, employment, and treatment services, many of which may be required as part of legal supervision (probation/parole). Returning citizens with a history of SUD are also often subject to monitoring related to substance use with severe penalties for lapse and relapse. Moreover, many returning citizens navigate these complex tasks with limited financial resources and social support (Mallik-Kane & Visher, 2008). As a result, returning citizens are often required to make decisions (including choices regarding engaging in illegal behaviors) that may have significant consequences (e.g. parole violations, reincarceration) in the context of a post-release environment marked by scarcity and instability. Compounding these challenges, resource-poor environments have been shown to negatively influence decision-making (Jacobs & Gottlieb, 2020). In settings which provide limited options and where the future seems uncertain, research has demonstrated that people are more likely to prefer smaller, but immediately available, rewards relative to larger, but delayed rewards, known as delay discounting (DD). According to life history theory (Stearns, 1992), natural selection processes shape the development of decision-making, such that unpredictable and resource-scare environments promote opportunistic behaviors (“ get what you can get, when you can get it ”). As scarcity and unpredictability increase, individuals’ time horizons decrease, focusing attention on doing things that will meet immediate needs even at the expense of longer-term outcomes or prioritizing ethical/legal behavior (Yang et al., 2023). Delay discounting and substance use among incarcerated individuals. Previous research also suggests that DD is associated with health-related outcomes, including multiple factors related to substance misuse. Higher DD is linked to earlier onset and more rapid increases in misusing substances (Audrain-McGovern et al., 2009; Felton et al., 2020) as well as greater severity of SUDs (Amlung et al., 2017). Additionally, higher DD is associated with worse treatment outcomes, including lower treatment readiness (i.e. motivation) (Stevens et al., 2015), worse response to treatment (Washio et al., 2011), greater rates of treatment drop-out (Stevens et al., 2015), and higher rates of relapse (Sheffer et al., 2014). In contrast, lower rates of DD are correlated with longer periods of abstinence (Athamneh et al., 2019) and positive SUD treatment outcomes (MacKillop & Kahler, 2009). Much less research has examined rates of DD among incarcerated individuals, but the existing literature suggests that this population more steeply discounts delayed rewards than non-incarcerated individuals (Trommsdorff et al., 1980). This association has been found even among incarcerated individuals who do not have an SUD, highlighting the relevance of DD to this population (Arantes et al., 2013) and its potential utility as a treatment target for returning citizens. Episodic Future Thinking. One approach to decreasing DD is episodic future thinking (EFT). EFT is the mental ability to vividly call to mind and imagine specific, personally relevant future events. It uses mental projection to create images of a future experience that are consistent with individuals’ desired future goals (Binswanger et al., 2013), and how these scenes may look and feel. A growing literature demonstrates that EFT can decrease rates of DD (Stein et al., 2016; Dassen et al., 2016) among both healthy (Bromberg et al., 2017) and clinical populations (Patel & Amlung, 2020). More recently, EFT has been used as an intervention component to target health behaviors associated with elevated DD. For instance, emerging evidence suggests that EFT-based interventions can reduce overeating (Daniel et al., 2015) and cigarette smoking (Stein et al., 2016). A recent systematic review of EFT-based interventions for substance use outcomes shows that, despite considerable heterogeneity across specific studies, there is a general trend for EFT to improve substance use outcomes (Collado & Stokes, 2024). However, to our knowledge, EFT interventions to improve treatment engagement have not been tested, despite evidence that elevated DD is linked to premature treatment termination. Additionally, this approach has not been examined during the reentry period, a vulnerable period for engaging in impulsive behaviors. Several aspects of EFT suggest its unique potential for implementation with returning citizen populations. EFT is a time- and resource- efficient approach (Rösch et al., 2022), most often delivered as a single-session intervention (e.g. Snider et al., 2016) ; Chiou & Wu, 2017). Because EFT is flexible and straight-forward, it has specific promise for delivery by peer recovery coaches (PRCs, also known as peer recovery specialists), state-certified individuals in sustained recovery who bring their experiences into the treatment team. PRCs have historically utilized primarily non-directive approaches while working with individuals in recovery, but recent research suggests that PRCs can be trained to deliver evidence-based interventions with fidelity to improve substance use treatment engagement (Magidson et al., 2022). PRCs are widely employed in community-based substance use treatment settings (Gagne et al., 2018) and most US states now reimburse for their services through Medicaid (Substance Abuse and Mental Health Services Administration, 2024), supporting future sustainability and scalability of PRC-delivered approaches. Additionally, research suggests that PRCs are experienced as less stigmatizing to work with than other specialized health providers (Anvari et al., 2022) and are perceived as more acceptable for engaging and retaining low-income and racial or ethnic minoritized clients (Reif et al., 2014). Given elevated rates of stigma among returning citizens who misuse substances (van Olphen et al., 2009), utilizing PRCs with similar lived experiences with incarceration to deliver EFT may further reduce stigma and other barriers to retention (Eddie et al., 2019). The current study. This study aimed to evaluate the implementation potential and preliminary effectiveness of a PRC-delivered EFT intervention to improve decision-making (i.e. reduce DD and increase individuals’ focus on the future) and, as an exploratory aim, improve ongoing SUD treatment engagement among returning citizens recruited from an outpatient treatment center, compared to a standardized episodic thinking (SET) intervention. This proof-of-concept project examined a manualized version of EFT, F uture- O riented C oaching for U nlocking recovery S uccess (FOCUS), that was co-designed with PRCs for implementation in a community-based SUD treatment setting. We conducted a randomized controlled trial to assess the feasibility, acceptability, and suitability of FOCUS for broader implementation. Additionally, we examined its potential to elongate individuals’ time horizon (including reducing DD and increasing consideration of future consequences) as our primary effectiveness aim. Related clinical outcomes, including reduced substance misuse and reincarceration, and improved recovery indicators and treatment retention, were also examined. Method Setting. Recruitment primarily took place at an outpatient SUD treatment center in Detroit, Michigan which provides services for a large number of justice-involved individuals, many of whom were court-ordered to receive treatment through the center. Among incarcerated individuals in Michigan broadly, almost two-thirds screen positive for drug dependence/misuse, with the vast majority eventually returning to community settings to receive treatment. The treatment center serves a predominantly low-income and racially diverse population, most (> 95%) of whom are insured through Medicaid. Clients are matched with PRCs at intake to receive regular PRC support, and provided an array of services, including individual and group counseling and peer-facilitated 12-step programs. Participants. Participants ( n = 40) were recruited from the treatment center using flyers displayed at the facility, announcements made at 12-step meetings, and/or approached directly to gauge interest in participating. Interested individuals were screened for eligibility prior to enrollment, including being: (1) at least 18 years of age, (2) having experienced incarceration within the last 12 months, (3) self-identifying as being in substance use recovery, (4) able to participate in written assessments and an intervention conducted in English, and (5) willing to receive check-ins from the PRC, either in-person or via phone call. Participants were excluded from the study if they self-reported active, untreated psychosis. Eligible and interested participants were then consented by research staff. Participant flow and retention are reported in Fig. 1 and demographic data is reported in Table 1 . Table 1 Demographic data for participants in the FOCUS and SET Conditions Total Sample ( n = 40) ETHoR ( n = 27) ERT ( n = 6) Participant sex (female) 30.0% 29.6% 66.7% Parent age in years, M (SD) 44.23 (10.38) 44.81 (10.87) 40.50 (5.89) Participant race/ethnicity White 25.0% 25.9% 33.3% Black 75.0% 74.1% 66.7% American Indian/Alaska Native 2.5% 3.7% 0% Other 2.5% 3.7% 0% Hispanic, Latine or of Spanish Origin 2.5% 3.7% 0% Current Employment Paid employment 37.5% 48.1% 16.7% Not employed, looking for work 37.5% 33.3% 33.3% Not employed, not looking for work 12.5% 11.1% 16.7% Not employed, looking for work in another occupation 0% 0% 0% Skipped 12.5% 7.4% 33.3% Total Household Income Less than $ 5,000 47.5% 44.4% 66.4% $ 5,000 through $ 11,999 15.0% 11.1% 16.7% $ 12,000 through $ 15,999 5.0% 3.7% 0% $ 16,000 through $ 24,999 12.5% 18.5% 0% $ 25,000 through $ 34,999 0% 0% 0% $ 35,000 through $ 49,999 12.5% 11.1% 16.7% $ 50,000 through $ 74,999 2.5% 3.7% 0% Skipped 5% 7.4% 0% Highest Grade Completed Less than high school 32.5% 37% 33.3% High school graduate/GED 35.0% 25.9% 50% Some college 32.5% 37% 16.7% College graduate 0% 0% 0% Master’s/Professional degree 0% 0% 0% Did not report 0% 0% 0% On Legal Supervision (Probation/Parole) 82.5% 85.2% 66.7% Mandated to Treatment 27.5% 33.3% 33.3% Table 1 Means, Standard Deviations, and Correlations among Key Study Variables 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.. 13. 14. 15. 16. 17. 18. 1. DD T1 1.00 .72 − .18 − .65 .19 − .10 .78 .88 − .14 − .53 − .66 − .54 − .97** − .80 − .31 − .30 − .26 − .96 2. DD T2 .72** 1.00 .55 − .65 .01 .22 .27 .87 − .08 − .17 − .75 − .48 − .31 − .65 .05 − .06 .27 − .77 3. CFC T1 − .71** − .45* 1.00 .34 − .11 .84 − .03 .50 .13 .83 − .22 − .12 .33 .43 .35 .72 .75 .18 4. CFC T2 − .64** − .47* .60** 1.00 .29 .12 − .68 − .17 .11 .28 .48 − .16 − .06 .85 .59 .90 .28 .49 5. DAST T1 .18 − .06 − .22 − .26 1.00 .94* − .17 .29 .80 .74 .55 .29 .01 .13 − .87* .70 .53 .91 6. DAST T2 − .27 − .27 − .11 .14 .69** 1.00 − .12 .20 .90 .90* .53 .37 .36 .25 − .84 .66 .98** .67 7. SMAST T1 .33 .38 − .001 − .45 .37 .16 1.00 .65 .32 − .07 − .38 − .34 .57 − .37 − .26 − .61 − .10 − .81 8. SMAST T2 .37 .38 − .46* − .56* .22 .05 .47* 1.00 .35 − .05 − .65 − .77 − .05 − .31 − .28 .12 .21 − .94 9. BAM Substance Use T1 .14 .31 − .13 − .17 .25 − .02 .19 .40 1.00 .91* .52 .10 .59 .37 − .75 .61 .68 .23 10.BAM Substance Use T2 .08 .16 − .28 − .06 .05 − .14 .03 .29 .87** 1.00 .76 .43 .64 .58 − .59 .71 .95* .58 11. BAM Risk Factors T1 .14 .16 − .31 − .06 .41* .39 .03 .19 .51** .39 1.00 .73 .34 .733 − .42 .60 .34 .88 12. BAM Risk Factors T2 .06 .26 − .04 − .05 − .09 .02 .02 .12 .26 .19 .54* 1.00 .10 .08 − .40 .03 .27 .77 13. BAM Protective Factors T1 − .19 − .20 .31 .05 − .08 .09 − .22 − .36 − .60** − .66* − .40* − .24 1.0 .48 − .11 .14 .47 − .12 14. BAM Protective Factors T2 − .26 − .36 .13 .44* − .11 .31 − .28 − .18 − .45* − .34 − .53* − .25 .44* 1.0 .31 .74 .42 .49 15. MAM Recovery Satisfaction T1 − .21 − .02 .40* − .01 − .23 − .05 .06 − .13 − .34 − .47* − .37 − .33 .58** − .003 1.0 − .18 − .27 − .30 16. MAM Recovery Satisfaction T2 − .23 − .23 .36 .51* − .07 .17 − .06 − .47* − .35 − .16 − .28 − .55* .14 .31 .34 1.0 .75 .69 17. MAM Recovery Confidence T1 − .24 − .19 .27 − .05 − .12 .18 − .10 − .24 − .68** − .73** − .50** − .46* .70** .38 .58** .27 1.0 .58 18. MAM Recovery Confidence T2 − .21 − .30 .28 .23 − .40 .01 − .16 − .32 − .81** − .67** − .58** − .33 .45* .47* .32 .41 .75** 1.0 FOCUS M (SD) − .90 (1.06) -1.50 (1.42) 4.36 (1.14) 5.00 (.89) 4.70 (3.52) 4.10 (3.65) 6.48 (2.81) 6.45 (2.70) 3.67 (2.96) 3.76 (2.66) 10.89 (3.67) 10.24 (4.73) 16.52 (4.88) 18.33 (5.27) 3.52 (1.16) 4.33 (.86) 4.19 (1.18) 4.62 (.81) SET M (SD) -1.26 (1.40) − .68 (1.98) 4.95 (.87) 4.14 (.34) 5.83 (3.43) 5.80 (4.02) 6.60 (2.19) 5.80 (3.42) 4.33 (2.66) 4.40 (2.30) 13.67 (6.12) 13.60 (7.09) 14.83 (3.87) 10.40 (4.16) 3.00 (1.41) 2.00 (1.23) 4.33 (1.03) 3.50 (1.73) Note. Sex was coded (0) female, (1) male; T1 = baseline, T2 = 1 month follow up; DD = Delay Discounting, CFC = Consideration of Future Consequences, DAST = Drug Abuse Screening Test, SMAST = Short Michigan Alcohol Screening Test, BAM = Brief Addiction Monitor, MAM = Monthly Addiction Monitor; * p < .05; ** p < .01. Design and Procedures. All procedures were approved by the [MASKED FOR REVIEW] IRB (IRB Approval #16686). Participants were randomized in a 3:1 ratio to receive either FOCUS ( n = 30) or the SET ( n = 10) comparison condition (detailed below) using block randomization without stratification. A random number generator created the randomization sequence. Condition was concealed until a research assistant pressed a “randomization” button within the data collection tool following participant enrollment. The study design and 3:1 allocation procedures were used to achieve our two study goals: first, to evaluate the feasibility of conducting a randomized control trial (RCT) of a peer-delivered intervention in a