Aversion Therapy: Definition, Techniques, Application, Limitations, and Effectiveness

Aversion therapy for addiction involves associating an addictive substance or behavior with an unpleasant or aversive stimulus, such as nausea or electric shocks, to reduce the individual’s desire for or craving for the addictive substance or behavior.

The main techniques used in aversion therapy involve pairing the undesirable behavior or substance with an aversive stimulus, such as electric shocks, nausea-inducing drugs, foul odors, or other unpleasant experiences, to create a conditioned response that discourages the individual from engaging in the target behavior.

The key limitations of aversion therapy include the temporary nature of its effects, the potential for relapse, the ethical concerns around administering aversive stimuli, the difficulty in generalizing the conditioned response to real-world situations, and the lack of evidence for its long-term efficacy compared to other addiction treatment approaches.

The effectiveness of aversion therapy for addiction treatment has been debated, with some studies suggesting short-term reductions in substance use but limited evidence for long-term abstinence or relapse prevention compared to other addiction treatment approaches.

According to a randomized controlled trial by Rohsenow et al. (1992) titled, Patient treatment matching for alcoholic patients, while aversion therapy led to short-term reductions in alcohol consumption, there were no significant differences in long-term abstinence rates between the aversion therapy group and the control group at 6-month and 12-month follow-ups.

What is Aversion Therapy for Addiction?

Aversion therapy is a behavior modification technique that reduces or eliminates unwanted behaviors by associating them with unpleasant or aversive stimuli. The goal is to create a negative conditioned response in the patient, where they come to associate the unwanted behavior with an unpleasant experience, thereby discouraging them from engaging in that behavior in the future.

The significance of aversion therapy lies in its potential to treat a range of problematic behaviors, including addictions, phobias, and other unwanted habits. The primary goal of aversion therapy is to help individuals overcome their undesirable behaviors by making them psychologically and physiologically averse to engaging in those behaviors.

The core mechanism of aversion therapy involves the systematic pairing of the unwanted behavior with an aversive stimulus. This aversive stimulus takes various forms, such as:

• Nausea-inducing drugs (emetic therapy) – The patient is administered a drug that causes nausea and vomiting when the unwanted behavior is performed or the addictive substance is consumed.
• Electrical shocks (faradic therapy) – The patient receives mild electric shocks when exposed to the unwanted behavior or trigger.
• Unpleasant odors or tastes – Foul or unpleasant sensory stimuli are introduced in conjunction with the unwanted behavior.

The repeated pairing of the unwanted behavior with the aversive stimulus is intended to create a strong negative association in the patient’s mind, ultimately reducing their desire or urge to engage in the problematic behavior.

By integrating these aversive stimuli, aversion therapy aims to help individuals overcome addictions, phobias, and other harmful habits by making the targeted behaviors psychologically and physiologically undesirable.

History and Development of Aversion Therapy

Aversion therapy has a long and complex history, with its origins tracing back to the early 20th century.

• Origins in the Early 20th Century: The foundations of aversion therapy is found in the work of Russian physiologist Ivan Pavlov in the late 19th and early 20th centuries. Pavlov’s pioneering research on classical conditioning laid the groundwork for the concept of using aversive stimuli to modify behavior.
• The 1930s and 1940s: In the 1930s, American psychologist Joseph Wolpe began experimenting with aversion therapy techniques, particularly in the treatment of phobias. Wolpe’s work laid the groundwork for the widespread adoption of aversion therapy in the decades that followed.
• The 1950s and 1960s: During the 1950s and 1960s, aversion therapy gained significant attention and widespread use, particularly in the treatment of alcohol and tobacco addictions. Influential figures such as Hans Strupp and Sargent and Flanagan conducted extensive research and published seminal works on the application of aversion therapy.
• The 1970s and 1980s: As the use of aversion therapy expanded, researchers continued to refine and explore its effectiveness. Notable figures like Nathan Azrin and Alan Marlatt made significant contributions to the understanding of the mechanisms and limitations of aversion therapy.
• The Modern Era: In the late 20th and early 21st centuries, the use of aversion therapy has evolved, with a growing emphasis on ethical considerations and the integration of aversive techniques within a broader, comprehensive treatment approach. Scholars and practitioners continue to debate the long-term efficacy and appropriate applications of aversion therapy.

