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]

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]

Cocaine dependency

Emetic (to induce vomiting) therapy and faradic (administered shock) aversion therapy have been used to induce aversion for cocaine dependency. [5] When used in a multimodal 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]

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. [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]

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 treating sexually deviant behavior, aversion therapy is implemented in the form of shame. 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]

In history

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 the Shadel Sanatorium where he began treating alcoholics for their substance use disorder. [11] 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. [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 of conversion therapy.

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. [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]

Criticism

Aversion therapy has been scrutinized in recent decades due to the controversy 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 be unethical since it is implementing punishment as a therapeutic tool. Aversion therapy has the risk of creating other psychological issues such as anxiety, depression, pain, fear and in severe cases even post-traumatic stress disorder (PTSD). [18]

See also

Related Research Articles

Operant conditioning, also called instrumental conditioning, is a learning process where voluntary behaviors are modified by association with the addition of reward or aversive stimuli. The frequency or duration of the behavior may increase through reinforcement or decrease through punishment or extinction.

<span class="mw-page-title-main">Disulfiram</span> Chemical compound

Disulfiram is a medication used to support the treatment of chronic alcoholism by producing an acute sensitivity to ethanol. Disulfiram works by inhibiting the enzyme aldehyde 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.

<span class="mw-page-title-main">Drug rehabilitation</span> Processes of treatment for drug dependency

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, and 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 medical consequences that can be caused.

<span class="mw-page-title-main">Aversives</span> Unpleasant stimulus that induces changes in behavior through punishment

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 may be reduced. Aversives can vary from being slightly unpleasant or irritating to physically, psychologically and/or emotionally damaging.

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.

Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. 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.

Conditioned taste aversion occurs when an animal acquires an aversion to the taste of a food that was paired with aversive stimuli. The effect explains that the aversion develops more strongly for stimuli that cause nausea than other stimuli. This is considered an adaptive trait or survival mechanism that enables the organism to avoid poisonous substances before they cause harm. The aversion reduces consuming the same substance in the future, thus avoiding poisoning.

<span class="mw-page-title-main">Apomorphine</span> Chemical compound

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").

<span class="mw-page-title-main">Avoidance response</span> Response that prevents an aversive stimulus

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.

An addictive behavior is a behavior, or a stimulus related to a behavior, that is both rewarding and reinforcing, and is associated with the development of an addiction. There are two main forms of addiction: substance use disorders and behavioral addiction. The parallels and distinctions between behavioral addictions and other compulsive behavior disorders like bulimia nervosa and obsessive-compulsive disorder (OCD) are still being researched by behavioral scientists.

Cocaine dependence is a neurological disorder that is characterized by withdrawal symptoms upon cessation from cocaine use. It also often coincides with cocaine addiction which is a biopsychosocial disorder characterized by persistent use of cocaine and/or crack despite substantial harm and adverse consequences. The Diagnostic and Statistical Manual of Mental Disorders, classifies problematic cocaine use as a stimulant use disorder. The International Classification of Diseases, includes "Cocaine dependence" as a classification (diagnosis) under "Disorders due to use of cocaine".

Behavioral addiction, process addiction, or non-substance-related disorder is a form of addiction that involves a compulsion to engage in a rewarding non-substance-related behavior – sometimes called a natural reward – despite any negative consequences to the person's physical, mental, social or financial well-being. In the brain's reward system, a gene transcription factor known as ΔFosB has been identified as a necessary common factor involved in both behavioral and drug addictions, which are associated with the same set of neural adaptations.

<span class="mw-page-title-main">Conditioned place preference</span> Pavlovian conditioning

Conditioned place preference (CPP) is a form of Pavlovian conditioning used to measure the motivational effects of objects or experiences. This motivation comes from the pleasurable aspect of the experience, so that the brain can be reminded of the context that surrounded the "encounter". By measuring the amount of time an animal spends in an area that has been associated with a stimulus, researchers can infer the animal's liking for the stimulus. This paradigm can also be used to measure conditioned place aversion with an identical procedure involving aversive stimuli instead. Both procedures usually involve mice or rats as subjects. This procedure can be used to measure extinction and reinstatement of the conditioned stimulus. Certain drugs are used in this paradigm to measure their reinforcing properties. Two different methods are used to choose the compartments to be conditioned, and these are biased vs. unbiased. The biased method allows the animal to explore the apparatus, and the compartment they least prefer is the one that the drug is administered in and the one they most prefer is the one where the vehicle is injected. This method allows the animal to choose the compartment they get the drug and vehicle. In comparison, the unbiased method does not allow the animal to choose what compartment they get the drug and vehicle in. Instead, the researcher chooses the compartments.