returning citizen population; and second, to be sufficiently powered to detect longitudinal changes in the FOCUS condition. An intent-to-treat approach was used, meaning that all participants were asked to contribute data at all assessment points regardless of previous engagement in study activities. Assessments were completed using an online data capture tool, REDCap, and were administered at baseline (immediately following consenting procedures) and at one-month following intervention delivery. Participants completed assessments in one session or multiple sessions as needed based on participants’ request, attention span, or time availability. Participants were informed they could skip any questions without penalty. Participants received $ 25 for completing the initial (baseline) assessment, $ 20 for completing additional assessment questions during the intervention, $ 5 for completing each check-in (detailed below), and $ 25 for completing the one-month follow-up assessment. Interventions. Participants met with interventionists (PRCs) either in-person in a private room or virtually via a secure web conferencing platform. Interventions were recorded with the permission of the participants for fidelity purposes. F uture- O riented C oaching for U nlocking recovery S uccess (FOCUS) Intervention. FOCUS is a brief (60–90 minute), PRC-delivered, single session manualized intervention that uses Episodic Future Thinking (EFT) to decrease rates of delay discounting. Using a codesign approach, the content of FOCUS was created collaboratively with PRCs, focusing on blending EFT techniques with the unique aspects of PRC delivery, including a focus on sharing PRCs’ lived experiences. The research team originally developed a brief outline of possible elements which was reviewed and discussed with stakeholders during three working group meetings comprised of ( n = 13) PRCs with a history of incarceration. The research team was responsible for adapting the delivery of the core components following each meeting and PRCs’ shared their feedback on subsequent drafts. The final intervention manual included three main components: (1) PRCs’ sharing their own experiences of incarceration and reentry; (2) a discussion of participants’ personal values; and (3) creation of EFTs based on those values. During the intervention, consistent with EFT procedures (Sofis et al., 2022 ), participants were asked to envision and verbally describe four specific events reflecting positive activities in which they engage in substance and incarceration-free activities that align with their values and take place at a future time point. Participants were encouraged to include as many contextual and emotional details as possible to create a clear image of the activity. After describing each event, participants were asked to rate the image on a scale from one to six for clarity, enjoyableness, importance, and excitement. Participants who rated their events three or less on any of the dimensions were asked to generate and rate a new event. Following the intervention, participants were scheduled for regular check-ins with the PRC to expand on their vision of these future events (encouraging additional future thinking). PRCs were trained to avoid discussing recent or current events during the check-in with the participant and to redirect the conversation to focus on future activities and events as needed. Check-ins were planned to occur two to three times weekly over a span of four to five weeks, for up to eight sessions, and were completed in-person or over the phone depending on participant preference. Comparison Condition. Participants randomized to the comparison condition received a standardized episodic thinking (SET) intervention. SET was designed by the research team to mirror the content of FOCUS without engaging prospective thinking. Components of the intervention included: (1) PRCs’ sharing their own experiences of incarceration and reentry; (2) identification of two positive things that have happened to participants recently (in the past day or two); and (3) identification of two negative events that happened recently. PRCs were trained to encourage participants to describe the recent positive and negative events with as much detail as possible, including contextual and emotional details. After identifying each event, participants were asked to rate the event on the same scale used in the FOCUS condition, with responses ranging from one to six for clarity, enjoyableness, importance, and excitement. Participants in the EFT condition only who rated their events three or less on any of the dimensions were asked to describe and rate a new recent event. Following the intervention, participants were scheduled for weekly check-ins with the PRC to discuss their identified recent events post intervention and continue to focus on the present. Check-ins were planned to occur two to three times weekly over a span of four to five weeks, for up to eight sessions and took place either in-person or over the phone. PRC Interventionist Training and Supervision. Three state-certified PRCs who worked at the recruitment site and had a personal history of incarceration were trained to deliver both FOCUS and SET. Each interventionist had experience working with clients in SUD recovery. PRC training included an in-depth walkthrough of the intervention manual, explanation of the manual content, and multiple, one-on-one mock intervention sessions with research study staff where they received feedback on their content delivery. The research study team provided weekly supervision to the interventionists which included review of randomly selected segments of participant intervention sessions. Interventionists received ongoing feedback on their sessions with participants and were scheduled to take part in additional mock intervention sessions as needed if drift from manual was detected. Additionally, interventionists used a “flipbook”-style (tented tri-fold) manual during the session, in which prompts and key points to cover were printed on one side (only visible to the interventionist) and relevant graphics and key words were printed on the other (visible to the participant). Outcome Measures Implementation Outcomes Implementation outcomes and benchmarks were identified a priori and guided by a framework developed by Proctor and colleagues (2011) that describes established implementation factors. For the current study, we focused on feasibility, acceptability, and fidelity. Feasibility and Acceptability. Feasibility was operationalized in the current study as ≥ 75% of enrolled participants completing the intervention. Acceptability was defined as at least ≥ 75% of participants who completed the intervention engaging in at least one check-in call (indicating interest in continuing to use future/recent thinking). Additionally, all participants completed the Client Satisfaction Questionnaire – 8 items (CSQ-8; (Larsen et al., 1979 ). The measure asks participants to reflect on their general satisfaction with the intervention. Items were slightly modified to accommodate the current populations and included questions such as “to what extent did the intervention meet your needs as a returning citizen?” Responses on items were averaged with higher scores reflecting greater satisfaction. The measure is widely used in treatment research and demonstrates adequate psychometric properties (CITE). In the current study, reliability was slightly below traditional cut-offs (coefficient alpha = .56). Fidelity . Fidelity was evaluated by coding intervention recordings. A checklist of required elements was created by the research team prior to the start of the trial. One of two independent raters then listened to each session and identified whether each element was delivered during the intervention. A proportion reflecting the number of elements that were delivered relative to the total number of required elements was created for each participant and averaged across all coded interventions. A benchmark of ≥ 75% was used to define delivery with fidelity. Effectiveness Outcomes (dup: abstract ?) Time Orientation. The 5-Trial Adjusting Delay Task (Koffarnus & Bickel, 2014 ) was used to assess participants’ rate of delay discounting. The task administers 5 trials of choices between a smaller but immediately available reward (e.g. $ 5) versus a larger, but delayed reward (e.g. $ 10 in two weeks). In each trial, the time delay is adjusted based on the participant’s previous response while the amounts stay fixed. Indifference points (the point at which the value of the smaller, sooner reward is perceived as approximately equal to the larger, later reward) were then used to calculate a rate of discounting ( k ) in which higher values reflect steeper rates of discounting (i.e. more impulsive responding). Because k values are typically skewed, a logarithmic transformation was applied prior to analysis. Participants’ consideration of the short-term vs long-term consequences of their potential behaviors was measured using the Consideration of Future Consequences – 14 item (CFC-14; (Joireman et al., 2012 ). Seven of the items ask participants about their immediate orientation (e.g. “I only act to satisfy immediate concerns, figuring the future will take care of itself”) and seven ask about their future orientation (e.g. “I consider how things might be in the future, and try to influence those things with my day to day behavior”). Participants are asked to rate how much each item relates to them on a 7-point Likert scale ranging from 1, “Not at all like you” to 7, “Very much like you.” Immediate-orientation items were then recoded and all items were summed to create an overall future orientation scale, with higher values reflecting greater overall orientation. The CFC-14 has demonstrated strong psychometric properties in other studies of adults (Nigro et al., 2016 ). Reliability in the current study was good at both baseline assessment (coefficient alpha = .85) and at one month follow-up (coefficient alpha = .78). Current Drug and Alcohol Use . The Short Michigan Alcohol Screening Test (SMAST; Selzer et al., 1975 ) and the Drug Abuse Screening Test (DAST-10; Skinner, 1982 ) were used to examine alcohol and drug use, respectively. The SMAST is a 13-item questionnaire of alcohol use (e.g. “do you feel that you are a normal drinker?”). Each question is answered either (0) No or (1) Yes. Items are then summed to create a total score in which higher values indicate more alcohol use problems. The SMAST is widely used in samples of adults in recovery (Walsh et al., 1991 ) and demonstrated adequate reliability in the current sample at baseline (KR-20 = .74) and one month follow-up (KR-20 = .71). The DAST-10 is a 10-item questionnaire that measures the individual’s involvement with drugs (aside from alcohol and tobacco) in the last year. Items include questions like “Have you used drugs other than those required for medical reasons?” and respondents answer (0) No or (1) Yes. Responses are summed to calculate a total score, with higher values suggesting greater drug use. The measure is commonly used in treatment-seeking samples (Roy-Byrne et al., 2014 ) and demonstrates strong psychometric properties (Yudko et al., 2007 ). In the current sample, reliability was adequate at both baseline (KR-20 = .75) and one month follow-up (KR-20 = .82). Recovery Risk and Protective Factors . The Brief Addiction Monitor (BAM; Cacciola et al., 2013) is a 17-item questionnaire which consists of 3 subscales: Substance Use, Risk Factors, and Protective Factors. The Substance Use subscale includes 3 items that ask about alcohol and drug use (e.g. “In the past 30 days, how many days did you drink ANY alcohol?”). The Risk Factors subscale includes six items that tap potential risk for misusing substances (e.g. “In the past 30 days, how many days have you experienced significant levels of pain that make it hard to do things you wanted to do?”). The Protective Factors subscales also includes 6 questions that assess factors that may mitigate cravings for substance use (e.g. “Does your religion or spirituality help support your recovery?”). Items for each subscale are summed to create subscale scores with higher values reflecting greater use, risk factors or protective factors, respectively. The measure demonstrates strong psychometric properties among adults who misuse substances (Cacciola et al., 2013b ). In the current sample, reliabilities at baseline for use (coefficient alpha = .74) and risk factors (coefficient alpha = .74) were adequate, while the reliability for the protective factors subscale was below traditional cut-offs (coefficient alpha = .57). At one month follow-up, the reliability for the use subscale was below cut-offs (coefficient alpha = .50) while the reliabilities for the risk (coefficient alpha = .88) and protective factors (coefficient alpha = .76) were adequate. Reincarceration and Treatment Engagement . Recidivism and treatment engagement were measured using items from the Monthly Addiction Monitor (MAM; Center for Research, Treatment & Recovery, n.d.). Reincarceration was assessed using two items: “Have you been arrested in the past 30 days?” and “Have you spent at least one night in jail in the past 30 days?” Item responses were coded as (1) yes or (0) no and were examined separately. Three aspects of treatment engagement were also evaluated using the MAM. First, treatment satisfaction was measured by asking: “How satisfied are you with your progress toward achieving your recovery goals in the past 30 days” with responses ranging from (1) not at all to (5) extremely. Second, confidence in recovery was assessed using the item: “In the next 30 days, how confident are you in your ability to be completely abstinent form substances?” with responses ranging from (1) not