Aversion therapy as a psychological treatment for addiction

Quite a short topic here - like everything else on addiction, they've never really asked anything more than a 10-marker on this! Be prepared to be asked to apply this for AO2 marks - this can happen.

Black: AO1 - Description
Blue: AO2 - Evaluation - studies
Red: AO2 - Evaluation - evaluative points/IDAs
Purple: My notes/hints/tips

Aversion therapy is based on classical conditioning, eliminating the association between the addictive behaviour and pleasure, and forming a new association between the addictive behaviour and unpleasant consequences. Alcohol is often paired with an emetic to induce vomiting and to form a new association, the most commonly used emetic being disulfiram. Usually administered through a tablet or surgical implant, disulfiram prevents the body from metabolising alcohol, causing unpleasant, hangover-type effects whenever a small amount of alcohol is consumed, such as nausea, vomiting, headache, chest pains, weakness ands anxiety. A new association is formed between alcohol and the host of negative of symptoms, replacing pleasure with pain and discouraging people from taking any more alcohol.

While the negative effects such as nausea are actually desired consequences of the treatment, required in order for the association replacement to be successful, disulfiram can have several negative side effects that occur even in the absence of alcohol. These can include liver damage, drowsiness, and fatigue due to the disulfiram metabolite tryptophol, and extrapyramidal symptoms (drug-induced movement disorders) such as muscle spasms and motor irregularity.

Krampe et al (2006) found supporting evidence for the effectiveness of aversion therapy in their double blind, longitudinal study of 180 alcoholics attempting to quit, comparing a group taking disulfiram to a group taking a placebo. An abstinence rate after 9 years of at least 50% was found in the disulfiram group, far higher than that of a placebo, suggesting that drug-assisted aversion therapy is a very effective method of reducing alcoholism.

Fuller et al (1986) carried out a controlled blind study of 605 men, assigned to disulfiram, a placebo, or no treatment. There were no significant long-term differences between groups in total abstinence, social stability, or time until relapse – disulfiram was found to reduce drinking frequency after relapse, but did not make patients more likely to successfully remain abstinent – challenging the drug’s reported effectiveness as a stimulus in aversion therapy.

Jørgensen et al (2011) carried out a meta-analysis and found Disulfiram to be more effective than placebos or other treatments on rates of abstinence, days until relapse and number of drinking days, suggesting that drug-assisted aversion therapy is a very effective alcoholism reduction method. However, one limitation of the analysis was that the vast majority of the studies only studied the effectiveness of Disulfiram over a short period of time.

Tablets might be better due to psychological establishment of routine daily actions based around ending alcoholism, implants might be better due to not being removable – if people really want to relapse on tablets they can just stop taking them, and there’s no option like this with an implant.