Throughout its history, aversion therapy has been shaped by the work of various pioneers, researchers, and clinicians, each contributing to the understanding and development of this behavioral modification technique.

Theoretical Foundations of Aversion therapy

The theoretical foundation of aversion therapy combines classical conditioning, where a neutral stimulus is paired with an aversive stimulus to create a negative response, and operant conditioning, where the negative consequences reduce the likelihood of the behavior being repeated.

Classical Conditioning

Classical conditioning, as pioneered by Ivan Pavlov, is the core mechanism behind aversion therapy. In this process, an initially neutral stimulus (e.g., a sight, sound, or smell) is repeatedly paired with an unconditioned stimulus that elicits an unpleasant or aversive response (e.g., nausea, pain, or discomfort). 

Over time, the neutral stimulus becomes a conditioned stimulus that triggers the same aversive response, even in the absence of the unconditioned stimulus. This conditioned response is the basis for aversion therapy, as it aims to create a lasting association between the unwanted behavior and the aversive experience.

Operant Conditioning

Operant conditioning, developed by B.F. Skinner also plays a role in the theoretical foundations of aversion therapy. This theory suggests that behaviors are shaped by their consequences, with positive reinforcement increasing the likelihood of a behavior and negative reinforcement decreasing it. 

In the context of aversion therapy, the aversive stimulus is used as a form of negative reinforcement, discouraging unwanted behavior and encouraging the individual to adopt more desirable behaviors.

How Does Aversion Therapy Work for Addiction?

Aversion therapy works for addiction by creating a negative association between the addictive behavior or substance and an unpleasant stimulus, thereby reducing the desire to engage in the behavior.

1. Creating Negative Associations

The core principle of aversion therapy is to create a strong negative association between the addictive substance or behavior and an unpleasant or aversive stimulus. This is typically done through classical conditioning, where the addictive stimulus is repeatedly paired with an aversive experience, such as nausea, discomfort, or unpleasant imagery.

A study by Skinner and Aubin (2010) discusses the use of disulfiram (Antabuse) in aversion therapy for alcohol use disorder. It highlights how the medication is used to create a negative association with alcohol consumption, effectively targeting specific triggers related to drinking behavior.

2. Weakening the Reward Response

Addiction is often characterized by a heightened reward response to the addictive substance, which leads to craving and compulsive use. Aversion therapy aims to weaken this reward response by associating the addictive stimulus with an unpleasant experience, thereby reducing the individual’s desire to engage in the addictive behavior.

3. Cognitive and Behavioral Changes

Aversion therapy also facilitates cognitive and behavioral changes. As individuals experience the negative consequences of addictive behavior, they develop a stronger aversion to it, leading to a shift in their thought patterns and decision-making processes. This helps the individual develop a stronger motivation to abstain from the addictive substance or behavior.

A study by McConaghy et al. (1991) examined aversion therapy in reducing deviant sexual arousal patterns, suggesting that it is effective in certain controlled settings to modify unwanted behaviors through conditioned responses.

4. Relapse Prevention

Aversion therapy is often used as part of a comprehensive addiction treatment program, to help the individual maintain long-term abstinence. By creating a strong aversion to the addictive stimulus, aversion therapy serves as a relapse prevention tool, making it easier for the individual to resist the urge to engage in the addictive behavior, even in high-risk situations.

5. Targeting Specific Triggers

Aversion therapy is tailored to address specific triggers or cues that elicit craving and relapse. For example, in the case of alcohol addiction, aversion therapy focuses on creating a strong negative association with the sight, smell, or taste of alcohol, making it easier for the individual to avoid these triggers.

