Behavioral, craving, and anxiety responses among light and heavy drinking college students in alcohol-related virtual environments

Drinking-related behavior in college students represents a public concern with consequences for health and academic performance. The aim of the present study was to determine which measures (behavioral and self-reported measures of craving and anxiety) differentiate best between light- and heavy-drinking college students when exposed to a virtual reality (VR) alcohol-cue environment. 25 college students participated in this study, of whom 13 were light drinkers (standard drink units (SDU)/month ≤ 10) and 12 heavy drinkers (SDU)/month ≥ 11). Participants completed the Alcohol Use Disorder Identification Test (AUDIT) before exposure to the VR environment. Heavy drinkers scored higher than light drinkers on AUDIT. The virtual environment consisted of four situations: restaurant, bar, chill-out area, and bedroom, where participants could choose alcoholic or non-alcoholic beverages. An Oculus Rift DK2 headset was used as the HMD. In each situation, craving and anxiety were self-reported on a visual analog scale (VAS, from 0 to 10). The results showed differences between groups in the type of beverage chosen in the VR situations, whereby heavy drinkers chose alcoholic drinks more frequently. However, no statistically significant differences were found between groups in craving or anxiety levels reported on the VAS during VR exposure. Heavy-drinking students show a preference for alcoholic beverages in all VR situations compared with light drinkers, but do not experience different levels of craving or anxiety as assessed with VAS. If virtual environments are used to detect heavy drinking cases, behavioral parameters such as choosing between alcoholic or non-alcoholic cues seem more suitable than self-reports of craving or anxiety. Nevertheless, future studies are necessary to determine whether more objective measures of craving and anxiety (eye tracking or psychophysiological responses) perform better than selfreports in differentiating between heavy and light drinking

Tolcapone suppresses ethanol intake in alcohol-preferring rats performing a novel cued access protocol

BACKGROUND: Dopamine (DA) has been shown to play a central role in regulating motivated behavior and encoding reward. Chronic drug abuse elicits a state of hypodopaminergia in the mesocorticolimbic (MCL) system in both humans and preclinical rodent models of addiction, including those modeling alcohol use disorders (AUD). METHODS: Working under the hypothesis that reductions in the bioavailability of DA play an integral role in the expression of the excessive drinking phenotype, the catechol-O-methyltransferase (COMT) inhibitor tolcapone was used as a means to amplify cortical DA concentration and drinking behaviors were then assessed. Sucrose and ethanol (EtOH) consumption were measured in P and Wistar rats in both a free choice drinking protocol and a novel cued access protocol. RESULTS: Tolcapone attenuated the consumption of EtOH, and to a lesser extent sucrose, in P rats in the cued access protocol, while no effect was observed in the free choice drinking protocol. Tolcapone also decreased EtOH consumption in high drinking Wistar rats. A follow-up experiment using the indirect DA agonist d-amphetamine showed no change in EtOH consumption. CONCLUSIONS: Collectively, these data suggest that COMT inhibitors may be capable of alleviating the extremely motivating or salient nature of stimuli associated with alcohol. The hypothesis is put forth that the relative specificity of tolcapone for cortical DA systems may mediate the suppression of the high seeking/drinking phenotype

Identifying Triggers of Alcohol Craving to Develop Effective Virtual Environments for Cue Exposure Therapy

Background: Many studies have indicated that alcohol craving is a core mechanism in the acquisition, maintenance, and precipitation of relapse in alcohol use disorder (AUD). A common treatment approach in AUD is cue exposure therapy (CET). New technologies like virtual reality (VR) have the potential to enhance the effectiveness of CET by creating realistic scenarios in naturalistic environments. In this study, we aimed to determine relevant triggers of alcohol craving in patients with AUD. Methods: We enrolled 75 outpatients diagnosed with AUD according to the DSM-5 criteria Participants completed the Alcohol Use Disorder Identification Test and a self-administered questionnaire to assess alcohol craving. The variables included in the craving questionnaire were as follows: presence of others, situations, time of the day, day of the week, mood, and type of alcoholic beverage. Results: Greater levels of alcohol craving were seen in many situations, including being at a party, in a restaurant, in a bar or pub, and at home. Drinking alone and drinking with two or more friends were equally associated with higher levels of craving. Drinking at night and drinking at weekends also emerged as triggers for alcohol craving. Emotional states like anxiety or tension, sadness, stress, frustration, or irritability were highly associated with urges to drink alcohol. The alcoholic drinks most highly associated with increased levels of craving were beer, wine, and whisky. Gender and age implications were discussed. Conclusion: This study is part of a larger project aiming to develop and validate CET based on VR technology for patients with AUD who are resistant to classical treatment. The identified triggers have been used to develop relevant VR environments for CET, and further research is ongoing to implement our findings

