Substance abuse and addiction represent a major medical problem. The German Federal Ministry of Health reports that approximately 12 million people smoke, 1.6 million people are dependent on alcohol, and around 2.3 million people are dependent on medication. About 600,000 people show problematic use of cannabis and other illegal drugs, and 500,000 people exhibit problematic or even pathological gambling behavior.

Current addiction treatment is unsatisfactory. Even in countries with high incomes and well-developed healthcare systems, only about 7% of affected individuals receive adequate treatment. High relapse rates and chronic impairments in quality of life characterize the significant burden experienced by patients.

Virtual reality therapy has been studied across a wide range of psychiatric indications, including post-traumatic stress disorder, phobias, and eating disorders. This includes virtual exposure therapy (VET) as well as virtual cognitive behavioral therapy (VCBT) for specific and social phobias. The advantages are clear: virtually unlimited, artificially created environments can be used as needed. Users can interact with objects and their surroundings and, under guidance, learn new responses and behaviors.

VR also represents a promising approach for individuals with addiction. Therapeutic use in addiction medicine requires simple yet sophisticated software, as well as data demonstrating patient benefits compared to, or in combination with, conventional therapeutic approaches. An analysis published in the renowned journal Frontiers in Neuroscience examines whether VR is truly effective across a broad range of different addictions.

A total of 471 scientific articles were screened, and 37 were analyzed in detail. The results were categorized according to reactions to virtual stimuli and treatment outcomes. Each individual study result was compiled into tables and interpreted in an overview format.

Across all areas—nicotine, alcohol, cocaine, cannabis, gambling, and internet gaming disorder—it was shown that patients react to virtual stimuli with increased craving. Such virtual cues included cigarette packs, alcohol bottles, or lottery terminals, presented individually, in combination, and in some cases with social pressure exerted by avatars. Overall, the data show that virtual cue exposure is comparable to real-life cues in both psychological and physiological terms. Complex combinations of cues and social pressure from avatars may enhance craving-related effects. This suggests that stepwise increases in exposure can be easily implemented. The findings support the fundamental functionality of treating substance abuse and addiction using VET and VCBT.

The studies included in the review addressed a wide variety of substance-related and behavioral addictions in different environments. Traditional exposure therapies are difficult, as substance confrontation is often separated from social contexts or can only be conducted in vivo with considerable effort. These methodological limitations also complicate research aimed at producing clear data.

VR can overcome these limitations by using virtual immersion to simulate everyday life and typical exposure situations. VET has proven effective in reducing craving across different stimuli. Aversive elements as well as cognitive-behavioral coping strategies may provide additional therapeutic benefits.

The diversity of topics, stimuli, and intervention protocols limits the comparability of available data. In addition, the number of studies is still relatively small in some areas. Further research is therefore desirable to support the consistency of the observed effects.

The review demonstrates that inducing craving through VR-based exposure leads to positive outcomes. Furthermore, the work by Segawa et al. confirms the fundamental effectiveness of VR-supported addiction therapy. Learning coping strategies in virtual environments has a positive impact on craving and abstinence behavior. Overall, it can be concluded that VET and VCBT represent promising extensions of the therapeutic repertoire for substance abuse and addiction disorders.

Source: https://www.bundesgesundheitsministerium.de/themen/praevention/gesundheitsgefahren/sucht-und-drogen.html; Segawa T, Baudry T, Bourla A, Blanc JV, Peretti CS, Mouchabac S, Ferreri F. Virtual Reality (VR) in Assessment and Treatment of Addictive Disorders: A Systematic Review. Front Neurosci. 2020 Jan 10;13:1409. doi: 10.3389/fnins.2019.01409. PMID: 31998066; PMCID: PMC6965009. Hanshans, C & Faust, M & Bröll, L (2021). Virtual Reality als neues Werkzeug in der Suchtbehandlung. 1. 2021. 10.5281/zenodo.4774784.