Is Substance Abuse Treatment Possible Through Simulated Environments in Virtual Reality?
Can we treat substance abuse through Virtual Reality technology? Today’s Guest Author Patrick Bailey submitted an article to share how substance abuse can indeed be treated through virtual reality, further connecting the dots between healthcare education for patients and the latest in simulated-based technologies. Patrick takes on a journey through the history of VR technology, its applications and uses across multiple industries, the need to change substance abuse therapies, and how VR is already making an impact. Are you utilizing healthcare simulation VR technologies in your patient therapies like ICT out of USC? Share your story by submitting an article of your own above or commenting below!
A Background on VR and a New Challenge
Although we see Virtual Reality enhancing the video game experience, the technology is actually not new. It’s been around since the late 50s and early 60s through Morton Heilig, who introduced “Sensorama” to the world. By the 80s, VR technology is already being used by NASA in all its simulation programs. The modern VR gear was introduced in the market in the 1990s, but the public was turned off because the early devices couldn’t deliver on what they promised.
With the many applications of VR across different industries, it’s just natural that it will also be adopted to assist patients suffering from both alcohol and drug addiction.
In 2011, Patrick S. Bordnick, M.P.H., Ph.D., Brian L. Carter, Ph.D., and Amy C. Traylor broached this possibility in a research titled, “What Virtual Reality Research in Addictions Can Tell Us about the Future of Obesity Assessment and Treatment.”
While treatment programs have been proven to be effective in flushing out the toxins and getting the patient sober, centers still could not curb the high relapse rate, which is estimated to be between 40 and 60 percent. The relapse rate is highest during the first year after finishing the program.
The research thinks that VR technology would play an important role in filling the gaps. Early studies have already established that recovering patients still react to stimuli like alcohol, cigarette or drugs when they are exposed to the scenario. Just how much is still not clear since there’s no widespread study on the use of technology in treating addiction.
The challenge, however, appears insurmountable.
In March, the Centers for Disease Control and Prevention issued a warning about the rising number of drug overdose deaths in the US. In 2016, 63,632 people died from drug overdose, and the figure represented a 21.5% increase in incidents. Most of the deaths were males between the ages of 25 and 44.
More than 6 in 10 of the fatalities were caused by prescription opioid, particularly fentanyl, which is a hundred times more powerful than morphine and 50 times more potent than heroin.
While there are an estimated more than 23 million dependents in the US, only about 10 percent are receiving treatment. This is alarming considering that alcohol and drug abuse is proven to be a highly treatable disease.
Raising Substance-Addled Youth
Meanwhile, we are raising a generation of drug and alcohol dependents. About 1 in 12 of teenagers is suffering from a substance use disorder. That’s five percent of the total adolescent population in the US. The lackadaisical approach to prescription opioids is contributing to the epidemic as they serve to be the gateway drug, apart from marijuana, for the youth to be hooked on illicit drugs.
In 2013, Dr. Patrick Bordnick again led a study on the application of VR technology to addiction. He published the research titled “Virtual Reality Cue Reactivity Assessment: A Comparison of Treatment- vs. Nontreatment-Seeking Smokers.” The study concluded that the technology can become a useful tool in monitoring the progress of the patients by presenting them with what he called “cue reactions,” or real-life scenarios that the individuals may encounter when they leave the facility.
In an interview with The Fix, Bordnick said that through the use of the technology, clinicians can induce stimulus from the patient by showing them specific scenario that will trigger a response. He gave an example where the VR will show a party scene where copious amounts of alcohol, drugs, and cigarettes are being used.
How Does This Work?
Simply put, the VR technology allows researchers to bring in real-world scenarios in a controlled environment. By constantly exposing them to the stimuli, it is hoped that they can better cope when they leave the rehab center and exposed to the same scenarios.
The technology just offers possibilities that present traditional rehab programs can only dream of. While physicians and social workers can “walk through” the patient on what they can do when presented with a challenging situation when they go outside, there’s no substitute for showing them the same situation in an immersive experience. In that way, clinicians can track the response of the patient.
It’s easy for the patient to say that he won’t ever accept any offer of drugs when he goes outside. It’s not to say that the patient is less than truthful. In fact, he may even believe what he’s saying. The controlled environment inside the rehab center will contribute to this skewed assessment.
