Aversion therapy

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Aversion therapy
ICD-9-CM 94.33
MeSH D001348

Aversion therapy is a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus with unpleasant sensations with the intention of quelling the targeted (sometimes compulsive) behavior.

Contents

Aversion therapies can take many forms, for example: placing unpleasant-tasting substances on the fingernails to discourage nail-chewing; pairing the use of an emetic with the experience of alcohol; or pairing behavior with electric shocks of mild to higher intensities.

Aversion therapy, when used in a nonconsensual manner, is widely considered to be inhumane. At the Judge Rotenberg Educational Center, aversion therapy is used to perform behavior modification in students as part of the center's applied behavioral analysis program. The center has been condemned by the United Nations for torture.

In addictions

Various forms of aversion therapy have been used in the treatment of addiction to alcohol and other drugs since 1932 (discussed in Principles of Addiction Medicine, Chapter 8, published by the American Society of Addiction Medicine in 2003).

Alcohol addiction

An approach to the treatment of alcohol dependence that has been wrongly characterized as aversion therapy involves the use of disulfiram, [1] a drug which is sometimes used as a second-line treatment under appropriate medical supervision. [2] When a person drinks even a small amount of alcohol, disulfiram causes sensitivity involving highly unpleasant reactions, which can be clinically severe. [1] Rather than as an actual aversion therapy, the nastiness of the disulfiram-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]

Cocaine dependency

Emetic therapy and faradic aversion therapy has been used to induce aversion for cocaine dependency. [4]

Cigarette addiction

It is unknown whether aversion therapy, in the form of rapid smoking (to provide an unpleasant stimulus), can help tobacco smokers overcome the urge to smoke. [5]

In compulsive habits

Aversion therapy has been used in the context of subconscious or compulsive habits, such as chronic nailbiting, hair-pulling (trichotillomania), or skin-picking (commonly associated with forms of obsessive compulsive disorder as well as trichotillomania).

In history

Pliny the Elder attempted to heal alcoholism in the first century Rome by putting putrid spiders in alcohol abusers' drinking glasses. [6]

In 1935, Charles Shadel turned a colonial mansion in Seattle into the Shadel Sanatorium where he began treating alcoholics for their substance use disorder. [7] His enterprise was launched with the help of gastroenterologist Walter Voegtlin and psychiatrist Fred Lemere. Together, they created a medical practice that exclusively treated chronic alcoholism through Pavlovian conditioned reflex aversion therapy. [8]

Judge Rotenberg Center

The Judge Rotenberg Center is a school in Canton, Massachusetts that uses the methods of ABA to perform behavior modification in children with developmental disabilities. Before it was banned in 2020, the center used a device called a Graduated Electronic Decelerator (GED) to deliver electric skin shocks as aversives. The Judge Rotenberg center has been condemned by the United Nations for torture as a result of this practice. [10] 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. [11] [12]

See also

Related Research Articles

Alcoholism Problematic alcohol consumption

Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Alcoholism is not a recognized diagnostic entity. Predominant diagnostic classifications are alcohol use disorder (DSM-5) or alcohol dependence (ICD-11).

Operant conditioning is a type of associative learning process through which the strength of a behavior is modified by reinforcement or punishment. It is also a procedure that is used to bring about such learning.

Disulfiram Chemical compound

Disulfiram is a drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to ethanol. Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, causing many of the effects of a hangover to be felt immediately following alcohol consumption. Disulfiram plus alcohol, even small amounts, produces flushing, throbbing in the head and neck, a throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, fast heart rate, low blood pressure, fainting, marked uneasiness, weakness, vertigo, blurred vision, and confusion. In severe reactions there may be respiratory depression, cardiovascular collapse, abnormal heart rhythms, heart attack, acute congestive heart failure, unconsciousness, convulsions, and death.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.

Kleptomania Inability to resist the urge to steal

Kleptomania is the inability to resist the urge to steal items, usually for reasons other than personal use or financial gain. First described in 1816, kleptomania is classified in psychiatry as an impulse control disorder. Some of the main characteristics of the disorder suggest that kleptomania could be an obsessive-compulsive spectrum disorder, but also share similarities with addictive and mood disorders.

Alcohol dependence is a previous psychiatric diagnosis in which an individual is physically or psychologically dependent upon alcohol.

In psychology, aversives are unpleasant stimuli that induce changes in behavior via negative reinforcement or positive punishment. By applying an aversive immediately before or after a behavior the likelihood of the target behavior occurring in the future is reduced. Aversives can vary from being slightly unpleasant or irritating to physically, psychologically and/or emotionally damaging. It is not the level of unpleasantness or intention that matter, but rather the level of effectiveness the unpleasant event has on changing (decreasing) behavior that defines something as aversive.

Motivational salience is a cognitive process and a form of attention that motivates or propels an individual's behavior towards or away from a particular object, perceived event or outcome. Motivational salience regulates the intensity of behaviors that facilitate the attainment of a particular goal, the amount of time and energy that an individual is willing to expend to attain a particular goal, and the amount of risk that an individual is willing to accept while working to attain a particular goal.

Impulse-control disorder (ICD) is a class of psychiatric disorders characterized by impulsivity – failure to resist a temptation, an urge, or an impulse; or having the inability to not speak on a thought. Many psychiatric disorders feature impulsivity, including substance-related disorders, behavioral addictions, attention deficit hyperactivity disorder, fetal alcohol spectrum disorders, antisocial personality disorder, borderline personality disorder, conduct disorder and some mood disorders.

Substance dependence, also known as drug dependence, is an adaptive state that develops from repeated drug administration, and which results in withdrawal upon cessation of drug use. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.