at all to (5) extremely. Finally, treatment engagement at one month follow-up was assessed by asking participants if they engaged in any of the following forms of treatment: “individual alcohol and drug abuse counseling sessions,” “group alcohol and drug counseling sessions,” and “self-help meetings like AA or NA to support your recovery.” Items were summed and dichotomized, such that engagement in any services was coded as (1), while engagement in no services was coded as (0). Data Analytic Plan Our primary analytic goals were to examine feasibility of conducting an RCT (including enrolling returning citizens into both the active and comparison condition) and to examine preliminary effectiveness of the FOCUS intervention in changing targeted mechanisms of risk for negative decision-making (participant time orientation). Related clinical outcomes were also examined as exploratory aims. First, descriptive statistics were used to evaluate implementation outcomes (feasibility, acceptability, and intervention delivery fidelity, described above). Next, changes in effectiveness were examined. The primary focus of these analyses was to examine longitudinal changes in the FOCUS condition; however, longitudinal analyses related to SET are included for completeness. Given the directionality of our hypotheses, we used one-tailed paired samples t -tests to evaluate changes from pre-intervention to one month follow-up in both conditions separately. We were underpowered to examine differences in pre- to post-intervention changes across groups. However, exploratory one-way repeated measures ANOVAs were also examined, in which baseline and one month follow-up assessments were our within-subjects factor and intervention condition was our between-subjects factor. Differences in any ongoing treatment engagement at follow-up between the FOCUS and SET groups were also explored using a Chi-Square Test of Independence. Results Participants Participant flow through the study is depicted by a CONSORT diagram in Fig. 1 . In total, 40 participants were enrolled, randomized into the RCT (33 to FOCUS and 7 to SET), and completed baseline assessments. Of those, 27 completed FOCUS and 6 completed SET. At one-month following the intervention, 21 participants from the FOCUS condition and 5 participants from the SET condition completed a follow-up assessment. Participant characteristics are presented in Table 1 . Most participants were currently on probation/parole. Participants reported that they had been incarcerated, on average, 4.5 times (range 1–15) and that they had been convicted of a crime, on average, 5.1 times (range 0–30). Respondents were also asked to self-identify which substances they misused over the past year. The majority (52.5%) of respondents identified alcohol, followed by cocaine (22.5%), cannabis (17.5%), prescription opioids (12.5%), heroin (10%), fentanyl (10%), and amphetamines (7.5%). Additionally, 17.5% reported that they had previously or are currently using medication to a treat opioid or alcohol use disorder. Implementation Outcomes Feasibility and Acceptability. Each of our measures of feasibility and acceptability surpassed the a priori benchmarks. With regard to feasibility, 83% of participants who enrolled in the study completed the intervention (82% in the FOCUS condition and 86% in the SET condition). Of the 33 participants who received either condition, 88% also took part in at least one check-in with a PRC interventionist (89% in the FOCUS condition and 83% in the SET condition). Overall ratings of satisfaction in both groups were high at one-month follow-up (FOCUS: M = 2.98, SD = .26; SET: M = 2.71, SD = .56). An independent samples t -test suggested marginally significant differences between the groups, indicating higher satisfaction in the FOCUS condition, t (24) = 1.60, p = .061. Fidelity. Due to technical problems, audio recordings were only available for 29 out of the 33 interventions completed. Interventionists delivered, on average, 95% of the required intervention elements, suggesting strong overall fidelity. Effectiveness Outcomes Means, standard deviations, and bivariate correlations for all key study variables (in both the FOCUS and SET conditions) are presented in Table 2. Delay Discounting and Future Orientation (Primary Outcomes). Changes in delay discounting were first evaluated utilizing paired-samples t-tests. Two participants in the FOCUS condition and one in the SET condition did not complete the measure and were therefore not included the analyses. Results suggest that participants in the FOCUS condition evidenced statistically significant decreases in rates of delay discounting, t (18) = 2.54, p = .010. No statistically significant differences were found in the analyses of the SET group: t (3) = .27, p = .403. Results of the exploratory repeated measures ANOVA analyses did not indicate a significant impact of intervention condition on changes in rates of delay discounting: F (1,21) = .820, p = .375. Next, we evaluated pre-post intervention change in the Consideration of Future Consequences Scale. One participant in each condition did not complete the measure. Examining differences in pre-post group means separately, we found statistically significant increases in considering future consequences among participants in the FOCUS condition: t (19) = -1.96, p = .032. Statistically significant differences were found among participants receiving the SET condition suggesting a decrease in considering future consequences: t (3) = 2.90, p = .031. Exploratory ANOVA results suggest a statistically significant effect of intervention condition on consideration of future consequences: F (1,22) = 6.08, p = .022. Substance Misuse (Secondary Outcome). One participant in the FOCUS condition and another in the SET condition did not complete the SMAST at follow-up. Examination of descriptive statistics suggest that self-reported substance misuse was low at both timepoints. At baseline, 77% of participants reported that they did not drink and 79% reported that they did not use drugs in the past 30 days. Rates of abstinence slightly decreased at follow-up, with 69% reporting not having had a drink and 64% reporting not using drugs in the past 30 days. Paired samples t-tests suggest non-significant decreases in the FOCUS group related to drug use (as measured by the DAST, t (20) = .90, p = .189) and alcohol use (as measured by the SMAST, t (19) = .31, p = .380). Similarly, no significant change was noted in the SET group for either drug use, t (4) = 1.21, p = .147 or alcohol use, t (3) = − .24, p = .412). Exploratory ANOVA results were also not statistically significant for drug use: F (1,24) = .03, p = .867 or alcohol use: F (1,22) = .09, p = .772. Addiction Severity (Secondary Outcome). Change from pre- to post-intervention for each of the three subscales of the Brief Addiction Monitor were examined separately by intervention group. No significant differences from pre- to post-intervention were found for either group for the Use or Risk Factors subscales; among the FOCUS group, Use subscale: t (20) = .134, p = .447 and Risk subscale: t (4) = .053, p = .478 and among the SET group, Use subscale: t (4) = .784, p = .238 and Risk subscale: t (4) = .540, p = .309. Pre-post differences were evident in the Protective Factors subscale. In the FOCUS group, participants reported increased protective factors, t (20) = -1.95, p = .032, while in the SET group, participants evidenced decreased protective factors, t (4) = .784, p = .238. Exploratory ANOVA results were not statistically significant for the Use subscale, F (1,24) = .207, p = .653 or the Risk Factors subscale, F (1,24) = .295, p = .592. Findings were significant for the Protective Factors subscale, suggesting that significant effects of intervention condition: F (1,24) = 6.52, p = .017. Reincarceration and Treatment Engagement (Secondary Outcome). Given the low rates of arrest and re-incarceration, we examined frequencies by intervention condition but did not statistically compare them. In the FOCUS condition at baseline, two participants reported having been arrested and three reported having spent at least one night in jail in the past 30 days. No one in the FOCUS condition reported arrest or jail detention at follow-up. In SET at baseline, no one reported past 30-day arrest and one reported past 30-day jail detention. One participant in the SET condition had spent a night in jail at follow-up. Next, we evaluated changes in satisfaction with personal recovery and confidence in future recovery. Paired samples t-tests by group suggest statistically significant increases in individuals’ satisfaction with their personal recovery: t (20) = -2.75, p = .006 and confidence in future recovery: t (20) = -2.42, p = .013 from pre- to post-intervention in the FOCUS group. There was no significant change in the SET condition for either satisfaction with personal recovery: t (4) = .74, p = .251 or confidence in future recovery: t (3) = 1.41, p = .126. Exploratory ANOVA results suggest a marginally significant impact of condition on respondents’ satisfaction with their personal recovery: F (1,24) = 4.04, p = .056 and statistically significant impact on their confidence in their future recovery efforts: F (1,24) = 8.24, p = .009. Finally, we examined differences in yes/no treatment engagement (in any of three modalities: individual or group therapy and/or peer-facilitated groups such as AA/NA) between intervention conditions following the intervention. At one month follow-up, 81.5% of participants in the FOCUS condition were engaged in treatment relative to 33.3% of SET participants. Results of the chi-square test suggest a significant association between intervention condition and treatment engagement, χ 2 (1) = 4.09, p = .043. Discussion This study examined the implementation potential and preliminary effectiveness of a brief, PRC-delivered intervention to improve decision-making and related correlates of successful recovery during reentry. Results suggest that the intervention (Future-Oriented Coaching for Unlocking recovery Success; FOCUS) is feasible and acceptable to implement in a returning citizens population and able to be delivered with fidelity by PRCs. Additionally, findings demonstrate that participants who received FOCUS evidenced decreases in delay discounting and increases in their consideration of future consequences. With regard to exploratory clinical outcomes, no changes in self-reported substance misuse were found; however, individuals in the FOCUS condition reported increases in other protective factors, including their satisfaction with, and confidence in, their personal recovery process. Finally, exploratory results suggest that participants in FOCUS were more likely to be engaged in ongoing substance use treatment one month after the intervention relative to individuals who received the comparison condition (standardized episodic thinking; SET). Foremost among these findings, our results suggest that delivering a PRC-administered intervention for returning citizens in a community-based treatment setting is feasible and acceptable. We found that clients were largely satisfied with the intervention and that PRCs evidenced high (95%) fidelity to the manual. These findings support other recent research (Felton et al., 2023 ; Magidson et al., 2022 ) demonstrating the potential for PRCs to play a role in increasing access to manualized, evidence-based treatment. Given that PRCs are one of the fastest growing workforces within the behavioral health field (Fortuna et al., 2022 ) and the potential cost-savings associated with utilizing non-specialists to deliver a brief intervention, these results highlight the potential for the scalability and sustainability of this approach. Findings from the current study also replicate other work demonstrating that EFT-based interventions have the potential to reduce DD and increase participants’ overall time horizon (Lin & Epstein, 2014 ) and impact substance use-related outcomes (Collado & Stokes, 2024 ). Results are among the first, however, to suggest that EFT may improve treatment engagement. Given that elevated DD is related to early treatment termination (Stevens et al., 2015 ) it may be that directly targeting DD increases participants’ ability to focus on longer-term rewards associated with ongoing treatment engagement. Findings are novel in demonstrating the utility of EFT in boosting protective factors associated with recovery (including confidence in maintaining their recovery and satisfaction with their progress). Future research is needed to examine whether EFT may support treatment engagement by increasing those factors associated with longer-term treatment retention (e.g. motivation, confidence, etc.). Although speculative, these results may also point to the potential for adding EFT elements to other established evidence-based approaches to increase treatment engagement for other DD-linked health disorders and maladaptive behaviors, such as overeating and gambling. Future studies are needed to explore whether the addition of an EFT component could strengthen retention outcomes in other interventions. Strengths, Limitations, and Future Directions. Strengths of the study include its engagement of a highly vulnerable population and the co-development of an intervention with the potential to be scaled and sustained in low-resource communities. Limitations include low rates of self-reported substance use at baseline and follow-up; thus, future research should consider including biochemical verification to ensure that outcomes were accurately reported. Second, we followed participants over a short timeframe. Future research is needed to evaluate whether treatment gains (including increased protective factors and engagement) are maintained over time. Third, because