Aversion Therapy: How It Works & What to Expect

What Is Aversion Therapy?

Aversion therapy uses negative physical and emotional associations to encourage behavior change. By pairing a problem behavior with something that creates physical or emotional discomfort, the positive association with the behavior is broken and a new, negative association is developed. This process is also referred to as “counterconditioning,” and is designed to encourage behavior change.¹

Aversion therapy is an umbrella term that actually includes a variety of different treatment methods. Some of these have more evidence to support their use and are more commonly used. For example, the use of pharmacological aversion treatments like Antabuse for alcoholism or orlistat for obesity are much more common than methods using electrical shock or sensory methods.

Aversion Therapy & Behaviorism

Aversion therapy operates off of the principles of behaviorism, which encourages positive behaviors through rewards and discourages unwanted behaviors through punishments. Essentially, behaviorism is based on the idea that human behavior is motivated by natural urges to seek pleasure and avoid pain. Counterconditioning involves pairing behaviors or behavioral cues with painful, unpleasant or uncomfortable experiences to encourage future avoidance.³

When Is Aversion Therapy Used?

Aversion therapy is typically used to interrupt addictive patterns. Drugs and certain compulsive behaviors like sex, gambling, or stealing are believed to activate reward centers in the brain, causing the release of dopamine and causing a pleasurable “high.” Over time, repeating the behavior causes reward or “addiction” pathways to form in the brain, resulting in strong urges to repeat the behavior and making it much harder to stop. Aversion therapy aims to reverse this process by interrupting the reward process and punishing the behavior to create a negative association.^1,4,5

In recent years, aversion therapy techniques are most commonly used to treat:^3,6

• Drug and alcohol addiction
• Overeating and obesity
• Tobacco or nicotine use
• Compulsive gambling

Less commonly, aversion therapy has a history of being used to treat:^2,3

• Self-harming behavior (i.e. cutting)
• Nail biting or thumb sucking
• Trichotillomania (hair pulling)
• Excoriation (skin picking)
• Problem sexual behaviors

Aversion therapy is usually recommended only when other frontline treatments have been ineffective or when there are other factors complicating treatment. For example, aversion therapy has been used to help reduce self-harming and compulsive sexual behaviors in people who have an underlying brain injury or developmental disorder.^2,4 Someone with a history of serious drug use and multiple failed treatments is more likely to be recommended for aversion therapy than a person seeking treatment for the first time.

Types of Aversion Therapy

Aversion therapy may have some success inhibiting certain unwanted behaviors or urges. However, it’s advised that professionals use sound clinical judgment when employing different aversion techniques, and to preferably combine this form of therapy with other therapeutic interventions.²

Types of aversion therapy include:

• Medication-based aversion therapy: In certain cases, some people are prescribed medication to help them with concerns related to mental health, weight loss, or smoking cessation.^2,3,7
• Chemically-based aversion therapy: Typically used for issues regarding alcohol misuse, this method aims to reduce the person’s craving for alcohol through a chemically-induced nausea.^8,9
• Sensory aversion therapy: This primarily focuses on the senses to trigger an uncomfortable physical or emotional response, like taking something that feels, tastes, or smells unpleasant to create the aversion.^2,3,8,9
• Electrical aversion therapy: Involves instantly applying an electrical shock after an undesirable urge/behavior. This technique is rarely employed, but it may be clinically necessary to treat severe dangerous behaviors, like harm to self or others or severe sexual deviance.¹¹

Aversion Therapy Examples

Aversion therapy has been a controversial treatment and there were many documented instances where its use was unethical and even inhumane. Because of this complicated history, aversion therapy is often misunderstood. However, certain methods involving aversion therapy can be applied ethically and may be used in specific situations.

The following are examples of aversion therapy as it is most commonly used today:

Aversion Therapy for Smoking

‌Aversion therapy for smoking cessation may be employed in different ways. One study compared aversion therapy using onion-powdered cigarettes to quit smoking versus nicotine replacement therapy and traditional behavioral therapy. It was concluded that providing regular behavioral interventions together with aversion therapy and nicotine replacement treatment can be a simple method that’s easy to apply, practical, cost-efficient, and could help in smoking cessation.^2,16

Another technique entails the person smoking cigarettes back-to-back at a fast pace (chain smoking) until they cannot tolerate it any longer. However, this intervention appeared to only provide short-term results and it is no longer used for smoking cessation.³

Aversion Therapy for Alcohol Use Disorder

The FDA-approved medication disulfiram (or Antabuse) is often prescribed to people with alcohol use disorders. Disulfiram is a medication that, when taken daily, causes an adverse response to alcohol by blocking enzymes in the liver. When people on this medication drink alcohol, they will develop uncomfortable symptoms like nausea and vomiting, headaches, changes in blood pressure, sweating, anxiety, and trouble breathing. Some people choose to take the medication to help safeguard against a relapse.^8,9