Excoriation disorder Medical condition

Excoriation disorder is an obsessive-compulsive spectrum mental disorder that is characterized by the repeated urge or impulse to pick at one's own skin to the extent that either psychological or physical damage is caused.

Apomorphine

Apomorphine, sold under the brand name Apokyn among others, is a type of aporphine having activity as a non-selective dopamine agonist which activates both D2-like and, to a much lesser extent, D1-like receptors. It also acts as an antagonist of 5-HT2 and α-adrenergic receptors with high affinity. The compound is historically a morphine decomposition product made by boiling morphine with concentrated acid, hence the -morphine suffix. Contrary to its name, apomorphine does not actually contain morphine or its skeleton, nor does it bind to opioid receptors. The apo- prefix relates to it being a morphine derivative ("[comes] from morphine").

Avoidance response

An avoidance response is a response that prevents an aversive stimulus from occurring. It is a kind of negative reinforcement. An avoidance response is a behavior based on the concept that animals will avoid performing behaviors that result in an aversive outcome. This can involve learning through operant conditioning when it is used as a training technique. It is a reaction to undesirable sensations or feedback that leads to avoiding the behavior that is followed by this unpleasant or fear-inducing stimulus.

Judge Rotenberg Educational Center A school condemned for torture by the UN

The Judge Rotenberg Center is an institution and school in Canton, Massachusetts, United States, for people with developmental disabilities, emotional disorders, and autistic-like behaviors. The center has been condemned for torture by the United Nations Special Rapporteur on Torture. The JRC is known for its use of the Graduated Electronic Decelerator (GED), a device that administers electric shocks to residents through a remote control. The device was designed by Matthew Israel, the institute's founder. While the FDA issued a formal ban on the GED in 2020, the device continues to be used on some residents pending an administrative stay for the duration of the Coronavirus pandemic.

Compulsive behavior Performing an act persistently and repetitively without it necessarily leading to an actual reward or pleasure

Compulsive behavior is defined as performing an action persistently and repetitively without it necessarily leading to an actual reward or pleasure. Compulsive behaviors could be an attempt to make obsessions go away. The act is usually a small, restricted and repetitive behavior, yet not disturbing in a pathological way. Compulsive behaviors are a need to reduce apprehension caused by internal feelings' a person wants to abstain from or control. A major cause of the compulsive behaviors is said to be obsessive–compulsive disorder (OCD). "The main idea of compulsive behavior is that the likely excessive activity is not connected to the purpose to which it appears directed." Furthermore, there are many different types of compulsive behaviors including shopping, hoarding, eating, gambling, trichotillomania and picking skin, itching, checking, counting, washing, sex, and more. Also, there are cultural examples of compulsive behavior.

Addiction A disease resulting in compulsive engagement in rewarding stimuli despite adverse consequences

Addiction is a biopsychosocial disorder characterized by repeated use of drugs, or repetitive engagement in a behavior such as gambling, despite harm to self and others. According to the "brain disease model of addiction," while a number of psychosocial factors contribute to the development and maintenance of addiction, a biological process that is induced by repeated exposure to an addictive stimulus is the core pathology that drives the development and maintenance of an addiction. Many scholars who study addiction argue that the brain disease model is incomplete and misleading.

Community reinforcement approach and family training (CRAFT) is a behavior therapy approach in psychotherapy for treating addiction developed by Robert J. Meyers in the late 1970s. Meyers worked with Nathan Azrin in the early 1970s whilst he was developing his own community reinforcement approach (CRA) which uses operant conditioning techniques to help people learn to reduce the power of their addictions and enjoy healthy living. Meyers adapted CRA to create CRAFT, which he described as CRA that "works through family members." CRAFT combines CRA with family training to equip concerned significant others (CSOs) of addicts with supportive techniques to encourage their loved ones to begin and continue treatment and provides them with defences against addiction's damaging effects on themselves.

Shain Mahaffey Neumeier is an American autistic and nonbinary transgender attorney from Los Angeles, California. Neumeier is best known for advocacy against coercive and forced treatment, including advocacy to close the Judge Rotenberg Center, an institution for people with developmental disabilities that has been condemned by the United Nations for torture due to its use of electric shocks on people with disabilities. They are also an activist for autism rights, disability rights, youth liberation, asexuality, and transgender rights. Neumeier has multiple disabilities including post-traumatic stress disorder, cleft lip and palate, ectodermal dysplasia, and depression.

Walter L. Voegtlin American gastroenterologist

Walter Lyle Voegtlin was an American gastroenterologist and pioneer of the Paleolithic diet.

Graduated electronic decelerator Device that administers electric shocks

The graduated electronic decelerator (GED) is an aversive conditioning device that delivers a powerful electric skin shock to punish behaviors considered undesirable. The GED was created by Matthew Israel for use on students at the Judge Rotenberg Center as part of the school's behavior modification program. The school has since been condemned for torture by the United Nations special rapporteur on torture for its use of the GED and other inhumane punishments. In 2020, the device was banned by the United States Food and Drug Administration.

References

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  9. Geerling, Wayne (2018). "Choice, liberty and repression in A Clockwork Orange". In Charity-Joy Revere Acchiardo; Michelle Albert Vachris (eds.). Dystopia and Economics: A Guide to Surviving Everything from the Apocalypse to Zombies. Taylor & Francis. pp. 107ff. ISBN   978-1-351-68564-1.
  10. Pilkington, Ed (5 March 2020). "US bans shock 'treatment' on children with special needs at Boston-area school". The Guardian. Retrieved 26 July 2020.
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