R&R Other Project Information 7. Project Summary/Abstract Neurobiological changes caused by addiction impair behavioral control and increase relapse risk (Volkow, Koob, & McLellan, 2016), substantiating the need for long-term care coordination and recovery engagement for individuals with Substance Use Disorders (SUD) (Humphreys, Malenka, Knutson, & MacCoun, 2017). Because addiction creates stress and reward system dysregulation impairing emotional regulation and executive functioning capacities when experiencing intense craving (Volkow, Koob & McLellan, 2016), traditional didactic relapse prevention strategies may have limited efficacy for those in early recovery when they transition back to their natural communities’ post-discharge from treatment, where they will be exposed to SUD-related stimuli. New recovery support models that detect implicit cue-induced neurophysiological dysregulation and restore real-time regulatory capacity to decrease relapse risk are of clinical significance. This feasibility Phase I study will use Virtual Reality (VR) technology to 1) simulate a patient-specific drug cue-triggering experience (VR_drug) to calibrate a personalized neurophysiological relapse risk set-point, captured in-session using fNIRS (Functional Near-Infrared Spectroscopy) sensors, a portable alternative to fMRI which will be integrated into the VR HMD (Head Mounted Display), and physiological sensors (smartwatch Empatica E4) worn during the VR_drug scenario (Aim 1); and 2) simulate a recovery-regulation experience (VR_recovery) using patient-specific virtually-generated sober-supportive relationships, recovery-enhanced environmental conditions, and recovery-associated sensory cues, to calibrate a recovery-regulated neurophysiological set-point, captured by the same in-session neurophysiological sensors systems (Aim 2). If successful, in Phase II, a mobile recovery support system product will be developed to help individuals in SUD recovery modulate real-time craving by monitoring their personalized neurophysiological relapse risk and activating their recovery-regulation intervention (VR_recovery) to alter urge reactivity in real-time. This type of mobile intervention that is immediately available to individuals in recovery as they leave treatment institutions and transition back into their natural communities may help manage in-the-moment drug urges in ways that allow engagement in other recovery-related activities (e.g., calling a sponsor, getting to a meeting), decreasing real-time relapse risk (Matto,& Seshaiyer, 2018; Matto, 2015; Matto, et al, 2014).