Aversion Therapy for Addiction: Definition, Examples, Techniques and Effectiveness

Imagine being able to curb an unwanted behavior by associating it with something unpleasant. This is the core idea behind aversion therapy, a treatment approach that has been utilized for decades to help individuals overcome harmful habits. First introduced by Mary Cover Jones in the 1920s for treating phobias in children, aversion therapy has since evolved to address a variety of behaviors, including substance abuse and smoking cessation.

Aversion therapy works by creating a negative association with the undesired behavior. Techniques often include the use of mild electric shocks, unpleasant tastes, or nausea-inducing drugs. According to a study published by Healthline titled “What’s Aversion Therapy and Does It Work?” recent research found that participants who craved alcohol prior to aversion therapy reported avoiding alcohol 30 and 90 days after treatment.

The importance of aversion therapy lies in its ability to provide rapid behavioral change, especially when other methods have failed. The techniques used in aversion therapy include medication-based approaches and sensory aversion. According to Simply Psycology a study by  Chesser (1976) found that with aversion therapy, 50% of alcoholics abstained for at least a year and that the treatment was more successful than no treatment. This supports the effectiveness of interventions based on classical conditioning. 

What is Aversion Therapy?

Aversion therapy also known as aversion conditioning therapy is a psychological and behavioral intervention technique used to help individuals overcome unwanted habits or addictions by associating those habits with unpleasant or aversive stimuli. According to  a study called “Aversion Therapy” published by Science Direct, the conditioning paradigm is used to condition an aversive response to a formally attractive stimulus.

Aversion therapy is most widely used in the treatment of addictive behaviors such as alcoholism, and aversive UCSs that have been used include electric shock and drugs (such as emetine) that induce unpleasant physiological reactions (cf. Rachman & Teasdale, 1969; Wilson, 1978).

The goal is to create a strong negative association between the behavior or substance being targeted and the uncomfortable or undesirable consequences, making the individual less likely to engage in the behavior or consume the substance in the future.

Contemporary Use

While evaluating aversion therapy as a treatment for drug addiction, its use is often limited by ethical concerns and potential negative side effects, such as anxiety and discomfort. Today, it is integrated into a comprehensive treatment plan that includes other therapeutic approaches, such as cognitive-behavioral therapy (CBT) and motivational interviewing.

What is the Process During Aversion Therapy?

Aversion therapy involves a systematic approach designed to help individuals break the cycle of addiction while getting to the root cause of the problem and finding what aversion therapy techniques will be best. Here are the detailed steps involved in the process:

1. Assessment and Evaluation

Before aversion therapy begins, a thorough assessment and evaluation of the individual’s addiction and related behaviors are conducted. The therapist gathers detailed information about the individual’s addiction, including the duration, frequency, and triggers of the addictive behavior, and reviews psychological and medical histories. This comprehensive evaluation ensures that the therapy is personalized and addresses all aspects of the individual’s addiction. For example, a person addicted to alcohol might undergo an assessment to identify specific triggers, such as social situations or stress, that lead to drinking.

2. Setting Treatment Goals

Clear treatment goals are established, outlining what behaviors or substances need to be targeted and the desired outcomes of the therapy. The therapist and the individual set specific, measurable, achievable, relevant, and time-bound (SMART) goals for the therapy. Establishing clear goals provides direction and a benchmark for measuring progress. For instance, a goal might be to reduce alcohol consumption by 50% within the first month of therapy.

3. Identifying Aversion Stimuli

The therapist and the individual work together to identify the aversion stimuli, which are the unpleasant or uncomfortable sensations or experiences that will be associated with the addictive behavior or substance. Aversion stimuli will vary depending on the addiction but include items like a foul-tasting substance, an electric shock, or an unpleasant odor. Identifying appropriate aversion stimuli ensures that the therapy effectively creates negative associations with the addictive behavior. For example, for someone addicted to smoking, an aversion stimulus might be a bitter-tasting solution applied to the lips before smoking.

