A Behavioral Economics Substance-Free Activity Session (SFAS) Approach to Reducing Substance Use: Narrative Review and Intervention Manual

Abstract

Introduction.

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 goal-directed and mood-enhancing activity patterns that might provide alternatives to alcohol and drug-related reward.

Method.

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 session, including a session vignette.

Results.

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.

Discussion.

The SFAS shows promise as a brief intervention that supports substance-use reductions via motivating patterns of substance-free activities.

Background

Behavioral economic (BE) theory posits that constraints on access to substance-free rewards or a diminished ability to experience substance-free reward (i.e., anhedonia) increases the relative reinforcing value of substances (Acuff et al., 2023; Bickel et al., 2014; Herrnstein, 1961; Hogarth, 2020). Laboratory and observational studies have supported BE theory by demonstrating that substance use increases when the environment lacks substance-free rewards, chronic substance use is linked to reduced dopamine response to natural reinforcers, and increasing access to alternative rewards can reduce substance use (Bickel et al., 2014; Higgins et al., 2004; Vuchinich & Heather, 2003). A lack of environmental reward has been shown to predict alcohol use disorder (AUD) symptoms in young adults (Joyner et al., 2016). Choice between substances and substance-free activities is also influenced by an individual’s general tendency to value immediate rather than delayed rewards. Individuals who steeply discount future rewards may find substances highly reinforcing due in part to their relatively immediate effects. Indeed, steep delayed reward discounting is a robust and potentially malleable predictor of substance misuse (Amlung & MacKillop, 2011; Kluwe-Schiavon et al., 2020).

Low reward availability and steep delayed reward discounting may interact in ways that sustain a heightened valuation of short-term, highly reinforcing rewards like alcohol and drugs over reinforcement derived from goal-directed activities associated with work, education, hobbies, or relationships. This process, termed reinforcer pathology, is self-perpetuating such that frequent substance use can reduce neural sensitivity to the rewarding effects of non-substance stimuli (e.g., socializing, food), thereby weakening the appeal of non-drug alternatives and strengthening a preference for substances (Field et al., 2020; Tucker, Buscemi, et al., 2023). This process may be especially pernicious during emerging adulthood, a critical period when behavioral investment in long-term social, health, educational, and vocational development sets the stage for subsequent life-long availability of viable behavioral alternatives to drugs.

Clinical Implications of Behavioral Economic Theory

BE-informed intervention strategies aim to both increase the response cost of substance use and encourage substance-free reward (Fazzino et al., 2019; McKay, 2017). This is accomplished by increasing the actual (e.g., effort required to obtain a substance) and/or perceived costs of use (e.g., awareness of financial, social, and health “costs” associated with use). Equally important is a concurrent effort to increase engagement in rewarding substance-free activities by increasing access or the salience of the perceived benefits of these activities (Kuhlemeier et al., 2024; Murphy, Dennhardt, et al., 2022). Intensive intervention approaches such as contingency management and community reinforcement have shown efficacy by addressing these mechanisms (Pfund et al., 2024), and there is more general support for substance-free reinforcement as a mechanism of behavior change in addiction treatment (Witkiewitz et al., 2022). Behavioral activation approaches, originally developed to increase engagement in goal-directed activities in the treatment of depression, have also been successfully applied to addiction treatment (Daughters et al., 2018). There is evidence that increasing the salience of delayed outcomes can mitigate impulsive decision-making and enhance future-oriented thinking (Ashe & Wilson, 2020). For example, episodic future thinking—the process of reflecting on potential positive future events—has been shown to reduce both alcohol demand and delayed reward discounting (Patel & Amlung, 2020; Snider et al., 2016). Likewise, reward bundling—the concept of viewing future rewards as part of a larger behavior pattern—has been found to decrease discounting (Rung & Madden, 2018). The substance-free activity session (SFAS), described next, is a brief intervention approach that integrates these behavioral economic elements with established brief intervention elements such as motivational interviewing and personalized feedback (Murphy, Dennhardt, et al., 2012). Thus, as noted below, it combines the benefits of these three approaches while also explicitly addressing motivation to change via the motivational interviewing style and inclusion of personalized feedback on recent activity patterns and potential additional substance-free activities available in the individual’s local environment.