Attentional bias, alcohol craving, and anxiety implications of the virtual reality cue-exposure therapy in severe alcohol use disorder: a case report

Aims: Attentional bias (AB), alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder (AUD). The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy (VR-CET) to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content. Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance misuse. The protocol consisted of six VR-CET booster sessions and two assessment sessions (pre- and post-VR-CET) over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality (VR) exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking (ET) and VR technologies at different time points. Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB. Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed

L’intervention Avatar pour le trouble de l’usage de cannabis chez des individus ayant un trouble mental sévère

Le trouble de l’usage de cannabis (TLUC) est une problématique complexe particulièrement lorsqu’il est comorbide à un trouble mental sévère (TMS). D’une part, aucune pharmacothérapie n’a été approuvée pour son traitement et d’une autre part, les psychothérapies existantes offrent au mieux une efficacité faible et non maintenue dans le temps. L’émergence de la réalité virtuelle (RV) en psychiatrie pourrait augmenter l’efficacité considérant le potentiel qu’elle a démontré pour une variété de conditions psychiatriques. Actuellement, aucune intervention ayant incorporé la RV visant le traitement du TLUC n’a fait l'objet de recherche. L’intervention Avatar pour le TLUC se veut une approche innovante utilisant la RV en tant qu’outil thérapeutique afin de faire des apprentissages et les pratiquer au moment où les cravings et les émotions sont d’intensité similaire à celle de leur quotidien. Cette intervention comprenant huit séances utilise des techniques provenant de thérapie recommandée (ex., thérapie cognitivo-comportementale, entrevue motivationnelle). Durant les périodes d’immersion, les participants ont interagi avec un avatar représentant une personne significative en lien avec leur consommation dont le thérapeute joue le rôle. Cet essai clinique pilote a visé l’évaluation de l’efficacité ainsi que la faisabilité et l’acceptabilité à court terme chez 19 participants ayant un double diagnostic de TMS et TLUC. Les résultats ont montré une réduction significative modérée de la quantité de cannabis consommée (d=0,545; p=0,017), laquelle a été confirmée par quantification du THC-COOH dans les urines. Une tendance a été observée pour la fréquence de l’usage (d=0,313; p=0,052). Concernant la sévérité du TLUC et la motivation aux changements, une petite (d=0,474; p=0,046) et modérée (d=0,523; p=0,046) taille d’effet ont été obtenues respectivement. Aucun effet significatif n’a été observé pour la qualité de vie et les symptômes psychiatriques sont restés stables. Les résultats à moyen et long terme seront évalués lorsque les participants auront terminé les suivis à 3, 6 et 12 mois. Un essai randomisé contrôlé à simple insu comparant l’intervention Avatar pour TLUC à une intervention classique en toxicomanie est en cours.Cannabis use disorder (CUD) is a complex issue, particularly when it is comorbid with a severe mental disorder (SMD). On one hand, no pharmacotherapy has been approved for its treatment. On the other hand, existing psychotherapies offer, at best, low efficacy that is not sustained over time. The emergence of virtual reality (VR) in psychiatry could increase efficacy, given the potential it has demonstrated for a variety of psychiatric conditions. To date, no intervention incorporating VR for the treatment of CUD has been developed. The Avatar intervention for CUD is an innovative approach using VR as a therapeutic tool to learn and practice in real-time when cravings and emotions are of similar intensity to their everyday lives. This eight-session intervention uses techniques from commonly used therapeutic approaches (e.g., cognitive-behavioral therapy, motivational interviewing). During immersive sessions, participants interacted with an avatar played by the therapist, representing a significant person intrinsically linked with their consumption. This pilot clinical trial was designed to assess efficacy at short-term, feasibility, and acceptability in 19 participants with a dual diagnosis of SMD and CUD. Results showed a significant moderate reduction in the amount of cannabis consumed (d=0.545, p=0.017), which was confirmed by the quantification of THC-COOH in urine. Regarding the severity of TLUC and motivation to change, a small (d=0.474; p=0.046) and moderate (d=0.523; p=0.046) effect size were obtained, respectively. No significant effect was obtained for quality of life, and psychiatric symptoms remained stable. Once participants have completed the 3-, 6- and 12-month follow-ups, medium- and long-term results will also be assessed. A single-blind randomized controlled trial is currently underway to compare the Avatar intervention for CUD with a conventional addiction intervention