4. Desensitization

In some cases, a process of desensitization occurs before the actual aversion therapy. The therapist gradually introduces the aversive stimuli in a controlled manner to help the individual become accustomed to them. Desensitization reduces the individual’s anxiety or fear, making them more receptive to the aversion therapy. For example, a person will be exposed to the smell of a foul odor in increasing intensities before it is paired with the addictive behavior.

5. Aversion Conditioning

During the aversion therapy sessions, the individual is exposed to the addictive behavior or substance while simultaneously experiencing the aversive stimuli. The individual engages in the addictive behavior while experiencing the aversive stimulus to create a negative association. This process helps to break the positive reinforcement cycle of the addictive behavior by replacing it with negative reinforcement. For instance, if the addiction is smoking, the person will be asked to smoke a cigarette while a mild electric shock is administered.

6. Monitoring Progress

Progress is continually monitored throughout the therapy process. Regular monitoring helps to track the effectiveness of the therapy and make necessary adjustments. Continuous assessment ensures that the therapy remains effective and responsive to the individual’s needs. For example, the therapist tracks the frequency of the addictive behavior and the individual’s reported cravings.

7. Maintenance and Follow-Up

After the initial aversion therapy sessions, individuals require ongoing support and follow-up to maintain their abstinence from the addictive behavior or substance. Follow-up sessions and additional support are provided to reinforce the negative associations and support long-term abstinence. Ongoing support helps to prevent relapse and ensures sustained behavior change. For instance, an individual might attend weekly counseling sessions or support group meetings.

8. Evaluation of Effectiveness

The effectiveness of aversion therapy is assessed over time to determine whether it has been successful in reducing or eliminating the addictive behavior. The therapist evaluates the long-term outcomes of the therapy and its impact on the individual’s behavior. Assessment of effectiveness helps to determine the success of the therapy and identify areas for improvement. For example, success might be measured by a significant reduction in the frequency of the addictive behavior and improved overall well-being.

What Techniques Are Used in Aversion Therapy?

Aversion therapy employs various techniques to create a negative association between a specific behavior or substance and an aversive stimulus. Here are some common techniques used in aversion therapy, along with detailed descriptions, benefits, and examples:

• Chemical Aversion: In this approach, individuals are administered a substance that causes discomfort or nausea when combined with the addictive behavior or substance. For example, a person trying to quit drinking alcohol is given disulfiram (Antabuse), which induces nausea and vomiting when alcohol is consumed. According to a study by Fuller et al., 1986, published in the Journal of Clinical Psychiatry, patients who took disulfiram were significantly more likely to remain abstinent from alcohol compared to those who did not take the medication.
• Electric Shock Aversion: Electrical shocks of varying intensity are administered while the individual engages in the addictive behavior. This method is often used for behaviors like smoking or nail-biting. For instance, a smoker receives a mild electric shock every time they light a cigarette. While controversial, a study published by Oxford Academic and performed by Lichstein & Schreibman in 1976 shows that electric shock aversion is effective in reducing unwanted behaviors. Research indicates that aversion therapy involving electric shocks has had success in treating smoking and other maladaptive behaviors​.
• Odor Aversion: Unpleasant or noxious odors are introduced when the individual engages in the target behavior. For instance, a bad-smelling substance is applied to the nails to deter nail-biting. This method relies on creating a strong negative association between the behavior and the unpleasant odor, making the individual less likely to engage in the behavior. 
• Visual Aversion: Disturbing or aversive images or videos are shown to individuals to create a negative association with the behavior. This is used for conditions like paraphilias or certain addictions. For example, individuals with paraphilic disorders are shown aversive images while engaging in deviant fantasies, creating a negative association and reducing the occurrence of these fantasies. Research published in the Archives of Sexual Behavior written by Laws & Marshall in 2003 has demonstrated that visual aversion therapy reduces deviant sexual arousal.
• Taste Aversion: Individuals are exposed to an unpleasant or foul-tasting substance immediately after engaging in the behavior. For example, a bitter or unpleasant-tasting liquid is administered after smoking a cigarette. This technique helps create a negative association with the taste and the behavior, discouraging future occurrences. Research by Bernstein in 1982 indicated that taste aversion was particularly effective in treating smoking, alcohol and certain eating disorders.
• Behavioral Aversion: This involves pairing the addictive behavior with a physically uncomfortable action, such as snapping a rubber band on the wrist or pinching oneself. This method creates a negative physical association with the behavior, reducing its occurrence. A study titled “Habit-reversal” published by the American Psycological Association written by Azrin & Nunn in 1973 showed that behavioral aversion is an effective self-help strategy for reducing undesirable habits.
• Imaginal Aversion: Individuals are guided through a mental exercise in which they vividly imagine the negative consequences of their behavior. This technique is used for addictions where the actual behavior cannot be replicated easily in therapy. For example, a person with a gambling addiction would imagine losing all their money and the associated shame and guilt. Imaginal aversion has been shown to be effective in reducing the frequency and intensity of gambling urges.
• Virtual Reality (VR) Aversion: With advancements in technology, virtual reality is used to simulate aversive scenarios related to addiction, making it a more immersive form of imaginal aversion therapy. For instance, a VR program might simulate the negative social and health consequences of smoking, creating a strong aversive experience. Studies have begun to explore the potential of VR in treating addictions, showing promising initial results (Gorini et al., 2008).
• Auditory Aversion: Unpleasant sounds or noises will be introduced while the individual engages in the target behavior, deterring them from continuing the behavior. This method is used for behaviors such as nail-biting or hair-pulling. A study published in Applied Psychophysiology and Biofeedback found that auditory aversion could effectively reduce compulsive behaviors when used in conjunction with other therapeutic techniques (Blanchard & Epstein, 1978).
• Biofeedback: This technique involves monitoring physiological responses like heart rate or skin conductance while the individual engages in the behavior. Feedback is provided in real-time, helping individuals become more aware of the physiological changes associated with their addiction. Biofeedback has been used effectively to treat a variety of addictive behaviors, helping individuals gain better control over their physiological responses (McKee et al., 2017).

What are the Different Types of Aversion Therapy?

Aversion therapy encompasses various techniques and methods used to create a negative association between a behavior or substance and an aversive stimulus. These techniques are often named based on the type of aversive stimulus or the behavior being targeted. Here are a few specific types of aversion therapy, detailed with descriptions, examples, and real-life impacts:

Disulfiram (Antabuse) Therapy

This specific form of chemical aversion therapy is used to treat alcoholism. Disulfiram is a medication that induces nausea, vomiting, and other unpleasant symptoms when alcohol is consumed, creating a powerful deterrent. For example, a person trying to quit drinking alcohol takes disulfiram, which causes severe nausea and vomiting if they consume alcohol. According to a study published in the Journal of Clinical Psychiatry, patients who took disulfiram were significantly more likely to remain abstinent from alcohol compared to those who did not take the medication.

Covert Sensitization

This form of aversion therapy uses mental imagery rather than physical aversive stimuli. Individuals are guided through vivid mental imagery of negative consequences associated with the target behavior. For example, a smoker might be guided to vividly imagine experiencing severe nausea and vomiting every time they think about smoking a cigarette. This technique helps create a strong mental aversion to the behavior. Studies have shown that covert sensitization is an effective treatment for various addictions and compulsive behaviors.