Note that aversion therapy is often used in conjunction with other evidence-based treatments, such as cognitive-behavioral therapy, medication-assisted treatment, and support groups, to achieve the best outcomes in addressing addiction.

Types of Aversion Therapy

Aversion therapy utilizes electric shocks, unpleasant tastes, medication-induced nausea, and aversive imagery and visualization. An article by  Chesser, E. S. (1976), titled, Behaviour therapy: Recent trends and current practice,  found that with aversion therapy, 50% of alcoholics abstained for at least a year, which was more successful than no treatment.

1. Electrical Shocks

Aversive electrical shocks were historically used in the treatment of various addictions and compulsive behaviors. The patient would receive an unpleasant but non-harmful electrical shock when exposed to the target stimulus (e.g., the sight or smell of an addictive substance).

• Applications: Electrical shock therapy was used to treat addictions to alcohol, smoking, and even some paraphilic disorders. However, this approach has fallen out of favor due to ethical concerns and the development of more humane and effective alternatives.
• Effectiveness: While electrical shock therapy is effective in creating a strong aversion, the long-term efficacy has been mixed. The treatment is also associated with significant ethical concerns and potential for abuse, leading to its decreased use in modern practice.

The American Psychological Association (APA) Task Force on the Use of Aversive Techniques with Persons with Disabilities, published a report in 1990 strongly condemning the use of aversive techniques, including electrical shocks, citing significant ethical and human rights violations.

2. Unpleasant Tastes

Incorporating unpleasant tastes is a common aversive technique used in the treatment of addictions, particularly alcohol and substance abuse.

• Applications: In the treatment of alcoholism, the drug disulfiram (Antabuse) is often used. Disulfiram causes a severely unpleasant reaction, including nausea, vomiting, and flushing, when the patient consumes alcohol. This creates a strong aversion to alcohol consumption.
• Effectiveness: Antabuse-based aversion therapy has shown moderate success in reducing alcohol consumption and maintaining abstinence, particularly when combined with other therapeutic approaches. However, the long-term effectiveness is limited, as patients discontinue the medication or find ways to circumvent the aversive reaction.

3. Medication-Induced Nausea

Some aversion therapy techniques involve the use of medications or substances that induce nausea or vomiting when the patient is exposed to the target stimulus.

• Applications: In the treatment of alcohol addiction, medications like emetine or apomorphine is used to induce nausea and vomiting when the patient is exposed to the sight, smell, or taste of alcohol. This creates a strong aversive response to alcohol consumption.
• Effectiveness: Medication-induced nausea aversion therapy has been used with varying degrees of success in the treatment of alcohol and substance abuse. While it is effective in the short term, the long-term durability of the aversion and the potential for relapse remain concerns.

4. Aversive Imagery and Visualization

This approach involves exposing the patient to disturbing or unpleasant imagery or visualizations associated with the target behavior.

• Applications: Aversive imagery has been used in the treatment of addictions, paraphilic disorders, and other compulsive behaviors. Patients are exposed to graphic or disturbing images related to the consequences of their actions or the negative impact on their lives and loved ones.
• Effectiveness: Aversive imagery is a powerful tool in creating a strong emotional and physiological response to the target behavior. When combined with cognitive-behavioral techniques, this approach has shown promising results in promoting behavior change and relapse prevention.

What are the Key Techniques Used in Aversion Therapy?

Aversion therapy uses various techniques to create an unpleasant association with unwanted behaviors. Two prominent methods are emetic therapy and faradic aversion therapy.

1. Emetic Therapy

Emetic therapy involves the use of substances that induce nausea and vomiting to create an aversive reaction to the undesired behavior. This technique is often used to treat substance abuse disorders, such as alcoholism.