<span class="mw-page-title-main">Substance use disorder</span> Continual use of drugs (including alcohol) despite detrimental consequences

Substance use disorder (SUD) is the persistent use of drugs despite the substantial harm and adverse consequences to one's own self and others, as a result of their use. In perspective, the effects of the wrong use of substances that are capable of causing harm to the user or others, have been extensively described in different studies using a variety of terms such as substance use problems, problematic drugs or alcohol use, and substance use disorder.The National Institute of Mental Health (NIMH) states that "Substance use disorder (SUD) is a treatable mental disorder that affects a person's brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can be moderate to severe, with addiction being the most severe form of SUD".Substance use disorders (SUD) are considered to be a serious mental illness that fluctuates with the age that symptoms first start appearing in an individual, the time during which it exists and the type of substance that is used. It is not uncommon for those who have SUD to also have other mental health disorders. Substance use disorders are characterized by an array of mental/emotional, physical, and behavioral problems such as chronic guilt; an inability to reduce or stop consuming the substance(s) despite repeated attempts; operating vehicles while intoxicated; and physiological withdrawal symptoms. Drug classes that are commonly involved in SUD include: alcohol (alcoholism); cannabis; opioids; stimulants such as nicotine (including tobacco), cocaine and amphetamines; benzodiazepines; barbiturates; and other substances.

<span class="mw-page-title-main">Addiction</span> Disorder resulting in compulsive behaviours

Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in addiction's development.

About 1 in 7 Americans suffer from active addiction to a particular substance. Addiction can cause physical, psychological, and emotional harm to those who are affected by it. The American Society of Addiction Medicine defines addiction as "a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences." In the world of psychology and medicine, there are two models that are commonly used in understanding the psychology behind addiction itself. One model is referred to as the disease model of addiction. The disease model suggests that addiction is a diagnosable disease similar to cancer or diabetes. This model attributes addiction to a chemical imbalance in an individual's brain that could be caused by genetics or environmental factors. The second model is the choice model of addiction, which holds that addiction is a result of voluntary actions rather than some dysfunction of the brain. Through this model, addiction is viewed as a choice and is studied through components of the brain such as reward, stress, and memory. Substance addictions relate to drugs, alcohol, and smoking. Process addictions relate to non-substance-related behaviors such as gambling, spending money, sexual activity, gaming, spending time on the internet, and eating.

Community reinforcement approach and family training is a behavior therapy approach in psychotherapy for treating addiction developed by Robert J. Myers 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 assist those with addictions live healthily. 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 commence and continue treatment and provides them with defences against addiction's damaging effects on themselves.

Treatment and management of addiction encompass the range of approaches aimed at helping individuals overcome addiction, most commonly in the form of substance use disorders and behavioral addictions. Effective treatment often includes a combination of medical, psychological, and social interventions tailored to the specific needs of the individual. Common practices to this end include detoxification, counseling, behavioral therapy, medication-assisted treatment, and support groups. The goal of addiction treatment is to reduce dependence, improve quality of life, and ultimately support long-term recovery. Comprehensive management addresses both the physical and psychological aspects of addiction, recognizing it as a chronic but treatable condition.

<span class="mw-page-title-main">Walter L. Voegtlin</span> American gastroenterologist

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

<span class="mw-page-title-main">Disulfiram-alcohol reaction</span> Medical condition

Disulfiram-alcohol reaction (DAR) is the effect of the interaction in the human body of alcohol drunk with disulfiram or some mushrooms. The DAR is key to disulfiram therapy that is widely used for alcohol-aversive treatment and management of other addictions. Once disulfiram-treated patients take alcohol, even in small doses, they experience strong unpleasant sensations.

