Addictive Behaviours - Methods of modifying behaviour: Aversion therapy Flashcards
(17 cards)
When describing this therapy, what are the 3 components to describe + what is done before the therapy
- Antabuse
- rapid smoking
- electric shocks (Faradic aversion)
- Client undergoes medical examination + health check = Ensures they’re fit and able to proceed with therapy
- Therapist works with client = educating on how it works and what is to be expected
- Therapist obtains valid consent from client to proceed. Client MUST demonstrate they understand what the therapy will involve, confirming and giving consent to proceed
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: supporting research = is effective
E: Smith et al. (1997) alcoholics treated with aversion therapy maintained higher rates of abstinence after 1 year compared to those who received counselling alone.
T: Therefore aversion therapy is more effective than other methods as this research shows the tangible benefits of improving the patient’s chances of maintaining abstinence
C: However, 1 year isn’t long enough to truly confirm abstinence will be kept. According to Pavlov’s theory of classical conditioning, when the CS (alcohol) isn’t paired with the UCS (the shock or antabuse), then the CR (abstinence) becomes extinguished. Therefore after 1 year, patients may relapse which questions how effective it really is.
Evaluate the effectiveness of aversion therapy by comparing it to alternative therapies
P: Aversion therapies like rapid smoking has the advantage of being cost-effective and less time-consuming than cognitive restructuring therapies
E: Rapid smoking typically only one-session long and lasts 30-60 mins, whilst cognitive restructuring therapies may require multiple sessions over several weeks
T: Therefore a strength as it’s suitable for those who don’t have the time or financial resources for prolonged therapy sessions, making it more accessible for patients and more freeing for the therapist due to not requiring long-term involvement.
C: Rapid smoking can be extremely damaging to health, e.g. forcing someone to smoke excessively can cause nausea, dizziness and increased heart rate. Also increases risk of cancer. Given that safer alternatives exist (like the cognitive restructuring in CBT), aversion therapy therefore may not be always an effective choice.
Evaluate the effectiveness of aversion therapy only addressing symptoms and not cause
P: treats symptoms and not underlying cause = not effective
E: The Office for Health Improvement & Disparities (OHID) UK reported that in 2022-2023, nearly half receiving treatment had problems with overlapping substance dependencies. 30% of individuals reported alcohol misuse in combination with drug misuse.
T: Therefore this is a weakness as although it may stop once addition, if underlying psychological or biological causes of addiction go untreated then the individual never becomes free of addiction. Rendering aversion therapy as only a temporary solution as the individual will just substitute their addictions with other ones, e.g. drinking becomes gambling
Evaluate the effectiveness of aversion therapy having methodological issue with attrition
P: There is a high dropout rate in research studies, leading to biased samples that lower the generalisability of findings, making aversion therapy look more effective then it actually is
E: Bancroft (1992) found 50% of patients either refused or dropped out of aversion therapy. This high dropout rate creates biased sample as those who stayed in may be more motivated and have different characteristics from those who left
T: Therefore suggests that aversion therapy isn’t appropriate for all addicts, as it requires a high level of commitment and perseverance (which addicts already struggle with due to salience meaning their addiction takes priority of their thinking). So if many of the broader populations of addicts can’t adhere to aversion therapy programmes, it therefore cannot be effective.
C: However dropout rates are common in many addiction treatment programmes, not just aversion therapy. That said, a truly effective therapy should account for the fact that patients may not be ready, and help improve their motivation to adhere 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: risk of harm caused by aversive stimuli = unethical
E: Bancroft found that 50% of patients either refused or dropped out of aversion therapy. Symptoms such as vomiting from antabuse and health complications from rapid smoking may account for this high dropout rate as the aversive stimuli may be too unpleasant to handle,
T: Therefore this is a weakness as the emotional and psychological harm experienced may be all too distressing for patients and lead to the reluctance to engage in therapy that Bancroft highlights due to the side effects. Moreover, when they drop out they could feel even more helpless that they will ever be able to change and get rid of their addiction, lowering their self-esteem and making them feel worse about themselves.
C: However, the patients do go through health checks before the therapy begins and are educated and then demonstrate what they have learnt to the therapist in order to start aversion therapy. Therefore the patients should in theory, be prepared for these negative side effects and know that it’s for their own good.
Evaluate the ethical implications of aversion therapy having issues with valid consent
P: issues with informed consent as addicts may be pressured into aversion therapy and not fully understand the risks of it = unethical
E: Billy Clegg who was treated with apomorphine in aversion therapy to “cure” his homosexuality led to him dying in a coma from convulsions. Societal pressures in 1958 USA of people being less accepting of homosexuals may have resulted in him being coerced into doing aversion therapy feeling like he deserved it.
T: Therefore, this is a weakness because of the negative stigmas that society has surrounding individuals with mental disorders like addiction could resulting in violating their autonomy through pressuring individuals into having aversion therapy and suffering the intense and potentially very dangerous side effects of aversive stimulus (that in extreme cases like Billy Clegg could get them killed).
C: However times have changed and so has stigmas. Homosexuality now isn’t viewed as a mental illness
Evaluate the ethical implications of aversion therapy having alternative forms like covert sensitisation
P: There are other alternatives of aversion therapy that are less harmful = ethical
E; Tom Kraft presented a series of case studies highlighting the success of covert sensitisation (an approach that uses images of unpleasant stimuli rather than the direct physical stimuli). This suggests that aversion therapy doesn’t have to be as invasive and can still be effective/
T: Therefore this is a strength because it suggests the principles of aversion therapy are adaptable enough that ethical alternatives can be developed that are still effective and avoid the psychological and physical risk of harm whilst also working to change behaviour.
C: However, covert sensitization may not be a robust option for all individuals as critics suggest it may require more intense treatment to see results which is time consuming and not a viable option for those without proper time and resources for multiple sessions.
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
Evaluate the social implications of aversion therapy’s increasing costs making it unrealistic to keep investing in
P: One weakness of aversion therapy is its high financial cost, both in terms of the therapy itself and the long-term costs associated with it.
E: According to Devlin (2008) in The Telegraph, the NHS spent £2.25 million on Antabuse and related medications in 2008, an increase from £1.08 million in 1998. This represents a significant financial burden for public health services.
T: Therefore the financial cost of aversion therapy, specifically medications like Antabuse, has been increasing over time and the long-term use of such treatments may not be sustainable for health services, especially in a time of budget constraints. It’s a weakness because the resources could be allocated to other, potentially more cost-effective treatments or preventative measures for addiction.
Counter: However, some argue that investing in these therapies could reduce long-term costs by preventing the broader social and economic consequences of addiction, such as healthcare costs and loss of productivity.
Evaluate the social implications of the cost to society of not investing in aversion therapy
P: Another strength of aversion therapy is its potential to address the significant social costs associated with untreated addiction.
E: The Centre for Social Justice (2013) report highlights that alcohol abuse costs the taxpayer £21 billion annually, including the costs of addiction-related health problems, unemployment, and crime. It also notes that addiction leads to social problems like homelessness, family breakdowns, and crime.
T: Therefore By potentially reducing relapse rates and improving recovery outcomes, aversion therapy could help individuals regain employment, avoid criminal behavior, and reduce strain on social services.
Counter: However, critics argue that aversion therapy may not address the underlying psychological and emotional causes of addiction, leading to higher relapse rates and, in turn, continued social costs. Moreover, the therapy’s success rate may not be guaranteed for all individuals, limiting its impact on reducing these broader social issues.
