Cognitive behavioral therapy (CBT) remains the leading approach for treating stimulant use disorder (StUD), which includes misuse of drugs such as methamphetamine, cocaine, and other amphetamines. However, there are currently no Food and Drug Administration (FDA)–approved medications for StUD, and relapse and treatment dropout rates remain high.
The Stimulant Use Recovery Via Immersive Virtual Environments (SURVIVE) tool from Charles River Analytics helps prevent a significant problem with the technique: frequent relapses. Charles River Analytics was awarded a Small Business Innovation Research (SBIR) grant from the National Institutes of Health/National Institute on Drug Abuse (NIH/NIDA) to create and evaluate a virtual reality (VR) simulation embedded with common StUD triggers and CBT techniques for managing cravings.
“To be used in a clinical setting, the VR-based CBT system will deliver one scenario to users with four levels of difficulty,” says Dr. Bethany Bracken, Principal Scientist and Director of Physiological Systems at Charles River. “The levels of difficulty for the scenario include various triggers for relapse—like seeing money on the table, which can spark an impulse in some patients to call a potential dealer,” said Bracken, the Principal Investigator on SURVIVE.
Phase I for SURVIVE started in September 2024, in partnership with Dr. Lisham Ashrafioun at the University of Rochester Medical Center. Dr. Ashrafioun conducted usability testing for the tool in a clinical setting. As part of this patient-centered testing, the clinic recruited 15 adult participants diagnosed with StUD who played through all four levels of difficulty in random order. As alternatives to using stimulants, users performed therapeutic activities within the VR world like painting, making a meal, or even sweeping the floor.
To support more effective treatment planning, the SURVIVE system will include a dedicated clinician interface designed to help providers monitor patient progress, manage risk, and personalize care. This digital dashboard will synthesize patient self-reports and headset-derived metrics to offer a clearer picture of how individuals respond to the virtual treatment scenarios.
“Clinicians are looking for access to data they can garner from the headsets”, Bracken says. A useful data point might be about the kinds of coping mechanisms—meditation exercises, positive affirmations—users might prefer so clinicians can tailor their treatments accordingly. Clinicians can use data from SURVIVE to personalize treatment plans and increase engagement among their patients. Phase II will include a clinical trial to test the effectiveness of SURVIVE at helping people quit using, as well as transform our user interface designs into fully implemented software for clinicians to use.
SURVIVE is part of the TheraVerse® group of tools from Charles River Analytics that uses VR to address addiction. Among the products under this umbrella is CESSATION, a narrative VR tool that helps users quit smoking (available for download through the Meta Quest Store), and NO VAPE, which uses VR technology and CBT techniques to encourage users to quit vaping.
SURVIVE will only be available in a clinical setting so that patients are only using it with clinician supervision. The eventual goal is to also allow patients and clinicians to meet in a shared virtual space so users might be able to dial in remotely through telehealth appointments. SURVIVE is especially effective because it brings imagined scenarios to life, which can have a greater impact on the patient, Bracken says. “If I don’t have a very good imagination, it’s hard to picture situations and react to them, but SURVIVE makes them more salient,” Bracken says. “It’s also much safer. You’re practicing difficult scenarios without potentially harmful real-world exposure,” she adds. Being able to conduct simulations in a safe and controlled environment also helps reduce stigma and improve treatment outcomes.
Equally important, the principles that drive SURVIVE can apply to a wide range of use cases that address drug dependence across multiple substances of abuse and also be extended to other mental health issues (e.g., anxiety, depression), Bracken says.
Contact us to learn more about SURVIVE, TheraVerse and our other health and medical capabilities.
This project has been funded in whole or in part with Federal funds from the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, under Grant No. 1R43DA059490-01. Any opinions, findings and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Institute on Drug Abuse, National Institutes of Health, or Department of Health and Human Services.
