Behavioural interventions

Aversion therapy is a type of therapy based on the principles of behaviourism. As a recap, behaviourism states that all behaviour arises due to stimulus and response conditioning. There are two kinds of conditioning; classical conditioning and operant conditioning.

Aversion therapy is based on classical conditioning. In this therapy, an undesired behaviour is paired with an aversive stimulus to produce an intense dislike (aversion) to the behaviour. Let us look at the different types of aversion therapy as well as the effectiveness of this therapy. After this, we will look at the strengths and weaknesses of this therapy.

No alcohol symbol in aversion therapy, flaticon.com/Vectors Market

Types of aversion therapy

Aversion therapy is usually used to treat additions to drugs or alcohol. It can also be used to help stop smoking, gambling, aggression, and even bad habits such as nail-biting.

Aversive stimuli include mild electric shocks, drugs that produce unpleasant sensations like nausea, and unpleasant tastes and smells.

Let us look at how aversion therapy is used in the examples of alcohol and gambling addictions.

Alcohol addiction

Patients with alcohol addiction are usually given a drug, for instance, Antabuse (unconditioned stimulus) that when taken has unpleasant effects, causing nausea or vomiting (unconditioned response).

Patients are asked to take the drug and then drink alcohol (neutral stimulus). The effects of the drug become associated with alcohol. The alcohol was a neutral stimulus, which becomes a conditioned stimulus with the unpleasant effects of the conditioned response, resulting in patients not wanting to drink alcohol anymore.

Aversion therapy for alcohol addiction, Erika Hae, StudySmarter Originals

Gambling addiction

Patients with a gambling addiction are commonly treated with mild electric shocks. For the gambling behaviour, the therapist could ask the patient to write down behaviours associated with gambling on cards. Neutral behaviours are written on other cards.

The patient reads the cards and each time they encounter a gambling-related card they give themselves an electric shock.

Aversion therapy for gambling addiction, Erika Hae, StudySmarter Originals

Effectiveness of aversion therapy

Research has shown that aversion therapy is effective in the treatment of alcohol addiction.

However, while aversion therapy is effective in the short term, its long-term effectiveness is still somewhat unclear. Aversion may be successful while undergoing the therapy but once the patient is out in the world without the help of the aversive stimulus, it is harder to avoid the undesired behaviour.

Elkins et al. (2017) conducted a study in which patients with alcohol use disorder received five sessions of chemical aversion therapy. The patients still avoided alcohol 30 and 90 days after treatment, 69% of patients were still sober one year after treatment. In addition, fMRI scans in the patients showed reductions in craving-related brain activity in the occipital cortex. This study highlights the longevity of the treatment plan and how effective it is after time has passed.

Smith et al. (1991) conducted a study in which 249 patients underwent aversion therapy (nausea-inducing drugs or mild electric shocks). They were compared with patients who had received counselling as treatment. After 6 and 12 months, the patients who received aversion therapy had higher alcohol abstinence rates than the patients who received counselling. This demonstrates the effectiveness of aversion therapy, especially when compared to other treatment plans.

Bordnick et al. (2004) found that aversion therapy (chemical, covert sensitization, and faradic) was effective in treating addiction to cocaine compared to a control relaxation group when studying and allocating 70 participants. Again, this demonstrates the effectiveness of aversion therapy, highlighting how the therapy can also apply to different addictions.

Evaluation of aversion therapy

Let us consider the strengths and weaknesses of aversion therapy.

Strengths

• There is research evidence that shows aversion therapy can be an effective treatment, as we demonstrated above with the studies by Elkins et al. (2017), Smith et al. (1991) and Bordnick et al. (2004).
• It uses strict ethical guidelines to ensure those who are participating in therapy are fully aware of their ability to withdraw, and what the therapy might entail. Still, the ethical issues remain in that the therapy may breach some of these guidelines still, as it induces stress, anxiety, potential pain and humiliation.

Weaknesses

• Patients can easily start the undesired behaviour again after aversion therapy is stopped. We also do not have much research that indicates how long-term the effects of aversion therapy are, and not all addictions can use aversion therapy effectively, suggesting it can be ineffective.
• Aversion therapy has some ethical issues (as we touched upon above) in that it could be considered as using 'punishment' as a form of treatment. During therapy, there should be no harm physically or psychologically caused to the patient; however, the aversive stimulus may cause stress, anxiety, humiliation, or pain. The aversion stimulus also causes physical discomfort such as drugs that cause nausea or vomiting and pain from mild electric shocks.
• There are strict ethical guidelines for working with vulnerable patients, such as those with addictions. Patients' addictions may influence their understanding of what the therapy involves, such as those with a drug addiction who may not be able to think clearly. Patients can also stop the therapy at any time but therapists may not make this point clear to them.
• Aversion therapy may get rid of the behaviour but does not treat the underlying causes of the behaviour. Thus, the original undesired behaviour may be treated but may very well show up as a different form of addiction.
• There is an unbalance of power between therapist and patient, patients are compliant to the therapist undergoing aversive stimulus the therapist prescribes them.