Changing addictive behaviours is an arduous process for someone to go through. With how complicated human behaviour is, are there ways of reducing addiction? According to aversion therapy, we can potentially tackle addictive behaviours through behavioural interventions, but how do we do this? And what are the merits of using aversion therapies over other treatment plans?
- First, we will briefly summarise behavioural interventions and define aversion therapy.
- Then we will explore aversion therapy alcohol interventions.
- After, we will look at different aversion therapy devices.
- Next, we will explore aversion therapy effectiveness.
- Finally, we will give an evaluation of aversion therapy.
Fig. 1 - Aversion therapy explores various ways to reduce addiction.
Behavioural Interventions
Behavioural interventions are treatments based on behaviourism, which believes that we learn from our environment through operant and classical conditioning. Therefore, to treat issues such as addiction, one must unlearn addictive behaviours.
Behavioural interventions tackle addictive behaviours through the method mentioned above, such as aversion therapy and covert sensitisation. Aversion therapy and covert sensitisation involve exposure to an unpleasant stimulus associated with the addiction.
Aversion therapy is a behavioural intervention which states that stimuli frequently occurring together will become associated. Unpleasant stimuli are paired up with addictive behaviours.
Covert sensitisation differs in that the person imagines the unpleasant stimulus, unlike aversion therapy, where they are actually exposed to it.
Both interventions are carried out safely by professional psychologists in a therapeutic setting. Aversion therapy looks different depending on the type of addiction, but the general treatment principle is the same, using a process known as counter-conditioning.
For example, suppose substance addictions are learnt through the association of the drug and its pleasant effects.
In that case, addiction can be unlearned by replacing the pleasant stimuli with an unpleasant response, such as vomiting. Instead, a new, less pleasant association is made, creating an aversion to the original substance.
We will look more at aversion therapy used in reducing alcohol addiction next.
Aversion Therapy: Alcohol
Aversion therapy is frequently used to treat alcoholism. In this process, professionals give the patient an emetic, a pill that causes severe nausea and vomiting. Having a strong alcoholic drink in a nauseous state causes vomiting.
- By taking the emetic and drinking alcohol, it creates an association between alcohol with the unpleasant vomiting response. The process is repeated multiple times to allow for a strong association to form.
An alternative is a disulfiram (e.g., Antabuse) drug. These drugs interfere with metabolising (breaking down) alcohol so that the patient experiences severe nausea and an instant hangover when they drink.
- As a result, a negative association with alcohol forms and the addict might put off drinking altogether to avoid the unpleasant symptoms.
However, the risk of vomiting and nausea in social situations where alcohol is available is high. It could lead to embarrassment for the patient, raising ethical issues about using aversion therapy.
Antabuse and emetic drugs are also used in aversion therapy for reducing drug addictions.
Fig. 2 - Emetic pills cause nausea and vomiting.
Aversion Therapy Devices
There are other examples of devices (other than drugs) used to help reduce addiction in other addictions.
Aversion therapy devices can be used in everyday life and don't always relate to a particularly serious or life-debilitating addiction.
For example, gels or polishes that taste unpleasant are put onto fingernails to stop people from chewing them.
Here we will identify some aversion therapy devices used for gambling and nicotine addictions.
Gambling Addiction
For behavioural addictions like gambling, aversion therapy uses external stimuli such as electric shocks. The shocks are strong enough to be painful but not harmful.
Barker and Miller (1966) reported how a man came to them to seek treatment for his gambling addiction. They recorded his habits in a gambling shop and then recorded his family in a separate video detailing the pains his gambling is putting them through.
- Over ten days, for half an hour, he received electric shocks to his wrist every time he watched the gambling video, and he would watch the video of his wife and family after.
- The man developed a deep sense of shame, according to Barker and Miller (1966), towards the end of treatment when watching himself gambling, and for the next two months, the study reported he did not go near a gambling shop again, and he and his wife were much happier.
Treatment can occur in different ways.
For example, treatment can involve writing down sentences related to the person's gambling behaviour on cards. The gambler reads the sentences aloud and is shocked for two seconds if the card is related to gambling.
The cards should also contain unrelated behaviours so that the player associates the gambling behaviour with the shocks. The intensity of the shock is chosen beforehand, which is done in a safe, therapeutic environment.
Nicotine Addiction
Rapid smoking can create an unpleasant stimulus associated with smoking that may help reduce smoking habits for those with nicotine addiction. Smoking rapidly causes nausea, dizziness, headaches, sore throat and increased heart rate.
Negative imagery (covert sensitisation) or a shock from snapping a rubber band when thinking of smoking are also aversion therapy devices that could be used to reduce nicotine addiction.
There are devices available to help people reduce cigarette smoking that isn't related to aversion therapy. They can, however, still have unpleasant side effects themselves, despite their purpose to reduce the unpleasant symptoms of nicotine withdrawal.