The Substance-Free Activity Session

The substance-free activity session (SFAS; Murphy et al., 2012, 2019) was initially developed as a single-session supplement to harm-reduction focused brief alcohol interventions (BAI) for non-treatment seeking college students. The BAI session is primarily focused on directly motivating reductions in alcohol use via discussion of risks and costs associated with alcohol, along with harm reduction strategies. The SFAS complements the BAI by enhancing motivation to engage in goal-directed and enjoyable patterns of substance-free activities. There is a specific emphasis on motivating activity patterns (e.g., studying, exercising, or engaging with hobbies or service) that are less compatible with drinking, consistent with the participant’s goals, and mood enhancing. Although activities do not need to be enjoyable to shift behavior away from substance use, a secondary goal of this session is to enhance mood and reduce negative affective symptoms, given the associations between negative affect and alcohol-related risk (Daughters et al., 2018; Hogarth, 2020). There is also a specific discussion of the compatibility of drinking or drug use with the participant’s values, goals, and desired activity pattern changes. Personalized feedback within the SFAS includes graphs depicting a participant’s recent time allocation to substance use compared to other important life domains, feedback on locally available substance-free activities that are consistent with their goals and interests, and feedback on coping with distress/sadness (given that these symptoms can undermine motivation to engage in substance-free activities). Importantly, from a dissemination perspective, most of the session is not directly focused on substance use, and thus is potentially beneficial for individuals with no desire to change their substance use who might be interested in the opportunity to discuss their goals, activity patterns, and mood-enhancing behaviors (Murphy, Gex, et al., 2022). This is important given the very low rates of help-seeking and interest in pursuing alcohol-focused counseling among emerging adults (Helle et al., 2022; Tucker, Cheong, et al., 2023). Consistent with behavioral economic theory and the research reviewed above, however, increases in future orientation and substance-free activity patterns may indirectly contribute to reductions in drinking or drug use by reducing the relative reinforcing value of substances even without an initial stated goal of substance reduction. In other words, given the zero-sum nature of time allocation, increased time allocated towards one activity category will generally result in reductions in another activity category (e.g., an early morning volunteer or exercise routine is somewhat incompatible with heavy drinking – 5/4 or more drinks on an occasion for males/females; Hingson et al., 2017; Miller et al., 2023). Through a series of empirical studies reviewed below, the composition of the SFAS has been modified over time based on the evolving empirical literature and the needs of the population subgroup.

Narrative Review of Efficacy, Adaptations, and Associated Mechanisms of Behavior Change

The following review aimed to synthesize the existing literature on the implementation of the SFAS in a variety of contexts. Relevant articles were identified through PsychInfo using search terms such as “substance free activity session”, “SFAS”, “behavior* econ* intervention”, or “substance free” + “intervention”. Specifiers were utilized to limit results to the English language, human subjects, and certain publication types (i.e., encyclopedia, electronic collections, peer-reviewed journal articles, all books). This search returned 114 articles. Title and abstract were examined to determine relevance (i.e., reference to an SFAS or adapted SFAS intervention). If needed, the methods and/or discussion sections of papers were also examined to determine eligibility. Of the 114 articles, 15 were empirical studies related to the SFAS intervention and eligible for inclusion, 10 of these were primary analyses, and five were secondary analyses.

An initial clinical trial evaluated the incremental efficacy of the SFAS, added to a standard brief alcohol intervention (BAI), compared to a BAI + Relaxation Training (RT) intervention in a sample of 82 college students who reported recent heavy drinking (Murphy, Dennhardt, et al., 2012). BAI + SFAS and BAI + RT were delivered in a pair of 50-minute individual sessions, separated by one week, in a university research laboratory. Six-month follow-up results indicated that the BAI + SFAS intervention was associated with significantly larger reductions in alcohol problems relative to the BAI + RT condition, an effect that was partially mediated by increases in self-regulation (Soltis et al., 2018). Self-regulation was measured using the 31-item Short Self-Regulation Questionnaire (SSRQ; Carey et al., 2004). This suggests that the SFAS may have enhanced participants’ ability to organize their behavior in service of pursuing important goals. BAI + SFAS was also associated with significantly larger reductions in heavy drinking among participants with elevated depressive symptoms and lower levels of substance-free reinforcement at baseline (Murphy, Dennhardt, et al., 2012). A larger follow-up trial (N = 393) compared BAI + SFAS and BAI + RT to an assessment control condition in a sample of college students (Murphy et al., 2019). In addition to the two sessions described above, participants later completed a 15-minute booster phone call to revisit goal progress and substance-free activity participation or relaxation skills depending on their condition assignment. Follow-up analyses over 16 months indicated both intervention conditions were associated with significant reductions in alcohol use and problems compared with assessment only (Murphy et al., 2019). Both intervention conditions were also associated with significant increases in substance-free reinforcement and decreases in depression and anxiety, and the BAI + SFAS condition was more effective for reducing AUD symptoms among participants with lower baseline environmental reward availability (Murphy et al., 2021).