the goals of this research were to examine the feasibility of conducting this study and evaluating preliminary effectiveness in the active condition (FOCUS), our comparison condition was underpowered to detect intervention effects. Future research should seek to replicate these findings in a fully-powered RCT. Finally, because of our pre-post intervention design, we were not able to examine whether DD served as a mechanism of change (i.e. whether the changes in DD/future orientation drove increases in protective factors and treatment engagement). Future studies with multiple follow-up points, should examine whether DD is mechanistically linked to improved treatment outcomes. Conclusions. The current study provides preliminary support for the implementation and effectiveness of a brief, EFT-based intervention to support positive treatment outcomes for returning citizens in recovery. Given the high rates of substance misuse and overdose among individuals exiting incarceration, a brief, low-cost intervention that can be effectively delivered by PRCs has the potential to increase access to care and save lives during the reentry period. Future research should continue to explore non-specialist delivered EFT approaches to increase treatment engagement for this highly vulnerable population. Declarations Author Contribution S.S. and J.W.F. wrote the main manuscript text, R.Y., J.J. and J.W.F. contributed to the design of the study, A.J., A.K., J.J. and J.W.F. oversaw completion of study, A.A. drafted the tables, and A.B. contributed to the text. All authors reviewed the manuscript. Acknowledgement The authors wish to acknowledge Eddie Killing, Annette Dewbury, and Jennifer Light for their work and support on this project. Data Availability The datasets generated during the current study are available from the corresponding author at reasonable request. References Anvari, M. S., Kleinman, M. B., Massey, E. C., Bradley, V. D., Felton, J. W., Belcher, A. M., & Magidson, J. F. (2022). In their mind, they always felt less than: The role of peers in shifting stigma as a barrier to opioid use disorder treatment retention. Journal of Substance Abuse Treatment , 108721. Athamneh, L. N., DeHart, W. B., Pope, D., Mellis, A. M., Snider, S. E., Kaplan, B. A., & Bickel, W. K. (2019). 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Over half of these returning citizens meet criteria for a substance use disorder (SUD;\u0026nbsp;(Karberg \u0026amp; James, 2005; Mumola \u0026amp; Karberg, 2006); yet, fewer than one-in-three formerly incarcerated individuals receives ongoing SUD treatment after release\u0026nbsp;(Malik-Kane \u0026amp; Visher, 2008), placing them at higher risk for recidivism, relapse, overdose, and other poor health outcomes. Thus, there is a critical need to ensure that returning citizens who misuse substances make decisions that support effective navigation of the reentry environment, including engaging in appropriate, ongoing SUD services. The current study reports on a clinical trial that examined the implementation potential and preliminary effectiveness of a brief, scalable intervention for supporting healthy decision-making and (as an exploratory aim) retention in substance use treatment services during the reentry period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDecision-making during the reentry period.\u0026nbsp;\u003c/strong\u003eReturning citizens with SUD face several decisions that impact their ability to remain in recovery during the reentry period (the time directly following release from incarceration). Reentry is characterized by numerous demands, including finding housing, employment, and treatment services, many of which may be required as part of legal supervision (probation/parole). Returning citizens with a history of SUD are also often subject to monitoring related to substance use with severe penalties for lapse and relapse. \u0026nbsp;Moreover, many returning citizens navigate these complex tasks with limited financial resources and social support\u0026nbsp;(Mallik-Kane \u0026amp; Visher, 2008). As a result, returning citizens are often required to make decisions (including choices regarding engaging in illegal behaviors) that may have significant consequences (e.g. parole violations, reincarceration) in the context of a post-release environment marked by scarcity and instability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompounding these challenges, resource-poor environments have been shown to negatively influence decision-making (Jacobs \u0026amp; Gottlieb, 2020). In settings which provide limited options and where the future seems uncertain, research has demonstrated that people are more likely to prefer smaller, but immediately available, rewards relative to larger, but delayed rewards, known as \u003cem\u003edelay discounting\u003c/em\u003e (DD). According to life history theory\u0026nbsp;(Stearns, 1992), natural selection processes shape the development of decision-making, such that unpredictable and resource-scare environments promote opportunistic behaviors (“\u003cem\u003eget what you can get, when you can get it\u003c/em\u003e”). As scarcity and unpredictability increase, individuals’ time horizons decrease, focusing attention on doing things that will meet immediate needs even at the expense of longer-term outcomes or prioritizing ethical/legal behavior (Yang et al., 2023). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDelay discounting and substance use among incarcerated individuals.\u0026nbsp;\u003c/strong\u003ePrevious research also suggests that DD is associated with health-related outcomes, including multiple factors related to substance misuse. \u0026nbsp;Higher DD is linked to earlier onset and more rapid increases in misusing substances (Audrain-McGovern et al., 2009; Felton et al., 2020) as well as greater severity of SUDs (Amlung et al., 2017). Additionally, higher DD is associated with worse treatment outcomes, including lower treatment readiness (i.e. motivation) (Stevens et al., 2015), worse response to treatment (Washio et al., 2011), greater rates of treatment drop-out (Stevens et al., 2015), and higher rates of relapse (Sheffer et al., 2014). In contrast, lower rates of DD are correlated with longer periods of abstinence\u0026nbsp;(Athamneh et al., 2019)\u0026nbsp;and positive SUD treatment outcomes\u0026nbsp;(MacKillop \u0026amp; Kahler, 2009).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMuch less research has examined rates of DD among incarcerated individuals, but the existing literature suggests that this population more steeply discounts delayed rewards than non-incarcerated individuals (Trommsdorff et al., 1980). This association has been found even among incarcerated individuals who do not have an SUD, highlighting the relevance of DD to this population (Arantes et al., 2013) and its potential utility as a treatment target for returning citizens.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEpisodic Future Thinking.\u0026nbsp;\u003c/strong\u003eOne approach to decreasing DD is episodic future thinking (EFT). EFT is the mental ability to vividly call to mind and imagine specific, personally relevant future events. It uses mental projection to create images of a future experience that are consistent with individuals’ desired future goals (Binswanger et al., 2013), and how these scenes may look and feel. A growing literature demonstrates that EFT can decrease rates of DD (Stein et al., 2016; Dassen et al., 2016) among both healthy (Bromberg et al., 2017) and clinical populations\u0026nbsp;(Patel \u0026amp; Amlung, 2020). More recently, EFT has been used as an intervention component to target health behaviors associated with elevated DD. For instance, emerging evidence suggests that EFT-based interventions can reduce overeating\u0026nbsp;(Daniel et al., 2015)\u0026nbsp;and cigarette smoking\u0026nbsp;(Stein et al., 2016). A recent systematic review of EFT-based interventions for substance use outcomes shows that, despite considerable heterogeneity across specific studies, there is a general trend for EFT to improve substance use outcomes\u0026nbsp;(Collado \u0026amp; Stokes, 2024). However, to our knowledge, EFT interventions to improve treatment engagement have not been tested, despite evidence that elevated DD is linked to premature treatment termination. Additionally, this approach has not been examined during the reentry period, a vulnerable period for engaging in impulsive behaviors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral aspects of EFT suggest its unique potential for implementation with returning citizen populations. EFT is a time- and resource- efficient approach (Rösch et al., 2022), most often delivered as a single-session intervention (e.g. Snider et al., 2016)\u0026nbsp;;\u0026nbsp;Chiou \u0026amp; Wu, 2017). \u0026nbsp;Because EFT is flexible and straight-forward, it has specific promise for delivery by peer recovery coaches (PRCs, also known as peer recovery specialists),\u0026nbsp;state-certified individuals in sustained recovery who bring their experiences into the treatment team. PRCs have historically utilized primarily non-directive approaches while working with individuals in recovery, but recent research suggests that PRCs can be trained to deliver evidence-based interventions with fidelity to improve substance use treatment engagement (Magidson et al., 2022). \u0026nbsp;PRCs are widely employed in community-based substance use treatment settings\u0026nbsp;(Gagne et al., 2018)\u0026nbsp;and most US states now reimburse for their services through Medicaid\u0026nbsp;(Substance Abuse and Mental Health Services Administration, 2024), supporting future sustainability and scalability of PRC-delivered approaches. Additionally, research suggests that PRCs are experienced as less stigmatizing to work with than other specialized health providers\u0026nbsp;(Anvari et al., 2022)\u0026nbsp;and are perceived as\u0026nbsp;more acceptable for engaging and retaining low-income and racial or ethnic minoritized clients (Reif et al., 2014). Given elevated rates of stigma among returning citizens who misuse substances\u0026nbsp;(van Olphen et al., 2009), utilizing PRCs with similar lived experiences with incarceration to deliver EFT may further reduce stigma and other barriers to retention (Eddie et al., 2019).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe current study.\u0026nbsp;\u003c/strong\u003eThis study aimed to evaluate the implementation potential and preliminary effectiveness of a PRC-delivered EFT intervention to improve decision-making (i.e. reduce DD and increase individuals’ focus on the future) and, as an exploratory aim, improve ongoing SUD treatment engagement among returning citizens recruited from an outpatient treatment center, compared to a standardized episodic thinking (SET) intervention. This proof-of-concept project examined a manualized version of EFT, \u003cu\u003eF\u003c/u\u003euture-\u003cu\u003eO\u003c/u\u003eriented \u003cu\u003eC\u003c/u\u003eoaching for \u003cu\u003eU\u003c/u\u003enlocking recovery \u003cu\u003eS\u003c/u\u003euccess (FOCUS), that was co-designed with PRCs for implementation in a community-based SUD treatment setting. We conducted a randomized controlled trial to assess the feasibility, acceptability, and suitability of FOCUS for broader implementation. Additionally, we examined its potential to elongate individuals’ time horizon (including reducing DD and increasing consideration of future consequences) as our primary effectiveness aim. Related clinical outcomes, including reduced substance misuse and reincarceration, and improved recovery indicators and treatment retention, were also examined.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cb\u003eSetting.\u003c/b\u003e Recruitment primarily took place at an outpatient SUD treatment center in Detroit, Michigan which provides services for a large number of justice-involved individuals, many of whom were court-ordered to receive treatment through the center. Among incarcerated individuals in Michigan broadly, almost two-thirds screen positive for drug dependence/misuse, with the vast majority eventually returning to community settings to receive treatment. The treatment center serves a predominantly low-income and racially diverse population, most (\u0026gt;\u0026thinsp;95%) of whom are insured through Medicaid. Clients are matched with PRCs at intake to receive regular PRC support, and provided an array of services, including individual and group counseling and peer-facilitated 12-step programs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants.\u003c/b\u003e Participants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;40) were recruited from the treatment center using flyers displayed at the facility, announcements made at 12-step meetings, and/or approached directly to gauge interest in participating. Interested individuals were screened for eligibility prior to enrollment, including being: (1) at least 18 years of age, (2) having experienced incarceration within the last 12 months, (3) self-identifying as being in substance use recovery, (4) able to participate in written assessments and an intervention conducted in English, and (5) willing to receive check-ins from the PRC, either in-person or via phone call. Participants were excluded from the study if they self-reported active, untreated psychosis. Eligible and interested participants were then consented by research staff. Participant flow and retention are reported in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and demographic data is reported in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic data for participants in the FOCUS and SET Conditions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Sample (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eETHoR\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eERT\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant sex (female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParent age in years, \u003cem\u003eM\u003c/em\u003e (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.23\u003c/p\u003e\u003cp\u003e(10.