Development and validation of an open-source virtual reality environment for alcohol use disorder and determinants of cue-induced craving among Indian participants.

Background: Alcohol use disorder (AUD) is a chronic relapsing illness that causes significant morbidity. Craving is a key factor responsible for relapse in AUD. Cue exposure (CE) has attempted as an assessment and therapeutic procedure in AUD. Virtual reality (VR) has allowed for efficient conducting of CE. Limited research exists on VR for AUD in Indian settings. Aim: This study intended to develop (using open-source tools) and validate eight VR environments for alcohol CE for Indian scenarios. We also determined the predictive variables associated with alcohol craving upon exposure to these environments. Methods: A cross-sectional study was conducted among 44 detoxified male inpatients with AUD. Eight alcohol-cue and two neutral VR environments were developed. Craving before and after exposure and the sense of presence in VR environments were evaluated. Sociodemographic, psychological, and alcohol consumption characteristics were examined as possible predicting variables. Results: Alcohol-cue environments significantly increased craving postexposure compared to neutral environments. Age, duration of AUD, baseline craving, severity of AUD, and sense of presence significantly correlated with the increase in craving postexposure. Multiple linear regression analyses showed baseline craving, physical, and self-presence were determinants of craving in alcohol cue environments. Conclusion: The developed environments induced craving, although the effect size was moderate, and there was heterogeneity in response. Baseline craving and sense of presence were key predictors of craving. These variables can help ease the identification of those who can benefit from VR CE. Environments are being made available for other researchers to stimulate further research.