Two clinical trials have evaluated the impact of the SFAS on cannabis outcomes. An initial pilot trial (N = 97) attempted to condense the SFAS into a 30-minute session administered immediately following a 30-minute BAI in college students who reported recent heavy drinking (Yurasek et al., 2015). Most participants (62%) also reported recent cannabis use. Six-month follow-up analyses indicated that BAI + SFAS and BAI + Education were associated with similar reductions in drinking, but only the BAI + SFAS was associated with significant reductions in cannabis use frequency. Another pilot trial evaluated the efficacy of the SFAS combined with a brief cannabis-focused intervention (BCI) compared to BCI + RT and to an assessment control condition in a sample of 133 college students (Murphy, Dennhardt, Utzelmann, et al., 2024). Relative to assessment only, both interventions were associated with significant reductions in cannabis problems and craving at the 1-month, but not the 6-month follow-up. Both active conditions were also associated with significant reductions in anxiety at the 6-month follow-up. Similarly, an open trial (N = 17) utilized an adapted SFAS for cannabis use disorder embedded between an initial MI session and later coaching sessions. Findings suggested the intervention was acceptable and feasible, and reductions in cannabis demand, cannabis use days, alcohol use days, and internalizing symptoms following the intervention were observed. Furthermore, cannabis-free reinforcement increased (Coughlin et al., 2023).

To enhance dissemination and reduce participant burden, Gex and colleagues (2023) adapted the BAI + SFAS approach for delivery via live text-messaging with a clinician. Participants were 66 college students who reported recent heavy drinking and were randomized to receive either alcohol plus nutrition education content (control) or to a BAI + SFAS, each followed by four weekly brief text-message booster sessions. Intervention effects on outcomes including drinks per week, heavy drinking episodes, and alcohol-related problems were tested, but results should be interpreted with caution given the small sample size. At 3-month follow-up, participants in the BAI + SFAS group reported significantly fewer heavy drinking episodes compared to the education group, but there were no significant group differences in reductions in weekly drinking or alcohol problems. However, there were significant, medium within-group effect sizes for drinks per week and alcohol problems in the BAI + SFAS condition that were not observed in the education condition. High levels of session engagement, completion, and satisfaction support the feasibility and acceptability of using live text-messaging to deliver BAI + SFAS, but future research is required to establish efficacy.

Based on promising results with college students, a pilot trial (N = 41) adapted the SFAS for use as a supplement to traditional integrated intensive outpatient alcohol treatment for adults (Meshesha et al., 2020). Participants were recruited from a treatment setting and were randomized to complete either an individual 50-minute SFAS session plus four personalized, unidirectional booster text messages that reminded them of their goals and provided them with information about substance-free activities or to an individual session and booster texts that provided sleep and nutrition education. Associations between condition and change in behavioral economic variables (e.g., alcohol demand, reinforcement) were tested, but the small sample size limits the interpretability of findings. Compared to education control, the SFAS was associated with significantly greater reductions in the proportion of substance-related reinforcement relative to substance-free activities as well as reduced alcohol demand. There were no group differences in delay-discounting at follow-up.

Another recently completed pilot trial compared a four-session integrated SFAS and mindfulness-based approach to an established contingency management approach for improving medication assisted opioid use disorder (OUD) treatment engagement in a sample of help-seeking adults (Derefinko et al., 2025). The primary aim was to improve retention in OUD pharmacotherapy. There was slightly better treatment engagement in the CM condition (73%) than in the SFAS + Mindfulness condition (59%), but this difference was not statistically significant, despite the lower intensity of the SFAS. Participants also evaluated both conditions favorably.

In an open trial (N = 15), Luciano and colleagues (2022) paired a brief alcohol intervention with an adapted SFAS for veterans who endorsed risky alcohol use and PTSD symptoms. Findings suggest the intervention was feasible and viewed favorably. There were reductions in drinking and alcohol-related problems from baseline to three-month follow-up, while PTSD symptoms reduced from baseline to one month and returned to baseline levels by three-month follow-up. These preliminary findings suggest there may be merit in further exploration of the SFAS in Veteran populations and among those with comorbid PTSD.

