The Use of Virtual Reality in Craving Assessment and Cue-Exposure Therapy in Substance Use Disorders

Abstract

Craving is recognized as an important diagnosis criterion for substance use disorders (SUDs) and a predictive factor of relapse. Various methods to study craving exist; however, suppressing craving to successfully promote abstinence remains an unmet clinical need in SUDs. One reason is that social and environmental contexts recalling drug and alcohol consumption in the everyday life of patients suffering from SUDs often initiate craving and provoke relapse. Current behavioral therapies for SUDs use the cue-exposure approach to suppress salience of social and environmental contexts that may induce craving. They facilitate learning and cognitive reinforcement of new behavior and entrain craving suppression in the presence of cues related to drug and alcohol consumption. Unfortunately, craving often overweighs behavioral training especially in real social and environmental contexts with peer pressure encouraging the use of substance, such as parties and bars. In this perspective, virtual reality (VR) is gaining interest in the development of cue-reactivity paradigms and practices new skills in treatment. VR enhances ecological validity of traditional craving-induction measurement. In this review, we discuss results from (1) studies using VR and alternative virtual agents in the induction of craving and (2) studies combining cue-exposure therapy with VR in the promotion of abstinence from drugs and alcohol use. They used virtual environments, displaying alcohol and drugs to SUD patients. Moreover, some environments included avatars. Hence, some studies have focused on the social interactions that are associated with drug-seeking behaviors and peer pressure. Findings indicate that VR can successfully increase craving. Studies combining cue–exposure therapy with virtual environment, however, reported mitigated success so far.

Virtual Reality (VR) in Assessment and Treatment of Addictive Disorders: A Systematic Review

“…Several results suggest that immersing subjects in virtual environments related to an addiction can combat many issues regarding craving assessment (Hone-Blanchet et al, 2014;Pericot-Valverde et al, 2016). VR have proved to be effective in triggering craving in both substance use disorder and behavioral addiction.…”

Noninvasive brain stimulation to suppress craving in substance use disorders: Review of human evidence and methodological considerations for future work

“…It can be discussed that abstinence-induced and cue-induced craving may ultimately represent the same neurological phenomena, but works have demonstrated that in smokers, craving can be induced with cues a few minutes after nicotine smoking (Franklin et al, 2007), suggesting that cue-reactivity may work independently from pharmacological stimulation and abstinence state. Additionally, it is often proposed that cue-induced craving paradigms may be a more ecologically valid approach, as recuperating SUDs patients are sensitive to environmental drug-related cues (Ferguson and Shiffman, 2009; Hone-Blanchet et al, 2014). …”

“…We focus here on craving because it is now a DSM 5 criterion for SUD. Craving is also considered a predictive factor of relapse following a quit attempt because of abnormal cue-reactivity in SUD patients (Baker et al, 2012; Goudriaan et al, 2010; Paulus et al, 2005; Hone-Blanchet et al, 2014) but this concept is still disputed (Perkins, 2012). For instance, in tobacco use disorder (TUD), it is suggested that therapies for smoking cessation should tune down cue-induced craving (Ferguson and Shiffman, 2009).…”

Isradipine enhancement of virtual reality cue exposure for smoking cessation: Rationale and study protocol for a double-blind randomized controlled trial

“…The increased availability of VR technology helps address this limitation by providing an immersive and standardized context that can be systematically applied to activate and extinguish cigarette cravings [47]. The use of VR is supported by recent reviews and metaanalysis of computer-generated smoking environments which found robust craving effects in cue-reactivity research [47][48][49]. However, there are several limitations of traditional, computergenerated VR environments, including the time and technical expertise required to produce them, and the video game quality of the graphics, which have not yet achieved an optimal level of realism.…”