Aversion Therapy: Uses & Effectiveness

What Is Aversion Therapy?

If someone becomes violently sick every time they drink alcohol, they are less likely to drink alcohol. This example represents aversion therapy treatment, a behavioral therapy in which unwanted behavior is paired with discomfort or pain to reduce or eliminate the undesirable behavior.

Having an aversion to something means you don’t like it. Producing the dislike can occur naturally or artificially, which is how aversion therapy works. Its roots in behavior therapy began in the 1930s and 1940s with Joseph Wolpe.

Aversion Therapy vs. Negative Reinforcement

Aversion therapy adds painful elements to deter negative behavior. For example, if you want to discourage someone from smoking cigarettes, each time they light a cigarette, you administer an electric shock to them. They associate smoking with electric shock and are less likely to smoke in the future.

In contrast, negative reinforcement is used to strengthen behavior. To do this, you remove something unpleasant associated with the behavior. By removing something painful, you encourage the continuance of a behavior.

For example, someone experiencing withdrawal symptoms eases their symptoms by continuing to drink or use drugs. Negative reinforcements are often incentives for someone to continue misusing substances.

Aversion Therapy vs. Other Techniques

Today, some therapists still use aversion therapy in combination with other protocols to help overcome certain substance use disorders and behavioral disorders. Aversion therapy is quite different from other techniques and is rarely used as a first line of treatment.

Today’s gold standard of therapies is cognitive behavioral therapy (CBT) and its sub-therapies, like exposure therapy and dialectical behavior therapy. CBT is often complemented with other behavioral therapies that teach you how to recognize, identify and change negative thought patterns.

Therapeutic techniques today include understanding that there is a relationship between your thoughts and behaviors. If your thoughts are negative, your behaviors are likely negative, too. The goal is to improve thinking patterns that will lead to healthy behaviors.

How Aversion Therapy Works

According to the American Psychological Association, aversive conditioning is when you pair an unpleasant stimulus with a negative behavior. When it is used in substance abuse treatment it is often called aversion therapy.

Common Aversion Therapy Techniques

Counselors treating someone with aversion therapies must choose between several techniques. The most common include the following:

Electrical Stimulation

Electrical stimulation refers to administering a shock to someone when they engage in unhealthy behaviors. If someone who drinks alcohol is given an electric shock each time they take a drink, they are more likely to avoid drinking alcohol to avoid the pain. While electrical stimulation is effective this type of aversion therapy is limited, may cause injuries and is rarely used in treatments today.

Chemical Aversion

Chemical aversion therapies change how the senses receive information. For someone drinking alcohol, pairing the alcohol with a foul tasting chemical for every drink will make someone not want to drink. Chemicals can create aversions to the sight, smell and taste of alcohol.

Nausea-Inducing Medications

Some medications have side effects that occur when certain substances are consumed. For example someone taking Disulfiram who drinks alcohol will experience nausea and vomiting as a result of the combination. This is one reason Disulfiram is a popular medicine prescribed to someone in alcohol addiction recovery.

Ethical Considerations in Aversive Therapy

Many treatment providers refuse to use aversion therapy, and for good reasons. The techniques can seem unethical, abusive and dangerous. In addition, some therapists consider the methods a form of punishment which they feel should never exist in therapy.

FAQs

Is Aversion Therapy Effective for Alcohol Addiction?

Aversion therapy treatment can be effective for alcohol addiction. However, many consider it unethical, and it may create additional problems for someone trying to overcome addiction. Someone may experience post traumatic stress depending on the exact method and amount of pain associated with it. There are many other behavioral treatments available that offer greater efficacy.

What is the Difference Between Aversion Therapy and Counterconditioning?

Aversion therapy pairs negative behavior with a painful experience to discourage someone from repeating the negative behavior. The pairing can lead to someone developing a fear of that behavior. To undo the fear, counterconditioning must occur. This therapy pairs the initial behavior with a more neutral stimulus to reduce aversion.

Are There Risks Involved with Aversion Therapy?

Aversion therapies are not always effective, and there are risks for participants. Potential risks include:

The individual can become desensitized to the aversive method.
The individual can develop new mental health symptoms.
The individual can develop new physical symptoms.
Aversions may not work.
Aversions may become rewards.

Aversion therapies affect each person differently, making the treatment inconsistent. You and your therapist must consider all risks before trying this method.

Applications of Aversion Therapy in Addiction Treatment

Chemical aversion therapy is a treatment still used today. Doctors prescribe medications that induce nausea and vomiting when paired with drinking alcohol. Drugs often used in aversion therapy alcohol include disulfiram, lithium, emetine and apomorphine.

However, only disulfiram has approval for use as a chemical aversion therapy by the U.S. Food and Drug Administration (FDA).

Chemical aversion therapy helps people struggling with alcoholism by creating fear of experiencing painful side effects when they drink alcohol. The medicine usually comes in pill form, and the aversion effects are only felt if you take the drug before drinking alcohol.

Other limitations include building a tolerance to the drug, finding the effects rewarding, and being able to drink past the aversions. Additionally, not all insurance companies cover aversion therapies for treating alcohol use disorders.

With these limitations in mind, other methods are often used to complement aversion therapy or in place of it:

Medications

Several pharmaceutical options exist for anyone who can’t take disulfiram. Your doctor may prescribe one of the following:

Naltrexone: Naltrexone blocks the effects of alcohol in the brain. You can drink any amount of alcohol yet not feel the effects. It can be dangerous for those who drink too much, trying to feel the effects. They risk overdosing on alcohol.
Acamprosate: Acamprosate works by healing the neural networks within the brain, reducing cravings and urges to drink alcohol. It is only beneficial as long as you are taking the drug, however.

