Assessment of virtual environments for alcohol Relapse Prevention in a less immersive and cost-effective setup: A qualitative study

Abstract Relapse prevention (RP) - helping people to develop relevant coping skills in high-risk situations that challenge abstinence - is an important part of alcohol use disorder treatment. Recreating personalised, high-risk situations can be challenging in clinical contexts. Virtual Reality Therapy (VRT) has the potential to offer immersive exposure to relevant, interactive stimuli presented in Virtual Environments (VEs). The use of VRT in RP remains unexplored. In this study, 10 casual and 13 high-risk drinkers assessed, via unstructured interviews, the realism of three ‘high-risk’ VEs: a home, a supermarket and a pub, and the extent to which they induced alcohol temptation when presented in a less immersive, cost-effective setup. Template analysis revealed that proximal (alcohol stimuli) and contextual (stimuli typically associated with alcohol) cues, and a sense of presence within the VEs, were key aspects to inducing realism and alcohol temptation. High-risk drinkers were tempted to drink in any VE and regular drinkers primarily in a social, pub VE. Temptation to smoke was induced in smokers. The results suggest that the VEs may help people with alcohol or comorbid tobacco misuse to practice coping with craving, refusal skills (saying ‘no’ to prompts to drink) and emotion regulation in social, private and alcohol vending contexts. The interconnections of realism, presence, alcohol temptation and related cues discussed here can inform future VRT applications for alcohol treatment.