Aversion therapy

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).

An approach to the treatment of alcohol dependence that has been wrongly characterized as aversion therapy involves the use of disulfiram, a drug which is sometimes used as a second-line treatment under appropriate medical supervision.{{cite journal | title = Disulfiram | journal = Stat Pearls | date = January 2018 | pmid = 29083801 | url = https://www.ncbi.nlm.nih.gov/books/NBK459340/ | vauthors = Stokes M, Abdijadid S }} When a person drinks even a small amount of alcohol, disulfiram causes sensitivity involving highly unpleasant reactions, which can be clinically severe.{{cite web |title=Disulfiram - FDA prescribing information, side effects and uses |url=https://www.drugs.com/pro/disulfiram.html |website=Drugs.com |access-date=25 April 2019 |language=en}} 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).{{cite journal | vauthors = Brewer C, Streel E, Skinner M | title = Supervised Disulfiram's Superior Effectiveness in Alcoholism Treatment: Ethical, Methodological, and Psychological Aspects | journal = Alcohol and Alcoholism | volume = 52 | issue = 2 | pages = 213–219 | date = March 2017 | pmid = 28064151 | doi = 10.1093/alcalc/agw093 | doi-access = free }} {{open access}}

Another approach in creating aversions to alcohol consumption is the implementation of succinylcholine chloride-induced paralysis and respiratory arrest following exposure to alcohol.{{Cite journal |last=Elkins |first=Ralph L. |title=Aversion Therapy for Alcoholism: Chemical, Electrical, or Verbal Imaginary? |url=http://www.tandfonline.com/doi/full/10.3109/10826087509026712 |journal=International Journal of the Addictions |year=1975 |language=en |volume=10 |issue=2 |pages=157–209 |doi=10.3109/10826087509026712 |issn=0020-773X }} 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.

Emetic (to induce vomiting) therapy and faradic (administered shock) aversion therapy have been used to induce aversion for cocaine dependency.{{cite book|author=Jerome J. Platt|title=Cocaine Addiction: Theory, Research, and Treatment|url=https://books.google.com/books?id=5tZqyz2i-cwC&pg=PA241|year=2000|publisher=Harvard University Press|isbn=978-0-674-00178-7|pages=241–}} 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.{{Cite journal |last1=Joseph Frawley |first1=P. |last2=Smith |first2=James W. |date=1990 |title=Chemical aversion therapy in the treatment of cocaine dependence as part of a multimodal treatment program: Treatment outcome |url=https://doi.org/10.1016/0740-5472(90)90033-M |journal=Journal of Substance Abuse Treatment |volume=7 |issue=1 |pages=21–29 |doi=10.1016/0740-5472(90)90033-m |pmid=2313768 |s2cid=33815965 |issn=0740-5472}}

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.{{cite journal | vauthors = Hajek P, Stead LF | title = Aversive smoking for smoking cessation | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD000546 | date = 2004 | volume = 2011 | pmid = 15266433 | pmc = 7045729 | doi = 10.1002/14651858.CD000546.pub2 }} 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.{{Cite journal |last1=Lee |first1=Cami R. |last2=Harrington |first2=Kathy |last3=Rockford |first3=Laura |last4=Shah |first4=Nipam |last5=Pruitt |first5=Chris |last6=Grant |first6=Makenzie |date=July 2020 |title=Aversive Therapy For Smoking Cessation: Worth Revisiting? A feasibility Trial |url=https://publications.aap.org/pediatrics/article/146/1_MeetingAbstract/480/4461/Aversive-Therapy-For-Smoking-Cessation-Worth?autologincheck=redirected |access-date=2023-06-06 |journal=Pediatrics |volume=146 |pages=480–481 |doi=10.1542/peds.146.1ma5.480b}}

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.{{Cite journal |last=Serber |first=Michael |date=1970-09-01 |title=Shame aversion therapy |url=https://dx.doi.org/10.1016/0005-7916%2870%2990005-4 |journal=Journal of Behavior Therapy and Experimental Psychiatry |language=en |volume=1 |issue=3 |pages=213–215 |doi=10.1016/0005-7916(70)90005-4 |issn=0005-7916}}

Pliny the Elder attempted to heal alcoholism in the first century Rome by putting putrid spiders in alcohol abusers' drinking glasses.{{Cite book|title=Assessment and therapy : specialty articles from the Encyclopedia of mental health|date=2001|publisher=Academic Press| vauthors = Friedman HS |isbn=978-0-08-052763-5 |edition= 1st|location=San Diego [Calif.]|oclc=171135237}}

