Methods of modifying behaviour 2: Aversion therapy Flashcards
What is aversion therapy?
Aversion therapy is based on the principles of classical conditioning which is a key assumption of the behaviourist approach. A naturally unpleasant stimulus (unconditioned stimulus, UCS) produces a negative response (unconditioned response, URS). The UCS is then paired with the addictive behaviour (neutral stimulus, NS) and a conditioned response (CR) is learned. The individual associates the addictive behaviour (conditioned stimulus,CS) with the negative CR, rather than the pleasure they used to experience. Its a less popular treatment today, there are 2 examples of this therapy.
Antabuse (disulfiram)
To treat alcoholism, individuals can be given a drug called antabuse to act as the averison stimulus. It works by affecting how the body metabolises alcohol. Alcohol is broken down to a compound called acetaldehyde and then further broken down by an enzyme called aldehyde hydrogenase. The disulfiram reaction occurs which causes the enzyme to stop working, leading to a build-up of acetaldehyde in the bloodstream, causing symptoms like sweating, headaches, and vomiting. It occurs within 10 minutes of consuming alcohol and can last for a few hours. Once the association is made, individuals may avoid contact with the behaviour and triggers associated with addiction, such as social situations like pubs.
Antabuse (UCS) = Vomiting (UCR)
Anatabuse (UCS) + Alcohol (NS) = Vomiting (UCR)
Alcohol (new CS) = Vomiting (new CR)
Antabuse (disulfiram) continued
In the UK, NICE guidelines suggest that antabuse treatment can begin after the individual has undergone withdrawal. They are given a dose of 200mg daily, but this may be increased if the reaction with alcohol is not aversive enough. The individual should be monitored every 2 weeks for the first 2 months and monthly for the next 4 months. Be cautious when taking medication, especially from other sources of alcohol like food or mouthwash, as they may cause the unpleasant reaction.
Rapid smoking
A form of aversion therapy used to help smokers overcome their addiction. In this process, smokers sit in a closed room and puff on cigarettes every 6 seconds until they finish a certain number or feel sick. In this case the unconditioned stimulus is not a drug, it is something else unpleasant - intensive smoking which creates the unconditioned respose of disgust or feeling sick. Similar to antabuse, the theory suggests that smokers associate unpleasant feelings with smoking an aversion to it. This might be repeated over several sessions to try and make the association stronger. In the 1970s, this treatment was popular in the USA, but is now less frequent due to the development of other treatment methods.
Effectiveness: Effectiveness of antabuse
Niederhofer and Staffen (2003) compared antabuse to a placebo and assessed their participants using a self-report methods and screening for 90 days. The anatabuse patients had significantly greater abstinence duration than the placebo group. Jorgensen et al (2011) found that those treated with antabuse had more days until relapse and fewr drinking days. However, long-term studies on antabuse effectiveness are rare and lack scientific rigour due to their lack of full randomised controlled trials. There are also few comparison studies between antabuse and other treatments for alcoholism, and they often take place on small samples (Ellis, 2013). Also placebo studies are challenging as patients are aware of their condition when they drink and no adverse effects occur.
Effectiveness: Effectiveness of rapid smoking
The effectiveness of rapid smoking treatment has been limited due to its decreased popularity. However, McRobbie (2007) carried out a study on 100 smokers attending a cessation clinic where rapid was compared with a control condition of watching a video about giving up smoking. The rapid smoking group showed a significant decrease in their urge to smoke in the 24 hours and weeks after the procedure. At four weeks the difference between the groups was no longer significant and therefore the impact of rapid smoking on long-term abstinence remains unclear. However, reducing urges in the early stages can initiate the process, followed by the use of other techniques.
Effectiveness: Elimates the behvaiour not the problem
A key issue with behavioural therapies such as aversion therapy that they may only treat the behaviour rather than the underlying cause. The aversion the individual feels towards the specific behaviour may remain after a period of time but if there is an underlying problem that caused the addiction, such as cognitive bias, then this will not be addressed. It is even possible that the individual might simply switch the focus of their addiction to another behaviour like gambling. The research we have considered often does not address the long-term effectiveness of aversion therapy and it might be that the individual needs a therapy like CBT to address deeper issues.
Social implications: Financial implications
An article in the Telegraph newspaper (Devlin, 2008) highlighted the dramatic increase in spreading on antabuse and other drugs to treat alcoholism. in 2008 the NHS spent just under € 2.25 million on the medication, up from €1.08 million in 1998. However Alcohol Concern argued that the NHS’s financial costs are small compared to the long-term treatment and prevention of alcoholism and related issues, arguing that investing in these areas saves the NHS money and is beneficial to society.
Social implications: The social cost of not treating addictions
The No Quick Fix (Centre for Social Justice, 2013) report highlights the social costs of addiction, stating that alcohol abuse costs the taxpayer €21 billion a year. For example, addiction can lead to unemployment and may in turn lead to the individual claiming benefits. The effects of addiction on physical health will also cost the NHS money, with the report stating that the cost of alcohol use to the NHS is €3.5 billion a year. In addition to the financial costs to society, addiction also causes the breakdown of families, homelessness, debt and crime. The right treatment decisions, such as aversion therapy, are crucial as the benefits to society may outweigh any financial or ethical costs associated with it.
Ethical implications: Risk of harm
Antabuse can cause severe negative effects if consumed while on medication or alcohol, and rapid smoking can be unpleasant. However, the treatment is designed to work in this way, and individuals must give informed consent based on information provided by their doctor or pharmacist. The harmful effects of antabuse can lead to issues with compliance, as individuals may drop out of the procedure, potentially affecting the effectiveness of studies and potentially affecting the results.
Ethical implications: More ethical alternatives
Other ethical methods, such as covert sensitisation could achieve the same association and can be employed to induce feelings of illness and vomiting in individuals with a drinking urge. Kraft (2005) presents a series of case studies highlighting that, although this technique is not commonly used, it can be a quick and highly effective treatment for many individuals. It is much ethical than using a drug like antabuse to induce such an unplesant reaction.