Just like former heavyweight boxer, Mike Tyson, so eloquently puts it: Everyone has a plan until they get punched in the mouth.
The China Experience on VR Technology
The use of VR is being used by the Shanghai Drug Rehabilitation Administration to great effect. Around 700 patients attend sessions where they wear the VR helmet for two main purposes: First, it allows the staff to monitor their cravings; and second, patients are desensitized to the sight of drugs.
The technology monitors eye movement, heart rate, along with other metrics to determine the body’s response when shown the drug. This eliminates any situation where the patient can just lie about being better in order to leave the rehab program.
In the desensitization treatment, the patients are shown in VR situations—whether in a bar or a friend’s party—where people are taking drugs. These are real-life scenarios that they may be exposed to when they leave the center.
However, just as they are watching people taking drugs, a video will be superimposed on the scene showing graphic images that shows how addiction can be harmful to their health.
In Zhejiang Province, the use of VR for drug rehab has been shown to have a 73.6% success rate in terms of reducing the cravings for the recovering patients. And the government employed the technology on 10,000 drug users, which is probably a critical mass that proves the success of this technology as an aiding tool to treat addiction.
Bravemind and PTS
The use of VR is actually being used in treating PTSD for war veterans and soldiers, and the technology—dubbed Bravemind—is almost two decades old. The technology has been updated to fit the more modern and lighter headsets of today, such as the HTC Vive, for instance, which is designed to be used for video gaming.
Psychologists have a term for it—presence. Bringing the patient into the now because of the hyperrealistic images loaded into the VR.
This has already been explored in treating anxiety issues. For instance, somebody who is afraid public speaking will benefit from being exposed to it in increments. But it would not be viable to always bring in a crowd to listen to them speak.
The answer? Virtual Reality.
In the same manner, somebody with a phobia with heights will benefit from the hyper-realistic scenarios offered by VR. They can skydive, scale tall buildings, and even bungee jump without spending too much money or risking their lives.
Bravemind is being used to bring soldiers back to where they developed the trauma. Psychologists typically do this through hypnosis but with VR, you can just strap on the device on the head of the patient and load the program.
The operative word here is control. The center always has control of the environment and can stop the treatment right away in case of any problems.
However, the dearth of programs for alcohol and drug addiction is an issue. The mind is very complex. You have to personalize the scenarios loaded into the VR to make it resonate with the patient. In most addictions, you also have to account for the mental health problems associated with it.
Because there’s a lot of gray area on the use of VR technology, it makes sense that it will draw some criticisms.
For instance, Mayank Mehta, a neurophysicist at the Los Angeles’ Center for Neurophysics, said there’s a lot of unknowns on the use of VR technology to treat substance abuse and PTSD. He’s not shooting from the hip either, since Mehta has been researching the changes in the brains of the lab rats, which couldn’t distinguish between real life and VR stimuli.
Mehta told USA Today that if the patients will feel that the VR technology is so real that it can lead to treatment, “can it also create experiences that are traumatic?”.
The criticism is understandable considering that there’s no metric yet that will determine the changes in the brain caused by VR. This is why for now, virtual reality is mainly used as a tool to determine respondent response when exposed to stimuli. Hopefully, like the Chinese experience, patients are better able to cope when they face the same situation in the real world.
The use of VR is still very much in its infancy stage. Most facilities don’t really employ the technology, which is seen for now as a novelty pending any widespread study on its efficacy. Nevertheless, the typical rehabilitation treatment center is sufficient to treat a patient stuck in the cycle of addiction.
Article Submitted By: Patrick Bailey
Lance Baily, BA, EMT-B, is the Founder & CEO of HealthySimulation.com, which he started while serving as the Director of the Nevada System of Higher Education’s Clinical Simulation Center of Las Vegas back in 2010. Lance is also the Founder and acting Advisor to the Board of SimGHOSTS.org, the world’s only non-profit organization dedicated to supporting professionals operating healthcare simulation technologies. His new co-edited Book: “Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice” is available now. Lance’s background also includes serving as a Simulation Technology Specialist for the LA Community College District, EMS fire fighting, Hollywood movie production, rescue diving, and global travel. He lives with his wife Abigail in Las Vegas, Nevada.