What Is Aversion Therapy?

Aversion therapy or aversive therapy is considered a type of behavioral therapy that involves the repetitive pairing of undesired behavior with discomfort. For example, a person in aversion therapy for smoking might receive an electrical shock when they see a cigarette image. Overall, the goal of the conditioning process is to make the person associate the stimulus with uncomfortable or unpleasant sensations. 

When it comes to aversion therapy, behavior is motivated through the configuration of negative associations with behavior. Unpleasant smells, tastes, medication, and electrical shocks are a few methods used to create negative associations that discourage undesirable behaviors. Aversion therapy is controversial, but research suggests that specific types can be effective, also known as alcohol aversion therapy. 

By pairing a problem behavior with something that creates emotional or physical discomfort, the positive association with the behavior is broken. From there, a new and negative association is developed. This particular process is called “counterconditioning” and it’s designed to encourage behavior change. 

During aversion therapy, the patient might be asked to think or engage in behavior they enjoy while simultaneously being exposed. Generally, to an unpleasant foul smell, bad taste, or even mild electrical shocks. Once unpleasant feelings are associated with the behavior, the hope is that unwanted actions or behaviors will decrease or stop. 

Some of the methods used in aversive therapy to create the unwanted associations include the following:

  • Pharmacological methods – The use of a medication that creates discomfort or illness when it interacts with a specific substance. 
  • Sensory methods – This is the use of something with an undesirable sensation such as taste, smell, or touch. 
  • Imaginal methods – The use of upsetting and unpleasant thoughts or images. 
  • Electrical methods – Administering electrical shocks. 
  • Emetic methods – The use of medication to induce vomiting and nausea. 

Benefits of Aversion Therapy

There are numerous benefits of aversive therapy. It is beneficial in reducing a few types of unwelcome habits and behaviors. Since our natural response when subjected to an aversive experience, is to withdraw and avoid undergoing that experience again. 

When there is some type of negative association that is created between habit and behavior, such as the following:

  • Electrical shocks
  • The sting of a snapping rubber band
  • Unpleasant odors or tastes

Aversive therapy can help individuals develop revulsion or resistance toward behavior/habit because they don’t want the negative experience repeated. This type of therapy operates off on behaviorism principles, which encourage positive behaviors through rewards. Furthermore, it discourages any unwanted behaviors through punishment.

Fundamentally, behaviorism is based on the idea that human behavior is motivated by natural urges to seek pleasure and avoid pain. Counterconditioning does involve the pairing of behaviors or even behavioral cues with uncomfortable, unpleasant, and painful experiences. This encourages future avoidance. 

Drugs and specific compulsive behaviors such as gambling, sex, or stealing are believed to activate reward centers in the brain. Furthermore, causing the release of dopamine and a pleasurable “high”. Gradually, the repetitiveness of the behavior causes “addiction” pathways or rewards to form in the brain. 

This results in strong urges to repeat the behavior and makes it more difficult to stop. Aversive therapy aims to reverse this process by interrupting the rewarding process. Thus, punishing the behavior to even cause a negative association. 

Aversive therapy is considered an umbrella term that includes various treatment methods. Some methods have more supportive evidence that is more commonly used. For example, pharmacological aversion treatment use such as Antabuse for alcoholism is more common via sensory methods or electrical shock. 

Aversion Therapy Treat Addiction

What Can Aversion Therapy Help With?

As stated, this therapy can be utilized for various behavioral issues, addictions, and lifestyle diseases. In more recent years, the techniques are more commonly utilized to treat:

  • Alcohol and drug addiction
  • Obesity and overeating
  • Nicotine and tobacco use
  • Compulsive gambling

Less commonly, this therapy has a history of being utilized to treat:

  • Self-harming behavior (cutting)
  • Thumb sucking or nail-biting
  • Trichotillomania (hair pulling)
  • Excoriation (skin-picking)
  • Problem sexual behaviors

Generally, this therapy is recommended only when other frontlines treatments have been ineffective. Furthermore, this aversive therapy has been used to assist those struggling with compulsive sexual behaviors or self-harming. Some people who have an underlying brain injury or a developmental disorder have benefited from aversion therapy. 

Another example of this therapy is when a person has a serious drug history and has experienced several failed treatments. This individual might be more likely recommended for aversive therapy than a person seeking treatment for the first time. Aside from what aversive therapy can help with, there are various examples. 

Aversion Therapy Examples

Aversive therapy has been a controversial treatment and there are several documented circumstances when the use was inhumane or unethical. Due to the complicated history of aversive therapy, it is misunderstood often. The following are examples of aversion therapy that are most commonly used today. 

Aversion Therapy for Alcohol Use Disorder – Alcohol Aversion Therapy

Alcohol-use disorders which include alcohol dependence and abuse make up one of the most widespread substance use disorder categories. According to an NIH study, the lifetime prevalence of AUDs in the US in adults 18 or older is 29%.  Alcohol dependence is considered “A maladaptive pattern of drinking leading to clinically significant impairment,” manifested by:

  • Lack of control over drug urges/cravings
  • The compulsion to drink 
  • Lack of control over the amount of alcohol consumed
  • Continued drinking despite the realization of problems

When a person is a chronic alcohol user, they develop stimulus-response conditioned habits. They learn to associate several situations, places, and people with drinking alcohol/euphoria. Therefore, even after treatment, individuals might encounter stimulus cues in their daily life, caused by cravings. 

