The Potential of Virtual Reality in Substance Use Treatment

Written By valentina uhlke

Substance use disorders (SUD) remain a major global health issue, and relapse continues to be a significant challenge, even when people receive well-established treatments (Auriacombe et al., 2018; Tsamitros et al., 2021). This is why researchers are increasingly exploring tools that can enhance existing approaches such as CBT, medication, AA, or motivational interviewing, without replacing them. One of the most promising additions to these therapeutic interventions is virtual reality (VR).

Although VR first entered the clinical world in the 1990s to treat phobias, today’s VR technology is far more immersive and is now being used for anxiety, PTSD, and SUD (Dellazizzo et al., 2020; Emmelkamp & Meyerbröker, 2021). Its unique advantage lies in its ability to safely recreate real-life triggers within a fully controlled environment (Scarfe & Glennerster, 2019).

Furthermore, craving in SUD is influenced by a complex interplay of emotional, situational, social, and temporal factors. Ghita et al. (2019) examined alcohol craving patterns in a clinical sample of 75 individuals with alcohol use disorder and found that urges were most pronounced in everyday contexts closely associated with prior drinking experiences. Heightened craving was reported across both public and private settings, including social venues and the home, as well as during specific times such as evenings and weekends. Importantly, increased urges were observed regardless of whether alcohol use typically occurred alone or in the presence of others. Emotional distress, including heightened tension, stress, low mood, and irritability, further amplified craving intensity. These empirically identified triggers were subsequently translated into immersive virtual reality environments, demonstrating how VR can be used to model realistic high-risk situations for cue exposure interventions in a controlled therapeutic context.

Building on this context-dependent nature of craving, virtual reality has been used to recreate such high-risk environments in a controlled setting systematically. Bordnick et al. (2008) developed a VR system that incorporated alcohol-related sights, sounds, and even smells. When 40 non-treatment-seeking adults with alcohol use disorders were placed in these VR alcohol environments, their cravings rose significantly compared with neutral VR scenes. This demonstrated VR’s ability to reliably mirror the real-world situations that elicit strong urges and may contribute to relapse.

Beyond its use in targeting craving mechanisms, VR has also been evaluated for its effectiveness as a treatment component. Hernández-Serrano et al. (2020) examined 42 patients receiving either treatment-as-usual or treatment-as-usual enhanced with VR cue exposure therapy. The VR-supported approach was especially beneficial for those entering treatment with high craving levels or with a history of illicit drug use. Other research has shown similar promise: ten VR-CET sessions were more effective at reducing craving than ten CBT sessions (Lee et al., 2009). And in a placebo-controlled study, Culbertson et al. (2012) found that adding VR-based cue exposure to CBT improved quit rates and reduced cigarettes smoked, with only the VR group showing consistent drops in craving during and after each session. However, the sample size was small (n = 11), which limits generalisability, but the findings still provide preliminary evidence for the potential added value of VR-based cue exposure.

Despite these promising advances, limitations remain in the evidence base for VR as a treatment for SUD. First, VR has not yet been tested in rigorous clinical trials to evaluate its effectiveness as a treatment. Second, it is still unknown whether the craving reactions seen in VR actually carry over to real-life situations. Third, there is currently no evidence on whether the effects of VR-based treatment last in the long term (Ghiţă & Gutiérrez-Maldonado, 2018).

Taken together, these findings highlight the growing potential of VR in SUD. It offers clinicians a safe, flexible way to present the exact cues that typically spark craving, giving individuals space to practice coping skills without real-world risks. While larger studies are still needed, current evidence suggests that VR could become a valuable and innovative complement to traditional treatments for SUD.

References:

  • Auriacombe, M., Serre, F., Denis, C., & Fatséas, M. (2018). Diagnosis of addictions. In The Routledge Handbook of Philosophy and Science of Addiction (pp. 132-144). Routledge.

  • Bordnick, P. S., Traylor, A., Copp, H. L., Graap, K. M., Carter, B., Ferrer, M., & Walton, A. P. (2008). Assessing reactivity to virtual reality alcohol based cues. Addictive behaviors, 33(6), 743-756.

  • Culbertson, C. S., Shulenberger, S., De La Garza, R., Newton, T. F., & Brody, A. L. (2012). Virtual reality cue exposure therapy for the treatment of tobacco dependence. Journal of cyber therapy and rehabilitation, 5(1), 57.

  • Dellazizzo, L., Potvin, S., Luigi, M., & Dumais, A. (2020). Evidence on virtual reality–based therapies for psychiatric disorders: meta-review of meta-analyses. Journal of medical Internet research, 22(8), e20889.

  • Emmelkamp, P. M. G., & Meyerbröker, K. (2021). Virtual Reality Therapy in Mental Health. Annual review of clinical psychology, 17, 495–519. https://doi.org/10.1146/annurev-clinpsy-081219-115923

  • Ghiţă, A., & Gutiérrez-Maldonado, J. (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

  • Ghiţă, A., Teixidor, L., Monras, M., Ortega, L., Mondon, S., Gual, A., Paredes, S. M., Villares Urgell, L., Porras-García, B., Ferrer-García, M., & Gutiérrez-Maldonado, J. (2019). Identifying Triggers of Alcohol Craving to Develop Effective Virtual Environments for Cue Exposure Therapy. Frontiers in psychology, 10, 74. https://doi.org/10.3389/fpsyg.2019.00074

  • Hernández-Serrano O, Ghiţă A, Figueras-Puigderrajols N, Fernández-Ruiz J, Monras M, Ortega L, et al. Predictors of changes in alcohol craving levels during a virtual reality cue exposure treatment among patients with alcohol use disorder. J Clin Med. 2020. https://doi.org/10.3390/jcm9093018

  • Lee, J. H., Kwon, H., Choi, J., & Yang, B. H. (2007). Cue-exposure therapy to decrease alcohol craving in virtual environment. Cyberpsychology & behavior : the impact of the Internet, multimedia and virtual reality on behavior and society, 10(5), 617–623. https://doi.org/10.1089/cpb.2007.9978

  • Scarfe, P., & Glennerster, A. (2019). The Science Behind Virtual Reality Displays. Annual review of vision science, 5, 529–547. https://doi.org/10.1146/annurev-vision-091718-014942

  • Tsamitros, N., Sebold, M., Gutwinski, S. et al. Virtual Reality-Based Treatment Approaches in the Field of Substance Use Disorders. Curr Addict Rep 8, 399–407 (2021). https://doi.org/10.1007/s40429-021-00377-5

valentina uhlke
Previous

Avatar Therapy for Auditory Hallucinations
Next

The Digital Mental Health Boom And the Myths Holding It Back