Virtual Reality-Based Treatment Approaches in the Field of Substance Use Disorders

Abstract

Purpose Substance use disorders (SUD) are burdening chronic conditions characterized by high relapse rates despite severe negative consequences. Substance-related cues that elicit craving by means of automatic physiological and behavioural responses have long been suggested to predict relapse. One major mechanism contributing to relapse behaviour are cue-induced behavioural approach tendencies towards the addictive agent. Recently, there has been an emerging interest in virtual reality (VR)-based approaches to assess and modify craving and its related responses. This review aims at elucidating (1) VR techniques applied in the field of SUD, (2) VR as an induction/assessment tool for biopsychological correlates of craving and (3) VR-based therapeutic approaches. Findings There is an emerging number of studies focusing on different substances of abuse incorporating VR in craving induction/assessment as well as therapy. Despite some limitations as missing of randomized controlled clinical trials with large samples and missing data on the long-term effects of VR treatment, the VR approach showed consistent results in eliciting and reducing craving across different substances. Summary This review suggests virtual reality as a promising tool for the assessment and treatment of craving among individuals with substance use disorders. Because of its ecological validity, VR unifies the benefits of a laboratory setting with the advantages of a realistic environment. Further studies with large samples and randomized controlled clinical trials using more homogenous VR techniques as well as assessment of objective biophysiological craving markers are required.

The Effectiveness of Virtual Reality Interventions on Smoking, Nutrition, Alcohol, Physical Activity and/or Obesity Risk Factors: A Systematic Review

“…A number of systematic reviews have examined the effectiveness of VR interventions on improving smoking, alcohol, physical activity and/or obesity risk factors [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] but none have focussed on nutrition. However, these reviews focus primarily on a single health risk behaviour [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], the outcome of cravings [ 20 , 21 , 22 ], a specific type of VR such as avatar-based studies [ 15 ], or included non-randomised controlled studies [ 20 ]. In relation to smoking tobacco, systematic reviews have shown promising results showing VR cue exposure therapy can be used to reduce cravings [ 16 , 20 ].…”

“…Furthermore, these reviews [ 16 , 20 ] included studies with no control group, non-randomised studies, compared VR with VR comparators, or the review focused on the type of therapies delivered through VR and not the effectiveness of VR itself. Existing systematic reviews examining VR interventions and alcohol have focused on VR cue exposure therapy as a treatment for cravings, driving simulations, or training and not the effectiveness of VR on cessation of alcohol use/misuse [ 11 , 14 , 20 , 21 , 22 ].…”

“…In addition to the effectiveness of VR interventions on reducing SNAPO risk factors, other factors such as use, satisfaction/acceptability of support received, and economic costs are also important to consider. None of the existing systematic reviews [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] have included outcomes on use of VR, user satisfaction/acceptability or costs, although, four reviews have noted there is a need for more studies to report costs [ 11 , 16 , 20 , 21 ].…”

“…Given the limitations of the existing systematic reviews [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], and current gaps in the literature, a comprehensive systematic review that examines the effectiveness of VR interventions across SNAPO risk factors is needed. The primary aim of this systematic review was to examine the effectiveness of VR interventions on reducing smoking tobacco, nutrition, alcohol, physical activity and/or obesity risk factors compared to (1) no intervention or minimal support control groups or (2) other behavioural or non-behavioural interventions.…”

Die Anwendung der Virtuellen Realität in der Behandlung psychischer Störungen

“…Die VR-Exposition mit suchtassoziierten Stimuli löste in mehreren Studien Craving bei Patienten mit Nikotin‑, Alkohol-, sowie Methamphetaminabhängigkeit aus, wobei zum Teil olfaktorische Reize zur Verstärkung eingesetzt wurden [ 40 ]. Die Wiederholung von Expositionen führte in mehreren Studien zu einer signifikanten Craving-Reduktion [ 27 , 42 ]. Bisher fehlen aber randomisierte kontrollierte Studien zur Wirksamkeit der VR-Anwendungen bezüglich Verbesserung von Abstinenzraten oder -dauern [ 27 , 42 ].…”