Aversion Therapy for Obesity

Another FDA-approved medication used as a form of aversion therapy for obesity is the drug orlistat (brand names are Xenical and Alli). Orlistat reduces the amount of fat metabolized by the body by approximately 30% but the side effects of the drug are what classify it as a form of aversion therapy. When a person taking orlistat eats foods that are high in fat, they will experience diarrhea, gas, and even an inability to control the bowels. These unpleasant and embarrassing side effects are intentionally designed to create a negative association with eating fatty foods.⁷

Aversion Therapy for Nail Biting

Aversion therapy for nail biting is also relatively common. This technique is usually accomplished by painting the nails with a bitter substance like neem oil or a formula using a spicy ingredient like cayenne pepper. This at-home technique can be accomplished using products easily bought online or at a drugstore, and has two main functions: The first function is to help nail biters become more aware of the behavior and the second is to create a negative taste association.¹¹

Is Aversion Therapy Effective?

Brain imaging studies have provided evidence that counterconditioning does interrupt reward activity, suggesting that it can be effective in counteracting addiction pathways in the brain.⁵ It is also well documented that aversion therapy can reduce cravings—but what is less clear is whether these results are lasting, as research on the topic has been mixed.^4,12 Many of the medications used in aversion therapy will not have lasting impact. So if a patient decides to stop taking the prescription there will no longer be the negative “consequences” to the behavior being addressed.

More current research on aversion therapy has proven it can be effective in treating the following issues:^1,3,4,5,6

• Addictions to alcohol, cocaine, methamphetamines
• Obesity and weight loss (Orlistat)
• Self-harming behaviors (i.e. cutting)
• Nail biting
• Compulsive gambling

Insufficient research exists on the use of aversion therapy for the following issues:^2,3

• Excoriation disorder (skin picking)
• Trichotillomania (hair pulling)
• Sexually compulsive behaviors (pedophilia, exhibitionism)
• Smoking cessation (specifically aversive smoking which involves rapid chain smoking)
• Compulsive gambling

Controversy & Criticism of Aversion Therapy

Today, there are many ethical codes, laws, and safeguards that protect people seeking treatment for a physical or psychological problem. Unfortunately, this was not always the case. Aversion therapy has been used in dangerous ways in the past, and electric shock treatment was employed unethically.

Ethical Issues

Much of the controversy surrounding aversion therapy stemmed from experimental psychological treatments done in the ’50s, ’60s, and ’70s. At this time, electric shock treatment was the most commonly used technique, and unlike modern methods of electrical treatment, was painful and inhumane.² Because of the controversy surrounding these techniques, aversion therapy was rarely used between the years of 1980-2000, and has only recently reemerged as a viable treatment option for addiction, lifestyle, and behavioral disorders. Still, some continue to raise ethical concerns about certain aversion techniques like the use of electrical shocks.

Shorter-Term Results

There is also some research which suggests that counterconditioning in aversion therapy provides only short-term results as opposed to the more lasting results seen in other types of treatment.¹²

Lacking Rigorous Scientific Evidence

Studies on the usefulness of aversion therapy are often inconclusive, and there really isn’t robust scientific evidence to support its efficacy. Much of the research that has been done over the years has only shown mixed or minimal results at best, and in some cases, there is lack of evidence showing that aversive therapy is effective at all.^10,13

Increased Anxiety in Some People

Aversive therapy, particularly when it involves using electrical shocks, can cause some individuals to experience a spike in anxiety levels or aggravate already-existing anxiety symptoms. Some professionals may claim that in certain instances aversion therapy can contribute to or worsen other negative emotions, such as anger or hostility. Unfortunately, these responses will negatively impact therapy and hinder the person’s progress.^10,13

Risk of Injury

With aversion therapy there can be a risk of misuse by the professional. But even with proper use, certain practices can result in emotional suffering, physical pain, and risk of injuries to a person’s wellbeing. For example, providing someone with nausea-inducing substances can increase emotional stress and lead to severe physical discomfort. Or the use of electrical shocks may endanger the health of certain individuals who have a medical condition. These, among other reasons, suggest that aversion therapy can end up doing more damage than good.^10,13

Conversion Therapy Is Unethical

In certain instances, the use of aversion therapy has left many individuals traumatized and emotionally scarred. This has been the case particularly with conversion therapy, where gay and lesbian people were subjected to numerous aversion interventions to “convert” them to a heterosexual sexual orientation and lifestyle. Those “treated” with this destructive practice were unjustifiably traumatized, and some became gravely depressed and suicidal.^10,13

Although this damage may probably never be repaired, fortunately conversion therapy has been banned. In 1994 the American Psychological Association (APA) declared that using aversion therapy to “treat” homosexuality is a dangerous practice.¹⁴ Then, in 2006, ethical codes were instituted by both the APA and the American Psychiatric Association. Today, employing aversion therapy to change sexual preference is deemed a violation of professional conduct.¹⁵

Cost of Aversion Therapy

The cost of therapy varies greatly depending on the type of aversion therapy, whether it is being self-administered or professionally administered, and individual factors like the length of treatment. The most common types of professional aversion therapy are medications which can be prescribed by a primary care doctor or a specialist.

