Virtual Drug Treatment Has Real-World Impacts

Seated in front of a computer in the corner of an L-shaped office, David Molina teleports his avatar—a younger, more clean-cut version of the bearded drug counselor—from a messy house to the ‘hood, a run-down industrial part of the World. There, David’s virtual persona switches to the face of a hardened drug dealer, his briefcase swaps out for $500 cash.

Now Molina can set up a scenario to test one of his clients: offer to sell them drugs.

Molina is a counselor at Janus Community Clinic, a private drug treatment program. One of the organization’s roles is to contract with Santa Cruz County to provide methadone, a synthetic opiate, to heroin and Oxycotin users trying to kick their habits.

The methadone clinic, on Emeline Avenue in Santa Cruz, serves about 300 clients, including 50 Scotts Valley and San Lorenzo Valley residents, according to Janus Executive Director Rod Libbey.

The treatment program includes a counseling component and, in the past two to three years, Molina has been piloting therapeutic virtual reality with a small group of clients.

That’s where the avatar comes in.

Sometimes, Molina’s avatar becomes invisible to represent the client’s addiction, whispering urges like “you know you want to.”

“It’s amazing how close I can get them to wanting to use,” he said. “They actually star sweating … they’ll get really anxious.”

Neither of these risky situations would be advised in the real world, but in VR—virtual reality—Molina and his client can work through a wide range of temptations without chancing a relapse.

“I can simulate that safely and by the time they leave, they have some new skills,” he said.

The avatar has other benefits as well.

Clients create their own virtual reality persona—think of it like your Mii character on a Nintendo Wii—which can lead to sharing moments. For example, when a white man made his character African-American, he and his counselor had a discussion about how he perceives himself, Libbey said.

There can be a certain amount of shame or denial in addiction that makes people not want to share with a therapist, but using avatars allows the clients to disassociate from themselves, Libbey said. Often they are quicker to open up and will share more.

“What we’ve found is it breaks down those barriers,” Libbey said. “It adds a whole new dimension to treatment.”

One man, through his avatar, talked about a relapse he hadn’t previously mentioned, Molina said.

However, both Libbey and Molina were clear that computers, headsets and virtual reality are not a solution in and of themselves.

“This is not a replacement for therapy,” Libbey said. “It’s a different way of putting therapy out there.”

The world where the cutting-edge therapy happens is a city about 5-6 square miles with hills, a bay, high-rises and an oil rig. The outlying area expands the entire “world” to about 10 square miles. There’s a beach, where Janus counselors have found clients become the more relaxed and open.

But it isn’t a game.

The virtual reality therapy is coupled with in-person counseling and an online component that requires clients to log in daily and rate their progress, such as how well they slept, their mood and their appetite.

The online virtual reality program, developed by InWorld Solutions, is still in a trial phase as a drug treatment tool. It will debut at the Santa Cruz County Jail this summer and the next round of patients will be able to participate remotely—the current study group comes to the Janus office for VR therapy.

That will be a boon for Watsonville residents, some of whom spend up to five hours using public transportation to get from South County to the methodone clinic and back home again.

Libbey said Janus is searching for a Watsonville site to open a satellite clinic, but has yet to find the right fit.

"We're still looking," he said. "Ther's a certian NIMBY issue to having a methadone clinic in your neighborhood. ... But it reduces crime, it increases the number of people going back to work."

In the interim, Janus is seeking a $17,000 Community Foundation grant to purchase laptops so people without home computers, including Watsonville residents, can participate in the virtual reality therapy from home.

"The patients are really dying for something new," Molina said. “I honestly believe that we’re looking at the future of therapy.”

The results of the virtual reality will be presented at the American Psychological Association world conference in August.

A version of the program may be offered to DUI offenders in Santa Cruz County in the near future also.

Molina has a lot of confidence in the program and how it helps his clients.

“I honestly believe this is really going to improve addiction medicine,” Molina said.