# Aversion therapy

Aversion therapy is a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus with unpleasant sensations with the intention of quelling the targeted (sometimes compulsive) behavior.
Aversion therapies can take many forms, for example: placing unpleasant-tasting substances on the fingernails to discourage nail-chewing; pairing the use of an emetic with the experience of alcohol; or pairing behavior with electric shocks of mild to higher intensities.
Aversion therapy, when used in a nonconsensual manner, is widely considered to be inhumane. At the Judge Rotenberg Educational Center, aversion therapy is used to perform behavior modification in students as part of the center's applied behavioral analysis program. The center has been condemned by the United Nations for torture.

## In addictions

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).

### Alcohol addiction

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. When a person drinks even a small amount of alcohol, disulfiram causes sensitivity involving highly unpleasant reactions, which can be clinically severe. 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).
Another approach in creating aversions to alcohol consumption is the implementation of succinylcholine chloride-induced paralysis and respiratory arrest following exposure to alcohol. 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.

### Cocaine dependency

Emetic (to induce vomiting) therapy and faradic (administered shock) aversion therapy have been used to induce aversion for cocaine dependency. 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.

### Cigarette addiction

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. 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.

## In compulsive habits

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.

## In history

Pliny the Elder attempted to heal alcoholism in the first century Rome by putting putrid spiders in alcohol abusers' drinking glasses.
In 1935, Charles Shadel turned a colonial mansion in Seattle into the Shadel Sanatorium where he began treating alcoholics for their substance use disorder. 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.
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. This was meant to work as a form of conversion therapy.

## In popular culture

* 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.
* 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.

## Judge Rotenberg Center

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. 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.

## Criticism

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).