VR heroin caveCourtesy University of Houston Graduate College of Social Work

In 2014, overdoses killed more Americans than guns or car accidents, and the epidemic of heroin and opioid abuse in the US continues to get worse. Doctors are trying to curb the epidemic by limiting access to prescription painkillers, expanding access to emergency treatments like naloxone, and creating more facilities for substance abuse treatment and preventative services.

But along with these critical interventions, there are innovative solutions that could help a subset of patients deal with problematic drug use. One unexpected tool that researchers at the University of Houston's Graduate College of Social Work (GGSW) are hoping could help fight addiction relies on — of all things — virtual reality, or VR.

They've created a virtual "heroin cave" that drug abusers can navigate with the help of a therapist so that they can learn to identify and resist the things that normally would trigger the craving to snort or inject heroin. And the researchers think that setting will seem real enough that users will actually be able to learn the skills they need to resist urges to use in the real world.

If it's shown to work — which still needs to be determined — this kind of VR therapy could be used along with cognitive-behavioral therapy and potentially combined with medication (like methadone), as part of a coordinated effort to reduce the risk of relapse.

"We're cautiously optimistic," says Patrick Bordnick, a therapist and assistant dean of research at the University of Houston GCSW. Bordnick has been researching ways to use VR in therapy for more than 10 years and has studied addiction for even longer.

Patrick Bordnick Patrick Bordnick. Courtesy Patrick Bordnick

So far, his team has shown ways to use VR to help stave off cravings for nicotine, and they've shown that VR can activate the same cues that trigger people's desire to drink alcohol or smoke marijuana, though more long-term research on all these treatments is needed.

Bordnick is hoping the same principles they've used with other substances could help people who are dependent on heroin. "Based on all the work that we've done, it makes theoretical sense," he tells Tech Insider.

This particular study on heroin users has not begun yet, and the success of this approach won't be known for a while. But it shows that medical researchers continue to see promise in using VR to treat addiction.

A 'heroin cave'

The way that this VR-enhanced treatment works is actually very similar to the way a therapist might normally try to help a patient overcome addiction.

As Bordnick explains, there are certain triggers that will make someone who is dependent on a substance want to use that substance. An obvious example is someone struggling to cut back on alcohol who suddenly finds themselves at their favorite bar with a group of friends — ordering a beer will just feel natural at that point. For someone who smokes, a stressful work conversation or a cup of coffee might be a trigger. For someone who uses heroin, it could be any place where they've purchased or used the drug in the past.

"Even just seeing a house can be a trigger," Bordnick says.

A therapist might have a patient walk them through those moments where they'd be tempted to smoke, drink, or use drugs. The patient would describe the scenario and try to learn how to recognize their response to a stressful situation so that they could train themselves to avoid a relapse.

This type of therapy relies on what's known as cue-reactivity therapy — someone sees a cue, in this case one that triggers their addictive behavior; and then they react. The goal is that they can learn to control that reaction and opt not to use. This type of therapy has been used in treatments for alcohol abuse and other addictive behaviors, and researchers are still investigating its effectiveness for addictions like heroin, which often requires treatment for physical dependence along with psychological dependence.

The difficulty of doing this in a therapist's office — meant to be a safe place — is that it's hard to really trigger "cues" for addiction in a location that doesn't come close to replicating the real world conditions of someone who is surrounded by people drinking or doing drugs.

That's where VR, where it is possible to actually replicate those environments, comes in.

Heroin Cave VRCourtesy University of Houston Graduate College of Social Work

To work with heroin users, Bordnick and his team have spent the past year and a half developing two separate scenarios.

They refer to their setup as a "cave" because their custom-designed VR system doesn't work like the Oculus Rift or Gear VR headsets — instead they have goggles that turn images projected onto the walls of a room (the cave) into a three dimensional HD experience. And while those images may appear a bit strange on camera to us, since they're meant to be seen through goggles, he says they do the job of transporting the person to that experience.

"I'm confident in the work that we've done," he says, explaining that people usually remark on how real both the environments and the people in them seem.

The two settings they've designed for the heroin study represent two different types of users.

In one scenario, a person approaches a house through a yard, passing by stray dogs. A woman says hello on the porch. Inside, a slumped over man sits on the couch, high. Someone is cooking up another dose by the kitchen.

In the other scenario, the participant walks through what appears to be a house party, with people drinking and hanging out. At the back of the house, there's a group of people huddled around a bathroom, snorting heroin.

The idea with these things is that a person navigates through the scenario, all while talking to their therapist about how they feel, able to practice coping strategies for dealing with the craving in a safe space, with no actual drugs present.

While these scenarios come with certain limitations — they can't involve the people or places that will be familiar to a user — they offer a more lifelike experience than is possible when an addict is engaging in cue-reactivity therapy on a couch, in an office. The idea is that VR can make these moments more "real," and much of Bordnick's past research on marijuana, alcohol, and nicotine show that VR can effectively cue these cravings.

Moving forward

Here's the tricky part in describing this: For someone who hasn't experienced VR, it's hard to believe that this type of scenario can really feel "real."

"It's like describing gravity or breathing to someone," Bordnick says. You need the experience to understand it. But researchers have known this for years now, which is why those that work with VR are such believers in its power.

As a 2005 review in Nature Neuroscience puts it:

You know that the events you see, hear and feel are not real events in the physical meaning of the word, yet you find yourself thinking, feeling and behaving as if the place were real, and as if the events were happening ... From a cognitive point of view, you know that there is nothing there, but, both consciously and unconsciously, you respond as if there is.

For now, we don't know yet how VR will work for heroin users. They've finished designing the scenarios and are currently or will soon be recruiting participants for the study.

The CDC does describe heroin and nicotine as similarly addictive, though that doesn't mean people hooked on them will respond to treatment in the same way. Many serious heroin addicts that are physically dependent might need methadone or other medications to get and stay clean. And for now, if this experiment works and turns into a real treatment, there's only one location where it would be accessible — and it's too soon to say how much it might cost.

Bordnick did say that he hopes they might be able to port this type of treatment over to more accessible VR devices, but even then, not everyone would have access to them.

Still, he thinks that VR as a component of therapy has real potential. As for for the potential for VR to transform not just therapy but other aspects of life too, he's even more optimistic.

"The sky's the limit at this point," he says.