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.81 (10.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.50 (5.89)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant race/ethnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmerican Indian/Alaska Native\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic, Latine or of Spanish Origin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePaid employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot employed, looking for work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot employed, not looking for work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot employed, looking for work in another occupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkipped\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Household Income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than \u003cspan\u003e$\u003c/span\u003e5,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e5,000 through \u003cspan\u003e$\u003c/span\u003e11,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e12,000 through \u003cspan\u003e$\u003c/span\u003e15,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e16,000 through \u003cspan\u003e$\u003c/span\u003e24,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e25,000 through \u003cspan\u003e$\u003c/span\u003e34,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e35,000 through \u003cspan\u003e$\u003c/span\u003e49,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e50,000 through \u003cspan\u003e$\u003c/span\u003e74,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkipped\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHighest Grade Completed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school graduate/GED\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSome college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollege graduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaster\u0026rsquo;s/Professional degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDid not report\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOn Legal Supervision (Probation/Parole)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMandated to Treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMeans, Standard Deviations, and Correlations among Key Study Variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"19\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e8.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e9.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e10.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e11.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e12..\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003e13.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003e14.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c16\"\u003e\u003cp\u003e15.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c17\"\u003e\u003cp\u003e16.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c18\"\u003e\u003cp\u003e17.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c19\"\u003e\u003cp\u003e18.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. DD T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.97**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. DD T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.72**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. CFC T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.71**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.45*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. CFC T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.64**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.47*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.60**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. DAST T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.94*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.87*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. DAST T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.69**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.90*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.98**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. SMAST T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. SMAST T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.46*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.56*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.47*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. BAM Substance Use T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.91*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10.BAM Substance Use T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.87**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.95*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11. BAM Risk Factors T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.41*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.51**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.733\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12. BAM Risk Factors T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.54*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13. BAM Protective Factors T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.60**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.66*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.40*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14. BAM Protective Factors T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.44*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.45*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.53*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.44*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15. MAM Recovery Satisfaction T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.40*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.47*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.58**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16. MAM Recovery Satisfaction T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.51*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.47*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.55*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17. MAM Recovery Confidence T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.68**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.73**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.50**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.46*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.70**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e.58**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18. MAM Recovery Confidence T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.81**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.67**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.58**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e.45*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e.47*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e.75**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFOCUS M (SD)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.90\u003c/p\u003e\u003cp\u003e(1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.50\u003c/p\u003e\u003cp\u003e(1.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.36\u003c/p\u003e\u003cp\u003e(1.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003cp\u003e(.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.70\u003c/p\u003e\u003cp\u003e(3.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.10\u003c/p\u003e\u003cp\u003e(3.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6.48\u003c/p\u003e\u003cp\u003e(2.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6.45\u003c/p\u003e\u003cp\u003e(2.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.67\u003c/p\u003e\u003cp\u003e(2.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3.76\u003c/p\u003e\u003cp\u003e(2.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e10.89\u003c/p\u003e\u003cp\u003e(3.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e10.24\u003c/p\u003e\u003cp\u003e(4.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e16.52\u003c/p\u003e\u003cp\u003e(4.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e18.33\u003c/p\u003e\u003cp\u003e(5.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e3.52\u003c/p\u003e\u003cp\u003e(1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e4.33\u003c/p\u003e\u003cp\u003e(.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e4.19\u003c/p\u003e\u003cp\u003e(1.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e4.62\u003c/p\u003e\u003cp\u003e(.81)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eSET M (SD)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.26\u003c/p\u003e\u003cp\u003e(1.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.68\u003c/p\u003e\u003cp\u003e(1.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.95\u003c/p\u003e\u003cp\u003e(.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.14\u003c/p\u003e\u003cp\u003e(.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.83\u003c/p\u003e\u003cp\u003e(3.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.80\u003c/p\u003e\u003cp\u003e(4.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6.60\u003c/p\u003e\u003cp\u003e(2.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e5.80\u003c/p\u003e\u003cp\u003e(3.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4.33\u003c/p\u003e\u003cp\u003e(2.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e4.40\u003c/p\u003e\u003cp\u003e(2.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e13.67\u003c/p\u003e\u003cp\u003e(6.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e13.60\u003c/p\u003e\u003cp\u003e(7.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e14.83\u003c/p\u003e\u003cp\u003e(3.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e10.40\u003c/p\u003e\u003cp\u003e(4.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003cp\u003e(1.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003cp\u003e(1.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e4.33\u003c/p\u003e\u003cp\u003e(1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e3.50\u003c/p\u003e\u003cp\u003e(1.73)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"19\"\u003e\u003cem\u003eNote.\u003c/em\u003e Sex was coded (0) female, (1) male; T1\u0026thinsp;=\u0026thinsp;baseline, T2\u0026thinsp;=\u0026thinsp;1 month follow up; DD\u0026thinsp;=\u0026thinsp;Delay Discounting, CFC\u0026thinsp;=\u0026thinsp;Consideration of Future Consequences, DAST\u0026thinsp;=\u0026thinsp;Drug Abuse Screening Test, SMAST\u0026thinsp;=\u0026thinsp;Short Michigan Alcohol Screening Test, BAM\u0026thinsp;=\u0026thinsp;Brief Addiction Monitor, MAM\u0026thinsp;=\u0026thinsp;Monthly Addiction Monitor; *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05; **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDesign and Procedures.\u003c/b\u003e All procedures were approved by the [MASKED FOR REVIEW] IRB (IRB Approval #16686). Participants were randomized in a 3:1 ratio to receive either FOCUS (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30) or the SET (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10) comparison condition (detailed below) using block randomization without stratification. A random number generator created the randomization sequence. Condition was concealed until a research assistant pressed a \u0026ldquo;randomization\u0026rdquo; button within the data collection tool following participant enrollment. The study design and 3:1 allocation procedures were used to achieve our two study goals: first, to evaluate the feasibility of conducting a randomized control trial (RCT) of a peer-delivered intervention in a returning citizen population; and second, to be sufficiently powered to detect longitudinal changes in the FOCUS condition. An intent-to-treat approach was used, meaning that all participants were asked to contribute data at all assessment points regardless of previous engagement in study activities. Assessments were completed using an online data capture tool, REDCap, and were administered at baseline (immediately following consenting procedures) and at one-month following intervention delivery. Participants completed assessments in one session or multiple sessions as needed based on participants\u0026rsquo; request, attention span, or time availability. Participants were informed they could skip any questions without penalty. Participants received \u003cspan\u003e$\u003c/span\u003e25 for completing the initial (baseline) assessment, \u003cspan\u003e$\u003c/span\u003e20 for completing additional assessment questions during the intervention, \u003cspan\u003e$\u003c/span\u003e5 for completing each check-in (detailed below), and \u003cspan\u003e$\u003c/span\u003e25 for completing the one-month follow-up assessment.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInterventions.\u003c/b\u003e Participants met with interventionists (PRCs) either in-person in a private room or virtually via a secure web conferencing platform. Interventions were recorded with the permission of the participants for fidelity purposes.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eF\u003c/span\u003e\u003cb\u003euture-\u003c/b\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eO\u003c/span\u003e\u003cb\u003eriented\u003c/b\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eC\u003c/span\u003e\u003cb\u003eoaching for\u003c/b\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eU\u003c/span\u003e\u003cb\u003enlocking recovery\u003c/b\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eS\u003c/span\u003e\u003cb\u003euccess (FOCUS) Intervention.