Virtual Reality (VR-GINSO) as an Complement to Intervention for Alcohol and Cannabis Use in Youth in Residential Care

Overview

The goal of this RCT is to evaluate the effects of a virtual reality intervention on self-efficacy regarding alcohol and cannabis use among at-risk youth in various residential mental health treatment centers who have co-occurring disorders and are under the care of the association where they receive treatment. The main question it aims to answer is: • Does the VR intervention enhance the therapeutic effect of residential treatment on self-efficacy regarding alcohol and cannabis use? If there is a comparison group: Researchers will compare the intervention with the usual care (UC) that minors receive at the centers for the treatment of dual diagnosis to see if VR adds value to this treatment. Participants will be randomly assigned to each condition and will be evaluated before and after one month. In the experimental group, participants will receive a treatment session using VR software, during which they will undergo training in the following modules: The first phase is an assessment phase, during which objective measures are determined for 1) emotional recognition, 2) avoidance/approach toward related stimuli, 3) degree of compliance with social pressure, and 4) craving in the presence of the drug, exposure to cues, and/or conditioned contexts.

Adolescence constitutes a developmental stage characterized by heightened neurobiological and psychosocial vulnerability. During this period, significant maturational changes occur at the cerebral, emotional, and social levels, increasing susceptibility to the development of risk behaviors and mental health problems. Among these behaviors, antisocial conduct and substance use are particularly prominent, frequently emerging in an interconnected manner. Adolescents and young people are at high risk of engaging in health-damaging behaviors, especially antisocial behavior and drug use. In this regard, juvenile offenders and youths involved in the juvenile justice system display significantly higher rates of substance use than the general population, particularly alcohol and cannabis consumption. Previous research has consistently shown that early substance use not only results from pre-existing psychosocial vulnerabilities, but also contributes to the perpetuation and aggravation of social exclusion, school dropout, violence, and criminal recidivism trajectories. Scientific literature has demonstrated a strong association between mental disorders and substance use in adolescent populations. In particular, externalizing disorders such as Attention-Deficit/Hyperactivity Disorder (ADHD) and conduct disorder exhibit the strongest association with substance abuse. These disorders are characterized by impaired inhibitory control, impulsivity, sensation seeking, and emotional dysregulation, all of which increase vulnerability to early initiation of substance use and the subsequent development of addictive behaviors. Moreover, there is a significant relationship between substance use and other psychopathological conditions, including depression, anxiety, and trauma-related symptoms. Many adolescents engage in substance use as a maladaptive emotional coping strategy, especially in contexts characterized by psychosocial adversity, family neglect, victimization, or early traumatic experiences. This bidirectional interaction between psychopathology and substance use contributes to the emergence of dual pathology, thereby complicating both clinical progression and therapeutic intervention. When substance use emerges during adolescence in association with socially disadvantaged environments and antisocial behavior, treatment becomes particularly challenging due to its multifactorial nature. Individual, familial, social, and neurobiological factors interact dynamically, facilitating the chronicity of the problem. Furthermore, early substance use has been identified as a relevant factor in the persistence of antisocial behavior into adulthood, increasing the risk of social exclusion, unemployment, interpersonal conflict, and psychiatric disorders later in life. Understanding the predictive factors associated with substance use and relapse in this population is essential for improving treatment effectiveness. Recent research has highlighted several psychological variables associated with addiction risk, including impulsivity, callous-unemotional traits, reduced empathy, deficits in emotional recognition, and impairments in decision-making processes. In parallel, biological variables have also been identified, such as altered physiological responses to emotional or drug-related stimuli, dysfunctions within the reward system, and abnormalities in neural circuits involved in self-control and emotional regulation. Although current interventions have demonstrated effectiveness in reducing substance use, important limitations remain regarding long-term relapse prevention, treatment adherence, and the internalization of therapeutic learning. Many socially vulnerable youths exhibit low treatment motivation, difficulties generalizing coping strategies to real-life situations, and limited engagement with conventional therapeutic approaches. In this context, emerging technologies represent a promising avenue for enhancing psychological interventions targeting vulnerable adolescent populations. In particular, Virtual Reality (VR) enables the development of immersive, interactive, and therapist-controlled environments, facilitating safe exposure to high-risk situations as well as the training of emotional and behavioral skills within ecologically valid contexts. VR constitutes a non-invasive technology capable of recreating real-life environments in a standardized, controlled, safe, and adaptable manner according to patients' clinical needs. Accordingly, the present study proposes the implementation of VR software aimed at treating addictive behaviors in youths experiencing social conflict. Following the development and validation of the virtual environment, a structured intervention program will be conducted, including several therapeutic and assessment modules. In the initial phase, objective measures will be obtained regarding: (1) emotional recognition; (2) avoidance and approach responses to substance-related stimuli; (3) susceptibility to social pressure and conformity; and (4) craving levels induced by exposure to drugs, conditioned cues, and substance-related contexts. Participants will subsequently be randomly assigned either to a VR intervention group or to a Treatment As Usual (TAU) control group. Psychological and physiological variables will be assessed using standardized instruments before and after the intervention. Participants in the experimental group will be assessed one week before the experimental session and one week after; participants in the TAU group will undergo the same assessments at the same time, but will not participate in the experimental session in between. During the experimental session, participants will also be assessed before and after the tasks involving the goggles and will undergo a protocol for measuring physiological parameters during the session itself, as detailed in the "Measurements" section. It is hypothesized that the incorporation of VR into conventional treatment will enhance therapeutic outcomes by improving emotional regulation, reducing craving, increasing treatment adherence, and decreasing relapse risk compared to the control condition. The findings derived from this research project may contribute substantially to improving clinical approaches for substance use disorders and dual pathology among adolescents and young people experiencing social conflict, while also providing innovative evidence-based therapeutic tools specifically adapted to the needs of this high-risk population.