Example and Evidence:

• Disulfiram (Antabuse): A common drug used in emetic therapy for alcohol dependence. When alcohol is consumed after taking disulfiram, it causes severe nausea, vomiting, and other unpleasant symptoms.
• Research Study: A study by Fuller and Roth (1979) examined the efficacy of disulfiram in the treatment of alcohol dependence. The study found that patients who adhered to disulfiram therapy had significantly lower rates of relapse compared to those who did not take the medication​.
• Review Article: A Cochrane review by Skinner et al. (2014) concluded that disulfiram is effective in promoting abstinence from alcohol, particularly when adherence is monitored.

2. Faradic Aversion Therapy

Faradic aversion therapy uses electric shocks to create an unpleasant experience when engaging in the undesired behavior. This method is commonly used for treating various behavioral disorders, including self-harm and certain sexual deviations.

Example and Evidence:

• Electric Shock: Mild electric shocks are administered when the patient engages in the target behavior.
• Research Study: A study by McConaghy (1981) on the treatment of homosexual behavior using faradic aversion therapy showed a reduction in the behavior in some patients. However, the study also highlighted ethical concerns and the potential for adverse psychological effects.
• Behavioral Interventions: Another study by Azrin et al. (1973) investigated the use of electric shock to reduce self-injurious behavior in individuals with intellectual disabilities. The study found significant reductions in self-harming behaviors, supporting the effectiveness of faradic aversion therapy.

What are the Limitations of Aversion Therapy?

The key limitations and drawbacks to the use of aversion therapy are ethical concerns, lack of long-term effectiveness, latrogenic effects, potential for abuse, lack of skilll development and wrong fit with real situations, which is why it has fallen out of favor in modern clinical practice.

1. Ethical Concerns

Aversion therapy often involves the use of highly unpleasant or painful stimuli, such as electric shocks, nausea-inducing drugs, or other aversive techniques. This raises major ethical concerns about the violation of patient autonomy, and human rights, and the potential for psychological trauma.

A 2009 systematic review in the Journal of Consulting and Clinical Psychology examined the ethics of using aversive techniques and concluded they “violate the basic ethical principles of respect for persons, beneficence, and justice.” (Lilienfeld, 2009).

2. Lack of Long-Term Effectiveness

Research has shown that the benefits of aversion therapy are short-lived. Patients will temporarily avoid the target behavior, but the effects often do not persist over time. Relapse rates are high compared to more comprehensive, positive therapeutic approaches.

A 1993 meta-analysis in the Journal of Consulting and Clinical Psychology found high relapse rates with aversion therapy for addictions compared to other treatments. (Hester & Miller, 1993).

3. Potential for Abuse and Misuse

There are concerns that aversion therapy is applied in coercive or abusive ways, especially when used without full informed consent. This power differential has potentials to be exploited, leading to further harm.

4. Iatrogenic Effects

Aversion therapy inadvertently causes additional mental health issues, such as increased anxiety, depression, or post-traumatic stress, which undermine the overall therapeutic process.

5. Difficulty Generalizing to Real-World Situations

A 1978 review in Behavior Therapy noted the limited real-world applicability of aversion therapy techniques. (Bandura, 1978). The highly controlled, artificial settings of aversion therapy do not translate well to the complex, unpredictable realities of everyday life where the target behaviors occur.

6. Lack of Skill Development

Aversion therapy primarily focuses on suppressing or avoiding undesirable behaviors, rather than teaching patients the essential skills and coping mechanisms needed for long-term, self-directed behavior change.

7. Ethical Dilemmas for Clinicians

The use of aversive techniques create significant moral and ethical conflicts for clinicians, who are compelled to prioritize the short-term reduction of symptoms over the long-term well-being and autonomy of their patients.

In summary, the substantial ethical concerns, limited long-term efficacy, and potential for harm or abuse have led the mental health field to largely abandon aversion therapy in favor of more humane, evidence-based, and person-centered approaches to treatment.

What Should I Expect in an Aversion Therapy Session?