The effects of alcohol odor cues on food and alcohol attentional bias, cravings, and consumption

Indiana University-Purdue University Indianapolis (IUPUI)In order to elucidate the role of classical conditioning in food and alcohol co-consumption, the present study examined: (1) the effects of alcohol odor cues on alcohol and food cravings and attentional bias (bias in selective attention toward either food or alcohol pictures relative to neutral pictures); and (2) the role of alcohol odor cue elicited cravings and attentional biases on subsequent consumption. Participants (n = 77; mean age = 30.84, SD = 9.46; 51.9% female, 83.1% Caucasian) first completed the lab portion of the study. In this portion, they were exposed to alcohol and neutral odorants, after which their food and alcohol cravings and attentional bias were assessed. Participants then received an online survey the next day, on which they reported their level of food and alcohol consumption following the lab portion of the study. Using repeated measures analysis of covariance, alcohol odor cues were differentially effective in increasing food and alcohol attentional bias and cravings (Fs= 0.06 to 2.72, ps= 0.03 to 0.81). Using logistic and multiple regressions, alcohol odor cue elicited alcohol attentional bias, food attentional bias, and food cravings were associated with later alcohol consumption, but not with later food consumption or concurrent consumption (βs = -0.28 to 0.48, ps = 0.02 to 0.99; Exp(B)s = 0.95 to 1.83, ps = 0.33 to 0.91). Overall, alcohol odor cues can become conditioned stimuli that elicit conditioned food-related and alcohol-related responses, both of which persist long enough to motivate later alcohol consumption; however, these conditioned responses might not persist long enough to motivate later food or concurrent consumption. These findings serve as a first step in clarifying the role of classical conditioning in concurrent consumption. In particular, they suggest that additional empirical investigations are needed to: (1) clarify the classical conditioning mechanisms underlying concurrent consumption; and (2) examine whether interventions targeting classical conditioning mechanisms are effective for reducing alcohol use

Attention and Social Cognition in Virtual Reality:The effect of engagement mode and character eye-gaze

Technical developments in virtual humans are manifest in modern character design. Specifically, eye gaze offers a significant aspect of such design. There is need to consider the contribution of participant control of engagement. In the current study, we manipulated participants’ engagement with an interactive virtual reality narrative called Coffee without Words. Participants sat over coffee opposite a character in a virtual café, where they waited for their bus to be repaired. We manipulated character eye-contact with the participant. For half the participants in each condition, the character made no eye-contact for the duration of the story. For the other half, the character responded to participant eye-gaze by making and holding eye contact in return. To explore how participant engagement interacted with this manipulation, half the participants in each condition were instructed to appraise their experience as an artefact (i.e., drawing attention to technical features), while the other half were introduced to the fictional character, the narrative, and the setting as though they were real. This study allowed us to explore the contributions of character features (interactivity through eye-gaze) and cognition (attention/engagement) to the participants’ perception of realism, feelings of presence, time duration, and the extent to which they engaged with the character and represented their mental states (Theory of Mind). Importantly it does so using a highly controlled yet ecologically valid virtual experience