Our research group is currently conducting a trial that has adapted the BAI + SFAS approach for racially and economically diverse 18–29-year-old adults who are not 4-year college students or graduates (Murphy, Dennhardt, Tempchin, et al., 2024). Adaptation centered on identifying substance-free activities outside of educational contexts and focusing more broadly on personal and vocational goals. The intervention is delivered via confidential videoconference sessions with four unidirectional text-message boosters similar to those used by Meshesha et al. (2020). The SFAS manual (see supplemental materials) presents a recommended order of session elements but, consistent with MI principles, modules are administered flexibly in a way that is responsive to the participant’s clinical presentation and interests.

The empirical evaluations of the SFAS session suggest that it can enhance the effects of other alcohol- and drug-focused interventions, particularly for salient harm-reduction related outcomes (e.g., AUD symptoms, alcohol-related problems). This suggests that the SFAS’s broader focus on values and life goals promotes changes in substance use that reduce the extent to which patterns of use interfere with functioning or goal pursuit. Strengths of the existing SFAS literature include the range of populations, delivery modalities, and substances studied. The inclusion of substance use outcomes as well as changes in negative affect and theoretical mechanisms of change (proportionate substance-free activities, self-regulation) is also a strength. Limitations include the absence of adequately powered randomized controlled trials outside of the college context and the absence of studies that evaluate the SFAS as a stand-alone approach. There is also a need for research that systematically investigates the specific SFAS elements and duration required to obtain clinically significant reductions in substance-related risk.

Substance-Free Activity Session Overview and Transcript

Prior to completing an SFAS, participants complete a pre-assessment that gathers information about their values and interests, how they spend their time, affective and stress-related symptoms they might be experiencing, and other variables of interest. The timing of the pre-assessment varies across studies and can range from a week prior to the session to shortly before the session begins. See supplementary materials for additional information about the pre-assessment and a resource to generate session feedback. The pre-assessment information is used to personalize the feedback and session content, which is divided into ten modules: 1. Session Introduction; 2. Values and Actions; 3. Goal Setting; 4. Time Allocation Feedback; 5. Relationship Between Substance Use and Life Goals/Values; 6. Personalized Feedback on Substance-free Activities; 7. Feedback on Symptoms of Distress and Coping Strategies; 8. Return to Goals; 9. Episodic Future Thinking; and 10. Session Synthesis/Closing. The following clinical vignette is structured according to these sections and represents content from a real session completed as part of a recent clinical trial (Murphy, Dennhardt, Tempchin, et al., 2024). In this study, SFAS pre-assessments were completed approximately one week prior to the SFAS appointment. Feedback visuals were automatically generated by the survey software and individualized substance-free activity lists were manually created by study clinicians. The participant was a 19-year-old multiracial cisgender man who reported four past-month binges (5+ standard drinks on one occasion) and regularly using cannabis and alcohol together. The transcript was edited for length, clarity, and deidentification purposes (see supplemental material for an additional session transcript from another participant).

1. Session Introduction

The goals of the introduction are to develop rapport, foster a spirit of collaboration and agency, and elicit the participant’s goals and values, which inform the rest of the session.

Facilitator: We’re going to spend some time today talking about the things that are important to you in life and how your activity patterns fit with those priorities. I’m also interested in hearing about your hobbies and interests. I want to emphasize that you’re the expert on you, and this will be a conversation about how you can live more consistently with who you want to be rather than me giving you information or telling you what to do. Tell me a bit about the things that matter most to you?

Participant: Right now, what matters most is achieving to my fullest potential.

Facilitator: What would achieving your fullest potential look like for you?

Participant: I want to complete my radiologic technologist training program to get a job to support my lifestyle. I want to be rich in spirit, rich in family, rich in health.

Facilitator: You’ve thought a lot about what that could look like for you.

2. Values and Actions

Second, participants are shown a graphical representation of the importance they place on various life domains and how closely their actions in the past week aligned with that importance, which was measured using the Valued Living Questionnaire(Wilson et al., 2010). Facilitators highlight domains that participants rated as important and for which their actions were inconsistent with this importance.

Facilitator: You said, family, spiritual life, education, and parenting are very important to you. You can see here, family is important and your actions were consistent with that. In some other areas, there’s a little bit more of a disconnect between importance and actions. For example, work is very important to you, but your actions were not quite as consistent. Tell me about that.

Participant: Work hasn’t been as consistent, because I haven’t been working. Hopefully when I start this job in a week or two, that will go up a lot more.

Facilitator: What else stands out to you?

Participant: My community life. Once I get my car, I want to start volunteering at a camp with kids.

3. Goal Setting

Participants are asked to identify short- and long-term goals. Goals can be in any domain that brings a sense of joy or accomplishment and should be feasible.

