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January 22 , 2007
Virtual reality may help smokers kick the habit by combating environmental triggers

by Dana Goldman

Emory University, in collaboration with the University of Georgia, is conducting a study that uses virtual reality technology to treat addictions. Currently underway at Emory Crawford Long Hospital, the controlled clinical research study is funded by the National Institute of Drug Abuse in the National Institutes of Health.

The study divides volunteers, all of whom smoke at least a pack of cigarettes a day, into two groups. One group will be given nicotine patches for 10 weeks, a typical course of treatment for smokers trying to quit. The other group will use the patches for 10 weeks and additionally will participate in weekly virtual reality sessions that place them in settings known to trigger cigarette cravings.

Patrick Bordnick, the study’s principal investigator and associate professor at the University of Georgia School of Social Work, previously has used virtual reality technology to show how different environments trigger physiological and subjective cravings for cigarettes, alcohol and cannabis.

“Overwhelmingly we’ve shown in nicotine studies that being in specific virtual reality environments related to the drug of abuse increases cravings significantly,” he said. For many smokers trying to quit, everyday acts such as drinking coffee may be so closely associated with smoking that even smelling it may lead to cravings to smoke.

Fernando Holguin, one of the study investigators, holds a joint appointment with Emory University School of Medicine and the Centers for Disease Control and Prevention, and directs the Asthma and Allergy Clinic at Grady Memorial Hospital. He said the research grew out of the understanding that persons with asthma who smoke have many more medical problems than nonsmokers.

“Smoking increases asthma severity,” Holguin said. “People who smoke have increased risk for emergency room visits, increased medication requirements and may be less likely to respond to standard treatments. If you look at people who smoke and have asthma, the amount of lung function they lose on a year-to-year basis is a lot steeper than people who have asthma and don’t smoke.”

Both Holguin and Bordnick believe that current clinical efforts to reduce smoking are often ineffective because they fail to address these environmental and behavioral triggers. Developing a study to combat the effects of those environmental factors — and to help smokers quit more easily — was a natural step for the researchers.

Study participants in the virtual reality group will spend an hour each week maneuvering through virtual environments known to trigger cigarette cravings, such as restaurants, parties, cars and courtyards attached to office buildings. These scenarios include visual, auditory and olfactory triggers, as well as nearby individuals who may be smoking or who may ask the study subject if he or she wants a cigarette.

During each virtual reality experience, a study therapist teaches the participants relapse prevention and coping skills to increase their ability to abstain from smoking in these scenarios.

The volunteers’ efforts to quit smoking and remain abstinent will be tracked over six months. The researchers hope that the virtual reality experience will result in increased long-term quitting rates.

“Success to me would be reducing the percentage of relapses,” Holguin said. “If virtual reality works, on top of patches and other treatments, then you have a therapeutic intervention that is virtually free of side effects and may have a potential long-lasting effect.”

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