Virtual reality for smoking cessation: a case report

This study presents a case report describing the use of Virtual Stop Smoking (VSS) program. The VSS includes a multicomponent behavioural approach and a Virtual Reality graded exposure technique. The subject was a 22-year-old female who smoked 20 cigarettes per day. Six weekly 90-minute sessions were conducted once a week over a 6-week period. Measures of efficacy included the number of cigarettes smoked, breath carbon monoxide levels, and self-reported subjective craving. The results obtained supported the efficacy of VSS for smoking cessation

Peak provoked craving after smoking cessation

Peak provoked craving (PPC) is an alternative approach to cue-induced craving that focuses on the highest craving level experienced during the exposure to drug-related cues. The main objective of this study was to assess the effect of abstinence on PPC in smokers and to determine whether PPC is altered by continuous abstinence. Results showed reductions on PPC levels only 24 hours after achieving abstinence and craving levels remain significantly lower after 7 days of abstinence

Habituation of Distress and Craving During Treatment as Predictors of Change in PTSD Symptoms and Substance Use Severity

Objective—Increasing evidence supports the efficacy of trauma-focused exposure therapy in the treatment of posttraumatic stress disorder (PTSD) and co-occurring substance use disorders. Little is known, however, about the mechanisms of change in treatment for patients with PTSD and co-occurring substance use disorders. The aim of the present study was to examine whether within- and between-session habituation of distress and substance craving during imaginal exposure relates to treatment outcomes among U.S. military veterans with PTSD and a co-occurring substance use disorder (N = 54). Method—Veterans received Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure, a manualized integrated treatment combining prolonged exposure with cognitive-behavioral therapy for substance use disorders as part of a larger randomized clinical trial. Self-reported distress and craving ratings were collected during each imaginal exposure session. Results—Data were analyzed using a series of random intercept and slope multilevel linear and generalized linear models. Results revealed that between-session habituation of distress and craving was associated with greater improvement in PTSD symptoms during treatment. Between-session habituation of craving was also associated with a marginally greater reduction in frequency of substance use among participants still reporting use during treatment. Within-session habituation of distress was unrelated to treatment outcome. Conclusions—Together, these findings indicate that habituation in both distress and craving may be important in maximizing treatment outcome for patients with PTSD and comorbid substance use disorders

Contingency management effects on delay discounting among patients receiving smoking cessation treatment

Antecedentes: la evidencia sugiere que el descuento por demora puede cambiar tras recibir intervenciones eficaces. No obstante, estudios previos que evaluaron el efecto del manejo de contingencias (MC) sobre el descuento por demora son escasos y presentan resultados mixtos. Se evaluó si el MC combinado con tratamiento cognitivo-conductual (TCC) para dejar de fumar se asoció con cambios en el descuento por demora al final del tratamiento y a los seis de seguimiento comparado con TCC. Método: Ciento dieciséis fumadores fueron asignados aleatoriamente a MC+TCC (n = 69) o a TCC solo (n = 47). Completaron la tarea de descuento por demora en la línea base, al final del tratamiento y a los seis meses de seguimiento. Evaluamos el efecto del MC en el descuento por demora con métodos paramétricos y no paramétricos. Resultados: Los análisis entre-grupos mostraron que ninguno de los tratamientos modificó el descuento por demora al final del tratamiento y a los seis meses de seguimiento. No obstante, algunos análisis intra-grupos mostraron que la condición de MC + TCC evidenció cierta reducción. Conclusiones: una intervención de MC no se asocia robustamente con cambios en el descuento por demora. Futuros estudios han de abordar qué tratamientos pueden modificarlo

Preliminary Evidence of the Association between Time on Buprenorphine and Cognitive Performance among Individuals with Opioid Use Disorder Maintained on Buprenorphine: A Pilot Study

People on buprenorphine maintenance treatment (BMT) commonly present cognitive deficits that have been associated with illicit drug use and dropout from buprenorphine treatment. This study has compared cognitive responses to the Stroop Task and the Continuous Performance Task (CPT) among individuals on BMT, with recent drug use, and healthy controls and explored the associations between cognitive responses and drug use, craving, and buprenorphine use among participants on BMT. The participants were 16 individuals on BMT and 23 healthy controls. All participants completed a 60 min laboratory session in which they completed the Stroop Task and the CPT, a saliva drug test, a brief clinical history that collected substance-use- and treatment-related information, and the Opioid Craving Scale. The results showed that the BMT participants presented more commission errors (MBMT participants = 2.49; Mhealthy controls = 1.38; p = 0.048) and longer reaction times (MBMT participants = 798.09; Mhealthy controls = 699.09; p = 0.047) in the Stroop Task than did the healthy controls. More days on buprenorphine were negatively associated with reaction time in the CPT (−0.52) and the number of commission errors (−0.53), simple reaction time (−0.54), and reaction time correct (−0.57) in the Stroop Task. Neither drug use nor craving was significantly associated with the results for the cognitive tasks. Relative to the control participants, the BMT individuals performed worse in terms of longer reaction times and more commission errors in the Stroop Task. Within the BMT participants, longer times on buprenorphine were associated with better cognitive results in terms of faster reaction times for both tasks and lower commission errors for the Stroop Task

