Examining the Power of Recovery Cues to Enhance Real-Time Regulation and Manage Substance Craving

Abstract

Evidence suggests individuals in substance-use treatment experience high relapse rates upon discharge due to repeated exposure to sensory-based reminders of their addiction. Thus, when a person in recovery is exposed to stressful triggers, changing the immediate sensory environment may help mitigate relapse risk. This proof-of-concept study deployed 27 customized virtual reality (VR) simulations that included drug triggers and “recovery cues” presented in three different VR scenarios to measure the impact of recovery cues on neurophysiological outcomes. Each participant (N = 12) experienced two 4-min. simulations (24 total simulations) featuring drug-related, non-drug related stressor cues, followed by recovery cues. Change was measured by both electroencephalography (EEG) and subjective interview prompts, with results offering preliminary support that recovery cue exposure helps regulate response to substance stimuli.

Keywords

virtual reality recovery cues relapse prevention technology substance use

Get full access to this article

View all access options for this article.

References

Aldridge

Barnes

Bethel

C. L.

Carruth

D. W.

Kocturova

Pleva

Juhar

(2019). Accessible Electroencephalograms (EEGs): A Comparative Review with OpenBCI’s Ultracortex Mark IV Headset. In 2019 29th International Conference Radioelektronika (RADIOELEKTRONIKA) (pp. 1–6). IEE. https://doi.org/10.1109/RADIOELEK.2019.8733482

Balban

M. Y.

Cafaro

Saue-Fletcher

Washington

M. J.

Bijanzadeh

Lee

A. M.

Chang

E. F.

Huberman

A. D.

(2021). Human responses to visually evoked threat. Current Biology, 31(3), 601–612.

Bell

I. H.

Nicholas

Alvarez-Jimenez

Thompson

Valmaggia

(2020). Virtual reality as a clinical tool in mental health research and practice. Dialogues in Clinical Neuroscience, 22(2), 169–177.

Bermúdez

Badia

Velez Quintero

Cameirão

M. S.

Chirico

Triberti

Cipresso

Gaggioli

(2018). Toward emotionally adaptive virtual reality for mental health applications. IEEE Journal of Biomedical and Health Informatics, 23(5), 1877.

Bickel

W. K.

Mellis

A. M.

Snider

S. E.

Athamneh

L. N.

Stein

J. S.

Pope

D. A.

(2018). 21st century neurobehavioral theories of decision making in addiction: Review and evaluation. Pharmacology, Biochemistry, and Behavior, 164, 4–21. https://doi.org/10.1016/j.pbb.2017.09.009

Brightline Interactive. https://www.brightlineinteractive.com/ (n.d.).

Byrne

K. A.

Roth

P. J.

Merchant

Baginski

Robinson

Dumas

Collie

Ramsey

Cull

Cooper

Churitch

Rennert

Heo

Jones

(2020). Inpatient link to peer recovery coaching: Results from a pilot randomized control trial. Drug and Alcohol Dependence, 215, 108234. https://doi.org/10.1016/j.drugalcdep.2020.

Campanella

Arikan

Babiloni

Balconi

Bertollo

Betti

Bianchi

Brunovsky

Buttinelli

Comani

Di Lorenzo

Dumalin

Escera

Fallgatter

Fisher

Giordano

G. M.

Guntekin

Imperatori

Ishii

Pogarell

(2021). Special report on the impact of the COVID-19 pandemic on clinical EEG and research and consensus recommendations for the safe use of EEG. Clinical EEG and Neuroscience, 52(1), 3–28. https://doi.org/10.1177/1550059420954054

Cofresí

R. U.

Bartholow

B. D.

Piasecki

T. M.

(2019). Evidence for incentive salience sensitization as a pathway to alcohol use disorder. Neuroscience and Biobehavioral Reviews, 107, 897–926. https://doi.org/10.1016/j.neubiorev.2019.10.009

10.