\u003c/b\u003e FOCUS is a brief (60\u0026ndash;90 minute), PRC-delivered, single session manualized intervention that uses Episodic Future Thinking (EFT) to decrease rates of delay discounting. Using a codesign approach, the content of FOCUS was created collaboratively with PRCs, focusing on blending EFT techniques with the unique aspects of PRC delivery, including a focus on sharing PRCs\u0026rsquo; lived experiences. The research team originally developed a brief outline of possible elements which was reviewed and discussed with stakeholders during three working group meetings comprised of (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13) PRCs with a history of incarceration. The research team was responsible for adapting the delivery of the core components following each meeting and PRCs\u0026rsquo; shared their feedback on subsequent drafts. The final intervention manual included three main components: (1) PRCs\u0026rsquo; sharing their own experiences of incarceration and reentry; (2) a discussion of participants\u0026rsquo; personal values; and (3) creation of EFTs based on those values.\u003c/p\u003e\u003cp\u003eDuring the intervention, consistent with EFT procedures (Sofis et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), participants were asked to envision and verbally describe four specific events reflecting positive activities in which they engage in substance and incarceration-free activities that align with their values and take place at a future time point. Participants were encouraged to include as many contextual and emotional details as possible to create a clear image of the activity. After describing each event, participants were asked to rate the image on a scale from one to six for clarity, enjoyableness, importance, and excitement. Participants who rated their events three or less on any of the dimensions were asked to generate and rate a new event. Following the intervention, participants were scheduled for regular check-ins with the PRC to expand on their vision of these future events (encouraging additional future thinking). PRCs were trained to avoid discussing recent or current events during the check-in with the participant and to redirect the conversation to focus on future activities and events as needed. Check-ins were planned to occur two to three times weekly over a span of four to five weeks, for up to eight sessions, and were completed in-person or over the phone depending on participant preference.\u003c/p\u003e\u003cp\u003e\u003cb\u003eComparison Condition.\u003c/b\u003e Participants randomized to the comparison condition received a standardized episodic thinking (SET) intervention. SET was designed by the research team to mirror the content of FOCUS without engaging prospective thinking. Components of the intervention included: (1) PRCs\u0026rsquo; sharing their own experiences of incarceration and reentry; (2) identification of two positive things that have happened to participants recently (in the past day or two); and (3) identification of two negative events that happened recently. PRCs were trained to encourage participants to describe the recent positive and negative events with as much detail as possible, including contextual and emotional details. After identifying each event, participants were asked to rate the event on the same scale used in the FOCUS condition, with responses ranging from one to six for clarity, enjoyableness, importance, and excitement. Participants in the EFT condition only who rated their events three or less on any of the dimensions were asked to describe and rate a new recent event. Following the intervention, participants were scheduled for weekly check-ins with the PRC to discuss their identified recent events post intervention and continue to focus on the present. Check-ins were planned to occur two to three times weekly over a span of four to five weeks, for up to eight sessions and took place either in-person or over the phone.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePRC Interventionist Training and Supervision.\u003c/b\u003e Three state-certified PRCs who worked at the recruitment site and had a personal history of incarceration were trained to deliver both FOCUS and SET. Each interventionist had experience working with clients in SUD recovery. PRC training included an in-depth walkthrough of the intervention manual, explanation of the manual content, and multiple, one-on-one mock intervention sessions with research study staff where they received feedback on their content delivery. The research study team provided weekly supervision to the interventionists which included review of randomly selected segments of participant intervention sessions. Interventionists received ongoing feedback on their sessions with participants and were scheduled to take part in additional mock intervention sessions as needed if drift from manual was detected. Additionally, interventionists used a \u0026ldquo;flipbook\u0026rdquo;-style (tented tri-fold) manual during the session, in which prompts and key points to cover were printed on one side (only visible to the interventionist) and relevant graphics and key words were printed on the other (visible to the participant).\u003c/p\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eImplementation Outcomes\u003c/h2\u003e\u003cp\u003eImplementation outcomes and benchmarks were identified \u003cem\u003ea priori\u003c/em\u003e and guided by a framework developed by Proctor and colleagues (2011) that describes established implementation factors. For the current study, we focused on feasibility, acceptability, and fidelity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFeasibility and Acceptability.\u003c/b\u003e Feasibility was operationalized in the current study as \u0026ge;\u0026thinsp;75% of enrolled participants completing the intervention. Acceptability was defined as at least\u0026thinsp;\u0026ge;\u0026thinsp;75% of participants who completed the intervention engaging in at least one check-in call (indicating interest in continuing to use future/recent thinking). Additionally, all participants completed the Client Satisfaction Questionnaire \u0026ndash; 8 items (CSQ-8; (Larsen et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1979\u003c/span\u003e). The measure asks participants to reflect on their general satisfaction with the intervention. Items were slightly modified to accommodate the current populations and included questions such as \u0026ldquo;to what extent did the intervention meet your needs as a returning citizen?\u0026rdquo; Responses on items were averaged with higher scores reflecting greater satisfaction. The measure is widely used in treatment research and demonstrates adequate psychometric properties (CITE). In the current study, reliability was slightly below traditional cut-offs (coefficient alpha\u0026thinsp;=\u0026thinsp;.56).\u003c/p\u003e\u003cp\u003e\u003cb\u003eFidelity\u003c/b\u003e. Fidelity was evaluated by coding intervention recordings. A checklist of required elements was created by the research team prior to the start of the trial. One of two independent raters then listened to each session and identified whether each element was delivered during the intervention. A proportion reflecting the number of elements that were delivered relative to the total number of required elements was created for each participant and averaged across all coded interventions. A benchmark of \u0026ge;\u0026thinsp;75% was used to define delivery with fidelity.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEffectiveness Outcomes (dup: abstract ?)\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eTime Orientation.\u003c/b\u003e The 5-Trial Adjusting Delay Task (Koffarnus \u0026amp; Bickel, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) was used to assess participants\u0026rsquo; rate of delay discounting. The task administers 5 trials of choices between a smaller but immediately available reward (e.g. \u003cspan\u003e$\u003c/span\u003e5) versus a larger, but delayed reward (e.g. \u003cspan\u003e$\u003c/span\u003e10 in two weeks). In each trial, the time delay is adjusted based on the participant\u0026rsquo;s previous response while the amounts stay fixed. Indifference points (the point at which the value of the smaller, sooner reward is perceived as approximately equal to the larger, later reward) were then used to calculate a rate of discounting (\u003cem\u003ek\u003c/em\u003e) in which higher values reflect steeper rates of discounting (i.e. more impulsive responding). Because \u003cem\u003ek\u003c/em\u003e values are typically skewed, a logarithmic transformation was applied prior to analysis.\u003c/p\u003e\u003cp\u003eParticipants\u0026rsquo; consideration of the short-term vs long-term consequences of their potential behaviors was measured using the Consideration of Future Consequences \u0026ndash; 14 item (CFC-14; (Joireman et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Seven of the items ask participants about their immediate orientation (e.g. \u0026ldquo;I only act to satisfy immediate concerns, figuring the future will take care of itself\u0026rdquo;) and seven ask about their future orientation (e.g. \u0026ldquo;I consider how things might be in the future, and try to influence those things with my day to day behavior\u0026rdquo;). Participants are asked to rate how much each item relates to them on a 7-point Likert scale ranging from 1, \u0026ldquo;Not at all like you\u0026rdquo; to 7, \u0026ldquo;Very much like you.\u0026rdquo; Immediate-orientation items were then recoded and all items were summed to create an overall future orientation scale, with higher values reflecting greater overall orientation. The CFC-14 has demonstrated strong psychometric properties in other studies of adults (Nigro et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Reliability in the current study was good at both baseline assessment (coefficient alpha\u0026thinsp;=\u0026thinsp;.85) and at one month follow-up (coefficient alpha\u0026thinsp;=\u0026thinsp;.78).\u003c/p\u003e\u003cp\u003e\u003cb\u003eCurrent Drug and Alcohol Use\u003c/b\u003e. The Short Michigan Alcohol Screening Test (SMAST; Selzer et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e1975\u003c/span\u003e) and the Drug Abuse Screening Test (DAST-10; Skinner, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e1982\u003c/span\u003e) were used to examine alcohol and drug use, respectively. The SMAST is a 13-item questionnaire of alcohol use (e.g. \u0026ldquo;do you feel that you are a normal drinker?\u0026rdquo;). Each question is answered either (0) No or (1) Yes. Items are then summed to create a total score in which higher values indicate more alcohol use problems. The SMAST is widely used in samples of adults in recovery (Walsh et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e1991\u003c/span\u003e) and demonstrated adequate reliability in the current sample at baseline (KR-20\u0026thinsp;=\u0026thinsp;.74) and one month follow-up (KR-20\u0026thinsp;=\u0026thinsp;.71).\u003c/p\u003e\u003cp\u003eThe DAST-10 is a 10-item questionnaire that measures the individual\u0026rsquo;s involvement with drugs (aside from alcohol and tobacco) in the last year. Items include questions like \u0026ldquo;Have you used drugs other than those required for medical reasons?\u0026rdquo; and respondents answer (0) No or (1) Yes. Responses are summed to calculate a total score, with higher values suggesting greater drug use. The measure is commonly used in treatment-seeking samples (Roy-Byrne et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and demonstrates strong psychometric properties (Yudko et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). In the current sample, reliability was adequate at both baseline (KR-20\u0026thinsp;=\u0026thinsp;.75) and one month follow-up (KR-20\u0026thinsp;=\u0026thinsp;.82).\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecovery Risk and Protective Factors\u003c/b\u003e. The Brief Addiction Monitor (BAM; Cacciola et al., 2013) is a 17-item questionnaire which consists of 3 subscales: Substance Use, Risk Factors, and Protective Factors. The Substance Use subscale includes 3 items that ask about alcohol and drug use (e.g. \u0026ldquo;In the past 30 days, how many days did you drink ANY alcohol?\u0026rdquo;). The Risk Factors subscale includes six items that tap potential risk for misusing substances (e.g. \u0026ldquo;In the past 30 days, how many days have you experienced significant levels of pain that make it hard to do things you wanted to do?\u0026rdquo;). The Protective Factors subscales also includes 6 questions that assess factors that may mitigate cravings for substance use (e.g. \u0026ldquo;Does your religion or spirituality help support your recovery?\u0026rdquo;). Items for each subscale are summed to create subscale scores with higher values reflecting greater use, risk factors or protective factors, respectively. The measure demonstrates strong psychometric properties among adults who misuse substances (Cacciola et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2013b\u003c/span\u003e). In the current sample, reliabilities at baseline for use (coefficient alpha\u0026thinsp;=\u0026thinsp;.74) and risk factors (coefficient alpha\u0026thinsp;=\u0026thinsp;.74) were adequate, while the reliability for the protective factors subscale was below traditional cut-offs (coefficient alpha\u0026thinsp;=\u0026thinsp;.57). At one month follow-up, the reliability for the use subscale was below cut-offs (coefficient alpha\u0026thinsp;=\u0026thinsp;.50) while the reliabilities for the risk (coefficient alpha\u0026thinsp;=\u0026thinsp;.88) and protective factors (coefficient alpha\u0026thinsp;=\u0026thinsp;.76) were adequate.