Facilitator: Try to think of two things you’d like to accomplish in the short-term, and then one long-term goal. Think about goals that are feasible and would bring you a sense of joy or accomplishment.

Participant: For the first short-term goal, I want to finish my training. I also want to get a car.

Facilitator: What about a longer-term goal?

Participant: I guess find the love of my life. That’d be really cool.

Facilitator: Why are these important to you?

Participant: I want to be a radiologic tech, and you have to have the training for that. For the second one, reliable transportation for my work, my community life, my social life, anything I want. That’s really just more beneficial for me. The long-term life goal, I don’t know, that’s something that’s always been on my mind.

Facilitator: We’ll come back in a little bit and think about specific steps you could take to progress towards these goals.

4. Time Allocation Feedback

Facilitators maintain a nonjudgmental, curious, and collaborative stance, especially when discussing time spent using/recovering from substances. Facilitators first elicit participants’ reactions to seeing a visual representation of their time allocation and then explore emotions that arise. If participants identify areas in which they would like to reduce time spent, facilitators can ask how many hours they would ideally dedicate to that domain and how they want to spend the time they save.

Facilitator: I’d like to talk about how you spend your time. One reason we summarize this information is because we don’t always zoom out and think about how we spend our time in a big picture way, even though it’s precious and it says a lot about the things that are important to us. You reported spending 25 hours with your friends, 25 with your family, 5 on sports/exercise, 35 either using alcohol or drugs or recovering from their effects, 45 on entertainment, 5 on hobbies, and 20 relaxing. What could you see yourself devoting more or less time to, to enhance your wellness or move towards your goals and values?

Participant: Entertainment is too high. I deleted all my social media recently because I realized how much of my life that took up. That opens a lot of opportunity for things that I want to go up, like family and sports. I’m trying to quit weed. I’m tired of my lack of productiveness that comes from it. I definitely want that to go down. I want to start finding other activities.

Facilitator: Weed takes up too much of your time and gets in way of other important things. What would you like to do more of?

Participant: I don’t know. There’s literally a club for every sport, like tennis or frisbee golf. I want to learn more stuff and find new hobbies, maybe start cooking. I definitely want to try a bunch of stuff.

Facilitator: If you cut back on weed there are so many things you could do with that time.

Participant: Yeah.

Facilitator: You mentioned you could see yourself volunteering more. What do you have in mind?

Participant: Just going out and helping people or being an assistant coach somewhere. Same thing with cultural activities. I really want to learn French.

Facilitator: You could see yourself spending some of that time that in the past you were using for weed and social media on hobbies and activities that feel important to you.

5. Relationship Between Substance Use and Life Goals/Values

Facilitators explore the extent to which participants’ substance use impacts their goals and is congruent with their values. In the transcript below, discussion of the relationship between substances and life goals/values was merged with the time allocation section, as the content related to the relationship between substance use and goals/values arose naturally. Facilitators can prompt the topic explicitly if needed:

• “I also wanted to get your thoughts on the relationship between alcohol/drugs and your goals and values. How does your alcohol or drug use fit in with these?”

• “How compatible is your current drinking/drug use with your core values and the future you envision for yourself?”

Facilitator: You mentioned you wanted to stop smoking. Tell me more about that.

Participant: I’ve just been smoking consistently. I definitely stopped at the beginning of the year, and then I picked it up again. But now, I don’t know, I’ve been praying about it a lot. And I think that’s where I’m at. I think it’s beneficial if you use it in the right way, but I’m to the point where it kind of controls my life.

Facilitator: There are some benefits to smoking, but where it is right now gets in the way of some important things.

Participant: I don’t know that I’m capable of only having a little bit of it. Maybe I just need to stop completely. I don’t even know what it would be like for me. I’ve just been smoking so consistently. I know a few of my friends have stopped smoking. They feel a lot better, sleep a lot better, a lot less tired throughout the day. Why would I not want that?

6. Personalized Feedback on Substance-free Activities

Facilitators generate a list of recommended activities in the local community that are consistent with the participant’s interests, preferentially highlighting activities that are culturally relevant, free or inexpensive, and unlikely to be compatible with substance use. Facilitators also elicit potential benefits of increasing engagement in these activities and collaboratively troubleshoot barriers to engagement.

Facilitator: I put together a list of some activities in your area. So, there’s a running club. There are cooking classes in person and online. There are adult recreational sports leagues. And these local libraries have books, movies, helpful resources, and events.

Participant: Yeah, you don’t realize how much is even out there. . .there are so many things you could be doing. . .I’m really trying to tap into something like that. . .There probably is a French class or just like resources at my library. I never even thought of that.

