Post-traumatic Stress Disorder (PTSD), Addiction, and Virtual Reality

Veterans, National Guardsmen, & Reservists with post-traumatic stress disorder (PTSD) and
problems with addiction need a wider array of treatment options than what is currently
available. The present project offers the promise of a complementary approach that uses
computer-based interventions to augment exposure therapy for veterans with both PTSD and use
alcohol, nicotine and/or other substances. If this new intervention is found to be
efficacious in the present project, it would provide an alternative to standard treatment
for a growing number of veterans who are at risk for lifetime problems with PTSD and
addiction, but who may be unwilling to begin usual psychotherapy. This direct way of
training new behavior in the clinic and extending learning into the real world is missing in
treatments for many medical and psychiatric conditions. As such, the impact of this project
could extend into treatment of a wide variety of other chronic conditions for which more
powerful new treatments are needed. Veterans will be recruited from the Durham Veterans
Affairs Medical Center (Durham VAMC) and local community.

Participants (N = 60) meeting full criteria for current diagnoses of both PTSD and at least
one SUD will be recruited through the Durham Veterans Affairs Medical Center (Durham VAMC).
100 participants will be enrolled (sign the consent form) in order to identify 60 who meet
inclusion/exclusion criteria. Participants will be randomly assigned to one of two treatment
conditions-exposure therapy alone or exposure therapy + virtual reality (VR)-based exposure
to cues for marijuana, cocaine, heroin, cigarette, and/or alcohol use, and (2) cellular
phone-based reminders of learning (extinction reminders, or, ERs) to VR exposure. Matching
between treatment groups will be based on age, gender, severity of PTSD and substance use.
In addition, to control for differential dropout and other changes in treatment due to cell
phone use in the VR/ER condition, participants in the control condition also will carry cell
phones, and will be randomly called three times a day via the automated server (same as the
VR/ER condition). These calls will be completed for assessment only, to obtain real time
self-reports of substance use and cravings (without the ER). Comprehensive assessments will
be conducted at pre-treatment, 10 weeks (post-treatment), and at a 6-month follow-up.

The goals of this project are to examine the acceptability and feasibility of the
complementary treatment and evaluate the effects of the complementary intervention on PTSD
and substance use.

Inclusion Criteria:

- Meets SCID-I criteria for PTSD; criterion A stressor must be deployment related, and
substance dependence; primary substance of dependence is cocaine, heroin, alcohol,
cigarettes, or marijuana

- Must be a Veteran

- Consents to outpatient treatment for PTSD and drug addiction

Exclusion Criteria:

- Full criteria met for current manic episode or psychotic disorder through using
SCID-I interviews

- Pregnant at time of treatment

- IQ less than 70; unable to give consent; can not read

- current and chronic absence of shelter

- impending jail/prison for more than three weeks

- Court order to treatment, court order to treatment or to jail, or agency order to
treatment or loss of child custody (due to inability to freely drop-out of treatment)

- Refuses to discontinue current mental health or drug abuse behavioral treatment
(i.e., psychotherapy) or random assignment

- Suicide attempt or self-harm in the past 6 months