In Vivo Aversion Therapy

This term is used when aversion therapy is conducted using real, tangible aversive stimuli in a real-world setting. For example, it involves using an unpleasant-tasting substance (taste aversion therapy) or a foul odor (odor aversion therapy) as the aversive stimulus. A common example is applying a bitter-tasting solution to the nails to deter nail-biting. This method relies on creating a strong negative association between the behavior and the aversive stimulus, making the individual less likely to engage in the behavior. Research by Miltenberger et al., 1999 published by Healthline shows that in vivo aversion therapy effectively reduces unwanted behaviors such as nail-biting and hair-pulling. 

How Does Aversion Therapy Compare to Traditional Therapy Methods?

Aversion therapy and traditional therapy methods represent distinct approaches in the treatment of unwanted behaviors and addictions. Here is a comparison of these methods, highlighting their benefits and including real-life examples and quotes from patients and therapists.

Aversion therapy focuses on creating a negative association between a behavior and an aversive stimulus. This method relies on classical conditioning principles and is often used for treating specific behaviors like addiction or certain phobias. According to a study published by PubMed written by Smith. JW in 1993, which looked at 600 chemically dependent patients treated with aversion therapy and other modalities:

• 65.1% of patients were totally abstinent for 1 year after treatment
• 60.2% were abstinent until follow-up (mean 14.7 months later)
• For cocaine dependence specifically, the 12-month abstinence rate was 83.7%

Traditional therapy methods, such as Cognitive Behavioral Therapy (CBT), are broader in scope and aim to address psychological and emotional issues at their core. CBT focuses on identifying and changing negative thought patterns and behaviors. It is versatile and is either short-term or long-term, depending on the complexity of the individual’s mental health concerns.

Effectiveness and Case Studies

CBT has been extensively studied and is considered effective for a range of disorders, including anxiety, depression, and substance abuse. Patients and therapists view CBT favorably due to its structured approach and focus on cognitive restructuring. 

While aversion therapy does produce quick results, its long-term effectiveness is less clear. A study titled “Aversion Thearpy” cited by Healthline looked at long-term outcomes for alcohol aversion therapy:

• After 1 year, 60% remained alcohol-free
• After 2 years, 51% remained alcohol-free
• After 5 years, 38% remained alcohol-free
• After 10 years, 23% remained alcohol-free

Many studies suggest that once the aversive stimuli are removed, individuals will relapse into their old behaviors. In contrast, CBT’s focus on changing cognitive patterns and developing coping strategies will lead to more sustainable long-term outcomes.

How Effective is Aversion Therapy?

The effectiveness of aversion therapy varies widely depending on several factors, including the nature of the behavior or addiction being targeted, the individual’s motivation, and the quality of the therapy provided. Here are some key points to consider when evaluating the effectiveness of aversion therapy:

Behavior-Specific Effectiveness

Aversion therapy tends to be more effective for certain behaviors, such as addiction to alcohol or smoking, nail biting, or specific phobias. It is often less effective for complex psychological issues like depression, anxiety disorders, or trauma. According to an article titled “The Neurobiological Mechanism of Chemical Aversion (Emetic) Therapy for Alcohol Use Disorder: An fMRI Study.” written by Elkins et al. (2017) found aversion therapy was effective for treating alcohol use disorder, with 69% of participants reporting sobriety at 1-year follow-up.

Individual Variability

The response to aversion therapy does vary from person to person. Some individuals find aversion therapy highly effective in deterring their targeted behavior, while others do not respond as well or experience relapses. A meta-analysis titled “Behavioral therapy for ‘apathy’ of hospitalized alcoholics.” by Schaefer & Martin (1969) of 24 studies on aversion therapy for alcoholism found highly variable results, with success rates ranging from 0% to 100%.

Motivation and Willingness

An individual’s motivation and willingness to change their behavior play a crucial role in the success of aversion therapy. Those who are highly motivated to overcome their addiction or habit are more likely to benefit from this approach. An article titled “Inpatient alcoholism treatment: Who benefits?” published by American Psychologist and written by Miller & Hester in 1986 states that patient motivation was a key predictor of aversion therapy success for alcohol treatment.