References

  1. 1 2 3 "Disulfiram - FDA prescribing information, side effects and uses". Drugs.com. Retrieved 25 April 2019.
  2. ↑ Stokes M, Abdijadid S (January 2018). "Disulfiram". Stat Pearls. PMID   29083801.
  3. ↑ Brewer C, Streel E, Skinner M (March 2017). "Supervised Disulfiram's Superior Effectiveness in Alcoholism Treatment: Ethical, Methodological, and Psychological Aspects". Alcohol and Alcoholism. 52 (2): 213–219. doi: 10.1093/alcalc/agw093 . PMID   28064151. Open Access logo PLoS transparent.svg
  4. 1 2 Elkins, Ralph L. (1975). "Aversion Therapy for Alcoholism: Chemical, Electrical, or Verbal Imaginary?". International Journal of the Addictions. 10 (2): 157–209. doi:10.3109/10826087509026712. ISSN   0020-773X.
  5. ↑ Jerome J. Platt (2000). Cocaine Addiction: Theory, Research, and Treatment. Harvard University Press. pp. 241–. ISBN   978-0-674-00178-7.
  6. ↑ Joseph Frawley, P.; Smith, James W. (1990). "Chemical aversion therapy in the treatment of cocaine dependence as part of a multimodal treatment program: Treatment outcome". Journal of Substance Abuse Treatment. 7 (1): 21–29. doi:10.1016/0740-5472(90)90033-m. ISSN   0740-5472. PMID   2313768. S2CID   33815965.
  7. ↑ Hajek P, Stead LF (2004). "Aversive smoking for smoking cessation". The Cochrane Database of Systematic Reviews. 2011 (3): CD000546. doi:10.1002/14651858.CD000546.pub2. PMC   7045729 . PMID   15266433.
  8. ↑ Lee, Cami R.; Harrington, Kathy; Rockford, Laura; Shah, Nipam; Pruitt, Chris; Grant, Makenzie (July 2020). "Aversive Therapy For Smoking Cessation: Worth Revisiting? A feasibility Trial". Pediatrics. 146: 480–481. doi:10.1542/peds.146.1ma5.480b . Retrieved 2023-06-06.
  9. ↑ Serber, Michael (1970-09-01). "Shame aversion therapy". Journal of Behavior Therapy and Experimental Psychiatry. 1 (3): 213–215. doi:10.1016/0005-7916(70)90005-4. ISSN   0005-7916.
  10. ↑ Friedman HS (2001). Assessment and therapy : specialty articles from the Encyclopedia of mental health (1st ed.). San Diego [Calif.]: Academic Press. ISBN   978-0-08-052763-5. OCLC   171135237.
  11. ↑ White W. "American Institutions Specializing in the Treatment of Alcohol and Drug Addiction 1840-1950" (PDF). Williamwhitepapers.com. Retrieved 29 July 2019.
  12. ↑ Lemere F (March 1987). "Aversion treatment of alcoholism: some reminiscences". British Journal of Addiction. 82 (3): 257–258. doi:10.1111/j.1360-0443.1987.tb01479.x. PMID   3471256. S2CID   2408353.
  13. ↑ Spandler, Helen; Carr, Sarah (2022-01-06). "Lesbian and bisexual women's experiences of aversion therapy in England". History of the Human Sciences. 35 (3–4): 218–236. doi: 10.1177/09526951211059422 . ISSN   0952-6951. PMC   9449443 . PMID   36090521.
  14. ↑ Geerling W (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.
  15. ↑ Pilkington E (5 March 2020). "US bans shock 'treatment' on children with special needs at Boston-area school". The Guardian. Retrieved 26 July 2020.
  16. ↑ Brown L. "The Crisis of Disability Is Violence: Ableism, Torture, and Murder". Archived from the original on 26 July 2020. Retrieved 26 July 2020.
  17. ↑ Gonnerman J. "The School of Shock". Mother Jones. Retrieved 27 July 2020.
  18. ↑ Drescher, Jack; Schwartz, Alan; Casoy, Flávio; McIntosh, Christopher A.; Hurley, Brian; Ashley, Kenneth; Barber, Mary; Goldenberg, David; Herbert, Sarah E.; Lothwell, Lorraine E.; Mattson, Marlin R.; McAfee, Scot G.; Pula, Jack; Rosario, Vernon; Tompkins, D. Andrew (2016). "The Growing Regulation of Conversion Therapy". Journal of Medical Regulation. 102 (2): 7–12. doi:10.30770/2572-1852-102.2.7. PMC   5040471 . PMID   27754500.
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