Treatment method intended to reduce or eliminate unwanted behaviors through painful or aversive associations: Explanations, instances, and debates
Aversion Therapy (AT) is a behavioral approach that connects unwanted behaviors with unpleasant experiences to decrease their appeal. It's also known as "aversive conditioning" or "deterrent therapy." This technique is most commonly used to manage behaviors related to addictions, such as smoking or alcohol use disorder (AUD), although it's less common than other treatment options for substance use disorders.
Despite its historical controversy, AT still has a place in modern mental health care. Here's how it works:
The Working of Aversion Therapy
AT involves repeatedly linking an unwanted behavior with a negative experience, making the behavior less enjoyable. This helps to discourage or eliminate the behavior.
Targeted Behaviors
AT can potentially help treat various behaviors, including:
- Nail biting
- Tobacco smoking
- AUD
- Gambling addiction
Examples of Aversion Therapy
Let's look at some examples of AT:
Emetic Counter Conditioning
This is a type of AT that may help reduce alcohol cravings in people with AUD. In ECC, a medication is given to induce nausea and vomiting, following which the person tastes and swallows different alcoholic beverages. Over several sessions, the individual learns to associate drinking alcohol with the unpleasant feeling of nausea or vomiting.
Graphic Warning Labels
You might have seen these on cigarette packages in 118 countries. These labels feature images of the potential health consequences of smoking, such as heavily diseased lungs and cancerous tumors. They are a type of AT because they connect the act of smoking with disturbing or upsetting images.
Rapid Smoking
Rapid smoking involves puffing on a cigarette every few seconds, causing uncomfortable sensations and making it harder to tolerate smoking. The goal is to reduce nicotine dependence. Yet, research indicates that rapid smoking is not an effective long-term treatment for quitting smoking[1].
Rubber Band Aversion Therapy
Rubber Band Aversion Therapy (RBAT) is a treatment used for obsessive compulsive disorder (OCD). The person wears a rubber band around their wrist and snaps it whenever they have an obsessive thought. The idea is that the physical pain of the rubber band gets linked with the obsessive thought, and the person starts to have fewer obsessive thoughts. However, RBAT is not an effective therapy for OCD[2].
Does Aversion Therapy Work?
While research suggests that AT can reduce addictive behaviors in the short term, its long-term effectiveness remains a topic of debate. In a small 2017 study, researchers observed significant reductions in alcohol-related brain activity in 13 people with AUD undergoing ECC treatment. Participants reported alcohol aversion at 30 and 90 days after treatment, and 69% of participants were still sober 12 months later[3].
However, the use of AT for other addiction-related behaviors like smoking and overeating is less promising. Some studies report short-term success, but the effects do not often last long term[1].
Controversy Surrounding Aversion Therapy
Some mental health professionals consider AT unethical because it involves punishment as a form of therapy. There are also ethical concerns regarding the use of AT to "treat" homosexuality, a practice now widely condemned[4]. Despite this, some practitioners still engage in conversion therapy, and it is illegal in some U.S. states[4].
Summary
Aversion therapy is a behavioral approach that links an unwanted behavior with an unpleasant experience to make the behavior less appealing. While moderately effective in the short term, AT's success is often limited in the long run. Its use is controversial due to ethical concerns surrounding its application.
[1] Aversive therapy (aversion therapy) for drug addiction: effectiveness, perspectives, and implications, Drug and Alcohol Dependence (2016)
[2] On the effectiveness of the rubber band treatment for obsessive-compulsive disorder: a systematic review, Journal of Behavior Therapy and Experimental Psychiatry (2010)
[3] Emetic counterconditioning for alcohol use disorder, International Review of Neurobiology (2017)
[4] The harms of conversion therapy to minors, Journal of Adolescent Health (2022)
- In the context of mental health and substance use disorders, Aversion Therapy (AT) is a technique that links unwanted behaviors, such as alcohol use disorder (AUD), with unpleasant experiences to decrease their appeal.
- AT has been used to treat a variety of behaviors, including nail biting, tobacco smoking, gambling addiction, and even obsessive-compulsive disorder (OCD) through methods like Rubber Band Aversion Therapy (RBAT).
- An example of AT for AUD is Emetic Counter Conditioning, where a medication is given to induce nausea and vomiting after the individual tastes and swallows alcoholic beverages.
- Graphic warning labels on cigarette packages, featuring disturbing images of the potential health consequences of smoking, function as a form of AT.
- Rapid smoking, a method that involves puffing on a cigarette every few seconds to create uncomfortable sensations, was originally intended to reduce nicotine dependence but has been found to be ineffective in the long term.
- Some practitioners still engage in conversion therapy, despite ethical concerns regarding its use to "treat" unwanted same-sex attractions, an practice now widely condemned in science, health-and-wellness, and mental-health communities.
- While Aversion Therapy has shown some success in reducing addictive behaviors in the short term, its long-term effectiveness remains a topic of debate in scientific communities. For instance, a 2017 study observed significant reductions in alcohol-related brain activity and maintained sobriety in 69% of participants undergoing ECC treatment, but the effects for smoking and overeating are less promising.