7. Feedback on Symptoms of Distress and Coping Strategies

Facilitators provide feedback on participants’ self-reported anxiety and depressive symptoms (Henry & Crawford, 2005). Participants are asked how they typically cope with stress and mood difficulties. If they mention using substances, facilitators inquire about their previous experiences and the long-term effectiveness of such strategies. Facilitators then solicit permission to review additional coping strategies. This section can present challenges and may look different for participants based on psychiatric history and exposure to mental health services. If significant mental health issues are identified, it is appropriate to ask whether participants are connected to services and to provide referrals to relevant resources.

Facilitator: You mentioned having some difficulty with sadness, lack of motivation, and worry. Does that seem right?

Participant: Yeah.

Facilitator: We talked earlier about you practicing meditation and prayer. What else helps you cope with some of these difficulties?

Participant: I think working out, being outside, being with friends and just getting back in my routine. When it hits me, it hits me hard. Sometimes I just need to remind myself to not drown myself and to just get back into a positive routine to break that cycle.

Facilitator: I think that’s true for a lot of people. There’s research that suggests having a structured but flexible routine where you have positive socializing, exercise, hobbies, and spiritual or values-consistent activities can be helpful in maintaining positive mood and coping with stress. Here’s a list of other things that you might consider or that might be helpful to remember. Any of these stand out to you?

Participant: Honestly, a lot of them. A good positive routine, going to sleep at a good time, waking up at a good time, not sleeping in. Also, praying, of course and meditating, avoiding substances. I feel like when you’re trapped in that cycle, like I was just talking about that loop where just everything’s coming down. It feels like when you’re doing a lot of drugs or alcohol at that time, it doesn’t help. Like if you wake up and you’re feeling groggy or hung over, it’s much harder to get started versus keeping that routine. And spending time outside too. That’s so free. And that’s something I feel can help reset me because it’s just a process and nature is the process.

8. Return to Goals

Facilitators and participants then return to the goals worksheet to revisit short-term goals that might have emerged from the time allocation, substance-free activities, and coping feedback. Participants are encouraged to make specific goals and to discuss the benefits and barriers associated with achieving these goals.

Facilitator: I want us to think about really specific, concrete steps you could take to get closer to these goals. For the first, what might be helpful?

Participant: Going to the gym. If I spent more time, even just two or three times a week it would help.

Facilitator: Okay, two to three times a week. Is there an amount of time you want to shoot for?

Participant: At least three hours.

Facilitator: What else?

Participant: Remembering to take some time for myself, whether it’s go outside, take a break. Just give myself a little reset. Don’t work myself up. Don’t stress about it too much.

Facilitator: How do you keep track of these things that you want to accomplish or your schedule?

Participant: I usually just use my app, but if it’s an important thing, a reminder in my calendar.

Facilitator: I wondered if that might be something to help you stay on track with the gym. Is that something you’d put in a calendar?

Participant: Definitely.

Facilitator: Thinking about the car, what would be helpful there?

Participant: The first step of that is me doing the behind the scenes, like the paperwork, looking online, going through things.

Facilitator: Okay. Third goal – finding the love of your life.

Participant: The first and worst step is making myself ready by practicing patience, by practicing what God wants me to be, by practicing love, my time management, anything that could benefit me, like getting into hobbies, understanding my flaws so that I could overcome them.

Facilitator: What are some initial steps with this goal?

Participant: I think build it into my schedule. Just reminding myself through prayer and through watching videos about all this stuff. And just a daily abstinence of unhelpful stuff, like deleting Snapchat. Taking myself out of that environment.

Facilitator: We’ll say reduce distractions. Is that how you think about that? [nods] Thinking about that daily schedule, is there an amount of time you see yourself focusing on that?

Participant: I feel like I would personally be someone who does it all in one thing. Maybe during a day, take 5–10 minutes and then readjusting.

Facilitator: How will you know if you’re getting off track?

Participant: For the car one, I would notice I’m not doing it. It’s like either you are looking for a car and doing that stuff or you’re not. And then for my schedule, it’s straightforward. For the love of my life, I think just going through each of those steps daily, and maybe I can incorporate that into my daily reflection to see if I really aligned myself and my day with those three things.

9. Episodic Future Thinking

Facilitators ask participants to think about the parts of their life they find most important and to envision a positive future event. The purpose of this task is to elicit hope and encourage future-oriented thinking.