\u003c/p\u003e\u003cp\u003e\u003cb\u003eReincarceration and Treatment Engagement\u003c/b\u003e. Recidivism and treatment engagement were measured using items from the Monthly Addiction Monitor (MAM; Center for Research, Treatment \u0026amp; Recovery, n.d.). Reincarceration was assessed using two items: \u0026ldquo;Have you been arrested in the past 30 days?\u0026rdquo; and \u0026ldquo;Have you spent at least one night in jail in the past 30 days?\u0026rdquo; Item responses were coded as (1) yes or (0) no and were examined separately. Three aspects of treatment engagement were also evaluated using the MAM. First, treatment satisfaction was measured by asking: \u0026ldquo;How satisfied are you with your progress toward achieving your recovery goals in the past 30 days\u0026rdquo; with responses ranging from (1) not at all to (5) extremely. Second, confidence in recovery was assessed using the item: \u0026ldquo;In the next 30 days, how confident are you in your ability to be completely abstinent form substances?\u0026rdquo; with responses ranging from (1) not at all to (5) extremely. Finally, treatment engagement at one month follow-up was assessed by asking participants if they engaged in any of the following forms of treatment: \u0026ldquo;individual alcohol and drug abuse counseling sessions,\u0026rdquo; \u0026ldquo;group alcohol and drug counseling sessions,\u0026rdquo; and \u0026ldquo;self-help meetings like AA or NA to support your recovery.\u0026rdquo; Items were summed and dichotomized, such that engagement in any services was coded as (1), while engagement in no services was coded as (0).\u003c/p\u003e\n\u003ch3\u003eData Analytic Plan\u003c/h3\u003e\n\u003cp\u003eOur primary analytic goals were to examine feasibility of conducting an RCT (including enrolling returning citizens into both the active and comparison condition) and to examine preliminary effectiveness of the FOCUS intervention in changing targeted mechanisms of risk for negative decision-making (participant time orientation). Related clinical outcomes were also examined as exploratory aims. First, descriptive statistics were used to evaluate implementation outcomes (feasibility, acceptability, and intervention delivery fidelity, described above). Next, changes in effectiveness were examined. The primary focus of these analyses was to examine longitudinal changes in the FOCUS condition; however, longitudinal analyses related to SET are included for completeness. Given the directionality of our hypotheses, we used one-tailed paired samples \u003cem\u003et\u003c/em\u003e-tests to evaluate changes from pre-intervention to one month follow-up in both conditions separately. We were underpowered to examine differences in pre- to post-intervention changes across groups. However, exploratory one-way repeated measures ANOVAs were also examined, in which baseline and one month follow-up assessments were our within-subjects factor and intervention condition was our between-subjects factor. Differences in any ongoing treatment engagement at follow-up between the FOCUS and SET groups were also explored using a Chi-Square Test of Independence.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eParticipant flow through the study is depicted by a CONSORT diagram in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In total, 40 participants were enrolled, randomized into the RCT (33 to FOCUS and 7 to SET), and completed baseline assessments. Of those, 27 completed FOCUS and 6 completed SET. At one-month following the intervention, 21 participants from the FOCUS condition and 5 participants from the SET condition completed a follow-up assessment. Participant characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eMost participants were currently on probation/parole. Participants reported that they had been incarcerated, on average, 4.5 times (range 1\u0026ndash;15) and that they had been convicted of a crime, on average, 5.1 times (range 0\u0026ndash;30). Respondents were also asked to self-identify which substances they misused over the past year. The majority (52.5%) of respondents identified alcohol, followed by cocaine (22.5%), cannabis (17.5%), prescription opioids (12.5%), heroin (10%), fentanyl (10%), and amphetamines (7.5%). Additionally, 17.5% reported that they had previously or are currently using medication to a treat opioid or alcohol use disorder.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eImplementation Outcomes\u003c/h2\u003e\u003cp\u003e\u003cb\u003eFeasibility and Acceptability.\u003c/b\u003e Each of our measures of feasibility and acceptability surpassed the \u003cem\u003ea priori\u003c/em\u003e benchmarks. With regard to feasibility, 83% of participants who enrolled in the study completed the intervention (82% in the FOCUS condition and 86% in the SET condition). Of the 33 participants who received either condition, 88% also took part in at least one check-in with a PRC interventionist (89% in the FOCUS condition and 83% in the SET condition). Overall ratings of satisfaction in both groups were high at one-month follow-up (FOCUS: \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.98, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.26; SET: \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.71, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.56). An independent samples \u003cem\u003et\u003c/em\u003e-test suggested marginally significant differences between the groups, indicating higher satisfaction in the FOCUS condition, \u003cem\u003et\u003c/em\u003e(24)\u0026thinsp;=\u0026thinsp;1.60, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.061.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFidelity.\u003c/b\u003e Due to technical problems, audio recordings were only available for 29 out of the 33 interventions completed. Interventionists delivered, on average, 95% of the required intervention elements, suggesting strong overall fidelity.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEffectiveness Outcomes\u003c/h3\u003e\n\u003cp\u003eMeans, standard deviations, and bivariate correlations for all key study variables (in both the FOCUS and SET conditions) are presented in Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDelay Discounting and Future Orientation (Primary Outcomes).\u003c/b\u003e Changes in delay discounting were first evaluated utilizing paired-samples t-tests. Two participants in the FOCUS condition and one in the SET condition did not complete the measure and were therefore not included the analyses. Results suggest that participants in the FOCUS condition evidenced statistically significant decreases in rates of delay discounting, \u003cem\u003et\u003c/em\u003e(18)\u0026thinsp;=\u0026thinsp;2.54, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.010. No statistically significant differences were found in the analyses of the SET group: \u003cem\u003et\u003c/em\u003e(3)\u0026thinsp;=\u0026thinsp;.27, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.403. Results of the exploratory repeated measures ANOVA analyses did not indicate a significant impact of intervention condition on changes in rates of delay discounting: \u003cem\u003eF\u003c/em\u003e(1,21)\u0026thinsp;=\u0026thinsp;.820, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.375.\u003c/p\u003e\u003cp\u003eNext, we evaluated pre-post intervention change in the Consideration of Future Consequences Scale. One participant in each condition did not complete the measure. Examining differences in pre-post group means separately, we found statistically significant increases in considering future consequences among participants in the FOCUS condition: \u003cem\u003et\u003c/em\u003e(19) = -1.96, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.032. Statistically significant differences were found among participants receiving the SET condition suggesting a \u003cem\u003edecrease\u003c/em\u003e in considering future consequences: \u003cem\u003et\u003c/em\u003e(3)\u0026thinsp;=\u0026thinsp;2.90, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.031. Exploratory ANOVA results suggest a statistically significant effect of intervention condition on consideration of future consequences: \u003cem\u003eF\u003c/em\u003e(1,22)\u0026thinsp;=\u0026thinsp;6.08, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.022.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSubstance Misuse (Secondary Outcome).\u003c/b\u003e One participant in the FOCUS condition and another in the SET condition did not complete the SMAST at follow-up. Examination of descriptive statistics suggest that self-reported substance misuse was low at both timepoints. At baseline, 77% of participants reported that they did not drink and 79% reported that they did not use drugs in the past 30 days. Rates of abstinence slightly decreased at follow-up, with 69% reporting not having had a drink and 64% reporting not using drugs in the past 30 days. Paired samples t-tests suggest non-significant decreases in the FOCUS group related to drug use (as measured by the DAST, \u003cem\u003et\u003c/em\u003e(20)\u0026thinsp;=\u0026thinsp;.90, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.189) and alcohol use (as measured by the SMAST, \u003cem\u003et\u003c/em\u003e(19)\u0026thinsp;=\u0026thinsp;.31, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.380). Similarly, no significant change was noted in the SET group for either drug use, \u003cem\u003et\u003c/em\u003e(4)\u0026thinsp;=\u0026thinsp;1.21, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.147 or alcohol use, \u003cem\u003et\u003c/em\u003e(3)\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.24, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.412). Exploratory ANOVA results were also not statistically significant for drug use: \u003cem\u003eF\u003c/em\u003e(1,24)\u0026thinsp;=\u0026thinsp;.03, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.867 or alcohol use: \u003cem\u003eF\u003c/em\u003e(1,22)\u0026thinsp;=\u0026thinsp;.09, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.772.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAddiction Severity (Secondary Outcome).\u003c/b\u003e Change from pre- to post-intervention for each of the three subscales of the Brief Addiction Monitor were examined separately by intervention group. No significant differences from pre- to post-intervention were found for either group for the Use or Risk Factors subscales; among the FOCUS group, Use subscale: \u003cem\u003et\u003c/em\u003e(20)\u0026thinsp;=\u0026thinsp;.134, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.447 and Risk subscale: \u003cem\u003et\u003c/em\u003e(4)\u0026thinsp;=\u0026thinsp;.053, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.478 and among the SET group, Use subscale: \u003cem\u003et\u003c/em\u003e(4)\u0026thinsp;=\u0026thinsp;.784, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.238 and Risk subscale: \u003cem\u003et\u003c/em\u003e(4)\u0026thinsp;=\u0026thinsp;.540, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.309. Pre-post differences were evident in the Protective Factors subscale. In the FOCUS group, participants reported \u003cem\u003eincreased\u003c/em\u003e protective factors, \u003cem\u003et\u003c/em\u003e(20) = -1.95, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.032, while in the SET group, participants evidenced \u003cem\u003edecreased\u003c/em\u003e protective factors, \u003cem\u003et\u003c/em\u003e(4)\u0026thinsp;=\u0026thinsp;.784, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.238. Exploratory ANOVA results were not statistically significant for the Use subscale, \u003cem\u003eF\u003c/em\u003e(1,24)\u0026thinsp;=\u0026thinsp;.207, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.653 or the Risk Factors subscale, \u003cem\u003eF\u003c/em\u003e(1,24)\u0026thinsp;=\u0026thinsp;.295, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.592. Findings were significant for the Protective Factors subscale, suggesting that significant effects of intervention condition: \u003cem\u003eF\u003c/em\u003e(1,24)\u0026thinsp;=\u0026thinsp;6.52, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.017.\u003c/p\u003e\u003cp\u003e\u003cb\u003eReincarceration and Treatment Engagement (Secondary Outcome).\u003c/b\u003e Given the low rates of arrest and re-incarceration, we examined frequencies by intervention condition but did not statistically compare them. In the FOCUS condition at baseline, two participants reported having been arrested and three reported having spent at least one night in jail in the past 30 days. No one in the FOCUS condition reported arrest or jail detention at follow-up. In SET at baseline, no one reported past 30-day arrest and one reported past 30-day jail detention. One participant in the SET condition had spent a night in jail at follow-up.\u003c/p\u003e\u003cp\u003eNext, we evaluated changes in satisfaction with personal recovery and confidence in future recovery. Paired samples t-tests by group suggest statistically significant increases in individuals\u0026rsquo; satisfaction with their personal recovery: \u003cem\u003et\u003c/em\u003e(20) = -2.75, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.006 and confidence in future recovery: \u003cem\u003et\u003c/em\u003e(20) = -2.42, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.013 from pre- to post-intervention in the FOCUS group. There was no significant change in the SET condition for either satisfaction with personal recovery: \u003cem\u003et\u003c/em\u003e(4)\u0026thinsp;=\u0026thinsp;.74, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.251 or confidence in future recovery: \u003cem\u003et\u003c/em\u003e(3)\u0026thinsp;=\u0026thinsp;1.41, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.126. Exploratory ANOVA results suggest a marginally significant impact of condition on respondents\u0026rsquo; satisfaction with their personal recovery: \u003cem\u003eF\u003c/em\u003e(1,24)\u0026thinsp;=\u0026thinsp;4.04, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.056 and statistically significant impact on their confidence in their future recovery efforts: \u003cem\u003eF\u003c/em\u003e(1,24)\u0026thinsp;=\u0026thinsp;8.24, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.009.