Development, evaluation and testing of a Virtual Reality-enhanced Cue Exposure Treatment integrated with a wearable device to address craving, prevent relapse and improve treatment outcomes of people with cocaine dependence.

Treatment for cocaine dependence relies on psychological interventions. However, these suffer from poor engagement and high rates of relapse where craving plays a significant role. There is existing evidence in alcohol dependence, and an emerging literature in cocaine dependence, that cue exposure treatment (CET) can reduce craving and cue reactivity and hence, reduce the risk of relapse to drug use. Our research aims to develop and test a technology-based, theory-driven Virtual Reality (VR)-enhanced CET for cocaine craving. This innovative approach incorporates the use of VR technology to simulate substance-related cues and environments within a therapeutic context, allowing individuals to confront and manage their cravings and responses in a controlled setting. We also plan to utilise wearable devices to monitor and identify craving and relapse in the natural environment. These devices have already demonstrated the capability to identify cocaine craving episodes based on physiological changes. Paired with Ecological Momentary Assessment (EMA) and just-in-time adaptive interventions (EMI), these wearable devices offer novel ways to support patients in their recovery. The research comprises three interlinked studies: Study 1: EMA and EMI App Development and Integration with Wearable Device This study aims to develop and test a smartphone app-based EMA and EMI system for tailored interventions. A secondary aim is to define physiological changes measured via wearable device to reliably identify cocaine use and craving. A sample of 90 treatment seeking patients for cocaine dependence and meeting the inclusion/exclusion criteria will be enrolled in this study. Participants will be asked to wear the device for four weeks and respond to a smartphone generated EMA prompt when required. In this way we aim to capture valuable data on the factors associated with cocaine craving and relapse in naturalistic environments. Study 2: VR-CET Development and Laboratory Testing This second study aims to develop immersive VR environments to deliver CET, and assess their acceptability and realism, and measure the physiological and subjective responses to the VR cues. A sample of 90 treatment seeking patients with cocaine dependence will attend two 45-minute sessions where they will be able to explore the VR environments whilst being monitored with the wearable device. Study 3: Proof-of-Concept Randomized Controlled Trial (RCT) This third study is a multi-centre proof-of-concept, individually randomised controlled trial with two arms and 12-week follow-up post-randomisation. It aims to assess the impact of VR-CET on reducing craving, cue reactivity and relapse, and examine feasibility and acceptability of the intervention. 60 treatment seeking patients with cocaine dependence will be randomised to either: Intervention: Six VR-enhanced CET sessions and wear the device continuously during follow-up with support via EMI when required. Control: Treatment as usual (TAU) and wear the device during follow-up but not receive EMI support. The project includes stop-go criteria to ensure readiness before proceeding to Study 3. Overall, this research aims to improve the efficacy of treatment for cocaine dependence by leveraging VR, wearable devices, and AI-driven interventions, and, in doing so, enhancing patient outcomes and reducing relapse rates in cocaine dependence.