Costs for these pharmacological aversion treatments vary considerably. For example, the generic version of the drug Antabuse averages around $35 for a 30 day supply. Additional to this cost would be the cost of the actual visit or consultation with the prescribing professional. Aversion therapy is often recommended in combination with other treatments. For example, those taking the drug Antabuse for alcohol dependence are also recommended to see a professional counselor or addiction specialist.

Often, prescribed medications and office visits are at least partially covered by mental health insurance. Visiting the insurers website or calling the number on the back of the insurance card is a good way to get detailed information about the cost of covered services and medications.

How To Find Aversion Therapy

Where to begin your search for aversion therapy greatly depends on the type of aversion therapy you are seeking, and the particular issue being addressed. Those who are seeking aversion therapy for health-related issues like weight loss or smoking cessation can sometimes set up an appointment with their primary care doctor. Those who are looking for aversion therapy for addiction or compulsive gambling should search for an addiction counselor.

Many people begin their search for an addiction counselor by doing a google search or by using an online therapist directory. Those with health insurance can often save money by selecting an in-network therapist. Reaching out to the insurance company or using their online portal can help identify a list of in-network therapists. Those who need addiction treatment should look for providers with secondary licenses or credentials to prove they are experienced in treating addiction.

Because aversion therapy is not very common, it may be difficult to find a therapist who specializes in this approach. There is not a formal designation or credential for aversion therapists, but calling around can sometimes lead to finding a counselor with specialized training in this area. Because of their education and training, most professional counselors are not able to prescribe medication, so those interested in medication-related treatments should find a doctor or other prescribing professional.

What to Expect At Your First Appointment

Those who begin aversion therapy with a licensed counselor can expect to spend 60-90 minutes completing a detailed intake and assessment. During this appointment, clients are asked to fill out paperwork and are also asked a number of questions designed to help determine a clinical diagnosis. At the end of the appointment, the counselor will review the diagnosis and discuss options for further treatment.

If the first appointment is with a prescribing professional (like a doctor, physician’s assistant, or nurse practitioner), the first appointment will involve a less formal discussion of the issue. Those seeking medication aversion therapy can expect for the practitioner to provide detailed information about the medication, purpose, and potential side effects.

After the First Appointment

When any medication is prescribed, a follow-up appointment is usually scheduled to determine whether the medication is having the desired effects after 2-6 weeks. If a person has adverse reactions or side effects prior to their follow-up, they are recommended to contact the doctor for advice on whether to continue the medication.

Other Treatment Options

If you are trying to change certain problematic habits or urges affecting your wellbeing, aversion therapy is not the only path to recovery. There are other interventions that may be more appropriate and suitable for you, like exposure therapy, support networks, and different medications.

Here are some other treatment options to consider if you’re looking into aversion therapy:

• Exposure therapy: With the support of a professional, exposure therapy gradually exposes a person to their anxiety-producing and avoided trigger in a safe and controlled environment which helps reduce their fear and avoidant behaviors.
• Other forms of behavioral therapy: The premise of behavioral therapies, like CBT or DBT, is that all behaviors are learned and can be changed. Consider researching other forms of behavioral therapies that can help you with whatever you are struggling with.
• Support networks for addiction recovery: This is often a peer-led group that assists people connect with others who are going through similar struggles helping members to feel less alone via shared experiences.
• Medication: Often, people recovering from addictions or compulsions may need extra help in the form of medication to ease underlying symptoms like anxiety, or depression. Talk to your PCP or therapist if you feel this may be your case.

History of Aversion Therapy

The use of aversion therapy became prevalent in the 50’s and 60’s, building upon the work of behaviorists like Pavlov.¹ It was used to treat drug and alcohol addictions, behavioral problems, and sexual perversion. At this time, electrical aversion therapy was the most widely used, but emetics (medication that induces vomiting) were also sometimes used.

In the early years, aversion therapy was used in ways that were unethical and inhumane. For example, aversion therapy was often administered without a patient’s consent. Electrical shock treatments were much more rudimentary and could result in painful and dangerous electrocution. Aversion therapy was also inappropriately used to “cure” homosexuality, which was considered a disorder at that time.²

As controversy and criticism grew in the 70’s, aversion therapy became less common. Contemporary aversion therapy began to reemerge in the late 90’s but never gained the same popularity it had before. The most common forms of aversion therapy utilized today are pharmacological treatments for addiction and obesity.³