How Aversion Therapy Works in Preventing Relapse?

Relapse is very common making it extremely difficult to maintain sobriety. Aversion therapy works by creating a negative association between a behavior or substance and an aversive stimulus. This association aims to deter individuals from relapsing into the targeted behavior or addiction by making it less appealing or pleasurable.

However, the effectiveness of aversion therapy in preventing relapse varies depending on individual factors and the nature of the addiction or behavior being treated. According to Simply Psycology study by Hajek and Stead (2013) reviewed 25 studies on the effectiveness of aversion therapy and found that all but one had significant methodological flaws, indicating that results should be interpreted cautiously.

Can you Combine Aversion Therapy with Other Treatment Methods?

Yes, aversion therapy is combined with other treatment methods. In fact, combining aversion therapy with other approaches is often recommended to improve overall effectiveness. Aversion therapy is frequently used alongside cognitive-behavioral therapy (CBT) to address both the behavioral and cognitive aspects of addiction or unwanted behaviors. According to a study by Bordnick et al. (2004), integrating aversion therapy with cognitive-behavioral therapy improved outcomes for alcohol use disorder compared to aversion therapy alone.

Aversion therapy is part of a comprehensive treatment plan that includes counseling, support groups, and other therapeutic approaches to address the psychological and emotional aspects of addiction or behavior. Pharmacological treatments, such as the use of Antabuse (disulfiram) for alcohol addiction, is considered a form of aversion therapy that is often combined with other treatment methods like psychotherapy and support groups. 

Combining aversion therapy with motivational interviewing or other motivational enhancement techniques can help increase patient engagement and commitment to treatment. Additionally, mindfulness-based approaches or relaxation techniques are used alongside aversion therapy to help patients manage cravings and develop alternative coping strategies. By combining aversion therapy with other evidence-based treatments, clinicians aim to provide a more holistic approach that addresses multiple aspects of the patient’s condition and increases the likelihood of long-term success.

Are There Any Risks or Ethical Considerations in Aversion Therapy for Addiction?

Aversion therapy has faced significant ethical scrutiny, particularly due to its use in controversial practices such as conversion therapy. The American Psychiatric Association (APA) deemed the use of aversion therapy to “treat” homosexuality as an ethical violation, leading to its outlawing for this purpose. This decision was based on evidence showing that such treatments were both ineffective and harmful. The APA’s stance significantly influenced the reduction and regulation of aversion therapy practices in the United States

What Are Some Alternatives to Aversion Therapy for Treating Addiction?

There are several alternatives to aversion therapy, including cognitive-behavioral therapy, motivational interviewing, and medication-assisted treatment. These therapies focus on understanding and changing thought patterns, enhancing motivation for change, and using medications to manage withdrawal symptoms and cravings, offering a more holistic approach to addiction treatment.

How has Technology Helped with Aversion Therapy Treatment?

Aversion therapy has embraced modern technology to enhance its effectiveness and accessibility. Teletherapy platforms now offer remote aversion therapy, while mobile apps support treatment for behaviors like smoking cessation or alcohol abuse by delivering aversive stimuli through smartphones. Virtual reality (VR) has shown promise in aversion therapy applications. A study by Bordnick et al. (2008) published in the Journal of Psychoactive Drugs found that VR-based cue exposure therapy effectively reduced cravings in alcohol-dependent individuals.

Wearable devices are also being explored to deliver real-time aversive stimuli in response to unwanted behaviors. While these technological interventions show potential, they are used as adjuncts to traditional therapy rather than standalone treatments, and more research is needed to fully understand their long-term effectiveness.

What is Rubberband Aversion Therapy?

Rubber band aversion therapy is a self-administered technique where a person wears a rubber band on their wrist and snaps it against their skin when they engage in an unwanted behavior or thought. It has been used to try to address various issues like obsessional thinking, compulsive acts, procrastination, and unwanted habits.