BACKGROUND: Substance abuse (SA) imposes a significant global health burden, demanding innovative and accessible interventions. Virtual reality (VR) offers a promising approach, providing engaging and personalized treatment experiences. However, rigorous evidence from randomized controlled trials (RCTs) on VR's efficacy in the treatment and prevention of SA remains limited. This systematic review aimed to characterize VR interventions for substance-related disorders and evaluate their effectiveness.

METHODS: To conduct this review, two researchers independently performed a comprehensive literature search across four databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS: Twenty RCTs met the inclusion criteria, focusing on alcohol, nicotine and illicit drug use. These studies utilized diverse VR modalities, most frequently exposure therapy (n = 10) and cognitive-behavioural therapy (n = 5), followed by approach bias modification, skills training, cognitive rehabilitation, counterconditioning and psychoeducation. Interventions varied in level of immersion and interactivity. Although the evidence was mixed, 17 studies demonstrated positive effects on at least one outcome variable. Most studies focused on proximal outcomes (e.g., craving), which frequently showed improvement. Clinically meaningful outcomes (e.g., substance use reduction and abstinence) were less frequently assessed, with seven of 10 studies reporting improvement.

CONCLUSIONS: VR shows promise in addressing substance-related disorders, particularly for alcohol and nicotine. However, substantial heterogeneity in VR interventions highlights the need for further research to standardize methodologies, optimize treatment parameters and explore the underlying working mechanisms of VR interventions. Additional research is also needed to assess VR's application to illicit drug use.