Facilitator: If you’re comfortable, you can close your eyes and really visualize. Just take that time and let me know when you’re done…

Participant: It is almost summer. The weather is much warmer now. Many of my friends are back from college. We just went swimming in a new spa we discovered. I am happy and my soul is at peace. I have work tomorrow and I’m ready. I just finished my training and I’m proud. I’m excited and I am peaceful.

Facilitator: That sounds really lovely.

10. Session Synthesis/Closing

Facilitators should incorporate the goals and values discussed throughout the session as well as specific steps or strategies the participant expressed a desire to implement.

Facilitator: You are really committed to becoming a radiologic technologist, and also to volunteering with children and to developing spiritually, physically, and through your hobbies and culture. You think it would be best if you stopped using weed, as that has gotten in the way of those other goals and contributed to feelings of stress and sadness. You talked about having a more structured schedule and spending more time outdoors as ways to improve your mood. Of all the information we covered, I’m curious about what stands out most for you?

Booster Texts

Facilitators send once weekly text messages/emails to participants during the four weeks following their SFAS session. These tailored, unidirectional messages can consist of reminders of goals or other session content and prompts about engaging in substance-free activities.

1. You wanted to spend more time working out and less time using substances to be more motivated and consistent with your schedule. Here is a resource that may be in line with your goals: [internet link]

2. You wanted to buy a car. Here are some resources that may help: [internet links]

3. You mentioned that you are interested in learning French. Here is a resource that might interest you: [internet link]

4. During our last meeting, you wrote about a future event in which you imagined yourself celebrating a new job with your friends. Remember the steps and actions you can take today to get you closer to your goals and the opportunity to celebrate them!

Discussion

Due to the personalized nature of the SFAS, sessions may vary considerably between participants with different priorities, difficulties, and level of motivation/engagement. The session content, focus, and participant goals should be approached flexibly based on the participant’s help-seeking status, level of interest, substance use severity, and motivation to change. For example, participants with low substance use risk may spend less time discussing the impact of substances on their goals and may not identify use/risk reduction goals but may still benefit from identifying goals and mood-enhancing activities.

Challenges and Considerations

The SFAS is naturally flexible and responsive to the diverse presentations and needs of individuals. However, several challenges emerged in previous sessions that warrant consideration. When developing recommendations, facilitators should be mindful that many participants, particularly those in rural and/or impoverished areas, may not have access to many safe and convenient substance-free activities (Murphy et al., 2025; Tucker et al., 2025). Rural settings often had fewer local resources available, an issue frequently compounded by a participant’s lack of transportation. Even when certain activities were technically available in one’s area, they were not always accessible (e.g., buildings may not be ADA compliant, childcare may not be available, individuals may not live in safe or walkable neighborhoods). Individuals’ family responsibilities may influence their ability to reallocate their time or engage in certain activities (e.g., participants with small children and limited social support may face unique constraints). In these instances, facilitators should validate these difficulties and problem solve with participants to identify potential workarounds or substitute activities that might be more accessible (e.g., cooking a meal or working on a hobby at home, walking around the block, talking with a friend on the phone). Facilitators should aim to identify culturally affirming activities based on what the participant reveals about their identities or cultural groups. Participants’ life stage may also confer differences in their approach to changing their activity patterns. In our experience, emerging adults and individuals participating in addiction treatment often readily approach the pursuit of new goals and activities. Additionally, some participants describe a level of substance misuse or other mental health symptom severity that will necessitate an in-session focus on discussing additional treatment resources.

Conclusion

This narrative review provides initial support for the efficacy and feasibility of the SFAS when integrated with other alcohol and drug treatment elements. In addition to reductions in substance use or problems, the SFAS may increase self-regulation and goal-directed substance-free activities and appears to be associated with decreases in negative affect. Given that rates of help-seeking for substance-focused interventions are low (Helle et al., 2022), the holistic, wellness emphasis of the SFAS may be attractive to those less ready to present for substance-focused treatment (Murphy, Gex, et al., 2022). Future research is necessary to more conclusively evaluate the efficacy of the SFAS, both as a stand-alone approach for individuals with lower severity (Murphy et al., 2019) and as a supplement to interventions for individuals with greater severity (Derefinko et al., 2025; Meshesha et al., 2020).

Figure 1.

Alignment of Participant’s Values and Actions

Figure 2.

Participant’s Time Allocation Chart

Figure 3.

Participant’s Stress and Mood Symptoms

Figure 4.

Completed Goals Worksheet

Table 1.

