Aversion Therapy

As we discussed in the ‘reducing addiction’ article, behavioural interventions include aversion therapy and covert sensitisation.

These involve exposing the addict to unpleasant stimuli associated with their addiction, leading them to ‘unlearn’ their addiction.

Behavioural interventions: aversion therapy

For example, suppose drug 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. This process is known as counter-conditioning.

Aversion therapy for alcoholism

Aversion therapy is frequently used to treat alcoholism. In this process, the addict is given an emetic, a pill that causes severe nausea and vomiting. The addict is given a strong alcoholic drink such as whiskey in the nauseous state and then vomits. This associates alcohol with the unpleasant vomiting response. This process is repeated multiple times to allow for an association to form.

Aversion Therapy, YB - StudySmarter Originals (Created using Canva)

An alternative to this process is using disulfiram (e.g., Antabuse) drugs. 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 and could lead to embarrassment for the patient, raising ethical issues of aversion therapy.

Aversion therapy for gambling addiction

For behavioural addictions such as gambling, aversion therapy uses external stimuli such as electric shocks. The shocks are strong enough to be painful but not harmful. The addict writes down sentences related to their gambling behaviour on cards. The gambler then reads the sentences aloud and is shocked for two seconds if the card is related to gambling. The cards should also contain some unrelated behaviours so that the player associates the gambling behaviour with the shocks. The addict chooses the intensity of the shock beforehand.

Behavioural interventions: Covert sensitisation

Traditional aversion therapy was a popular treatment for addiction during the 1960s and 1970s. But due to ethical and health concerns associated with it, it has fallen out of use, and covert sensitisation is much more common today.

The principle is precisely the same as with aversion therapy. Still, the addict experiences the unpleasant stimuli in vitro, meaning they have to imagine it rather than experience it.

Covert sensitisation for nicotine addiction

1. The therapist encourages the client to relax.

2. The therapist reads from a script and has the client imagine an unpleasant situation, such as smoking a dirty cigarette or smoking a cigarette followed by unpleasant consequences such as vomiting. The therapist goes into detail (sights, sounds, smells, etc.) because the more vivid the scene, the better.

3. The client then imagines turning their back on the aversive stimuli and experiences relief.

The stimuli must be as vivid and unpleasant as possible for the client to respond successfully.

McCurran (1994)’s study into covert sensitisation, YB - StudySmarter Originals (Made in Canva)

Evaluation of aversion therapy and other behavioural interventions

This section will look into the evaluation of aversion therapy and other 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 carried out with a therapist could be harmful and embarrassing to the patient.

In other forms of aversion therapy, such as treatment for gambling addiction, even the eventual addition of allowing patients to choose their own shock level was a tokenistic gesture to address these ethical issues.

As a result, covert sensitisation has grown in popularity as it poses much fewer medical and psychological risks to the patient.

Treatment adherence issues

Because aversion therapy uses unpleasant or traumatising stimuli, it has a low adherence rate. In practice and research, this makes it challenging to know the effectiveness of aversion therapy. 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, and covert sensitisation was more beneficial between two and nine years.

Methodological problems

Hajek and Stead (2001). reviewed 25 studies of aversion therapy in nicotine addiction. They found that it was extremely difficult 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 be an effective treatment for various addictions.