These include nicotine replacement therapy (that comes in the form of skin patches, gum, tablets, nasal or throat sprays), prescribed medication and e-cigarettes (vapours of which still contain nicotine but not carbon dioxide or tar, which is extremely harmful).
Fig. 3 - Aversion therapy and other devices can be used to reduce smoking.
Aversion Therapy Effectiveness
The effectiveness of aversion therapy varies between the addictive behaviour and the individual themselves; due to individual differences, some people find some therapy more helpful than others.
For instance, research has found a high success rate of aversion therapy for treating alcohol use disorders. 69% of participants involved in a chemical-aversion study (using emetic drugs) were still sober 12 months after the investigation started (Elkins et al., 2017).
We will look at why some aversion therapy might not be so effective for reducing other addictions in our evaluation of aversion therapy next.
Evaluation of Aversion Therapy
This section will look into the evaluation of aversion therapy as one of the common behavioural interventions.
Ethical Issues
Inflicting extreme nausea and vomiting on patients is ethically questionable. As we have previously discussed, using aversive drug treatments such as disulfiram could cause embarrassment and shame if someone experiences these symptoms in public. Even private aversion therapy with a therapist could harm and embarrass the patient.
In other forms of aversion therapy, such as treatment for gambling addiction, even the eventual addition of allowing patients to choose their shock level was a tokenistic gesture to address these ethical issues.
Treatment adherence issues
Because aversion therapy uses unpleasant or traumatising stimuli, it has a low adherence rate. In practice and research, knowing the effectiveness of aversion therapy is challenging. Those less likely to respond to the therapy often drop out of treatment early. Thus, the research could be overly optimistic.
Short-term versus long-term effectiveness
Aversion therapy seems only to be effective in the short term.
- McConaghy et al. (1983) found that aversion therapy was much more effective in reducing gambling behaviour and cravings after one month than a year.
- In a long-term follow-up study, McConaghy et al. (1991) found that aversion therapy was no more beneficial than a placebo. Other behavioural interventions, such as covert sensitisation, were more beneficial between two and nine years.
Methodological problems
Hajek and Stead (2001) reviewed 25 studies of aversion therapy in nicotine addiction. They found it challenging to judge the effectiveness of the studies as they all suffered from glaring methodological issues.
One of the most significant errors was failing to make the procedures blind, i.e. participants knew if they had received the real treatment or a placebo. These inbuilt biases might make the therapy appear more effective than it is.
Research support
McConaghy et al. (1983) directly compared aversion therapy to covert sensitisation for gambling addiction. At the one-year follow-up, he found that those who had received covert sensitisation were significantly more likely to have reduced gambling activity (90% versus 30%).
They also reported reduced gambling cravings. This finding suggests that covert sensitisation could effectively treat various addictions.
Aversion Therapy - Key takeaways
- Aversion therapy is a behavioural intervention which states that stimuli frequently occurring together will become associated. It is based on forming negative associations with addictive behaviours.
Behavioural interventions, therefore, treat addiction by associating the addictive substance/behaviour with unpleasant stimuli.
Aversion therapy for reducing alcohol addiction, for example, includes emetics or Antabuse drugs. Gamblers may receive electric shocks whenever they think or are around gambling-associated stimuli. Rapid smoking is an aversion therapy for nicotine addiction.
Covert sensitisation is a form of aversion therapy where the unpleasant stimuli are imagined rather than physically present.
- Research suggests aversion therapies are effective in some cases, but they are ethically questionable, have low retention rates and sometimes are only short-term solutions to addiction. Research also highlights methodological issues in studies examining different behavioural interventions.
References
- Barker, J. C., & Miller, M. (1966). Aversion Therapy for Compulsive Gambling. British Medical Journal, 2(5505), 115.
- Elkins, R. L., Richards, T. L., Nielsen, R., Repass, R., Stahlbrandt, H., & Hoffman, H. G. (2017). The neurobiological mechanism of chemical aversion (emetic) therapy for alcohol use disorder: an fMRI study. Frontiers in behavioral neuroscience, 182.
- McConaghy, N., Armstrong, M. S., Blaszczynski, A., & Allcock, C. (1983). Controlled comparison of aversive therapy and imaginal desensitization in compulsive gambling. The British Journal of Psychiatry, 142(4), 366-372.
- McConaghy, N., Blaszczynski, A., & Frankova, A. (1991). Comparison of Imaginal desensitisation with other behavioural treatments of pathological gambling a two-to nine-year follow-up. The British Journal of Psychiatry, 159(3), 390-393.
- Hajek, P., & Stead, L. F. (2001). Aversive smoking for smoking cessation. Cochrane Database of Systematic Reviews, (3).
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