Adolescent substance use is approximately 50%1. In 2018, 38% of high school seniors reported past-year cannabis use, with 5.8% reporting daily use1. Rates of vaping of cannabis are increasing annually, with the most recent data showing rates of 4.4% (8th grade), 12.4% (10th grade), and 13.1% (12th grade). In the past year, 12% of high school students reported the use of illicit drugs other than cannabis1. Vaping of nicotine has reversed previous declines in tobacco use, with 20% of high school seniors vaping nicotine in the past 30 days during 2018; increased from 10.9% from 20171.
Under-reporting of substance use is common and difficult to overcome with a biomarker that can demonstrate actual use2–4. Reporting of illegal use of a substance is even less likely to occur given potential negative consequences, and for almost all participants their use was illegal. Also, 8th and 10th grade youth are less likely to trust adult assurances that their responses are truly anonymous. Under-reporting issues are even greater for 12th grade participants since their participation is confidential, not anonymous to allow the investigators and track changes over time. Adolescents were less likely to report marijuana use and substance use in confidential versus anonymous surveys.5
Misunderstanding of the biological basis of substance use is still common. NIDA, despite its best efforts, continues to struggle against the fact that “Many people don’t understand why or how other people become addicted to drugs.”6. This attitude is in stark contrast to the understanding that addiction is a brain disease is now well-established, and many of the associated changes in the brain have been defined7–9. The fields of neuroscience/neuroimaging and psychotherapy identified brain mechanisms and circuits involved in behavior change from substance use therapies and sustained abstinence10–12.
Misunderstanding and bias against treatment harm interest in, demand for, payment of, and creation of addiction treatment. Alternatively reversing this problem can build a cascade of change. That is, increased interest can lead to demand, greater willingness of insurance providers to pay, and improved opportunity for addiction treatment. Or to utilize the above figures, with increased interest in treatment, the high rates of substance use and (downstream) lead to more availability and enthusiasm for substance use treatment.
Woefully few adolescents with substance use are receiving treatment and recovering. We estimate 1 in 20 adolescents with substance use get treatment and half of them relapse. The actual data reveal that few adolescents receive an actual diagnosis (4%)13, even fewer receive substance use treatment (0.7%)13. And relapse among treated adolescents is higher than the 40-60% rate seen in the adult population14,15. The disconnect between use → diagnosis → treatment → recovery calls out for a novel approach. The gap between substance use and recovery is especially worrisome because adolescent brains are still developing16, and all addictive substances9 negatively impact that development; successful early interventions could help avoid lifelong brain changes in adolescents with substance use problems.
Potential Value Of An Adjunctive Treatment
A strategy to efficiently solve this problem potentially starts at the end of the process – treatment. Our solution targets the few adolescents with substance use that are actually in treatment and have a diagnosed substance use disorder.
Our solution provides treatment providers and adolescents in substance use treatment with something novel – a fun and engaging VR experience to develop a newfound understanding of the brain and addiction, and useful skills to enhance their capability to recover from substance use. For adolescents, “fun and challenging” isn’t a bonus; it is an expectation and demand they learned to expect from video games17,18. And Adjunctive Virtual Reality Therapy (VRT) can engage, inform, offer skills practice, and prepare adolescents for substance use treatment and real-world challenges; translating the hard work of treatment into real-life changes to decrease relapse risk.
Although virtual reality has demonstrated a capability for cue reactivity for a variety of substances including alcohol24, cannabis25, cocaine26, methamphetamine27, and tobacco28 and to simulate cravings26,29–36, (especially for alcohol and tobacco), its potential is far beyond that limited use. Headset-based immersive virtual reality therapy (VRT) can prepare patients for treatment messages and interventions, reinforce treatment goals, and assist with practicing the corrective and alternative skills they will need to counter addiction in real-world contexts. VRT can provide a potent experience that enhances adolescent treatment enthusiasm and engagement in treatment; a well-established key to treatment success37,38.
How VR Brain Exploration Can Help
Our simulation is the first true 3D, inside-the-brain virtual experience39,40. An immersive VR experience takes the user inside a 3D model of the brain. Users can identify structures and pathways involved in the brain’s reward system, including unique brain regions, tracts, neurotransmitter activity, and labels of neuroanatomical elements.
Adolescents can navigate through the brain, identify brain structures and functions involved in addiction, control the impact of substances on the reward system, and actively enhance regions of the brain strengthened by treatment. In the process, they build a fundamental understanding of the neuroscience of addiction and the skills they will need in the real-world to protect their brain from addictive substances. Their health care provider will be able to tailor the experience based on their substance use and treatment so that it best enhances treatment in keeping with a prescribed digital therapeutic intervention.
In addition to obtaining and reinforcing addiction treatment skills, we anticipate the experience will enhance the adolescent’s assessment of treatment value. The perceived value should bolster their motivation to engage or remain in treatment—critical elements to avoiding relapse. The experience will also aim to enhance treatment and instill hope by showing that some aspects of addiction can be modified and that abstinence, repeated practice, use of will, and a circle of support also facilitate recovery. The experience will be designed to show that engaging in substance use treatment builds a brain that supports recovery.
Game-Based Skills Development
Health behavior skills-training simulations successfully impart health behavior change41–44. Simulations support positive emotions, engagement, social integration, and connectedness41–43. In sum, a simulation can provide an individualized, scalable, reproducible, comprehensive, and standardized experience offering visual reinforcement of messages about the harm of drug use and benefits of actions that support recovery and counteract addiction.
Simulations and games for learning (“serious games”) capitalize on the engaging and reinforcing nature of games and simulations and are gaining prominence due to a cultural shift toward visual, interactive, and entertainment-based learning45. They heighten enthusiasm46 and engagement, are effective teaching tools47, and increase motivation48.
A combination of self-determination theory49 and cognitive load theory50 support the planned use of exploration and simulation. These models provide theoretical underpinnings and guide our use of learner-controlled exploration, immersion, and reflection.
Learner Control and Self Determination49: Adolescents explore and navigate the simulation learning environment51 to identify factors and strategies relevant to them. For example, they may be more interested in neurological pathways related to regulating emotions, impulse control, or forming new habitual routines. Exploration puts the user in control and leads to increased learning and understanding52–55.
Cognitive Load Theory50 holds that cognitive challenges support efficient and rewarding task attainment, but too much difficulty feels overwhelming56–59. Immersion or heightened engagement adds value by enhancing interest, enthusiasm, and emotional involvement, and engaging both affective and cognitive processes60. High fidelity elements (accuracy, realism) are valuable if they raise the complexity of the experience sufficiently to yield engagement without overwhelming the learner. Adolescent transformation can occur during the simulation or via contemplation afterward, during a debriefing61. Reflection is encouraged during brief pauses to decrease cognitive load temporarily without disengagement and task switching62,63.
VR Brain Exploration Why It Works page also available as a downloadable PDF!