Summary of Studies Evaluating the Substance-Free Activity Session

Authors (Year)	Design	Sample	Key Findings
Murphy, Skidmore, et al. (2012)	Uncontrolled pilot study evaluating a novel behavioral economic intervention supplement (SFAS)	13 college freshman who reported heavy drinking	The addition of a behavioral economic supplement to brief alcohol interventions is feasible and may improve the effects of BAIs
Murphy, Dennhardt, et al. (2012)	Randomized controlled clinical trial evaluating a novel behavioral economic intervention supplement (SFAS)	82 first-year undergraduate students who reported heavy drinking	The SFAS can enhance the alcohol reduction effects of brief alcohol interventions, particularly for those with elevated depressive symptoms or lower levels of substance-free reinforcement
Dennhardt et al. (2015)	Secondary analysis of a brief substance use intervention trial examining behavioral economic variables	97 undergraduate students who reported heavy drinking	Brief interventions may reduce substance reward value, which may contribute to subsequent drinking and drug use reductions
Yurasek et al. (2015)	RCT of a behavioral economic intervention for alcohol and cannabis use	97 undergraduate students who reported heavy drinking	Drinking outcomes did not differ by condition, but BAI + SFAS participants reported fewer cannabis use days at 6-month follow-up
Soltis et al. (2018)	Secondary analysis of a brief alcohol intervention examining self-regulation as a potential mechanism of change	82 first-year undergraduate students who reported heavy drinking	Behavioral economic intervention elements that seek to increase goal pursuit and substance-free activities may boost the short-term efficacy of standard brief alcohol interventions
Voss et al. (2018)	Secondary analysis of a brief alcohol intervention trial examining protective behavioral strategies	393 college students who reported heavy drinking	Protective behavioral strategies (PBS) partially mediate the relationship between behavioral economic risk factors (e.g., alcohol reward, delay discounting) and alcohol problems, suggesting that PBS and BE risk factors may be important intervention targets
Acuff et al. (2019)	Secondary data analysis of four brief interventions across 3 studies examining alcohol-related blackouts	608 college students who reported heavy drinking	Two brief sessions (BMI + SFAS or BMI + RT) are substantial enough to result in reductions in alcohol-induced blackouts
Murphy et al. (2019)	Two-site randomized controlled clinical trial evaluating brief alcohol interventions and supplements	393 college students who reported heavy drinking	Two session interventions that combine BAI and either SFAS or relaxation training can yield long-term reductions in alcohol use among college students
Meshesha et al. (2020)	Pilot randomized trial comparing adjunctive single-session SFAS to health education control	41 adults in outpatient AUD treatment	SFAS participants reported high levels of satisfaction and greater reductions in alcohol demand and substance-related reward compared to control
Murphy et al. (2021)	Secondary data analysis of a brief alcohol intervention trial examining trajectories of alcohol severity and environmental reward	393 college students who reported heavy drinking	Emerging adults with low levels of environmental reward are at greater risk for more severe alcohol misuse and experienced greater declines in alcohol severity (heavy drinking, alcohol problems, AUD symptoms latent variable) when assigned to BAI + SFAS compared to BAI + Relaxation or assessment control.
Luciano et al. (2022)	Open trial of a personalized feedback intervention and substance-free activity supplement	15 veterans with PTSD and hazardous drinking	Participants reported decreases in drinks per week and PTSD severity at follow-up and evaluated the intervention favorably
Coughlin et al. (2023)	Open trial of a telehealth-delivered behavioral economic intervention for cannabis use	20 non-treatment-engaged adults with cannabis use disorder	Participants reported high levels of satisfaction with the intervention as well as decreases in cannabis demand, reinforcement, and use
Gex et al. (2023)	Randomized pilot trial of mobile delivered motivational interviewing and behavioral economic alcohol interventions	66 college students who reported heavy drinking	At follow-up, there were no group differences in drinks per week or alcohol-related problems, but BMI + SFAS participants reported fewer heavy drinking episodes
Murphy et al. (2024)	Randomized pilot trial evaluating brief interventions for cannabis use	132 college students who reported 5+ past-month cannabis use days	Both BMI + SFAS and BMI + RT were associated with reductions in cannabis use, cravings, and problems
Derefinko et al. (2025)	Randomized effectiveness trial of psychosocial interventions to increase treatment engagement	44 adults with opioid use disorder in an OUD treatment clinic	Participants indicated satisfaction with both contingency management and SFAS + Mindfulness interventions and treatment retention was similar across both groups

Public Health Significance:

Deficits in substance-free reinforcement are associated with elevated substance use and related harms. The substance-free activity session (SFAS) 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 SFAS has facilitated reductions in substance use and related harms in a variety of clinical trials over the past decade.