Virtualizing Alcohol Use Disorder Therapy: A Systematic Scoping Review

Virtual reality (VR) technology has become more mature and accessible in recent years. In the context of alcohol use disorder (AUD), it can be used for various therapeutic contexts, such as exposure therapy, diagnostics, and improved interactivity. Although promising, the data regarding its effectiveness vary; therefore, caution is warranted when it is introduced. This review aims to illustrate the current state of research on virtual reality in alcohol use disorder therapy.

In accordance with the PRISMA and Cochrane guidelines, publications focusing on implementing virtual reality to treat alcohol use disorder, published since 2015, were investigated. These included trials, prototype presentations, and expert interviews.

Thirty-two publications were identified, 19 of which were trials, with 653 participants. The results indicate that VR has been researched in various therapeutic contexts. In virtual cue-exposure therapy (CET), trials suggest that virtual reality can effectively increase craving and anxiety after one-time use and reduce craving after multiple uses. In diagnostics, trials demonstrate that it is possible to distinguish between heavy and light consumers based on the choices made in virtual reality, leading to a more standardized approach. In virtual approach-avoidance therapy (AAT), trials indicate increased effectiveness in the use of VR compared to the usual two-dimensional approach regarding craving. Non-trial publications focus on the inclusion of specific technologies, such as biofeedback, design choices, and ethical considerations.

Despite promising results, current research is limited. From a therapeutic perspective, the limitations are the variety of approaches to development and use, the heterogeneous designs, inconsistent trial results, and the lack of long-term data on abstinence, effectiveness, and potential risks for patients. Technologically, the adaptation of virtual environments and the inclusion of biofeedback devices require more research. Methodically, the interdependence of scientific disciplines increases the complexity. Since virtual reality has been used in other types of therapy with success (e.g., phobia and anxiety treatment) and a growing body of literature presents promising findings, there is a strong incentive to continue research on using virtual reality in treating alcohol use disorder.