\u003c/p\u003e\u003cp\u003eFinally, we examined differences in yes/no treatment engagement (in any of three modalities: individual or group therapy and/or peer-facilitated groups such as AA/NA) between intervention conditions following the intervention. At one month follow-up, 81.5% of participants in the FOCUS condition were engaged in treatment relative to 33.3% of SET participants. Results of the chi-square test suggest a significant association between intervention condition and treatment engagement, \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;4.09, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.043.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the implementation potential and preliminary effectiveness of a brief, PRC-delivered intervention to improve decision-making and related correlates of successful recovery during reentry. Results suggest that the intervention (Future-Oriented Coaching for Unlocking recovery Success; FOCUS) is feasible and acceptable to implement in a returning citizens population and able to be delivered with fidelity by PRCs. Additionally, findings demonstrate that participants who received FOCUS evidenced decreases in delay discounting and increases in their consideration of future consequences. With regard to exploratory clinical outcomes, no changes in self-reported substance misuse were found; however, individuals in the FOCUS condition reported increases in other protective factors, including their satisfaction with, and confidence in, their personal recovery process. Finally, exploratory results suggest that participants in FOCUS were more likely to be engaged in ongoing substance use treatment one month after the intervention relative to individuals who received the comparison condition (standardized episodic thinking; SET).\u003c/p\u003e\u003cp\u003eForemost among these findings, our results suggest that delivering a PRC-administered intervention for returning citizens in a community-based treatment setting is feasible and acceptable. We found that clients were largely satisfied with the intervention and that PRCs evidenced high (95%) fidelity to the manual. These findings support other recent research (Felton et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Magidson et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) demonstrating the potential for PRCs to play a role in increasing access to manualized, evidence-based treatment. Given that PRCs are one of the fastest growing workforces within the behavioral health field (Fortuna et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and the potential cost-savings associated with utilizing non-specialists to deliver a brief intervention, these results highlight the potential for the scalability and sustainability of this approach.\u003c/p\u003e\u003cp\u003eFindings from the current study also replicate other work demonstrating that EFT-based interventions have the potential to reduce DD and increase participants\u0026rsquo; overall time horizon (Lin \u0026amp; Epstein, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and impact substance use-related outcomes (Collado \u0026amp; Stokes, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Results are among the first, however, to suggest that EFT may improve treatment engagement. Given that elevated DD is related to early treatment termination (Stevens et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) it may be that directly targeting DD increases participants\u0026rsquo; ability to focus on longer-term rewards associated with ongoing treatment engagement. Findings are novel in demonstrating the utility of EFT in boosting protective factors associated with recovery (including confidence in maintaining their recovery and satisfaction with their progress). Future research is needed to examine whether EFT may support treatment engagement by increasing those factors associated with longer-term treatment retention (e.g. motivation, confidence, etc.). Although speculative, these results may also point to the potential for adding EFT elements to other established evidence-based approaches to increase treatment engagement for other DD-linked health disorders and maladaptive behaviors, such as overeating and gambling. Future studies are needed to explore whether the addition of an EFT component could strengthen retention outcomes in other interventions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths, Limitations, and Future Directions.\u003c/b\u003e Strengths of the study include its engagement of a highly vulnerable population and the co-development of an intervention with the potential to be scaled and sustained in low-resource communities. Limitations include low rates of self-reported substance use at baseline and follow-up; thus, future research should consider including biochemical verification to ensure that outcomes were accurately reported. Second, we followed participants over a short timeframe. Future research is needed to evaluate whether treatment gains (including increased protective factors and engagement) are maintained over time. Third, because the goals of this research were to examine the feasibility of conducting this study and evaluating preliminary effectiveness in the active condition (FOCUS), our comparison condition was underpowered to detect intervention effects. Future research should seek to replicate these findings in a fully-powered RCT. Finally, because of our pre-post intervention design, we were not able to examine whether DD served as a mechanism of change (i.e. whether the changes in DD/future orientation drove increases in protective factors and treatment engagement). Future studies with multiple follow-up points, should examine whether DD is mechanistically linked to improved treatment outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions.\u003c/b\u003e The current study provides preliminary support for the implementation and effectiveness of a brief, EFT-based intervention to support positive treatment outcomes for returning citizens in recovery. Given the high rates of substance misuse and overdose among individuals exiting incarceration, a brief, low-cost intervention that can be effectively delivered by PRCs has the potential to increase access to care and save lives during the reentry period. Future research should continue to explore non-specialist delivered EFT approaches to increase treatment engagement for this highly vulnerable population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.S. and J.W.F. wrote the main manuscript text, R.Y., J.J. and J.W.F. contributed to the design of the study, A.J., A.K., J.J. and J.W.F. oversaw completion of study, A.A. drafted the tables, and A.B. contributed to the text. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors wish to acknowledge Eddie Killing, Annette Dewbury, and Jennifer Light for their work and support on this project.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during the current study are available from the corresponding author at reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAnvari, M. S., Kleinman, M. B., Massey, E. C., Bradley, V. D., Felton, J. W., Belcher, A. M., \u0026amp; Magidson, J. F. (2022). In their mind, they always felt less than: The role of peers in shifting stigma as a barrier to opioid use disorder treatment retention. \u003cem\u003eJournal of Substance Abuse Treatment\u003c/em\u003e, 108721.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAthamneh, L. N., DeHart, W. B., Pope, D., Mellis, A. M., Snider, S. E., Kaplan, B. 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A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. \u003cem\u003eJournal of Substance Abuse Treatment\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(2), 189\u0026ndash;198. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jsat.2006.08.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jsat.2006.08.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZeng, Z. (2019). \u003cem\u003eBureau of Justice Statistics, April 2019\u003c/em\u003e. U.S. Department of Justice. Bureau of Justice Statistics.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"health-and-justice","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"heju","sideBox":"Learn more about [Health \u0026 Justice](https://healthandjusticejournal.biomedcentral.com/)","snPcode":"40352","submissionUrl":"https://submission.springernature.com/new-submission/40352/3","title":"Health \u0026 Justice","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Substance use, Returning citizens, Future orientation, Treatment engagement, Delay discounting, Episodic Future Thinking","lastPublishedDoi":"10.21203/rs.3.rs-7983432/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7983432/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e\u003cp\u003eReturning citizens with substance use disorders (SUD) make numerous decisions that involve engaging in behaviors with short-term, immediate rewards (i.e. the pleasurable effects of returning to use) relative to those with longer-term, but delayed, benefits (i.e. engaging in treatment), often in the context of resource-poor and unstable environments. Successful navigation of the reentry period may require making future-oriented decisions; yet previous research suggests that incarcerated individuals and those with SUD evidence steeper rates of delay discounting, or tendency to devalue something as a function of the delay of its receipt. Episodic future thinking has been shown to reduce delay discounting and improve decision-making, suggesting it may be particularly well-suited to support healthy decision-making among justice-involved populations. The current study evaluated the implementation potential and preliminary effectiveness of an episodic future thinking intervention adapted for individuals during the reentry period to reduce delay discounting and improve related clinical outcomes.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eReturning citizens (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;40) who identified as in recovery from SUD and had experienced incarceration within 12 months prior to enrollment were recruited to participate in a randomized controlled trial. Participants received either a brief (60-minute) adapted episodic future thinking intervention or a control intervention that did not activate future thinking. Both interventions were administered by a peer recovery coach in a community setting. Participants then completed weekly check-ins for up to four weeks and were assessed one month after the intervention.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFindings suggest that peer-delivered episodic future thinking was feasible and acceptable, and could be delivered with fidelity. Additionally, participants in the active condition experienced significant decreases in delay discounting, significant increases in considerations of future consequences, and increases in the presence of protective factors that may support longer-term recovery. Participants in the control condition did not experience changes in clinically-relevant outcomes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eResults of this study provide preliminary support for the implementation potential and effectiveness of brief, peer-delivered intervention focused on improving decision-making during the reentry period.\u003c/p\u003e","manuscriptTitle":"Results from a Peer Recovery Coach-Delivered Future Orientation Intervention for Returning Citizens in Substance Use Treatment: Feasibility and Preliminary Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-21 01:06:50","doi":"10.21203/rs.3.rs-7983432/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-01T18:30:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T02:40:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T14:51:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"170302385865628792814080742999123224962","date":"2026-03-27T15:45:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206136381853887198942359621644270741549","date":"2026-03-26T23:44:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330832828904681726261407230897824612229","date":"2026-02-23T16:38:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-10T16:02:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-06T23:49:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-06T23:48:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Health \u0026 Justice","date":"2025-10-29T21:51:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"health-and-justice","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"heju","sideBox":"Learn more about [Health \u0026 Justice](https://healthandjusticejournal.biomedcentral.com/)","snPcode":"40352","submissionUrl":"https://submission.springernature.com/new-submission/40352/3","title":"Health \u0026 Justice","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e910257e-2c0e-4b5d-80db-5cf495cd8e48","owner":[],"postedDate":"November 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-16T00:23:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-21 01:06:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7983432","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7983432","identity":"rs-7983432","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}