Delorme

Makeig

(2004). EEGLAB: an open source toolbox for analysis of single-trial EEG dynamics including independent component analysis. Journal of Neuroscience Methods, 134 (1), 9–21. https://doi.org/10.1016/j.jneumeth.2003.10.009

11.

Eddie

Bates

M. E.

Buckman

J. F.

(2020). Closing the brain-heart loop: Towards more holistic models of addiction and addiction recovery. Addiction Biology, 27, Article e12958. https://doi.org/10.1111/adb.12958

12.

Emmelkamp

P. M. G.

Meyerbroker

(2021). Virtual reality therapy in mental health. Annual Review of Clinical Psychology, 17, 21.1–21.5.

13.

Fadus

M. C.

Squeglia

L. M.

Valadez

E. A.

Tomko

R. L.

Bryant

B. E.

Gray

K. M.

(2019). Adolescent substance use disorder treatment: An update on evidence-based strategies. Current Psychiatry Reports, 21(10), 1–10.

14.

Faraj

M. M.

Lipanski

N. M.

Morales

Goldberg

Bluth

M. H.

Marusak

H. A.

Greenwald

M. K.

(2021). A virtual reality meditative intervention modulates pain and the pain neuromatrix in patients with Opioid Use Disorder. Pain Medicine, 22(11), 2739–2753.

15.

Gamito

Oliveira

Matias

Cunha

Brito

Lopes

P. F.

Deus

(2021). Virtual reality cognitive training among individuals with alcohol use disorder undergoing residential treatment: Pilot randomized controlled trial. Journal of Medical Internet Research, 23(1), Article e18482.

16.

Garland

E. L.

Recasens

Taple

B. J.

Donaldson

G. W.

Weisberg

R. B.

(2024). Virtual reality-based Mindfulness-Oriented Recovery Enhancement (MORE-VR) as an adjunct to medications for opioid use disorder: A Phase 1 trial. Annals of Medicine, 56(1), 2392870.

17.

Gerritsen

R. J. S.

Band

G. P. H.

(2018). Breath of life: The respiratory vagal stimulation model of contemplative activity. Frontiers in Human Neuroscience, 12, Article 397.

18.

Ghiţă

Gutiérrez-Maldonado

(2018). Applications of virtual reality in individuals with alcohol misuse: A systematic review. Addictive Behaviors, 81, 1–11. https://doi.org/10.1016/j.addbeh.2018.01.036

19.

Goodyear

Haass-Koffler

(2020). Opioid craving in human laboratory settings: A review of the challenges and limitations. Neurotherapeutics, 17, 100–104.

20.

Greenwald

H. J.

Berger

Wilson

R. L. H.

Greenwald

D. J.

Lannon

Johnson-Smith

Bergman

B. G.

Wilens

T. E.

(2024). A pilot study of virtual reality for inpatients with opioid use disorder. American Journal of Addiction, 33(4), 423–429. https://doi.org/10.1111/ajad.13526

21.

Griffiths

B. J.

Mayhew

S. D.

Mullinger

K. J.

Jorge

Charest

Wimber

Hanslmayr

(2019, November 29). Alpha/beta power decreases track the fidelity of stimulus-specific information. eLife 8, Article e49562. https://doi.org/10.7554/eLife.49562

22.

Hou

Zhang

Huang

Wang

(2020). Neurofeedback training improves anxiety trait and depressive symptom in GAD. Brain and Behavior, 11, Article e02024.

23.

Huang

Mohan

De Ridder

Sunaert

Vanneste

(2018). The neural correlates of the unified percept of alcohol-related craving: A fMRI and EEG study. Scientific Reports, 8(1), 923. https://doi.org/10.1038/s41598-017-18471-y

24.

Koob

G. F.

Volkow

N. D.

(2016). Neurobiology of addiction: A neurocircuitry analysis. Lancet Psychiatry, 3(8), 760–773. https://doi.org/10.1016/S2215-0366(16)00104-8

25.

