Augmented reality as a novel approach for addiction treatment: development of a smoking cessation app

Abstract

Objective: Augmented reality (AR) is a rapidly developing technology that has substantial potential as a novel approach for addiction treatment, including tobacco use. AR can facilitate the delivery of cue exposure therapy (CET) such that individuals can experience the treatment in their natural environments as viewed via a smartphone screen, addressing the limited generalizbility of extinction learning. Previously, our team developed a basic AR app for smoking cessation and demonstrated the necessary mechanisms for CET. Specifically, we showed that the AR smoking cues, compared to neutral cues, elicited substantial cue reactivity (i.e. increased urge) and that repeated exposure to the AR smoking cues reduced urge (i.e. extinction) in a laboratory setting. Here we report the next step in the systematic development of the AR app, in which we assessed the usability and acceptability of the app among daily smokers in their natural environments.

Method: Daily smokers (N = 23, 78.3% female, Mean Age = 43.4, Mean Cigarettes/Day = 14.9), not actively quitting, were instructed to use the AR app in locations and situations where they smoke (e.g. home, bar) at least 5 times per day over one week. The study is registered in clinicaltrials.gov (NCT04101422).

Results: Results indicated high usability and acceptability. Most of the participants (73.9%) used the AR app on at least 5 days. Participants found the AR cues realistic and well-integrated in their natural environments. The AR app was perceived as easy to use (Mean = 4.1/5) and learn (mean of 2 days to learn). Overall satisfaction with the app was also high. Secondary analyses found that 56.5% reported reduced smoking, with an average 26% reduction in cigarettes per day at follow-up.

Conclusions: These findings set the stage for a randomized controlled trial testing the AR app as an adjuvant therapy for treating tobacco dependence, with potential applicability to other substances. KEY MESSAGEThis study found that the augmented reality (AR) smartphone application that utlized cue exposure treatment for smoking cessation was perceived as easy to use and learn in the natural, day-to-day environment of daily smokers. Findings set the stage for a larger clinical trial testing the AR app as an adjuvant therapy for treating tobacco dependence, with potential applicability to other addictive behaviors.

Keywords: Cue exposure therapy; addiction; augmented reality; extinction; smartphone app; smoking; urge.

Conflict of interest statement

Thomas H. Brandon, Ph.D. is on the advisory board for Hava Health, Inc.

Figures

Figure 1.

Summary of previous findings. (a). Median of each participant’s mean urge ratings in response to smoking and neutral cues presented via AR and in vivo (adapted from Brandon et al. 2020). (b) Mean urge ratings at pretest and posttest of AR cigarette cues for Extinction vs Control conditions, demonstrating extinction at posttest (adapted from Yang et al. 2022). AR: Augmented Reality.

Figure 2.

Overview of the AR app. (a) Placement of AR cue within the AR app. (b) Sample AR trial from a participant’s view. (c) Seven AR cues within the AR app. AR: Augmented Reality.

Figure 3.

CONSORT diagram. CPD: Ciagarettes Per Day; AR: Augemented reality.