A key challenge in helping people to recover from cocaine addiction (or dependence) is that their craving for the drug can be triggered by environmental ‘cues’, such as being in a bar, going to a party or coming into contact with objects which remind them of the pleasurable effects of cocaine. This process is known as ‘classical conditioning’.
The effectiveness of current talking therapies for cocaine dependence is limited by poor service user engagement and a high rate of relapse soon after the treatment ends. Previous research in people with alcohol dependence showed that repeated exposure to triggers (or cues) for alcohol use, in a safe treatment environment, can significantly reduce their level of craving and relapse. This is known as ‘cue exposure treatment’ (CET). But CET has not yet been fully explored as a treatment for cocaine addiction.
In this research, an ARC team led by Professor Paolo Deluca, professor of addiction research at King’s College London, will use virtual reality to develop more realistic CET environments, which are tailored to the individual’s experiences. Professor Deluca says: “We hope that this will have a greater impact on reducing people’s craving for cocaine than previously available methods which for instance used a limited set of cues (pictures)."
The aim of this study is to reduce the risk of relapse to cocaine by using novel technologies, including virtual reality and wearable devices. The researchers want to offer new ways of delivering CET effectively to people with cocaine dependence.
We are planning to ask individuals to wear a novel watch-like device that can measure physical changes to cues in their everyday environment. With this technology we will be able to identify in real-time when they experience an episode of craving or start using cocaine again, to understand what real-life situations or circumstances have triggered these events and allow us to provide support remotely.
The research will be carried out over three studies. Study participants will be recruited from two geographical areas (London and Hull), which include areas of under-served and under-researched populations with socioeconomic and ethnic diversity.
Study 1: An observational study to develop and test an integrated smartphone app and wearable device to provide tailored, personalised and time-sensitive assessments and interventions, with 90 patients seeking treatment for cocaine substance use disorder (SUD).
Study 2: Virtual reality-enhanced CET intervention development in treatment settings and laboratory testing, with 30 patients seeking treatment for SUD.
Study 3: A proof-of-concept randomised controlled trial with two arms (comparing the CET intervention to usual care) and 12-week follow-up post-randomisation, with 60 patients seeking treatment for SUD. The researchers will also recruit 15 specialist addiction care providers across a range of disciplines (for example, medical, nursing, drug workers) to assess feasibility and barriers to implementation.
People with lived experience of cocaine dependence have been actively involved in the design of this research to ensure that it is both acceptable and meaningful to their needs. Currently, two patient and public involvement (PPI) representatives participate in all project meetings, and an extended PPI advisory group of 10 members meets monthly to provide ongoing guidance and advice.
The researchers are working with four other universities: Kent, Hull, Birmingham and Southampton. They are also collaborating with Empatica, who produce the wearable device, EmbracePlus.
This project is funded by the NIHR Invention for Innovation (i4i) Addiction Mission: Innovation for Treatment and Recovery Awards. It began in May 2024 and is expected to complete in May 2027.
Read more about the alcohol and addiction research at ARC South London.