An aversion therapy sessions begins with an initial assessment by your therapist, seeking consent and explaining the process to you. It progresses into conditioning sessions, monitoring, and adjustments, and ends with followups to ensure complete healing.

• Initial Assessment: The therapist conducts a comprehensive interview to understand the client’s history, the behavior to be modified, and any underlying issues. This helps in developing a personalized treatment plan.
• Explanation and Consent: The therapist explains the aversion therapy process, including the techniques, potential side effects, and expected outcomes. The client is informed about ethical considerations and gives their consent to proceed.
• Conditioning Sessions: The core of aversion therapy involves creating an unpleasant association with the undesired behavior. This includes the use of emetic drugs that induce nausea (e.g., disulfiram for alcohol dependence) or mild electric shocks (faradic aversion therapy) when the behavior is performed. In some cases, imaginal aversion, where clients vividly imagine the unpleasant consequences of the behavior, is used.
• Monitoring and Adjustment: Progress is regularly monitored through check-ins with the therapist, who assesses effectiveness and adjusts the treatment plan as necessary to ensure the desired behavior change is achieved.
• Follow-Up and Maintenance: Post-treatment, clients continue therapy at a reduced frequency and engage in additional supportive therapies, such as cognitive-behavioral therapy (CBT), to maintain behavior change and prevent relapse.

How Long Does Aversion Therapy Take?

Research indicates that the results of  aversion therapy start to appear after approximately four sessions. However, the effectiveness and duration of aversion therapy largely depend on the specific methods and aversive conditions used, as well as the client’s continued practice of relapse prevention after therapy concludes. 

A study in the 1950s by C.G. Costello observed a decline in abstinence rates over time, with participants maintaining reduced alcohol consumption for 30 to 90 days post-treatment, but the success rates diminished after the therapy ended​.

What are the Main Ethical Concerns with Aversion Therapy?

The use of aversive techniques in therapy has been widely condemned due to the potential for psychological harm, violation of patient autonomy and dignity, and lack of evidence for long-term effectiveness. Many professional organizations have issued statements opposing the use of aversion therapy.

What are Some Alternative, Ethical Treatments for Behavioral Issues?

Cognitive-behavioral therapy, acceptance and commitment therapy, motivational interviewing, and other humanistic approaches have demonstrated effectiveness in treating a range of behavioral and mental health concerns without the use of aversive techniques. 

Who should avoid aversion therapy?

Individuals who should avoid aversion therapy include those with high anxiety, certain medical conditions that could be exacerbated by the aversive stimuli, and individuals who have ethical or psychological concerns about the use of unpleasant or painful stimuli in therapy. 

People who have a history of trauma or who might be negatively impacted by the distress caused during aversion therapy sessions also need to avoid this form of treatment. You must consult a healthcare professional to determine the suitability of aversion therapy for specific cases.

Is aversion therapy still widely used?

Aversion therapy is no longer widely used, as its use has diminished due to ethical concerns, potential harm to individuals undergoing the therapy, and the availability of more effective and humane treatment approaches. Today, behavioral therapies such as cognitive-behavioral therapy (CBT) and exposure therapy are preferred for treating various conditions.

How does aversion therapy compare to other addiction treatments?

Aversion therapy often involves pairing an addictive behavior with an unpleasant stimulus to create a negative association. This approach contrasts with meditation for addiction, which focuses on mindfulness and stress reduction techniques to manage cravings and improve overall mental health. According to Verywell Mind, aversion therapy has shown mixed results in terms of long-term effectiveness, with many patients experiencing short-term benefits but often relapsing after the therapy ends.

In comparison, brief intervention approaches emphasize motivational interviewing and goal-setting, which can be more sustainable and less invasive. These methods help individuals identify the reasons behind their addictive behaviors and develop strategies to change them. The evidence suggests that combining aversion therapy with these other techniques can sometimes enhance outcomes by addressing both the psychological and behavioral aspects of addiction.