Cannabis is the most commonly used and misused drug among US adolescents and the primary drug of choice for adolescents entering substance abuse treatment. Adolescents are highly vulnerable to adverse use and misuse consequences; it is important to understand factors causing continued cannabis misuse. One factor is the reaction (i.e., craving, physiological changes) adolescents experience when confronted with cannabis cues. This reaction, cue reactivity, occurs when drug users are exposed to proximal (e.g., drug or paraphernalia) or contextual (e.g., drug environments or social interactions) cues. Scant extant research on proximal cues suggests adolescents' reactivity to cannabis cues is similar to adults', but no studies have examined reactivity to contextual cues. Further, incorporating cultural elements of adolescence (music, language, rituals, etc.) related to cues has been minimal. Examining adolescent cue reactivity to culturally grounded combined contextual and proximal cannabis cues is likely to provide unique insight into cannabis-related behaviors, identifying opportunities to improve prevention and intervention. This study aims to identify common cannabis-related proximal and contextual cues adolescents encounter to develop and test virtual reality (VR) cue environments specifically aimed at these users. This study will collect pilot data identifying cannabis- related contextual (social and environmental) cues encountered by adolescents, leading to development of VR cannabis environments incorporating these proximal and contextual cues. It will also explore the feasibility of VR to measure effects of VR cannabis cue exposure on adolescents' cue reactivity. The proposed research is innovative - the first to incorporate culturally grounded proximal and contextual cues into VR environments for adolescent cannabis-using populations. It will use a combination of focus group and cross-sectional design methods to develop and test VR cannabis cue environments specifically aimed toward adolescent cannabis users. Two focus groups of adolescents currently engaged in substance use treatment and a third group of providers will elicit insights on environments and interactions leading to cannabis use. This data will be used to develop VR environments containing combined proximal and contextual cues. These environments will be tested to determine feasibility of using VR to measure exposure to cannabis cues' effects on adolescents' self- reported craving, physiological response, mood state, and attention paid to virtual social cannabis interactions and proximal stimuli situations. Results will contribute to NIDA's strategic goals on drug abuse prevention and treatment by developing a better understanding of environments in which adolescents use cannabis, then creating and testing similar VR environments to determine the level of cue reactivity elicited. This study focuses primarily on developing and testing a VR cannabis cue environment to elicit reactivity in treatment- seeking adolescent cannabis smokers. Ultimately, such environments could be incorporated into treatment to effectively prevent escalation of cannabis use, treat current addiction and abuse, and prevent relapse.
The proposed research is relevant to NIDA's mission of bringing the power of science to bear on drug abuse and addiction as it utilizes virtual reality technology in an innovative manner to develop and test culturally grounded VR cannabis cue environments to elicit reactivity in treatment-seeking adolescent cannabis smokers. Ultimately, such environments could be incorporated into treatment to effectively prevent escalation of cannabis use, treat current addiction and abuse, and prevent relapse, thus supporting NIDA's strategic goals related to drug abuse prevention and treatment.