To understand how virtual reality might help with treatment for substance use disorder, we want you to ask yourself this question:
Have you ever come to a point in your life when you need to decide between two options, where one choice leads you in one direction and the other leads you in a completely different direction?
For instance, when you were at the very beginning of high school, we wonder if you asked yourself questions like these:
- If I join the football team, go all in and dedicate myself to the sport, what will I be like four or five years from now, when I’m a senior?
- If I decide to participate in an accelerated, intensive academic program, and make it my goal to get into an Ivy League college, what will I be like when I’m 25?
- What happens if I decide to skip school today? Will it really make any difference in the grand scheme of things?
These are simple examples, of course. We’re sure you can come up with different examples of times in life when you arrived at a fork in the road and wondered about the possible futures waiting for you on the two different paths ahead.
Wouldn’t it be amazing if you could time travel, meet your future selves – one from fifteen years down each possible road – and ask them for a report on your life in the fifteen years since you chose one road over the other?
We’ll answer that question for you.
Yes, of course, it would indeed be amazing.
It would allow us to compare the outcomes of our choices and decide between them, based on who we are now and who we want to be in the future. Of course, some people would not want to know: they want the future to be a mystery.
We get that.
However.
What if you could apply this time travel idea to the decision to either enter recovery or keep using alcohol or drugs?
That might impact your decision.
Virtual Reality, Future Selves, and Treatment for Substance Use Disorder (SUD)
But this is all speculation, right?
There’s no such thing as time travel.
Right: there’s no such thing as time travel.
What we do have, though, is a new, rapidly expanding technology called virtual reality. What we also have is creative and innovative researchers who work in both virtual reality and addiction treatment. These two fields of study may seem light years apart, but over the past several years, a research team at the University of Indiana School of Medicine collaborated with a virtual reality tech firm in nearby Indianapolis to apply virtual reality technology to substance use disorder treatment.
At this point, we bet you’re thinking, “That’s interesting – but how would that work?”
There are endless possibilities, but in this combined study/tech development/research effort – as reported in the publication “Virtual Reality Intervention Effects On Future Self-Continuity And Delayed Reward Preference In Substance Use Disorder Recovery: Pilot Study Results” – researchers used virtual reality to allow people early in recovery to, essentially, time travel.
Exactly as we describe above, in the high school scenarios we proposed.
We’ll explain.
The research team developed the ability to gather personal information from individuals, based on audio and video interviews, survey questions, and other sources, and combine the data to create three avatars for each person in the study.
Here’s a description of the avatars they created:
First Avatar
- This avatar was their Current Self. In the virtual world, it looks, talks, and behaves like the study participant as they are now.
Second Avatar
- This avatar was their Recovered Self. In the virtual world, it looks, talks, and behaves like the study participant might after fifteen years in recovery from alcohol or substance use.
Third Avatar
- This avatar was their SUD Self. In the virtual world, it looks, talks, and behaves like the study participant might after fifteen years of continued alcohol or substance use.
So far, so good, yes?
Although it seems farfetched, technology now is actually at the point where computer engineers can generate virtual reality (VR) characters that can interact and respond to VR users in real time. In this case, study participants had entered the VR world as their current self and interacted with both future selves: the Recovered Self and the SUD Self.
Let’s back up for a moment, though: is there any reason to think this might work, and change current behavior?
Virtual Reality and Behavior: The Precedent for This Study
We’re backing up for a reality check.
We all know virtual reality is not real, and that even thought it’s come a long way, and designers describe the current state of the most advanced VR as photorealistic, we have to be honest. The VR world still looks like a cartoon world, and the people in it – from out avatars to everyone else – still look like cartoon characters.
Therefore, the question is this: can interacting with a future cartoon version of yourself have any impact at all on your current behavior?
The answer is yes, it can:
- A study conducted in 2011 showed that interacting with future VR avatars can change current behaviors related to spending or saving money
- Another study – this one conducted in 2008 – showed that interacting with future VR avatars can change current behaviors related to exercising
- A third, more recent study conducted in 2015 showed interacting with future VR avatars can reduce current delinquency in adolescents, and promote current ethical behavior
We’ll add that even the most recent of these studies, conducted in 2015, occurred a lifetime ago, in technology years. That means the current VR avatars may have even more potential to create behavioral change than those did.
It’s time to take a look at the study, learn how researchers conducted the work, and examine the results.
Interacting With Your Future Self: The Study on Virtual Reality and Substance Use Disorder
We talk above, briefly, about how researchers created future avatars that were capable of acting as a stand-in for future selves. Researchers conducted audio and video interviews and administered surveys: we told you that, but they did more. In addition, the research team:
- Collected thorough demographic data
- Collected photographs
- Gathered extensive personal details:
- Names of loved ones
- Goals for the future
- Favorite activities
- Most commonly used terms for alcohol and drug use
- Most commonly used terms for recovery or abstinence
- Conducted a Timeline Follow-Back (TLFB) verified by things like:
- Text messages
- Pictures
- Personal calendars
- Bank statements
Once they collected all that data and created avatars for each of their 21 adult participants, they launched the study.
Here’s how it worked.
Part One: Intervention Day
- Pre-Intervention:
- Participants arrived at the test center, got acclimated to the VR technology, then participated in a series of tests and assessments to determine a baseline to gauge the effects of the intervention.
