Project Grant R01AA031282

USING VIRTUAL REALITY TO HELP DEVELOP DISCREPANCY AND ELICIT CHANGE TALK IN BRIEF MOTIVATIONAL INTERVENTIONS FOR HEAVY DRINKING YOUNG ADULTS - PROJECT SUMMARY/ABSTRACT ALCOHOL USE IS THE LEADING RISK FACTOR FOR PREMATURE DEATH AMONG YOUNG ADULTS GLOBALLY. BRIEF MOTIVATIONAL INTERVENTIONS (BMIS) CAN HELP YOUNG ADULTS REDUCE THEIR DRINKING. HOWEVER, RECENT RESEARCH HAS SUGGESTED THAT THESE INTERVENTIONS OFTEN HAVE MODEST OVERALL EFFECTS. RESEARCH EXPLORING NOVEL WAYS OF BOOSTING THE EFFECTS OF BMIS COULD HELP EXPAND THEIR IMPACT. STUDIES EXPLORING WHY INTERVENTIONS BASED ON MOTIVATIONAL INTERVIEWING (MI) WORK SUGGEST THAT A KEY MECHANISM MAY BE THAT THEY HELP DEVELOP A SENSE OF DISCREPANCY IN CLIENTS, OR A SENSE OF INCONGRUENCE BETWEEN THEIR CURRENT DRINKING AND IMPORTANT PRIORITIES OR GOALS. MI COUNSELORS OFTEN EXPAND THAT DISCREPANCY BY ASKING OPEN-ENDED QUESTIONS THAT ENCOURAGE CLIENTS TO CONSIDER THE INCONSISTENCY BETWEEN THEIR CURRENT BEHAVIOR AND IMPORTANT VALUES AND LIFE PRIORITIES. TO BE SUCCESSFUL, HOWEVER, THESE TECHNIQUES DEPEND ON CLIENTS' ENGAGEMENT AND INVESTMENT IN THE EXERCISE. VIRTUAL REALITY (VR) COULD PROVIDE A METHOD OF ENCOURAGING MORE MEANINGFUL REFLECTION ON DISCREPANCIES BETWEEN DRINKING AND DESIRED GOALS THAT REDUCES CLIENT RESISTANCE TO CHANGE. VR HAS BEEN USED AS AN ADJUNCT TO COUNSELING TO HELP TREAT A VARIETY OF BEHAVIORAL, COGNITIVE, AND MENTAL HEALTH PROBLEMS WITH CONSIDERABLE SUCCESS, BUT VERY FEW SUCH PROGRAMS EXIST TO ADDRESS HAZARDOUS DRINKING, AND THOSE THAT DO ARE ONLY FITTING FOR THOSE WHO HAVE ALREADY DECIDED TO CHANGE. RECENTLY, INTEREST HAS GROWN IN USING VR TO CREATE TRANSFORMATIVE EXPERIENCES THAT INSPIRE AWE, INCREASE EMPATHY, AND ENCOURAGE POSITIVE CHANGE. THROUGH COLLABORATIONS WITH LOCAL VR EXPERTS, WE DESIGNED AN IMMERSIVE VR EXPERIENCE TO HELP DEVELOP DISCREPANCY AND ELICIT CHANGE TALK IN MI SESSIONS THAT USES AN APPROACH SIMILAR TO THE "LOOKING FORWARD" TECHNIQUE. WE THEN CONSTRUCTED A PROTOTYPE AND TESTED IT WITH 15 HAZARDOUS DRINKING YOUNG ADULTS. AT 30-DAYS POST-INTERVENTION, PARTICIPANTS REPORTED 54% FEWER HEAVY DRINKING DAYS AND 60% FEWER ALCOHOL-RELATED PROBLEMS. QUALITATIVE DATA ALSO SUGGESTED THAT THE IMMERSIVE NATURE OF THE EXPERIENCE MAY HAVE ACCOUNTED FOR MUCH OF ITS IMPACT. THE GOAL OF THE PROPOSED RESEARCH IS TO DESIGN, BUILD, AND PILOT TEST A COMPLETE VR EXPERIENCE USING USER-CENTERED DESIGN RESEARCH METHODS AND THE INPUT OF SUBJECT MATTER EXPERTS. IN PHASE 1, WE WILL BUILD THE VR EXPERIENCE THROUGH AN ITERATIVE PROCESS OF UP TO FIVE BUILD-TEST-REFINE CYCLES IN WHICH PROGRESSIVELY MORE COMPLETE VERSIONS OF THE EXPERIENCE ARE EVALUATED THROUGH SEVERAL ROUNDS OF TESTING WITH INTENDED USERS (HAZARDOUS DRINKING ADULTS, N=15 EACH). FINDINGS FROM THESE CYCLES WILL BE USED TO REFINE THE EXPERIENCE. IN PHASE 2, WE WILL TEST THE EFFICACY OF THE COMPLETED EXPERIENCE IN 96 YOUNG ADULT (AGE 18-34; TARGET N=82 ) HAZARDOUS DRINKERS, WHO WILL BE RANDOMLY ASSIGNED TO RECEIVE EITHER (1) BMI WITH VR, OR (2) BMI ONLY. WE WILL ASSESS FEASIBILITY, TOLERABILITY, AND ALCOHOL OUTCOMES OVER 6-MONTHS POST-INTERVENTION. FINALLY, WE WILL CONDUCT QUALITATIVE IN-DEPTH INTERVIEWS WITH COLLEGE AND COMMUNITY ADDICTION TREATMENT CENTER DIRECTORS (N=30) TO EXPLORE CLINIC-LEVEL BARRIERS AND FACILITATORS TO IMPLEMENTATION OF VR.