Client: Dell Medical School - Department of Psychiatry
Prior research conducted by Dell Medical and the iSchool at the University of Texas has shown that additional treatment methods for opioid use would be welcomed by many in the community. However, many of those interviewed only felt that they could be reached during periods of incarceration because they were forced to detox and stay clean for an extended period of time.
The research conducted by Dell Med and the UT iSchool intends to expand on the concept of rehabilitation during incarceration by exploring treatment options such as virtual reality. During this study, we test the applicability and feasibility of using this technology in a jail environment with inmates.
The incarceration process is difficult for opioid users due to the nature of their addiction as well as the systematic processes seen within correctional facilities today.
A typical lifecycle for this process would see the inmate begin a detox process upon arrest that may include severe symptoms such as aches, pains, and nausea. This " comedown" period often involves two phases and can last through the transition from the local jail to the county facility. During their stay at the correctional facility they can attend classes but are forced through a waitlist due to demand. Finally, once they're legal issues are resolved and their time is served they transition back into society. Many inmates feel that the only time they are able to take responsible action to avoid relapse is during incarceration where they can pursue extended sobriety.
One of the major pain points of this process is the ability for the facility to provide class offerings to inmates. If an inmate serves a short sentence, they may never have the opportunity to attend classes they've waitlisted.
Another major pain point for the inmates is the difficult transition back into society. Within the correctional facilities the inmate may build a support network that is then inaccessible upon release. This leaves the inmate with fewer familiar options for continued recovery and limited means to support a healthier lifestyle. In addition, many inmates admit that they are unprepared for the transition back into a peer network that often promotes poor life choices.
I've mapped this concept below however, this process is very fluid and differs for each individual. This is only meant to assist with understanding the timeline that involves opioid use, incarceration, and transition back into society.>
Goal #1: Test the Oculus Rift virtual reality system with local inmates to determine if the system is accepted and considered feasible by the inmate.
Goal #2: Identify areas of opportunity for the Sheriff's Office and inform future research in regards to opioid addiction and treatment.
We conducted Qualitative Research to better understand how inmates perceive a virtual reality system and the underlying reasons why they feel it can or can't be used to curb opioid relapse.
The exploratory nature of this study provided insights into the issues inmates have with current treatment programs and how virtual reality can be used to improve incarceration outcomes.
To better understand virtual reality and the methods used to measure the level of acceptability across users we studied twelve journal articles that measured acceptability and/or feasibility of various technology systems.
Two challenges that we faced in data collection were the varying education levels represented in our sample as well as the sensitive topic that we were discussing with the participants. To account for this, we decided it best to simplify the language used during the interviews and Likert measurements. We also took additional measures to smooth the conversational transition to any sensitive lines of questioning. For example, prior to discussing rehabilitative opportunities available to opioid users, we discussed the current rehabilitative treatments taking place for veterans with PTSD.
We spoke with twenty (N=20) inmates at the Travis County Correctional Complex about virtual reality, day to day life, and their educational/rehabilitation opportunities inside and outside the correctional facility.
To test feasibility and acceptability each participant participated in two conditions using a single Oculus Rift system.
Condition One consisted of an introductory session that acted as an orientation for the inmate to help us determine if they felt comfortable and safe during use of the Oculus Rift system.
Condition Two allowed them to experience the more robust capabilities of virtual reality and fueled discussion about how they might use a system like this for the purpose of rehabilitation, training, and entertainment.
Likert measurements were used to record how the participant felt at various stages of the interview.
Initial questionnaires provided by the Department of Psychiatry were completed prior to escorting the participants into the interview space that contained our equipment. Our equipment was covered to avoid distraction but we found it proved proved difficult to avoid any and all bias due to the communication taking place in the common area of the prison.
Additionally, a heart rate monitor was worn to allow the Dell Medical researchers to analyze the physical response to the interview conditions.
While the primary purpose of this research was to determine acceptability and feasibility of VR, we also wanted to take advantage of the opportunity to speak with inmates about the things they may consider valuable about a system like the Oculus and the benefits it could provide them while incarcerated.
While entertainment was mentioned the most (apparently prison is boring...) we specifically directed our focus on the enthusiasm we heard from many participants about the opportunity to train on new skills and having new approaches to the rehabilitative training they were already taking part in at the correctional facility One such case involves the multi-step program associated with Alcoholics Anonymous.
The specific conditions we chose included an orientation as well as a more in depth user of the VR system:
To orient the participant, we allowed them to simply wear the headset and manipulate the hand controls within the Oculus main menu.
For the second condition, the participant was allowed to participate in an "open world" nature hike. The participant could plant trees and adjust the weather but was otherwise limited to navigating the digital landscape on foot by using the hand controls.
In the final portion of our interview, we completed some background research into the participants day to day as well as their participation in any form of counseling or training at the jail. This provided us with information that could be used to adapt the VR system to an existing set of courses available at the facility, promoting additional methods for the Sheriff's Office to adopt such a system.
Overall, participants were open to virtual reality technology and thought it could benefit them in rehabilitation and in a variety of ways unrelated to substance abuse and relapse prevention. Other suggestions included anger management, virtual counseling/therapy sessions, vocational skills training, conflict resolution, and meditation.
While an in-depth analysis wasn't necessary for the purpose of this study, stay tuned because I will be using this data to document my training with R (a programming language used for statistical computation) in the coming months. Link coming soon...
The overarching goal is to eventually implement a program at the Travis County Correctional Facility that utilizes Virtual Reality in the rehabilitation of individuals with substance abuse disorders and assists them in their transition back into society.
The response from the Sheriff in late August were positive and we hope that program development will be underway soon.
I'd like to thank Eric Nordquist, Doctor Kasey Clayborn, as well as the inmates and employees of the Travis County Correctional Facility for the opportunity to advance our treatment of opioid users.