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A key challenge for professionals in helping people recover from cocaine addiction is that their craving for the drug can be triggered by environmental ‘cues,’ such as going to a specific bar, attending a music festival, or coming into contact with objects, like snorting devices, which remind them of the pleasurable effects of cocaine use. This process is known as ‘classical conditioning.’
The effectiveness of current talking therapies for cocaine dependence is limited, with a high rate of relapse soon after these brief interventions end.[1] Research on people with alcohol dependence showed that repeated exposure to triggers (or cues) for alcohol use in a safe treatment environment can significantly reduce their level of craving and relapse. The research concludes that it would be more beneficial if the treatment environment resembled a conditioned context and contained as many related cues as possible.[2]
This is known as cue exposure therapy (CET). Its effectiveness as a modality to treat cocaine addiction is not yet fully explored.
New UK study suggests VR treatment could hold the key to beating cocaine addiction
A UK study led by Professor Paolo Deluca at King's College London is using advanced technology, specifically virtual reality (VR), to enhance CET to manage drug-related cues or triggers associated with cocaine addiction.[3]
The current UK study is pioneering in integrating VR technology into CET. This innovative approach allows researchers to create immersive virtual realities that closely mimic the specific drug cues associated with cocaine use. By drawing on the experiences of people who use drugs, the project creates tailored 3D experiences, such as being in a toilet stall or at a party with friends, where people can be immersed via a VR headset in realistic situations that trigger the urge to take drugs. This safe, simulated environment helps people who use cocaine to confront and manage their cravings without exposing them to drugs.
What is cue exposure therapy?
CET is a method used to treat substance use disorders by helping people confront and diminish their cravings. This is achieved by exposing them to familiar drug-related cues, such as sights, smells, sounds, or locations, in a controlled environment. These cues, like a specific setting or object associated with drug use, can evoke intense cravings because the brain has formed connections between them and drug consumption.[5]
CET operates by repeatedly presenting these triggers without the actual substance, allowing the brain to gradually "unlearn" the craving response. The goal is that, through consistent practice, these triggers will lose their influence, leading to a decrease in cravings and the desire to use the substance.[5]
Real-time monitoring and personalization
A unique aspect of the research is the use of wearable technology. These watches will monitor physiological responses to drug cues, like heart rate and skin conductance. In real-time, this data provides immediate insights into individual participants' emotional and physical reactions to everyday cues.
“We are planning to ask individuals to wear a novel watch-like device that can measure physical changes to cues in their everyday environment. With this technology we will be able to identify in real-time when they experience an episode of craving or start using cocaine again, to understand what real-life situations or circumstances have triggered these events and allow us to provide support remotely,” says Professor Paolo Deluca.[6]
Government support and implementation challenges
The research's potential is further underscored by the UK government's recognition of its innovative approach. The government has provided funding as part of a £12 million commitment to tackle addiction and overdose rates through advanced technology. The VR CET research is one of 11 initiatives that received funding from the UK government, a testament to its potential impact on addiction treatment.
The research will be carried out over three studies. It also involves people with lived experience as participatory researchers who have actively been involved in the study design and research to incorporate their valuable insights and to ensure that the research aligns with the target community’s values and preferences.[6]
However, it's essential to acknowledge that conducting this research comes with its own set of challenges. One significant hurdle for the researchers is privacy concerns. The use of surveillance technology to monitor real-time physiological data involves the continuous tracking of sensitive information related to participants' drug use and cravings.
This level of surveillance can infringe on their privacy, potentially making them feel uncomfortable or exposed. Ensuring the confidentiality and security of this data is complex, and any breach could have serious repercussions for the participants, including stigmatization and/or legal consequences.
Potential impact on cocaine addiction treatment
Addressing specific individual triggers of cocaine use by employing technologically enhanced CET provides a novel solution to assist people with managing their cocaine addiction. The ability to practice refusal skills and coping strategies in a realistic, controlled environment can help individuals manage cravings more effectively in their daily lives.
This project is funded by the National Institute for Health and Care Research (NIHR) Invention for Innovation (i4i) Addiction Mission: Innovation for Treatment and Recovery Awards. It began in May 2024 and is expected to be completed in May 2027.