Behavioral Therapies

Behavioral therapies must be part of a treatment plan. You need to learn specific skills to avoid relapse and maintain sobriety. Behavioral therapies occur in inpatient and outpatient treatment programs in individual and group settings.

Behavioral therapies for substance use disorders include the following:

Cognitive behavioral therapy (CBT)
Dialectical behavior therapy (DBT)
Mindfulness-based CBT (MB-CBT)
Acceptance and commitment therapy (ACT)
Motivation enhancement therapy (MET)

Behavioral therapies teach you the skills to change your thoughts, which will change your behaviors. There is vast evidence showing the effectiveness of behavioral therapies in substance use disorder treatment.

Complementary Treatments

Complementary treatments can be just as crucial in recovery as behavioral therapies and medications. Examples of these treatments include:

Family therapy
12 Step facilitation
Art or music therapy
Equine therapy
Fitness
Nutrition
Acupuncture
Meditation or prayer
Stress management
Relaxation

Think of the many different treatments as tools in your toolbox. The more you have, the better equipped you are to fix any problems and overcome obstacles in your recovery journey.

Use of Aversive Conditioning to Treat Behavioral Addictions

Aversive conditioning to treat behavioral addictions refers to pairing the negative behavior with a negative stimulus to reduce or eliminate the negative behavior. Gaming, gambling, and sex are examples of behavioral addictions. Aversive conditioning suggests pairing these actions with either a chemical, electric, or nausea-inducing stimulus so a person will stop engaging in negative behaviors.

For substance use disorder, the negative stimulus is applied when someone consumes drugs or alcohol. For other behavioral addictions, the negative stimulus also must be applied immediately after or while the negative behavior occurs to be most effective.

Aversion Therapy vs. Other Behavioral Therapy Approaches

Aversion therapy is one of many behavioral therapy approaches, each with advantages and disadvantages. Aversion therapy is not usually more effective than other behavioral therapies. It is applied to one specific behavior and one specific negative stimulus.

For example, someone taking disulfiram that makes them sick when they drink alcohol may decide to switch from alcohol to other sedatives that are not affected by disulfiram. In contrast, other behavioral approaches apply conditioning principles but also help you address underlying problems and teach you skills you can use for the rest of your life to avoid relapse.

Cognitive Behavioral Therapy (CBT)

Rather than try to create an aversion to a behavior, cognitive behavioral therapy involves changing behaviors by recognizing and replacing the thoughts that triggered the behavior. It is based on the premise that negative thoughts lead to damaging behaviors. Therefore, positive thoughts encourage positive behaviors.

Counterconditioning

Counterconditioning is undoing or neutralizing the effects of aversive therapy. Sometimes, aversion therapy can lead to developing fears and stressors that create even more issues. Therapists can work with you to associate the original behavior with a more pleasant stimulus.

When Aversive Conditioning Is Recommended vs. Other Methods

Aversive conditioning is typically used with people who struggle with alcohol or drug addictions and haven’t been able to stop using despite many efforts. It is also chosen to eliminate some behavioral addictions, like gambling and smoking cigarettes.

Risks and Benefits of Using Negative Reinforcement in Behavioral Therapy

A person can experience a more positive outcome by removing a negative stimulus. This is negative reinforcement, which has its benefits, such as increasing desirable behaviors and long-term changes for the better.

There are also risks of negative reinforcement, including:

Confusion over which behavior is desirable
Feeling rewarded by the removal of the negative stimuli
Potential for developing new mental health symptoms, like anxiety
Relying too much on the negative reinforcement

Negative reinforcement may not benefit everyone. Your therapist will weigh your risks and benefits before choosing a treatment to ensure you are not adversely affected.

Finding an Aversion Therapy Specialist

If you think aversion therapy may help you, it is crucial that you only work with a licensed and trained aversion therapy specialist. They may be a psychologist, psychiatrist or certified applied behavioral analyst. You may have to do some online research to find one near you to choose a therapist.

You may also use online navigation tools like the following:

Asking friends, family, coworkers and acquaintances for a referral is one of the best ways to find an aversion therapy specialist. They can also give you honest feedback on their experience.

How to Choose a Licensed Therapist Specializing in Aversion Therapy Treatment

Choosing a licensed aversion therapy specialist means ensuring they have the proper educational training and real-world work experience. They should be licensed or certified by the state in which they work. They should also be able to provide references whom you can call for feedback. Above all, they must have proof of their qualifications in implementing aversive therapy techniques.

Questions to Ask Before Starting Therapy

Treat your search for a therapist like a job interview. Great therapists will happily answer any questions you have before you begin treatment.

Ask questions like the following:

What is aversive therapy?
What is aversive conditioning?
What is your educational background in aversive therapy?
What is your job experience in aversive therapy?
How do you determine who will benefit from aversive therapy?
What are the aversive therapy techniques you use?
What other therapy techniques do you use in case aversive therapy isn’t a good fit?

Don’t be afraid to ask questions. If the therapist makes you feel uncomfortable when asking questions, they aren’t the right therapist.

Alternatives if Aversion Therapy Isn’t the Right Fit

If aversion therapy isn’t beneficial for you, you can still choose from many therapies that can help. Your therapist may want to try any of the following for substance use or mental health disorders:

Exposure therapy
Medication
Cognitive behavioral therapies
Support groups
12 Step facilitation groups
Alternative or holistic therapies

The best way to get the most from aversion therapy is to integrate it with other treatments, like those above. This helps you avoid relying on one treatment that may be successful or fail.