The discussion around Virtual Reality Exposure Therapy (VRET) in addiction medicine has noticeably gained momentum in recent years. An increasing number of studies are investigating whether virtual environments can actually help reduce cravings and prevent relapses. A look at the literature from 2022 to 2025 presents a picture that is both promising and complex. While more than four-fifths of the examined randomized controlled trials report at least one positive effect, the evidence regarding long-term abstinence and relapse rates remains inconsistent.
A particularly comprehensive review of Glavak-Tkalić et al. (2025) summarized 20 controlled studies on alcohol, nicotine, and illegal substances. The authors emphasize the high success rate regarding proximal outcomes such as the reduction of cravings, but also point out that clinically significant effects, such as sustained substance abstinence, have only been demonstrated in a portion of the studies so far. VRET is typically used either as exposure therapy or in combination with cognitive behavioral therapy.
The PICOC study by appears particularly innovative Lehoux et al. (2024), which tested a VRET intervention specifically for cocaine addiction for the first time. 54 inpatient patients underwent virtual cue exposure sessions, supplemented by a memory-oriented cognitive therapy. The VR environments were individually tailored to both the form of consumption and the cultural context. As a result, the intervention achieved an unusually high ecological validity. The results indicate a significant reduction in cravings, although long-term effects are still to be determined.
Another review of Taubin et al. (2022) showed that VR interventions were able to reduce substance use or at least cravings in many cases. While nicotine and opioid use were particularly positively affected, the effect on alcohol was less clear. It is also noteworthy that VR applications for mood and anxiety symptoms have so far only produced mixed results.
However, there are some new developments to observe in the area of alcohol. In Barcelona, the year 2024 saw the ALCO-VR-Studie started, in which patients with severe alcohol use disorder were engaged in multisensory VR exposures, including visual, haptic, and even olfactory stimuli. In Germany, the first studies combining VR exposures with AI will also take place in 2025. Here, an algorithm adjusts the difficulty in real-time and selects patient-specific triggers while monitoring physiological parameters.
Technologically, the systems have advanced significantly in recent years. In addition to standard headsets like the Meta Quest 2 or HTC Vive, haptic controllers and immersive 360° environments are now being used. One example is the TST-VR program ("Transcending Self Therapy") from Wiese et al., 2025, that a randomized study showed a significantly higher treatment completion rate compared to classical cognitive behavioral therapy.
Despite these advances, the methodological diversity of the studies remains a challenge. Different VR modalities, small sample sizes, and a lack of long-term data make it difficult to generalize the results. Additionally, side effects such as cybersickness have so far been inadequately studied.
Nevertheless, some promising application areas are emerging for practice. The evidence is particularly robust in the area of tobacco dependence, where VR repeatedly reduces cravings. There are also initial indications of effectiveness for opioid use, especially when mindfulness elements are integrated. Studies on cocaine are still young but methodologically very innovative. Alcohol remains the field with the greatest uncertainty but also with the greatest research dynamism..
From a clinical perspective, VRET currently seems to be particularly useful as an add-on to existing methods. Patient-specific triggers, multisensory exposures, and AI-supported adjustments open up new possibilities for complementing traditional therapy. It will be crucial to develop standardized protocols in the future and to examine long-term effectiveness in large-scale studies.
The assessment of the current literature is as follows: VRET is not a panacea, but a serious component in modern addiction therapy. With technological innovations, stronger standardization, and more robust long-term data, the method could make the leap from the experimental niche to clinical routine in the coming years, thereby sustainably changing the treatment of substance use disorders.
