Addictive Behaviours - Methods of modifying behaviour: Aversion therapy Flashcards
When describing this therapy, what are the 3 components to describe
- Antabuse
- rapid smoking
- electric shocks (Faradic aversion)
Describe Antabuse
- Antabuse is the brand name for the drug disulfiram, and is used to treat alcohol addiction by acting as an aversive stimulus.
- Antabuse works by affecting how the body metabolises alcohol
- Normally alcohol is broken down to a compound called acetaldehyde and then further broken down by an enzyme in the liver called aldehyde dehydrogenase.
- Antabuse causes a reaction known as the disulfiram reaction, which stops this enzyme from working and therefore causes a build-up of acetaldehyde in the bloodstream.
- In turn, this causes a range of unpleasant symptoms such as sweating, heart palpitations, headaches and vomiting.
- It occurs within 10 minutes of consuming alcohol and can last for a few hours.
- Once the association has been made the person will try and avoid contact with the behaviour, and may also avoid triggers associated with the addiction such as pubs or other social situations where people are likely to be drinking.
- NICE says you can take Antabuse once you’ve undergone withdrawals and are given 200mg daily as a tablet for as long as necessary. Some countries will offer implants. You should avoid all products containing alcohol (e.g. mouthwash)
Describe rapid smoking
- is a form of aversion therapy used to treat smoking addictions
- smokers sit in a closed room and take a puff on a cigarette every 6 seconds until they finish a specific number of cigarettes or feel sick
- the smoker will associate this unpleasant feeling with smoking and develop an aversion to it
- this might be repeated over several sessions to try and make the association stronger
- in the 1970s this was very popular in the USA, but has since been less common since the development of other treatments, perhaps due to the fact it endangers our health
Describe electric shocks (Faradic aversion)
- using electric shocks as the unpleasant stimulus, this has been used for substance addictions such as alcohol and smoking but has also been used to modify behavioural addictions, such as gambling.
- The Schick Shadel hospitals in the USA used faradic aversion therapy as part of a commercial program to help individuals stop smoking, as described by Smith (1988). This approach involved aversive counter-conditioning where electric shocks were paired with each step in the smoking process (e.g., opening a cigarette pack, lighting a cigarette, puffing).
- A desk-top device, powered by a 9-volt battery, delivered the electric shocks through stainless steel dime-sized contacts placed on the forearm. The intensity of the shocks could be adjusted by the therapist using a rheostat. While the voltage might be high enough to ensure the client felt the shocks, the current delivered was minimal (1–3 milliamps, with a maximum of 10 milliamps).
- The shocks were administered as a deterrent, creating a negative association with the act of smoking.
When evaluating this therapy, what 3 things do we talk about
- effectiveness
- ethical implications
- social implications
When talking about the effectiveness of aversion therapy, what do you talk about
:)
- supporting research
- comparison to other methods
:(
- only treats symptoms not cause
- methodological issues
Evaluate the effectiveness of aversion therapy using supporting research
P: One reason aversion therapy can be effective is the supporting research on Antabuse by Hemut Niederhofer and Wolfgang Staffen (2003), which demonstrated that Antabuse can be more effective than a placebo in promoting abstinence from alcohol.
E: Niederhofer and Staffen (2003) compared Antabuse to a placebo, using self-report and screening methods over 90 days. They found that the patients taking Antabuse had significantly greater abstinence durations compared to the placebo group.
T: This suggests that Antabuse can effectively help patients resist the urge to drink alcohol by associating alcohol with unpleasant effects. therefore this is a strength of aversion therapy because it shows that the treatment has tangible short-term benefits and can improve the patient’s chances of maintaining abstinence.
C: However, this study only assessed the short-term effects, meaning it does not address the longevity of the treatment. According to Pavlov’s classical conditioning theory, when the conditioned stimulus (alcohol) is no longer paired with the unconditioned stimulus (Antabuse’s effects), the conditioned response (abstinence) may become extinguished. Therefore, after the 90-day period, patients might relapse, questioning the long-term effectiveness of Antabuse as a treatment for alcohol addiction.
Evaluate the effectiveness of aversion therapy by comparing it to alternative therapies
P: Aversion therapy, such as rapid smoking, has the advantage of being more cost-effective and less time-consuming than cognitive restructuring therapies, which require significant therapist involvement.
E: Rapid smoking is typically a one-session therapy that lasts only 30 to 60 minutes, while cognitive restructuring therapies may require multiple sessions over several weeks.
T: Therefore, this suggests that rapid smoking is an efficient and relatively inexpensive option for those who may not have the time or financial resources for prolonged therapy sessions. The quicker results and lower costs make it more accessible than therapies requiring long-term therapist involvement.
C: However, rapid smoking can be extremely damaging to an individual’s health. For example, forcing someone to smoke excessively can cause nausea, dizziness, and increased heart rate, potentially exacerbating their health problems. It can also increase the risk of cancer. Given that safer alternatives exist, such as nicotine replacement therapy or cognitive behavioral therapy, rapid smoking could be considered an impractical and dangerous choice.
