Effects of proximal, contextual, and social alcohol cues on craving in an immersive virtual environment

BACKGROUND: Alcohol craving is a key concept in alcohol use disorder and is often used as the primary outcome measure in cue-exposure studies. In exposure studies, alcohol cues are classified into three categories: proximal (items that are proximally associated with consumption), contextual (physical situations where alcohol is consumed), and complex cues (a combination of contextual and proximal cues). In addition, alcohol drinking is also influenced by the presence and behavior of others in social drinking situations. However, the role of these different cues for eliciting craving is not well understood. The goal of the present study was to investigate the impact of alcohol proximal, contextual, complex, and social cues on craving in an immersive 360° environment.
METHODS: Six real-life virtual environments in 360° view were created to manipulate the presence/absence of alcohol proximal, contextual, and social cues. 157 social alcohol drinkers were randomly assigned to one of the 6 groups, and their craving level was assessed before and after virtual immersion.
RESULTS: The results indicate a significant effect of contextual cues (p<.01), proximal cues alone (p=.03), and complex-peer-drinking environment (p=.01) on elicited craving, as compared to the control condition without those cues. Moreover, perceived substance availability was significantly correlated with post-exposure alcohol craving (rS = .29, p<.001).
CONCLUSIONS: The various types of alcohol cues had a differential impact on elicited craving according to consumption levels. Contextual cues alone were as efficient in eliciting craving as more complex ones. Isolated proximal alcohol cues also did not differ from complex alcohol cues. Thus, the present results failed to show a significant additional effect of peer-drinking social cues over proximal or contextual cues alone. Our study therefore does not support the tendency in the literature suggesting using more complex cues and more ecologically valid environments.