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Alcohol-aversion therapy: relation between strength of aversion and abstinence.
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Aversion therapy. Council on Scientific Affairs.
Aversion therapy is a series of techniques designed to reduce unwanted or dangerous behaviors. The most common applications of these techniques are to obesity, tobacco smoking, sexuality, oral habits, self-injurious and aggressive behaviors, and substance abuse. Most enthusiastic reports suffer from lack of control groups and control procedures. At this time, the best accepted application is for the treatment of chronic self-injurious behavior.
Six- and twelve-month abstinence rates in inpatient alcoholics treated with aversion therapy compared with matched inpatients from a treatment registry.
Two hundred forty-nine patients who were treated for alcoholism in an inpatient multimodal treatment program that included aversion therapy were matched post hoc on 17 baseline variables with patients from a national treatment outcome registry. The latter patients received inpatient treatment that emphasized individual and group counseling as the primary therapeutic elements but did not include aversion therapy for alcohol. Six- and 12-month abstinence rates from alcohol and all mood-altering chemicals are reported. The patients treated with aversion therapy for alcohol had higher alcohol abstinence rates at 6 and 12 months (p less than 0.01). The abstinence rates from all mood-altering chemicals were higher in the aversion group at 6 months (p less than 0.05) but not at 12 months. The largest differences between treatment groups in 6-month alcohol abstinence rates were noted for males (p less than 0.001), those over 35 (p less than 0.001), daily drinkers (p less than 0.001), and those with alcohol-related work performance problems (p less than 0.05).
Chemical aversion therapy in the treatment of cocaine dependence as part of a multimodal treatment program: treatment outcome.
A pilot feasibility study of chemical aversion therapy in the treatment of cocaine dependence as part of a multimodal treatment program was conducted at the Schick Shadel Hospital of Santa Barbara. Twenty (20) patients (9 treating for cocaine only and 11 treating for cocaine/alcohol), who primarily snorted cocaine, completed a program which included chemical aversion therapy to develop a conditioned aversion to the sight, smell, and taste of a cocaine substitute (tetracaine, mannitol, and quinine with Psychem. Ninety-five (95) percent of patients were followed up in six months with a total abstinence rate from cocaine of 56% (78% current abstinence of at least 30 days prior to follow-up) in the cocaine only group and total abstinence from cocaine of 70% (also 70% current abstinence) for the cocaine/alcohol group. Ninety (90) percent were followed up at 18 months. Thirty eight (38) percent of the cocaine only group had been totally abstinent (75% were currently abstinent). Fifty (50) percent of the cocaine/alcohol group had been totally abstinent (80% were currently abstinent). Validation of results was obtained from "significant others" for 90% of patients.
[Apparative aversive therapy in combination with verbal suggestions in special obsessional syndromes (initial investigation)].
The author restricts the use of aversion therapy by means of deliberate production of pain to obsessional, especially therapy-resistant disturbances of a permanent nature, with consideration being, of course, given to ethical factors. Experiences worthy of generalization are derived from methodically varied courses of treatment, bringing out suggestive moments subliminally involved in any therapeutical situation and also specifically used by the therapist. In addition, the author emphasizes the need for simultaneously developing, besides aversion therapy, positive attitudes and behavior patterns.
Treatment outcome of 600 chemically dependent patients treated in a multimodal inpatient program including aversion therapy and pentothal interviews.
A sample of 600 patients treated in a multimodal treatment program using aversion therapy and narcotherapy at three Schick freestanding addiction treatment hospitals and one Schick unit in a general hospital were followed-up. Contact was made a minimum of 12 months and as many as 20 months after completion of treatment (mean 14.7 mos.). Telephone contact was made by an independent research organization with 427 of the patients (71.2%). Of these, 65.1% were totally abstinent for 1 year after treatment and 60.2% were abstinent until follow-up a mean of 14.7 months later. Fifty-two percent of the alcoholics were using or dependent on other drugs at admission. Seventy-five of these treated for cocaine dependence and 47 treated for marijuana dependence. The cocaine 12 month and "total" abstinence (mean 14.7 mos.) rates for the 49 contacted patients were 83.7% and 81.6%, respectively. The marijuana 12 month and "total" abstinence (mean 14.7 mos.) rates for the 30 contacted patients was 70.0% for both groups. Abstinence rates for alcohol and/or other drugs were also calculated including noncontacted patients who had chart documented evidence of relapse. The most powerful predictor of success was whether or not all urges to drink or use had been eliminated (presumably by aversion therapy). Of additional importance was the use of support groups and reinforcement treatments after completion of the initial hospitalization. The two most prominent factors initiating a relapse were "intrapersonal determinants" such as stress from work or marriage/family relationships and "interpersonal determinants" such as being around others who were drinking/using or being at a celebration or special event. The two factors were of equal importance in the alcoholics. However, interpersonal determinants were far more important in the cocaine and marijuana treated patients. Increased utilization of reinforcement treatments was associated with decreased urges to drink/use and increased abstinence rates. In contrast, increased frequency of support group utilization was associated with increased urges to drink/use and lower abstinence rates. This suggests the need to take seriously patient reports of "urges" in the first year after treatment and to carefully assess the cause and initiate or update an individualized plan of treatment. Such treatment may include increased reinforcement treatments, treatment of depression, and additional assistance in coping with intrapersonal and interpersonal determinants of relapse.
A marijuana smoking cessation clinical trial utilizing THC-free marijuana, aversion therapy, and self-management counseling.