Evaluate the effectiveness of aversion therapy only addressing symptoms and not cause
Point: A major weakness of aversion therapy is that it only addresses the symptoms of addiction, not the underlying causes, which can lead to patients substituting one addiction for another.
Evidence: The Office for Health Improvement & Disparities UK reports that in the 2022-2023 period, nearly half of those receiving treatment had problems with overlapping substance dependencies. Only 30% of individuals had issues with alcohol alone, while a significant portion of the rest reported alcohol misuse in combination with drug misuse.
Explain: This suggests that while aversion therapy might be effective in stopping one of the addictive behavior, it does not provide the individual with the tools to understand and overcome their deeper emotional struggles. As a result, the individual may never truly be free of addiction, rendering the treatment only a temporary solution.
Counter: However, there are arguments that some forms of aversion therapy, such as in combination with other therapies (e.g., counseling or support groups), could be more holistic and address both the symptoms and underlying causes of addiction, making it a more comprehensive approach.
Evaluate the effectiveness of aversion therapy having methodological issue with attrition
P: A significant issue with aversion therapy is the high dropout rate in research studies, which can lead to biased samples and undermine the generalizability of the findings.
E: For instance, Bancroft (1992) found that 50% of patients either refused or dropped out of the aversion therapy treatment. This high dropout rate may lead to a biased sample, as those who stay in the program may be more motivated or have different characteristics from those who leave.
T: Therefore this suggests that aversion therapy might not be suitable for all addicts, as it requires a high level of commitment and perseverance. If so many patients are unable to continue with the program, it raises concerns about the effectiveness of the treatment for the broader population of addicts.
C: However, dropout rates can be common in many addiction treatment programs, not just aversion therapy. Moreover, some patients who drop out might not be ready for treatment, which could explain the high dropout rate. Therefore, the dropout rate may not necessarily reflect the therapy’s ineffectiveness, but rather the patient’s own readiness to change. However, a truly effective therapy should account for this and work to improve the patient’s motivation alongside treating them.
When evaluating the ethical implications of aversion therapy, what do you talk about
:(
- risk of harm
- issues with valid consent
:)
- use of covert sensitisation
Evaluate the ethical implications of aversion therapy having significant risk of harm
P:One major ethical issue in aversion therapy is the risk of harm caused by the aversive stimuli used in the treatment.
E: Research by Bancroft (1992) found that 50% of patients either refused or dropped out of aversion therapy, highlighting the significant distress caused by the therapy’s aversive nature. Symptoms from Antabuse (such as vomiting) and health complications from rapid smoking (such as increased risk of cancer) may account for this high rate of drop out
T: This suggests that a significant number of individuals experience emotional or psychological harm due to the unpleasant nature of the treatment, which can lead to reluctance to engage with the therapy, potentially encouraging patients to never recover in order to avoid experiencing those side effects. Moreover, patients who refuse or drop out may be left with unresolved issues, leading to negative consequences in their treatment journey.
C: However, this could be viewed as part of the therapeutic process where clients may need to confront discomfort to achieve long-term change. The discomfort could be necessary to help individuals break free from harmful behaviors.
Evaluate the ethical implications of aversion therapy having issues with valid consent
P: A significant ethical concern with aversion therapy is the issue of informed consent and the potential for violating patients’ autonomy.
E: Critics argue, such as in the case of Billy Clegg (the individual subjected to Faradic aversion therapy to “treat” his homosexuality, which led to his death), that patients may not fully understand the risks and limitations of the therapy or may be coerced into undergoing treatment due to societal pressures or authority figures.
T: Therefore aversion therapy may violate the principle of autonomy by pressuring individuals into treatment without fully informed consent. It also highlights the possibility of patients being subjected to extreme measures that may not align with their personal well-being or ethical values, especially in controversial cases like Clegg’s.
Counter: However, there are much less invasive versions of aversion therapy such as covert sensitisation which gets patients to imagine the aversive stimuli as opposed to actually experiencing them.
Evaluate the ethical implications of aversion therapy having alternative forms like covert sensitisation
P: A potential strength of modern aversion therapy alternatives, such as covert sensitization, is that it offers a less harmful approach while still being effective.
E: Tom Kraft (2005) presented a series of case studies highlighting the success of covert sensitization, an approach that uses imagery of unpleasant consequences rather than direct physical stimuli. Despite not being as widely used, Kraft’s studies suggest that covert sensitization can be effective and less invasive.
T: This suggests that contemporary variations of aversion therapy can address the ethical concerns of harm, providing a viable alternative that reduces the risk of psychological damage while still aiming to modify behavior. As covert sensitization relies on mental imagery rather than direct physical punishment, it can avoid the physical and emotional distress associated with traditional aversion techniques.
C: However, it can be argued that the efficacy of covert sensitization may not be as robust for all individuals, as some may require more intense treatments to see results. In cases where it is less effective, traditional aversion therapy may still be considered necessary.
When evaluating the social implications of aversion therapy, what do you talk about
:)
- the cost if we didn’t invest in aversion therapy
:(
- increasing expenses making it no longer viable
