Jolanda Fernández-Ruiz

El manejo del trastorno por consumo de alcohol (TCA) resistente al tratamiento presenta desafíos. La terapia de exposición a señales con realidad virtual (TES-RV) es un enfoque complementario al tratamiento estándar (TE). Este ensayo clínico aleatorizado (ECA) evaluó la eficacia de TES-RV con TE, comparado con TE solo, para reducir craving y ansiedad por el alcohol en pacientes con TCA resistente. También buscó determinar niveles de craving y ansiedad durante las sesiones de TES-RV y explorar efectos a largo plazo en la abstinencia. Participaron 85 pacientes con TCA del Hospital Clínic de Barcelona. Fueron asignados aleatoriamente a un grupo experimental (GE), con TES-RV más TE, o a un grupo control (GC), solo con TE. El GE completó seis sesiones de TES-RV junto con TE; el GC continuó solo con TE. Se evaluaron craving y ansiedad por el alcohol antes y después del tratamiento en ambos grupos, y durante las sesiones de TES-RV en el GE. Las recaídas se monitorizaron a los 3, 6 y 12 meses post-tratamiento. Los resultados no mostraron efectos significativos del tipo de tratamiento (GE vs. GC) sobre craving ni ansiedad. No obstante, un factor temporal significativo indicó reducciones en craving y ansiedad del pretest al postest, independientemente del tratamiento. Durante las sesiones de TES-RV, los participantes del GE reportaron niveles mínimos de craving y ansiedad al finalizar. No se hallaron diferencias estadísticamente significativas en las tasas de recaída entre el GE y el GC en ningún seguimiento. El estudio discute implicaciones clínicas, limitaciones y futuras líneas de investigación.

The identification of variables that can modulate the efficacy of cue exposure using virtual reality (VR) is crucial. This study aimed to explore determinant variables of cue-elicited alcohol craving and perceived realism (PR) of environments and alcoholic beverages during a VR cue-exposure session among alcohol use disorder (AUD) outpatients. A prospective cohort study was conducted amongst 72 outpatients with AUD from a clinical setting. Alcohol craving experienced during VR exposure and PR of virtual environments and alcoholic drinks were evaluated after a VR session of exposure to alcohol-related contexts and cues. Sociodemographic, psychological and consumption characteristics were examined as possible predicting variables. Multiple linear regression analyses showed that the AUD severity and PR of beverages were predictors of cue-elicited alcohol craving. Educational level, PR of beverages and age were predictors of the PR of VR environments. In relation to the PR of VR beverages, cue-elicited alcohol craving and the PR of environments were predictors. A simple mediational model was also performed to analyze the influence of the PR of beverages on the relationship between the AUD severity and alcohol craving experienced during VR exposure: an indirect or mediational effect was found. PR of alcoholic beverages was (1) a key predictor of the PR of VR environments (and vice versa) and the alcohol craving (and vice versa) experienced during VR cue-exposure sessions using ALCO-VR software among AUD patients and (2) a mediator between AUD severity and cue-elicited alcohol craving.

Background/Objective: Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes from admission to discharge in outpatients with alcohol use disorder (AUD) undergoing treatment-as-usual (TAU), or treatment-as-usual supplemented with virtual reality cue-exposure therapy (TAU + VR-CET). Method: A prospective cohort study was conducted amongst 42 outpatients with AUD (n = 15 TAU + VR-CET and n = 27 TAU) from a clinical setting. Changes in the levels of alcohol craving between admission and discharge were assessed with the Multidimensional Alcohol Craving Scale. Sociodemographic characteristics (age, gender, education, and socioeconomic and civil status), cognitive-affective behavioral patterns (AUD severity, abstinence duration, psychiatric comorbidity, state anxiety, attentional bias, and substance use), and type of treatment (TAU + VR-CET and only TAU) were also evaluated. Results: The TAU + VR-CET group showed greater changes of improvement in the levels of alcohol craving than the TAU group (χ² = 10.996; p = 0.001). Intragroup changes in alcohol craving from pre to post-treatment were significant in the TAU + VR-CET group (χ² = 13.818; p = 0.003) but not within the TAU group (χ² = 2.349; p = 0.503). The odds of an improvement in any of the craving levels between pre- and post-test was 18.18 (1/0.055) times higher in the TAU + VR-CET group with respect to the TAU group. The use of illicit drugs in the month prior to the test increased the odds of having a positive change by 18.18 (1/0.055) with respect to not having consumed. Conclusions: Including VR-CET in TAU programs may provide benefits in the treatment of AUDs mainly among patients with intense alcohol craving and individuals having used illicit substances prior to treatment.