Twenty-two volunteer adult chronic marijuana smokers participated in a smoking cessation clinical trial. The mean age of the 16 male and 6 female subjects was 29.8 years. The mean number of years of marijuana smoking was 13.7. The mean number of daily marijuana cigarettes smoked was 3.4. The clinical trial consisted of five consecutive days of 50 minute aversion therapy sessions (faradic, rapid smoking, and quick puffing) utilizing THC-free marijuana. Three weekly 60 minute group cohort sessions in self-management counseling followed. The treatment period spanned four weeks. Pretreatment and posttreatment (one month interval) the Shipley Institute of Living Scale was administered to measure changes in both cognitive functioning and organic brain dysfunction. All 22 subjects achieved abstinence (by self-report) by the end of the five days of aversion therapy; 19 of 21 subjects (90.5%) reported abstinence at the conclusion of the clinical trial, following the group sessions. At six months post treatment follow-up 15 of the 20 subjects (75.0%) reported abstinence; at 12 month posttreatment follow-up 16 of the 19 subjects (84.2%) achieved abstinence. The mean number of daily marijuana cigarettes smoked by the subjects decreased from a baseline pretreatment level of 3.40 to 0 at the conclusion of aversion therapy, .07 at the conclusion of the clinical trial, .26 at six month posttreatment follow-up and .23 at the 12 month posttreatment follow-up. The mean scores on the Shipley Institute of Living Scale, were: IQ 106 and CQ 92 at pretreatment; IQ 112 and CQ 104 at posttreatment. The difference in these means was significant for both intelligence and conceptual quotient. The investigators conclude that the treatment procedure offers promise as a marijuana smoking cessation treatment program.
Drug-seeking behavior and its mediation: effects of aversion therapy with narcotic addicts on methadone.
The effectiveness of aversion therapy was tested in the modification of drug-seeking behavior in addicts maintained on methadone. Covert imagery was paired with electric shock, and treatment sessions were randomized sequences of classical and avoidance learning trials. A significant decrease in positive ratings of drug stimuli was found immediately after treatment. However, there was no significant difference found between mean percent drug urines for experimental and control groups immediately after treatment, and at 3 and 6 months posttreatment for experiment volunteers and for eligible nonvolunteers, suggesting that motivational and expectancy variables may have interacted systematically with treatment. Implications for further research are discussed.
Electrical aversion therapy with alcoholics: a comparative follow-up study.
A group of alcoholics treated by partially reinforced electrical escape conditioning were found to have a significantly better outcome on follow-up than a selected control group, who showed a parallel level of motivation, and were treated by conventional methods. No sex differences in outcome were found for either group. In the experimental group, better prognosis was associated with higher social class and older age, and poorer prognosis with single marital status. There were no variations in outcome for age in the control group. In the age range 20-40 aversion therapy showed no better results than conventional therapies, but with subjects above this age range it was very significantly superior. The results are discussed with reference to the application of aversion therapy to alcoholism.
Case of homosexuality treated by aversion therapy.
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Hepatitis induced by drugs used as alcohol aversion therapy.
We report here on the hepatic lesions produced in 17 alcoholic patients who had received Cyanamide or Disulfiram as aversion therapy. The characteristic lesion consists of cytoplasmic inclusions, similar to Lafora bodies. They are found predominantly in periportal hepatocytes, including those lining the cholangioles. They appear to be persistent but are lost after death of the inclusion-bearing liver-cell when both the inclusion body and the dead hepatocyte are removed by macrophages. As well as the inclusion bodies, portal or periportal inflammation and necrosis of isolated liver-cells are seen. The inflammatory infiltrate is usually denser in the periportal areas and is associated with liver-cell destruction. The inflammation is usually followed by portal fibrosis which can be severe if treatment is prolonged. In one case, in which two biopsies were performed, cirrhosis developed while that patient was on Cyanamide.
The conditioning of aversions to familiar and preferred flavours: a new aversion therapy model.
The present study examined the ability of rats to develop aversions to familiar flavours and to flavours that they had previously acquired a preference for. Rats were first conditioned to prefer a CS+ flavour over a CS- flavour by pairing CS+ intake with the consumption of a starch solution (16% Polycose). A second group was exposed to the same training but preference conditioning was prevented by inhibiting starch digestion with the drug acarbose. The rats were next given aversion training; the CS+ flavour was now paired with toxicosis (LiCl injection) while the CS- flavour paired with a control treatment (NaCl injection). The results of two-choice tests revealed that aversion training produced significant avoidance of the CS+ flavours in both the group that had acquired a preference for this flavour as well as in the no-preference group. The value of using conditioned flavour preferences as targets for aversions to model the aversion therapy approach to alcoholism is discussed.
Long-term abstinence from alcohol in patients receiving aversion therapy as part of a multimodal inpatient program.
A sample of 200 patients who had been treated for alcoholism in a multimodal inpatient program that used aversion therapy as a treatment component was selected for outcome evaluation. One hundred sixty (80%) were located. A minimum of 13 months had elapsed since treatment (mean 20.5 months) collateral reports were used to verify self-reports in 36% of the cases. Abstinence status was determined for the first 12 months since treatment, the entire elapsed time since treatment (range 13 to 25 months, mean 20.5 months), and "current abstinence" (last 6 months). The abstinence rate for the first 12 months was 71.3%; for the total period since treatment, the rate was 65% (mean 20.5 months); the current abstinence rate was 78.1%. The data was also viewed from other perspectives. The findings of this study suggest that a multimodal alcoholism treatment program utilizing aversion conditioning is at least as acceptable to patients as counseling centered programs and can be expected to yield favorable abstinence rates.
Case of fetishism treated by aversion therapy.
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A note on aversion therapy.
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Editorial: The ethics of aversion therapy.
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Picking up the pieces...after aversion therapy.
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