| Objectives:(1)To explore the relationship between cues craving and withdrawal craving in men with methamphetamine use disorder(MUD),based on the virtual reality(VR)cue exposure paradigm;(2)To explore the relationship between attentional bias and psychological craving in men with MUD,based on the picture addiction Stroop task;(3)To explore the effect of the intervention on psychological craving and attentional bias of men with MUD,based on VR cue exposure therapy and its combination with aversive therapy.Methods:(1)A total of 150 men with MUD were recruited for this study.A self-administered questionnaire was used to collect data on general information and substance addiction.In terms of assessment of psychological craving,for withdrawal craving,visual analog craving scale(VAS)was used to assess the level of drug craving during the abstinence period.For cues craving,participants were exposed in neutral scenario,MA related paraphernalia scenario and MA use scenario based on VR,and the VAS built in system was used to assess the craving in different virtual scenarios.(2)Among the 150 men with MUD,134 finished the assessment of attentional bias,which was evaluated by the picture addiction Stroop task.(3)Furthermore,89 qualified participants were included in the intervention study.Based on the research of randomized controlled trial,all individuals were randomly assigned to three groups: cue exposure therapy group(CET group),cue exposure combined with aversion group(CETA group)and neutral scenario compared group(NS group).All subjects participated in the VR intervention project on the basis of routine rehabilitation in detoxification center.CET group was repeatedly exposed to a virtual reality environment matching MA drug-taking scenarios and neutral scenarios.CETA group was repeatedly exposed to a VR environment matching MA drug-taking scenarios and aversion scenarios,the negative consequences caused by MA addiction.The NS group was repeatedly exposed to a neutral VR environment.The intervention frequency were 2 times per week,for 8 weeks,16 times in total.After the intervention,all individuals participated in the posttest,including craving assessment,addiction Stroop task,psychological evaluation,and other post-tests.Results:(1)The relationship between cues craving and withdrawal craving.(1)In VR environment,the score of drug-taking scenario cue craving of men with MUD was higher than that of neutral scenario cue craving and paraphernalia scenario cue craving(p<0.001),as well as that of withdrawal craving before the exposure(p<0.05).(2)The score of withdrawal craving and those of neutral scenario cue craving,paraphernalia scenario cue craving,drug-taking scenario cue craving showed positive correlation with each other(p<0.01).Both the scores of withdrawal craving and cues craving showed positive relationship with the score of MUD Severity Scale(p<0.05).There were positive correlations between withdrawal craving and MA dosage,as well as withdrawal duration(p<0.05).(2)The relationship between attentional bias and psychological craving.(1)In the addiction Stroop task,the response time of participants to MA related pictures was significantly higher than that to neutral pictures(p<0.001).(2)The score of attentional bias was positive correlation with withdrawal craving and drug-taking cue craving(p<0.05).There were differences on the scores of attentional bias among groups with different levels of withdrawal craving(F=5.364,p<0.01).(3)The exploration of intervention paradigm.(1)Main outcomes:In terms of withdrawal cravings,there was a significant decrease in both CET group and CETA group after the intervention,compared to baseline(p<0.05).However,the NS group showed no change between the baseline and the posttest(p>0.05).In the posttest,the withdrawal craving of CET group was significantly lower than that of NS group(p<0.05).In terms of cues craving,all groups’ scores in drug-taking scenarios were significantly decreased(p<0.05)after the intervention.In terms of attentional bias,compared to baseline,the CET group and the NS group showed a significant decrease in response time to MA related picture stimuli after the intervention(p<0.05).However,both the CET and CETA groups still showed significant differences between the response time to MA related picture stimuli and time to neutral picture in the posttest(p<0.05).(2)Secondary outcomes: Compared with the sores in baseline,after the intervention the scores of rehabilitation confidence of all three groups were significantly improved(p<0.05).The self-efficacy of refusing drug in the CETA group was significantly increased after the intervention(p<0.01),and significantly higher than that of the NS group in the posttest(p<0.05).In the posttest,the General Anxiety Disorder score of CET group was significantly lower than that of NS group(p<0.05).Conclusions:(1)The VR-based cue exposure paradigm can be used as an effective tool for the assessment of MA related cues craving.Men with MUD with higher withdrawal craving show higher craving response to cues;men with MUD with higher psychological craving show stronger attentional bias.(2)VR-based cue exposure therapy and its combination with aversion therapy may effectively reduce MUD participants’ psychological craving,providing evidence to the application of the interventions in the clinical treatment of MUD.However,the effect on attentional bias is uncertain.More longitudinal studies with large samples are necessary to verify the effects. |
