Enhancing Prospective Thinking in Early Recovery

We propose testing a novel VR paradigm for efficacy for increasing future self-identification, future time perspective, delayed reward preference, and recovery/abstinence outcomes. All participants will undergo VR, behavioral testing, longitudinal follow-up, and repeated drug testing. Both groups will receive the 5-min Park VR habituation (no avatar). The VR group will receive the Future Reality Portal VR experience plus mRecovery daily reminders for 30 days. TAU participants will experience the Park VR habituation and a matched-duration Park VR experience without an avatar and a non-personalized mRecovery ("Generic") daily reminder. All personality and behavioral assessments, and follow-up procedures will be mirrored between groups, with identical participant burden.

All participants will be phone screened and interviewed in-person to determine eligibility (see Human Subjects). We target a total of N=88 participants in StUD recovery (ns=44 for each of the 2 groups). These numbers include additional participants budgeted for attrition and unforeseen problems (7% over target sample) to obtain usable data for N=82, ns=41 per group. Outpatient participants (≥14 days and <6 months abstinent) performing recovery activities will be recruited in-person and through flyers placed at recovery-oriented facilities, e.g., local treatment/detox centers and recovery houses. Our pilot study currently recruits from 5 local addiction treatment providers. TAU comprises the recovery programming a participant would otherwise engage (intensive outpatient, mutual-help groups, individual counseling), but varies according to individualized treatment plans and participant-motivated activities. Randomization will largely address heterogeneity, with stratification by recruitment site to equally distribute site-specific variability across groups. During the interview, participants will provide informed consent, demographic data, drug/alcohol history with the Structured Clinical Interview for DSM-5 [SCID] to determine type and severity of use disorders (elaborated by the Timeline Followback [TLFB] for the 35 days prior to treatment to quantify use patterns in the three most-abused substances-acknowledging common polysubstance use), mental health assessments using CAT-MH™ (validated adaptive assessment for depression, anxiety, PTSD, severe mental illness, risky sexual behavior, and social support [121]), a quality-of-life scale, currently-used psychotropic medications, current/previous treatment history, and personal information. Participants will also perform a brief 1-minute behavioral delay discounting task. We will collect voice samples and studio-lit, high-resolution, multi-angle photos for creating avatars. Importantly, participants will name chief motivations for recovery and/or abstinence (from rank-ordered quality of life items), costs of prior StUD behavior (from items 5-9 in SCID detailing social, physical, and psychological problems), and hopes for their future. Urine and breath will be screened for illicit drugs and alcohol (ethyl glucuronide). A single lapse to drug/alcohol use will not necessarily be exclusionary if subjects remain committed to recovery (potentially allowing a positive screen to permit inclusion in the study). Relapse, i.e., return to undesired drug use (analogous to NIAAA's recent definition of AUD recovery) or disinterest in long-term abstinence (recovery) before study day will be exclusionary.

Drug and Alcohol Use. We will quantify StUD severity, use pattern, and drug types with the Structured Clinical Interview for DSM-5 [SCID-RV]. The Timeline Followback [TLFB] will provide daily use pattern and amount within the previous 35 days for the three most-used drugs, preceding treatment, and also to quantify post-study use, as required.

Recovery Activities. We will characterize recovery-related activities in all participants, such as intensive outpatient, mutual-help (e.g., 12-Step, SMART), or individual (counselor, psychiatrist) at interview, study day, and follow-ups to quantify type, frequency, and philosophical orientation of activities engaged.

Personality, Traits, and Mood States. We will assess mental health traits (CAT-MH™ validated adaptive assessment for depression, anxiety, PTSD, severe mental illness, risky sexual behavior, and social support), childhood trauma (ACE-Q), self-efficacy ('confidence in maintaining recovery'; 0-100 scale anchored by "not confident at all" to "very confident"), a single-item craving assessment ("How much do I crave drugs and/or alcohol right now?"), quality of life (QoL), Mood States (modified from), state anxiety (STAI short form), time perspective (ZTPI), reward and punishment sensitivity (SRSPQ), impulsivity and SS (UPPS-P), and IQ (WTAR). Some of these will be administered repeatedly, to assess state changes associated with the VR experience. A brief suicide screen (ASR) performed at the interview, and before and after the intervention on the study day will monitor participants' safety. STAI performed before the Future Reality Portal will ensure low state anxiety for participant safety.