A team at Indiana University School of Medicine is developing a virtual reality-based treatment that tackles a tough challenge: helping people stay sober.
The high-tech approach allows a patient recovering from drug addiction to interact with potential future versions of themselves. It is intended to help patients have a clearer view of their future and avoid relapses, steps that can be particularly difficult for those who are just beginning their recovery.
“Virtual reality lets you do the impossible: time travel,” said Brandon Oberlin, the project’s principal investigator and assistant professor of psychiatry at IU School of Medicine.
The project, which has been in development for four years, has recently gained traction. Over the past five months, it has attracted more than $4.9 million in funding from the National Institutes of Health.
In September, the team released the results of their first study, and the results indicated that the concept is promising enough to continue development.
Oberlin and fellow research team member Andrew Nelson also formed a startup, Relate XR LLC, to lay the groundwork for commercialization opportunities. IU helps the two pursue marketing.
Nelson, who is a former IU and founder of Indianapolis-based Half Full Nelson LLC, has a background in virtual reality development. Half Full Nelson specializes in creating educational games and virtual reality experiences.
In the world of research grants, $4.9 million isn’t a huge number, acknowledged Lakshmi Sastry-Dent, director of technology commercialization in IU’s Office of Innovation and Commercialization. . But the grant indicates the team has an idea worth pursuing, she said. “I think it’s a very respectable start for a technology at this stage of development.”
How it works
The research team is developing a tool that takes photos, informative interviews, and voice samples of a patient and uses that information to create two separate avatars. One depicts a future in which the patient has been sober for 15 years. The other—a more disheveled, restless, and visibly aged future self—represents what the patient might be like after 15 years of continued drug addiction.
During a session, the patient can talk with each avatar about their sober or addicted life, with details relevant to that patient’s life. The sober avatar, for example, might talk about graduating from college or reuniting with family members. The drug addict avatar may express regret regarding missed opportunities or time spent behind bars.
“We make it lively and focused,” Oberlin said.
It’s too early to draw firm conclusions about the treatment’s potential effectiveness, but early results are encouraging, he said.
The study looked at 21 people currently in drug treatment in Indianapolis. Following the virtual reality session, the subjects received daily text messages with an image of their future sober avatar. Of these 21 participants, 85% maintained abstinence over a 30-day period, based on both self-report and drug test results.
“That’s a pretty good rate,” Oberlin said, especially for people in the early stages of recovery. All subjects had been recovering for less than a year.
Relapse rates vary depending on how long a person recovers and the type of substances they abused, he said, but in general about 50% of recovering patients experience a relapse in the six months. “In this early recovery window, the relapse rates are really high.”
The intent, Oberlin said, is that clinicians can use the tool as part of a larger treatment program, not as a standalone solution. “We have no illusions that this thing is going to be powerful on its own, necessarily.”
Oberlin and Nelson say they plan to continue research and development over the next few years and consider it premature to say when the product might be ready for commercialization.
Nelson said the team remains flexible on the final product, especially as virtual reality technology continues to improve.
“It’s exciting to see where all of this is going,” he said.
One technical aspect the team is working on is the time and effort required to create each avatar.
When the project first started, Nelson said, it took four or five days to create a custom avatar. The team has reduced this to around one day and hope to reduce this window even further.
Initially, Nelson said, it’s likely that clinicians will collect patients’ personal information and then provide it to Relate XR, which will make the avatar. Over time, the goal is to make the process simple enough that avatar creation can be done at the clinician’s desk.
“At the end of the day, the ultimate goal is that we don’t need to be in the know so much,” he said.
Although commercialization can take years, IU helps Oberlin and Nelson gain patent protection for their technology and connect them with entrepreneurial resources.
Sastry-Dent said his office has already connected Oberlin and Nelson with a venture capitalist who may be interested in the future.
IU’s Office of Innovation and Commercialization, which helps IU researchers commercialize their innovations, reviews 160 to 180 projects each year. She selects about 60% in which she sees commercialization potential.
Sastry-Dent said the project caught his eye because it could help solve a big societal problem. “I think there’s a huge need right now for innovations in the recovery space.”
Aside from 12-step programs like Alcoholics Anonymous, Sastry-Dent said, “Patients really have very little that supports them at this critical time. … There is a huge void in this space—and [early recovery] is a dangerous time.
A local professional with expertise in the addiction field also said she saw great promise in the IU team project.
“I love it clinically,” said Stephanie Anderson, vice president of strategic initiatives and quality improvement at Mental Health America of Indiana. Anderson is a licensed clinical social worker and has worked in the public and private sectors in the substance abuse field.
Anderson said the only other virtual reality project she knows of in the addictions field is at Johns Hopkins University in Maryland. This project involves using technology to help recovering patients manage stress and anxiety.
The IU project appears to build on some centuries-old aspects of recovery programs, she said. Drug addiction reduces a person’s ability for abstract thought and impulse control, she said, and 12-step programs are usually structured to help people cope with these challenges.
As an example, Anderson said, a new member of Alcoholics Anonymous is asked to write a letter to his addicted self. This letter can take different forms, she said, but it’s usually designed as a tool people can turn to if they’re tempted to relapse. The letter, for example, could talk about the person’s negative experiences due to the addiction.
The UI project “takes that idea to a different level,” Anderson said. “…It kind of touches on all of those areas and really helps a person who needs some real-world focus.”
Oberlin said he thinks his team’s project could eventually be used by patients struggling with issues other than substance abuse.
“There are other areas in the mental health space that are crying out for new solutions.”•