Imagine this: a person looking at pictures of individuals drinking alcohol, seeing alcoholic beverages, or fantasizing/visualizing themselves drinking. They may experience the pleasurable effects of drinking their favorite alcoholic beverage as if it were happening. Therefore, that person may feel inclined to start drinking again. 

Individuals who quit drinking alcohol and detox without treatment have a higher risk of relapse. Research studies indicate correlations between cravings and the severity of alcohol dependence. Furthermore, treatments that target cravings such as alcohol aversion therapy are effective. 

The FDA-approved medication named Antabuse or Disulfiram is prescribed often for individuals with alcohol use disorders. Disulfiram is a medication that when taken daily, causes an adverse response to alcohol by blocking enzymes in the liver. When individuals are on this medication and decide to drink alcohol, they’ll develop some of the following uncomfortable symptoms:

  • Blood pressure changes
  • Nausea and vomiting
  • Difficulties breathing
  • Headaches
  • Sweating 
  • Anxiety 

Some individuals choose to engage in this medication to assist in safeguarding against a relapse. 

How Long Does Aversion Therapy Last?

When individuals begin aversion therapy, the detailed intake and assessment will last about 60-90 minutes. During the initial meeting, the clients are asked to fill out paperwork and also asked a certain amount of questions. The questions are designed to assist in determining a clinical diagnosis. 

By the end of the appointment, the counselor will review the diagnosis and discuss any further treatment options. If the first appointment is with a prescribing professional, such as a physician’s assistant, nurse practitioner, or doctor, it’ll involve:

  • A less formal discussion of the issue
  • Assessment 
  • Intake 

If an individual is seeking pharmacological aversion therapy, they can expect the practitioner to provide detailed information about:

  • Potential side effects
  • The medication 
  • Overall purpose

When a medication is prescribed, an appointment is scheduled to determine if the medication is having desired effects after 2-6 weeks. If a person experiences adverse reactions or side effects before the follow-up, they’re recommended to contact their doctor for advice. 

Aversion Therapy for Alcohol Use Disorder

What Drugs Are Used in Alcohol Aversion Therapy?

There are numerous drugs utilized in alcohol aversion therapy, also known as chemical aversion therapy. The three most commonly used medications are Apomorphine, Lithium, and Emetine. None of the above-mentioned drugs have been approved by the FDA, for the specific use of alcohol aversion therapy.  When the above-mentioned drugs are employed in combination with therapy, patients undergoing treatment need to be kept under medical supervision. 

How Does Aversion Therapy Help Treat Addiction?

Aversion therapy utilizes conditioning but focuses on creating a negative response to an unwelcome stimulus, like drug or alcohol addiction. Oftentimes, in individuals with substance use disorders, the body is conditioned to receive pleasure from a specific substance. For instance, the substance tastes good and makes them feel good. 

In aversion therapy, that idea is modified. The way that aversion therapy is performed depends on the unwanted habit or behavior that’s being treated. A commonly used aversive therapy is alcohol aversion therapy, or chemical aversion therapy. 

Overall, the goal is to reduce an individual’s cravings for alcohol by enforcing chemically-induced nausea. In chemical aversion therapy, the doctor administers a drug that causes vomiting or nausea if the person treated drinks alcohol. Then, they give the person the alcohol so that they can get sick. 

This process is repeated until the person associates drinking alcohol with feeling ill. Thus, giving them an adverse reaction to drinking, and stopping cravings as well. The other methods that have been utilized in aversive therapy are:

  • Negative imagery through visualization 
  • Shame

The Power of Drug Addiction and Why Aversion Therapy Is Necessary

Drugs and alcohol create intense deceptive feelings of well-being in a person’s mind, meanwhile, aversive therapy does the opposite. The result is a lack of confidence and concern over areas of life, which is compounded by physical substance dependency. Once this occurs, individuals feel the need to give up their most basic needs. 

The repetitious act of engaging in alcohol or drug use strengthens an individual’s memory. Similar to a digital camera or hard drive, physical experiences stored in the memory are played back once they’re triggered. Addiction builds associations in a person’s brain that become embedded in long and short memory. 

When drug and alcohol rehabilitation is paired with counter conditioning, it works. Because it targets the signals of memories with an adverse response.  Experiencing pleasurable feelings is the root of a person’s craving. 

The stimuli are paired with medically supervised stimuli to create an aversion or an undesirable response such as nausea. Since the patient’s brain is now automatically associating any addictive substances with an unwanted feeling, it effectively eliminates the craving. It’s important to understand that many individuals have experienced counterconditioning before in their lives. 

For example, let’s say that a person loved oranges. One day, they ate so many oranges that they became violently sick afterward. As a result of that, the thought of oranges would make them nauseous because they associate them with that experience. 

Discovery Institute Can Help You Recover From Addiction 

When a person decides to choose to rid themselves of alcohol dependency, it’s not an easy task. For many individuals, it’s simple to give up on the treatment course and go resort back to old habits. This is why it’s a great idea to invest in our treatment facility, we can help.

We understand how difficult it is to break free from dependency. Aversive therapy is an ideal behavioral method that can assist in your way to freedom. You can talk to us, we’ll listen.

Reviewed for Medical & Clinical Accuracy by Dr. Jeffrey Berman, MD

Dr. Jeffrey Berman is a psychiatrist in Teaneck, New Jersey and is affiliated with Robert Wood Johnson University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years. He also speaks multiple languages, including French and Hebrew.