Langener

Van Der Nagel

van Manen

Markus

Dijkstra

De Fuentes-Merilles

Klaassen

Heitmann

Heylen

Schellekens

(2021). Clinical relevance of immersive virtual reality in the assessment and treatment of addictive disorders: A systematic review and future perspective. Journal of Clinical Medicine, 10, 3658. https://doi.org/10.3390/jcm10163658

26.

Lebiecka

Skoneczny

Tyburski

Samochowiec

Kucharska-Mazur

(2021). Is virtual reality cue exposure a promising adjunctive treatment for alcohol use disorder? Journal of Clinical Medicine, 10, 2972.

27.

Lee

S. H.

Han

D. H.

Lyoo

I. K.

Lee

Y. S.

Renshaw

P. F.

Lukas

S. E.

(2009). Quantitative electroencephalographic (qEEG) correlates of craving during virtual reality therapy in alcohol-dependent patients. Pharmacology Biochemistry and Behavior, 91(3), 393–397. https://doi.org/10.1016/j.pbb.2008.08.014

28.

Keil

(2023). Sensing fear: Fast and precise threat evaluation in human sensory cortex. Trends in Cognitive Sciences, 27(4), 341–352. https://doi.org/10.1016/j.tics.2023.01.001

29.

Wilson

D. A.

(2023). Threat memory in the sensory cortex: Insights from olfaction. The Neuroscientist: A Review Journal Bringing Neurobiology, Neurology and Psychiatry, 30(3), 285–293. https://doi.org/10.1177/10738584221148994

30.

Man

D. W.

(2020). Virtual reality-based cognitive training for drug abusers: A randomized controlled trial. Neuropsychological Rehabilitation, 30(2), 315–332. https://doi.org/10.1080/09602011.2018.1468271

31.

Manual

J. I.

Yuan

Herman

D. B.

Svikis

D. S.

Nichols

Palmer

Deren

(2017). Barriers and facilitators to successful transition from long-term residential substance abuse treatment. Journal of Substance Abuse Treatment, 74, 16–22.

32.

Matto

H. C.

Seshaiyer

Carmack

Peixoto

Scherbel

(2021). When triggers become tigers: Taming the Autonomic Nervous System via sensory support system modulation. Journal of Social Work Practice in the Addictions, 21, 382–395. https://doi.org/10.1080/1533256X.2021.1973833

33.

McHugh

R. K.

Fulciniti

Mashhoon

Weiss

R. D.

(2016). Cue-induced craving to paraphernalia and drug images in opioid dependence. American Journal of Addiction, 25(2), 105–109.

34.

Metrik

Aston

E. R.

Kahler

C. W.

Rohsenow

D. J.

McGeary

J. E.

Knopik

V. S.

MacKillop

(2016). Cue-elicited increases in incentive salience for marijuana: Craving, demand, and attentional bias. Drug and Alcohol Dependence, 167, 82–88. https://doi.org/10.1016/j.drugalcdep.2016.07.027

35.

National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services. (2020). Drugs, brains, and behavior: The science of addiction (NIH Publication No. 20-DA-5605). https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain

36.

Oculus Rift S: PC—Powered VR Gaming Headset—Oculus . (n.d.). https://www.oculus.com/rift-s/

37.

Paliwal

Hyman

S. M.

Sinha

(2008). Craving predicts time to cocaine relapse: Further validation of the Now and Brief versions of the cocaine craving questionnaire. Drug Alcohol Dependence, 93(3), 252–259. https://doi.org/10.1016/j.drugalcdep.2007.10.002

38.

Parvaz

M. A.

Moeller

S. J.

Malaker

Sinha

Alia-Klein

Goldstein

R. Z.

(2017). Abstinence reverses EEG-indexed attention bias between drug-related and pleasant stimuli in cocaine-addicted individuals. Journal of Psychiatry & Neuroscience, 42(2), 78–86. https://doi.org/10.1503/jpn.150358

39.

