Drug and alcohol addiction are a huge problem in America and around the world.
The World Health Organization estimates that 5.4% of the world population suffers from drug or alcohol addiction. The National Institute on Drug Abuse reports that drug and alcohol abuse costs the U.S. economy approximately $600 billion in healthcare, criminal justice, legal and lost workplace productivity every year. There has been a recent upsurge in the prevalence of opioid addiction that has reached epidemic levels, and is of grave concern. Even so, the problems of addiction are not new.
In addition to the huge loss in productivity and quality of life associated with drug and alcohol addiction, as a society we spend an enormous amount of money on rehabilitation programs. A typical 30- to 60-day inpatient rehabilitation program can cost anywhere from $12,000 - $60,000. Unfortunately, although addicts are often successful at avoiding destructive behaviors while in rehabilitation, and despite the best efforts of those in the health care system, the relapse rates following drug rehabilitation remain high.
From a psychological science perspective, it is as if rehabilitation causes the abusing behavior to disappear but only temporarily. Once out of rehabilitation and back in society, the abusing behaviors return. The rehabilitation process temporarily suspends the bad behavior but does not induce true unlearning of the abusing behavior.
Brain Science of Learning and Addiction
The brain science of learning and addiction provide some answers. Although the brain mechanisms and neurotransmitter systems involved in opioid addiction differ substantially from those involved in alcohol and other forms of addiction, the recidivism rates are high regardless of the abusive substance. This suggests that the relapse problem is not specific to any substance of abuse, but rather is a more general phenomenon.
An extensive body of research on the neuroscience of learning and addiction suggests that the real culprit is context. The reappearance of addictive behavior that a rehabilitation program was designed to eliminate (and did successfully eliminate within the rehabilitation context) suggests that the intervention did not induce true unlearning, but rather induced context-specific unlearning.
Learning and unlearning are exquisitely sensitive to context. The idea is that the rehabilitation center serves as a new environmental context that causes new learning, rather than unlearning of the previously acquired addictive behavior. As a result, the addictive behavior reappears when the “rehabilitated” addict re-enters their original addictive environment.
For those readers familiar with the instrumental conditioning literature, this failure of true unlearning is thought to underlie such phenomena as fast re-acquisition following extinction, spontaneous recovery, and renewal. The interested reader is referred to a classic textbook by B.F. Skinner (1938), and a number of seminal studies conducted by Bouton and colleagues (1992, 2002, 2004). Full references are provided at the end of this article.
From a neuroscience perspective, the initial addictive behavior is learned through the pairing of addictive behaviors and the associated context with reward. For example, a heroin addict pairs the heroin using context with the euphoria (reward) associated with heroin injection. Critically, this context is rich. It includes the needle, spoon and heroin, but also a common group of individuals, typical locations, common sights, sounds, and smells. This rich and consistent context is all part of the addiction process. The rehabilitation center provides a completely different context. Although part of the rehabilitation process might involve working to unlearn the pairing of the needle and spoon with euphoria it is nearly impossible to simulate the rest of the using context. Thus, the learning that takes place in the rehabilitation is not unlearning that transfers to the user’s typical context, but rather new learning that is specific to the rehabilitation center. It is as if the brain “tags” the learning with a context label, and the rehabilitation center is sufficiently different from the using environment that it gets its own tag.
How might we leverage technology to overcome this problem of context-specific unlearning?
Virtual Reality (VR) as an Addiction Rehabilitation Tool
VR enthusiasts often point to the fact that high quality VR experiences can “transport” you from one reality into another reality. When done correctly, you get an instant sense of immersion and “presence”. It is as if you are really in that virtual environment. Users find this experience highly motivating and engaging.
Let’s apply this information to the recidivism problem outlined above, and the issue of context-dependent learning. Imagine incorporating VR into the rehabilitation process. Suppose an addict is transported into a virtual environment that shares many of the contextual cues associated with their typical “using” environment. Now imagine incorporating some of the behavioral extinction or unlearning procedures, commonly utilized during rehabilitation, into this virtual environment.
What might occur?
Since the addict is in a virtual environment that is similar in context to their “using” environment, true unlearning of the addictive behaviors within this virtual “using” context could take place. Recall that the problem with rehabilitation is that rehabilitative learning is new learning that is specific to that context, and not to the “using” context. The destructive behaviors associated with the using context remain intact. By incorporating VR environments that share many contextual cues with the using environment into the rehabilitation setting, true unlearning is more likely to occur.
A Tool for Medical and Addiction Experts, Not a Replacement
To be clear, we view VR as a potential tool to be used by medical and addiction experts in the fight to eradicate addiction. This tool will be ineffective, in and of itself, unless it is in the hands of trained medical and addiction professionals. VR in no way can or will replace these professional’s expertise. VR can provide a tool, and we believe a very powerful tool, for helping medical and addiction experts to fight the problem of context-dependent learning in rehabilitation settings.
VR can transport the user back into a using context, where, simultaneously rehabilitation and behavioral extinction techniques can be incorporated. This should significantly increase the likelihood of true unlearning of these destructive within the virtual using context that will transfer to their everyday life in society.
Bouton, M.E. and Peck, C.A. (1992) Spontaneous recovery in cross-motivational transfer (counterconditioning). Animal Learning & Behavior, 20, 313-321.
Bouton, M.E. (2004). Context and behavioral processes in extinction. Learning & Memory, 11(5), 485-494.
Bouton, M.E. (2002). Context, ambiguity, and unlearning: sources of relapse after behavioral extinction. Biological Psychiatry, 52(10), 976-986.
Skinner, B.F. (1938). The Behavior of Organisms. Appleton & Company, U.S.