ABSTRACT

IN recent years aversion treatment has been used predominantly in the management of sexual disorders. Formerly, however, these forms of treatment were used almost exclusively in an attempt to cure alcoholics. For various reasons, the interest in aversion treatment was relatively short-lived. Aversion treatment, particularly chemical aversion, can be an unpleasant and arduous form of therapy and this fact, coupled with the often equivocal results obtain in the treatment of alcoholics, probably contributed to its decline in popularity. Franks (1960, 1963) has drawn attention to the poor quality of much of the early work on aversion treatment for alcoholics.‘Unfortunately, not all modern practice is sound … For example, some clinicians advocate giving the alcohol after the patient reaches the height of nausea. This, of course, is backward conditioning (since the unconditioned stimulus of the apomorphine or the emetine is preceding the conditioned stimulus of the alcohol) and backward conditioning, if it occurs at all, is at best very tenuous.’ (Franks, 1963.) In any conditioning situation, the time-intervals which elapse between the presentation of the various stimuli and the response are of considerable importance and, as Franks has pointed out, aversion therapists were either ignorant of this fact, or tended to ignore it. He says that‘Under such circumstances, it is hardly surprising that reports of evaluation studies range from virtually zero success to virtually one hundred per cent success.’ Furthermore, some of the drugs which have been used to induce nausea also act as central depressants. The effect of this type of drug would be to interfere with the acquisition of the conditioned response. An additional difficulty of some importance is the confusion regarding the nature of the unpleasant response which one is attempting to attach to the sight, smell, and taste of the alcohol. In some of the earlier studies, the therapists concentrated on the actual vomiting rather than on the feeling of nausea. As Raymond (1964) has shown, however, the act of vomiting is not the important event—it is the feeling of nausea which influences the acquisition of an avoidance reaction to alcohol. The difficulties involved in chemical techniques of aversion conditioning are multiplied by the existence of individual differences in reactivity to the various nausea-producing drugs. People differ in the speed and extent of their reaction to the various drugs and, furthermore, the same person may react differently to the same quantity of drug on different days or even at different times on the same day. Individual differences in reactivity, therefore, make the planning of a carefully controlled form of conditioning treatment extremely difficult.