Pericot-Valverde

Secades-Villa

Gutierrez-Maldonado

(2019). A randomized clinical trial of cue exposure treatment through virtual reality for smoking cessation. Journal of Substance Abuse Treatment, 96, 26–32.

40.

Rayi

Murr

N. I.

(2022). Electroencephalogram. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563295

41.

Ribic

(2020). Stability in the face of change: Lifelong experience-dependent plasticity in the sensory cortex. Frontiers in Cellular Neuroscience, 14, Article 76. https://doi.org/10.3389/fncel.2020.00076

42.

Rosenthal

Ebrahimi

Wedemeyer

Romanczuk-Seiferth

Beck

(2022). The treatment of substance use disorders: Recent developments and new perspectives. Neuropsychobiology, 81, 451–472.

43.

Ryan

J. J.

Kreiner

D. S.

Chapman

M. D.

Stark-Wroblewski

(2010). Virtual reality cues for binge drinking in college students. Cyberpsychology Behavior and Social Networking, 13, 159–162.

44.

Samora

Jeong

Conway

F. N.

Claborn

K. R.

(2024). Applications of immersive virtual reality for illicit substance use: A systematic review. Journal of Studies on Alcohol and Drugs, 85(2), 158–167.

45.

Segawa

Baudry

Bourla

Blanc

J.-V.

Peretti

C.-S.

Mouchabac

Ferreri

(2020). Virtual reality (VR) in assessment and treatment of addictive disorders: A systematic review. Frontiers in Neuroscience, 13, Article 1409.

46.

Son

J. H.

Lee

S. H.

Seok

J. W.

Kee

B. S.

Lee

H. W.

Kim

H. J.

Lee

T. K.

Han

D. H.

(2015). Virtual reality therapy for the treatment of alcohol dependence: A preliminary investigation with positron emission tomography/computerized tomography. Journal of Studies on Alcohol and Drugs, 76(4), 620–627. https://doi.org/10.15288/jsad.2015.76.620

47.

Taubin

Berger

Greenwald

Burke

Gongora

D. S.

Wilens

(2023). A systematic review of virtual reality therapies for substance use disorders: Impact on secondary treatment outcomes. American Journal of Addiction, 32(1), 13–23.

48.

Ultracortex Mark IV—OpenBCI Documentation . (2022, September 28). https://openbci.github.io/AddOns/Headwear/MarkIV/

49.

Vial

Boudhraâ

Dumont

(2022). Human-centered design approaches in digital mental health interventions: Exploratory mapping review. JMIR Mental Health, 9(6), Article e35591. https://doi.org/10.2196/35591

50.

Volkow

N. D.

Koob

G. F.

McLellan

A. T.

(2016). Neurobiologic advances from the brain disease model of addiction. The New England Journal of Medicine, 374(4), 363–371. https://doi.org/10.1056/NEJMra1511480

51.

Wang

Y.-G.

Liu

M.-H.

Shen

Z.-H.

(2019). A virtual reality counterconditioning procedure to reduce methamphetamine cue-induced craving. Journal of Psychiatric Research, 116, 88–94. https://doi.org/10.1016/j.jpsychires.2019.06.007

52.

Wiese

A. M.

Reisweber

Lambert

Bjork

J. M.

(2024). Transcending Self Therapy-Virtual Reality (TST-VR) and Substance Use Disorder (SUD) treatment completion in veterans. Journal of Medical Extended Reality, 1(1), 242–248.

53.

Yilmaz

Huberman

A. D.

(2019). Fear: It’s all in your line of sight. Current Biology, 29, R12241251.

54.

Yi Wen

Mohd Aris

S. A

. (2020). Electroencephalogram (EEG) stress analysis on alpha/beta ratio and theta/beta ratio. Indonesian Journal of Electrical Engineering and Computer Science, 17(1), 175. https://doi.org/10.11591/ijeecs.v17.i1.pp175-182

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

3.70 MB