Aplicaciones de la realidad virtual en el tratamiento del tabaquismo

Tesis doctoral por el sistema de compendio de publicaciones. Tesis con mención internacionalEl término craving, que define el deseo o ansia por consumir una droga, es un concepto importante en el ámbito de las adicciones. En el caso del tabaco, el craving es considerado una de las principales causas de su consumo compulsivo y de las dificultades con las que se enfrentan los fumadores durante el proceso de dejar de fumar, precipitando en ocasiones la recaída. El craving puede desencadenarse durante la exposición a una situación o estímulo asociado al consumo de sustancias. A diferencia de lo que ocurre en otras drogas, donde los estímulos o situaciones relacionadas con el consumo suele darse en contextos muy específicos e incluso marginales que conviene evitar para el mantenimiento de la abstinencia, el consumo de tabaco está asociado a una amplia variedad de situaciones que en muchas ocasiones no se pueden ni deben evitar. La técnica de exposición a pistas consiste en la exposición controlada y repetida a estímulos asociados al uso de la sustancia, con el objetivo de reducir el craving asociado a esos estímulos. Estudios recientes han demostrado cómo la realidad virtual resulta una alternativa igual de eficaz que otros procedimientos de exposición y que además presenta varias ventajas frente a los métodos tradicionales. Sin embargo, estos estudios presentan serias limitaciones que reducen el impacto de los resultados obtenidos. Los estudios realizados solo han utilizado uno o dos entornos virtuales, han evaluado un tipo de craving, no han aplicado de manera sistemática la técnica de exposición y no han tratado de identificar las variables individuales relacionadas con el craving. La presente Tesis Doctoral tiene el objetivo principal superar algunas de las limitaciones de los estudios previos mediante los siguientes objetivos específicos: (1) determinar qué situaciones y qué elementos de las mismas provocan en los fumadores respuestas de craving, (2) evaluar si esas situaciones y elementos, convertidas en entornos de realidad virtual, producen craving en fumadores, (3) identificar las variables individuales que modulan la eficacia de los entornos virtuales para producir craving en fumadores, (4) evaluar el efecto de un tratamiento de exposición a pistas a través de realidad virtual en el craving por el tabaco y (5) identificar las variables individuales asociadas con una mayor eficacia de un tratamiento de exposición a través de realidad virtual para reducir el craving en fumadores. A partir de las respuestas a un cuestionario, se desarrollaron ocho entornos virtuales que simulaban siete situaciones diferentes de la vida cotidiana asociadas al consumo de tabaco y una situación que se pretendía utilizar como control. Los siete entornos con claves fueron capaces de producir craving en fumadores mientras que el entorno control no incrementó el deseo de consumo. También se encontró que la sensación que experimentaron los sujetos de “estar” en los entornos virtuales, la puntuación en un cuestionario de presencia, fue la variable con mayor capacidad predictiva de los niveles de craving de los fumadores. Por otro lado, se encontró que la técnica de exposición a pistas mediante realidad virtual fue capaz de disminuir los niveles de craving después de cada sesión y a lo largo de las sesiones de tratamiento. Los participantes más jóvenes, con un consumo mayor de tabaco, más impulsivos y con mayor sintomatología depresiva experimentaron un mayor descenso del craving al finalizar el tratamiento. Estos resultados deben ser tomados con cautela puesto que el tamaño muestral de los estudios no fue demasiado elevado, los participantes eran relativamente jóvenes o presentaban una dependencia moderada del tabaco y no se dispuso de un grupo control en uno de los estudios. A pesar de las limitaciones mencionadas, los resultados de la presente Tesis Doctoral muestran cómo la técnica de exposición a pistas es una estrategia útil para manejar el craving y que, por tanto, podría ayudar a mejorar los tratamientos para la dependencia del tabaco. Sin embargo, son necesarios más ensayos clínicos que incorporen dicha técnica en los protocolos de intervención y que evalúen su eficacia a medio y largo plazo

Identifying Specific Cues and Contexts Related to Smoking Craving for the Development of Effective Virtual Environments

Craving is considered the main variable associated with relapse after smoking cessation. Cue Exposure Therapy (CET) consists of controlled and repeated exposure to drug-related cues with the aim of extinguishing craving responses. Some virtual reality (VR) environments, such as virtual bars or parties, have previously shown their efficacy as tools for eliciting smoking craving. However, in order to adapt this technology to smoking cessation interventions, there is a need for more diverse environments that enhance the probability of generalization of extinction in real life. The main objective of this study was to identify frequent situations that produce smoking craving, as well as detecting specific craving cues in those contexts. Participants were 154 smokers who responded to an ad hoc self-administered inventory for assessing craving level in 12 different situations. Results showed that having a drink in a bar/pub at night, after having lunch/dinner in a restaurant and having a coffee in a cafe or after lunch/dinner at home were reported as the most craving-inducing scenarios. Some differences were found with regard to participants' gender, age, and number of cigarettes smoked per day. Females, younger people, and heavier smokers reported higher levels of craving in most situations. In general, the most widely cited specific cues across the contexts were people smoking, having a coffee, being with friends, and having finished eating. These results are discussed with a view to their consideration in the design of valid and reliable VR environments that could be used in the treatment of nicotine addicts who wish to give up smoking

Efficacy of virtual reality for triggering smoking craving: relation with level of presence and nicotine dependence

Virtual Reality environments that reproduce typical contexts associated with tobacco use may be useful for aiding smoking cessation. The main objective of this study was to assess the capacity of eight environments to produce the craving to smoke and determine the relation of craving to nicotine dependence and level of presence. The results show that all the environments were able to generate the desire to smoke; a direct relation was found between sense of presence and craving