| Aversion therapy | |
|---|---|
| ICD-9-CM | 94.33 |
| MeSH | D001348 |
Aversion therapy is a form ofpsychological treatment in which the patient is exposed to astimulus while simultaneously being subjected to some form of discomfort. Thisconditioning is intended to cause the patient to associate the stimulus with unpleasant sensations with the intention of quelling the targeted (sometimes compulsive) behavior.
Aversion therapies can take many forms, for example: placing unpleasant-tasting substances on thefingernails to discouragenail-chewing; pairing the use of anemetic with the experience ofalcohol; or pairing behavior withelectric shocks of mild to higher intensities.
Aversion therapy, when used in a nonconsensual manner, is widely considered to be inhumane. At theJudge Rotenberg Educational Center, aversion therapy is used to performbehavior modification in students as part of the center'sapplied behavioral analysis program. The center has been condemned by theUnited Nations fortorture.
Various forms of aversion therapy have been used in the treatment of addiction to alcohol and other drugs since 1932 (discussed inPrinciples of Addiction Medicine, Chapter 8, published by theAmerican Society of Addiction Medicine in 2003).
An approach to the treatment ofalcohol dependence that has been wrongly characterized as aversion therapy involves the use ofdisulfiram,[1] a drug which is sometimes used as asecond-line treatment under appropriate medical supervision.[2] When a person drinks even a small amount of alcohol, disulfiram causessensitivity involving highly unpleasant reactions, which can be clinically severe.[1] Rather than as an actual aversion therapy, the nastiness of thedisulfiram-alcohol reaction is deployed as a drinking deterrent for people receiving other forms of therapy who actively wish to be kept in a state of enforced sobriety (disulfiram is not administered to active drinkers).[1][3]
Another approach in creating aversions to alcohol consumption is the implementation of succinylcholine chloride-induced paralysis and respiratory arrest following exposure to alcohol.[4] However, this method has not been found to be effective in emetic therapy or covert sensitation. Additionally, many patients reported a sense of fear and anxiety pertaining to dying as a result of the treatment, therefore this tactic is not recommended for therapeutic use.[4]
Emetic (to inducevomiting) therapy and faradic (administered shock) aversion therapy have been used to induce aversion for cocaine dependency.[5] When used in amultimodal program, chemical aversion therapy displayed high patient acceptability among cocaine users as well as promising outcomes such as aversions to the sight, taste, and smell of the drug.[6]
It is unknown whether aversion therapy, in the form of rapid smoking (to provide an unpleasant stimulus), can helptobacco smokers overcome the urge to smoke.[7] Although in recent years, a new tactic in aversion therapy has been introduced specifically to individuals who struggle with nicotine addiction. A device, which is worn on the wrist of the user, holds a self administered electrical stimulus within it aimed at deterring the use of nicotine.[8]
Aversion therapy has been used in the context of subconscious or compulsive habits, such as chronicnailbiting, hair-pulling (trichotillomania), or skin-picking (commonly associated with forms ofobsessive compulsive disorder as well as trichotillomania).
In treating sexuallydeviant behavior, aversion therapy is implemented in the form ofshame. The goal in this kind of therapy is to target the individuals who feel disgusted by their compulsive behaviors. The disgust aspect is what would implement shame, thus hopefully limiting their need and want to act on their compulsive behaviors. This is done by ensuring that the individual is aware they are being observed and judged during the act.[9]
Pliny the Elder attempted to heal alcoholism in the first century Rome by putting putrid spiders in alcohol abusers' drinking glasses.[10]
In 1935,Charles Shadel turned a colonial mansion in Seattle into theShadel Sanatorium where he began treating alcoholics for their substance use disorder.[11] His enterprise was launched with the help of gastroenterologistWalter Voegtlin and psychiatrist Fred Lemere. Together, they created a medical practice that exclusively treated chronic alcoholism through Pavlovian conditioned reflex aversion therapy.[12]
In the 1960s and 1970s aversion therapy was used on a small group of lesbian and bisexual identifying women in England. Electric shocks and injections to induce vomiting were used to prevent the woman from looking at other women.[13] This was meant to work as a form ofconversion therapy.
TheJudge Rotenberg Center is a school in Canton, Massachusetts that uses the methods of ABA to perform behavior modification in children withdevelopmental disabilities. Before it was banned in 2020, the center used a device called aGraduated Electronic Decelerator (GED) to deliver electric skin shocks as aversives. The Judge Rotenberg Center has been condemned by theUnited Nations fortorture as a result of this practice.[15] While many human rights and disability rights advocates have campaigned to shut down the center, as of 2020 it remains open. Six students have died of preventable incidents at the school since it opened in 1971.[16][17]
Aversion therapy has been scrutinized in recent decades due to thecontroversy surrounding the techniques implemented in this kind of psychological treatment. These techniques such as electrical shocks and taste aversion, directly aim at creating an unpleasant stimuli to deter unwanted compulsive behavior. Some mental health professionals deem this tactic to beunethical since it is implementing punishment as a therapeutic tool. Aversion therapy has the risk of creating other psychological issues such asanxiety,depression, pain, fear and in severe cases evenpost-traumatic stress disorder (PTSD).[18]
