A behavioral economics substance-free activity session (SFAS) approach to reducing substance use: Narrative review and intervention manual.

Standard brief alcohol and drug use interventions focus on motivating reductions in use and associated harms and have shown reliable reductions in these outcomes.However, effect sizes are small, and dissemination is limited by low rates of help seeking.Incorporating intervention elements focused on enhancing wellness, mood, and goal pursuit might enhance efficacy and appeal.The substance-free activity session (SFAS) integrates behavioral economic and motivational interviewing elements to enhance goaldirected and mood-enhancing activity patterns that might provide alternatives to alcohol-and drug-related reward.We conducted a narrative review of 15 empirical studies that investigated the efficacy of the SFAS and evaluated mechanisms of behavior change.We then provide an overview of how to conduct the SFAS, including a session vignette.There is support for the efficacy of the SFAS when integrated with standard brief alcohol interventions for college students.There is also evidence that the SFAS reduces negative affective symptoms and increases self-regulation and proportionate reinforcement from substance-free activities.Evidence for cannabis use reductions is less robust.The SFAS has been successfully implemented as an adjunct to intensive alcohol and drug treatment for adults, but not in the context of adequately powered efficacy trials.The clinical vignette and intervention manual provides a model for how to motivate an individual to pursue reductions in substance use supported by increased engagement in goal-directed and enjoyable substance-free activities.The SFAS shows promise as a brief intervention that supports substance use reductions via motivating patterns of substance-free activities. Public Health SignificanceDeficits in substance-free reinforcement are associated with elevated substance use and related harms.The substance-free activity session is designed to increase substance-free reinforcement and includes personalized feedback about time allocation and substance-free activities available in the participants' environment delivered in a motivational interviewing style.The substance-free activity session has facilitated reductions in substance use and related harms in a variety of clinical trials over the past decade.