Applications of Immersive Virtual Reality for Illicit Substance Use: A Systematic Review

Objective: This study aims to review applications of immersive, head -mounted display (HMD)-delivered virtual reality (VR) technology for the assessment and modification of clinically relevant factors (e.g., craving, electrophysiological reactions, brain activation) present in illicit substance use. Method: A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta -Analyses) -guided systematic review was conducted and retrieved articles from four databases. Articles included were peer -reviewed, empirical studies and were screened on criteria pertaining to sample using (or with a history of using) substances and measurement of substance -related factors. Results: Eighteen articles met inclusion criteria. Applications of immersive, HMD-delivered VR in assessment and modification were most prevalent among individuals using (or with a history of using) methamphetamine and targeted subjective craving, electrophysiological biomarkers (e.g., heart rate variability,skin conductance), and brain activity. Environments presented through VR involved substance -relevant cues (e.g., paraphernalia) and neuropsychological assessments. The majority of assessment studies elicited clinically relevant factor(s) present in illicit substance use through VR and all reviewed modi fi cation studies effectively reduced clinically relevant factors in methamphetamine and opioid use (e.g., craving, subjective pain). Conclusions: There is evidence to support the use of immersive, HMD-delivered VR in the assessment and modi fi cation of clinically relevant factors in methamphetamine use, as well as preliminary evidence to support its effectiveness for clinically relevant factors in opioid use. Future research should further examine the effectiveness of HMD-delivered VR in modifying illicit substance use and triangulate biomarkers measured in individuals using illicit substances.