In 1935, Charles Shadel turned a colonial mansion in Seattle into the Shadel Sanatorium where he began treating alcoholics for their substance use disorder.{{cite web | vauthors = White W |title=American Institutions Specializing in the Treatment of Alcohol and Drug Addiction 1840-1950 |url=http://www.williamwhitepapers.com/pr/AddictionTreatmentPrograms1840-1950.pdf |website=Williamwhitepapers.com |access-date=29 July 2019}} 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.{{cite journal | vauthors = Lemere F | title = Aversion treatment of alcoholism: some reminiscences | journal = British Journal of Addiction | volume = 82 | issue = 3 | pages = 257–258 | date = March 1987 | pmid = 3471256 | doi = 10.1111/j.1360-0443.1987.tb01479.x | doi-access = | s2cid = 2408353 }}

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.{{Cite journal |last1=Spandler |first1=Helen |last2=Carr |first2=Sarah |date=2022-01-06 |title=Lesbian and bisexual women's experiences of aversion therapy in England |journal=History of the Human Sciences |volume=35 |issue=3–4 |pages=218–236 |doi=10.1177/09526951211059422 |pmid=36090521 |pmc=9449443 |issn=0952-6951|doi-access=free }} This was meant to work as a form of conversion therapy.

• In Anthony Burgess's novel A Clockwork Orange (1962) and the film adaptation (1971) directed by Stanley Kubrick, the main character Alex is subjected to a fictional form of aversion therapy, called the "Ludovico technique", with the aim of stopping his violent behavior.{{cite book| vauthors = Geerling W | editor=Charity-Joy Revere Acchiardo |editor2=Michelle Albert Vachris| title=Dystopia and Economics: A Guide to Surviving Everything from the Apocalypse to Zombies|chapter-url=https://books.google.com/books?id=wnhQDwAAQBAJ&pg=PT107| year=2018|publisher=Taylor & Francis |isbn=978-1-351-68564-1| pages=107ff| chapter=Choice, liberty and repression in A Clockwork Orange}}
• In The Simpsons episode "There's No Disgrace Like Home" (1990), Dr. Monroe administers aversion therapy to the family to deter bad behavior.
• In the King of the Hill episode "Keeping up with the Joneses" (1997), one of the characters is forced to smoke an entire carton of cigarettes to discourage them from smoking, only for this tactic to backfire and worsen addiction.

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.{{cite news | vauthors = Pilkington E |title=US bans shock 'treatment' on children with special needs at Boston-area school |url=https://www.theguardian.com/us-news/2020/mar/05/us-bans-electric-shock-treatment-children-boston-area |access-date=26 July 2020 |work=The Guardian |date=5 March 2020}} 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.{{cite news|vauthors=Brown L|title=The Crisis of Disability Is Violence: Ableism, Torture, and Murder|url=https://www.questia.com/magazine/1P3-3473107981/the-crisis-of-disability-is-violence-ableism-torture|access-date=26 July 2020|archive-date=26 July 2020|archive-url=https://web.archive.org/web/20200726183802/https://www.questia.com/magazine/1P3-3473107981/the-crisis-of-disability-is-violence-ableism-torture|url-status=dead}}{{cite web | vauthors = Gonnerman J |title=The School of Shock |url=https://www.motherjones.com/politics/2007/08/school-shock/ |website=Mother Jones |access-date=27 July 2020}}

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).{{Cite journal |last1=Drescher |first1=Jack |last2=Schwartz |first2=Alan |last3=Casoy |first3=Flávio |last4=McIntosh |first4=Christopher A. |last5=Hurley |first5=Brian |last6=Ashley |first6=Kenneth |last7=Barber |first7=Mary |last8=Goldenberg |first8=David |last9=Herbert |first9=Sarah E. |last10=Lothwell |first10=Lorraine E. |last11=Mattson |first11=Marlin R. |last12=McAfee |first12=Scot G. |last13=Pula |first13=Jack |last14=Rosario |first14=Vernon |last15=Tompkins |first15=D. Andrew |date=2016 |title=The Growing Regulation of Conversion Therapy |journal=Journal of Medical Regulation |volume=102 |issue=2 |pages=7–12 |doi=10.30770/2572-1852-102.2.7 |pmc=5040471 |pmid=27754500}}

• Behavior modification

{{Reflist}}

{{Psychotherapy}}

Category:Treatment of mental disorders

Category:Behaviorism

Category:Sexual orientation change efforts

Category:Psychiatry controversies

Category:Mind control