- Assessments measured the following:
- Cravings for alcohol or substances
- Self-similarity/self-continuity, i.e. the ability to identify with/feel connected to a theoretical future, recovered self
- Delayed discounting, i.e. the ability to forgo a small, short term reward for a larger reward at a later date.
[Note: In this article, we do not discuss all assessments conducted during the study. Please click the source link above and read the source material for a comprehensive discussion of all study metrics and results]
- Intervention:
- Participants entered the VR world as their present selves
- They spent five minutes interacting with their Future Recovered Self
- They spent five minutes interacting with their Future SUD Self
- Post-Intervention
- Participants repeated all the assessments they took before the VR intervention (VRI)
Part Two: Recovery
- Avatar Interactions
- Every day for 30 days, participants received, via text message, a picture of their Future Recovered Self, accompanied by the question:
“How confident am I that I will remain abstinent and recovering today?”
- Participants answered by moving a slider in 25% increments between 0% confident and 100% confident
Part Three: Follow Up, One Month Post Intervention
- Participants appeared at the testing center and repeated all pre-intervention assessments
- Participants self-reported alcohol or drug use, and took alcohol breath tests and urine screens for the presence of substances
- Among participants who reported relapse completed detailed questionnaires related to the circumstances and outcome of the relapse event/events
That’s how they conducted the study.
Now let’s take a look at the results.
Interacting With Your Future Self: The Impact on Alcohol and Substance Use
First, the big picture takeaways from the study are that all participants reported, at follow up, that the entire process was acceptable and did not cause stress or psychological distress. That includes the process that involved creating the avatars, the pre-intervention questionnaires, the VR experience itself, the post-intervention questionnaires, and the month of texts from their avatars: all participants reported the process was easily tolerable. Also, researchers reported that during the course of the study, no participants reported any health emergencies or adverse effects related to the study design or related activities.
Now, for the data.
Abstinence/Relapse:
- At thirty days post VR intervention:
- 18 participants reported total abstinence
- 3 participants reported relapse
Cravings:
- Pre-VR Intervention (VRI):
- All participants reported significant cravings for the substance corresponding to their diagnosis
- Post-VRI:
- All participants reported significant reduction in cravings immediately following the VR intervention
- 30-day Follow Up:
- Reduction in craving did not persist, but returned to baseline within thirty days post VR intervention, for all participants
Self-Similarity/Self-Continuity:
- Pre-VRI:
- Participants reported moderate ability to identify with/feel connected to their virtual future Recovered Self
- Post-VRI:
- Participant’s ability to identify with and feel connected to their virtual Future Recovered Self increased significantly
- 30-day Follow Up:
- The increased ability to identify with and feel connected to their virtual Future Recovered Self persisted, and remained at levels reported post-VR intervention
Delayed Discounting:
- Pre-Test:
- All participants had significant problems choosing time-delayed rewards in place of immediate rewards
- Post-Test
- All participants showed significant improvement in choosing time-delayed rewards in place of immediate rewards
- 30-day Follow Up
- The improvements in delayed discounting did not persist, and were largely absent at the 30-day follow-up
The first thing we want to point out is the rate of abstinence: 85 percent is a high success rate for any intervention or treatment approach for AUD or SUD. Granted, 30 days is not long-term recovery, but compared to data that indicates an average relapse rate of 40-60 percent for people with AUD or SUD, a relapse rate of 15 percent is significant, and alone could verify the efficacy of this therapeutic approach.
Next, we’ll talk about the less-than-inspiring findings: improvements in cravings and the ability to delay reward that appeared immediately after the VRI did not persist until the 30-day follow-up assessments. However, this finding is mitigated, somewhat, by the relapse rate: despite cravings and a tendency toward instant gratification, 85 percent of the study group remained abstinent.
Finally, with regards to the experimental results, we’ll observe that among all participants, the ability to identify with/feel connected to their virtual Future Recovered Self increased after the VRI, and these increases persisted for the entire study period. What that tells us is that what we secretly thought might be a little bit corny – interacting with your future cartoon self – was not corny at all, but rather effective in important ways. We mention abstinence – important, of course – but the fact that the VRI helped people see a positive vision of their future, and maintain that positive vision, is a major accomplishment: ask any treatment professional: when a person believes they can recover, they’re more likely to achieve long-term recovery.
Future Directions for Virtual Reality in SUD Treatment
We weren’t the only people impressed with the results of this experiment.
Based on these results, the research team received a $4.9 million grant from the National Institute of Drug Abuse (NIDA) and the National Institute of Alcohol Abuse and Alcoholism (NIAAA) to continue this work.
That’s a big grant – and this technology can make a big difference in the lives of people diagnosed with AUD or SUD.
The idea of talking to your future self to evaluate present decisions is novel, and this research shows it has real potential. Dr. Brandon Oberlin, a lead researcher on this study, elaborates on this approach in an interview in Science Daily:
“This experience enables people in recovery to have a personalized virtual experience, in alternate futures resulting from the choices they made. We believe this could be a revolutionary intervention for early substance use disorders recovery, with perhaps even further-reaching mental health applications.”
This is not the stuff of science fiction. With the results of this study, what Dr. Oberlin discusses is not stuff at all, but rather, real science. He continues:
“The ultimate goal of our work is to leverage state-of-the-art VR technology for providing therapeutic experiences to support early recovery – a very dangerous time period marked by a high risk for relapse.”
This work is promising. With time, energy, funding – and an open mind – this may become a valuable tool in our work supporting people with AUD and SUD. We’ll keep an eye on this research – and report new developments here as soon as researchers publish their data.