Despite experimental findings supporting the use of cues as a means to induce and extinguish cocaine cravings, treatments using cue exposure for cocaine addiction have not demonstrated efficacy. Two particular problems related to cue exposure treatment are: (1) reliably re-creating conditioned responding and extinguishing cravings to a variety of conditioned stimuli in the therapeutic environment and (2) generalization of extinguished responses to cocaine-related stimuli in the patient's natural environment. To date, these problems have not been adequately addressed by cue exposure-based treatments for cocaine addiction, and therefore may be responsible for a lack of treatment efficacy. Consistent with the mission of Stage 1 treatment research, the aims of this proposal are to develop and manualize a cue-exposure based cocaine treatment using virtual reality (VR) based cue exposure/extinction software and computerized extinction reminder (CER) technology for use in high-risk situations outside treatment sessions. We will recruit a total of 76 subjects (N = 16 for focus groups, N = 20 for Stage la open trials; N = 40 for Stage lb). During Stage la, the VR and CER technology will be developed and refined using two focus groups and two small open clinical trials. At the conclusion of Stage la, a treatment manual detailing the rationale and parameters of VR and CER technology will be completed. Next, a Stage lb pilot randomized clinical trial will be conducted in order to determine the acceptability and feasibility of this treatment to patients and therapists, and to obtain treatment outcome effect size estimates. Specifically, during the Stage 1b trial, 40 cocaine dependent individuals will be randomly assigned to receive a NIDA approved Individual/Group Drug Counseling (I/GDC) cocaine treatment or I/GDC plus VR/CER. Assessment measures will be collected at baseline, post-treatment, and 6-month follow-up. Results from this Stage la/b study will be used to direct the implementation of a future Stage 2 efficacy trial.
