Aversion Therapy: Is It Effective?

Medically reviewed by Melissa Guarnaccia, LCSW
Updated May 29, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention substance use-related topics that could be triggering to the reader. If you or someone you love is struggling with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). Support is available 24/7. Please see our Get Help Now page for more immediate resources.

Aversion therapy is a modality developed in the 1930s to support individuals living with addiction or substance use disorders. In the modern day, aversion therapy is not a recommended or evidence-based practice, as it is associated with controversy and harm. It may be helpful to understand the basis of aversion therapy and its history. However, when seeking addiction treatment or care for a mental illness, experts recommend an evidence-based alternative.

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What is aversion therapy for unwanted behavior?

To understand the definition of aversion therapy, it may be helpful to understand aversion. Aversion is a strong dislike. If you're averse to a situation, stimulus, or idea, you might feel emotions like disgust, fear, or revolt. Aversion can cause some individuals to experience distressing physical symptoms or discomfort.

While some forms of therapy rely on positive cues and stimuli to enact change, aversion therapy is based on the theory that negative and unpleasant stimuli or consequences can reduce unwanted or “problematic” behavior. It was initially developed to treat substance use disorders, especially excessive alcohol use.

Although this modality is not backed by research, it was used in the mid- and late-20th century to help individuals reduce maladaptive behaviors. However, more modern research has found that positive reinforcement can be more effective.

What aversion techniques are used in aversion therapy?

Aversion therapy is not an official modality. However, those who practice it may use techniques to cause a client to become averse to a certain stimulus. For example, a client wanting to stop biting their nails might put a bitter nail polish on to become averse to the taste. A client looking to stop using alcohol might add disgusting flavoring to all their alcohol. These techniques are considered controversial and are not practiced in an evidence-based setting.

Is aversion therapy for lifestyle behaviors backed by research?

Aversion therapy is considered by a significant amount of professionals in the mental health sphere as unethical, as it uses forms of punishment to attempt to change behaviors. A study in ScienceDirect mentions some of the harmful forms of aversion therapy that have been used in the past. In the 1990s, electrical aversion therapy (EAT) was used to administer minor electric shocks to reduce unwanted behavior. Some forms also used chemical aversion (as with the bittering agent for nail-biting mentioned earlier). However, these techniques were often used in non-consenting clients, like non-verbal Autistic children, making them harmful and unethical.

The differences between aversion and conversion therapy

The study mentions how aversion therapy was often connected to harmful practices like conversion therapy, which was a technique used to attempt to change the identity of LGBTQ+ individuals. Conversion therapy is not a real type of therapy and should not be practiced by any licensed therapist, counselor, social worker, or professional. The American Psychiatric Association, World Health Organization, American Psychological Association, and other significant organizations in psychology condemn the use of conversion therapy and note that homosexuality and transgender identity are not diseases, nor should they be “cured” or “treated.” Conversion therapy, according to a helpful report for the BBC in 2023, can involve lots of self-shaming indoctrination up to and including mental, emotional, and even physical abuse. 

While aversion therapy is focused on getting a person to avoid a certain undesirable stimulus or some compulsive behaviors - so-called lifestyle behaviors that are more based on habit than inherent personality -it is usually not focused on causing a person to feel any discomfort toward their sexual orientation or gender identity. Specific forms of aversion therapy (namely electroshock aversion therapy, which used electrical shocks as an aversive stimulus) are banned in some parts of the United States and other countries; all forms of conversion therapy are outlawed in 16 countries including Canada, Brazil, and Germany as well as 20 states in the US.

More medically reviewed information on the dangers of conversion therapy can be found in a report where medical reviewers confirmed the dangers of conversion therapy.

If you’re an LGBTQ+ youth or young adult in crisis, reach out to The Trevor Project hotline by calling 1-866-488-7386 or texting “START” to 678-678. You can also use their online chat. 

Is aversion therapy effective?

There are mixed results in studies and systematic reviews about the effectiveness of aversion therapy and aversion therapy uses due to its controversy and the wide range of methods that might be used, so the presence of concrete scientific evidence of its efficacy is debatable. For example, using a bitter nail polish to stop nail biting may not cause long-term harm to a client. However, electrical shock, verbal aggression, violent behavior, and other aggressive forms of punishment in aversion therapy (rather than the advertised “unpleasant stimulus”) can cause worsened mental health instead of improving a client’s challenges.

One study found that a past form of aversion therapy for smoking cessation involved having a client “rapid smoking” or smoke heavily and puff in the smoke every five or six seconds until they could no longer tolerate it. This type of heavy smoking may have done physical harm and was unethical in practice.

Some forms of aversion therapies used in treating obesity used aversive stimuli in the form of associating a negative smell with various foods. Though the “treatment” initially seemed to have worked, the effects were short-term and deemed ineffective as a long-term weight control system. 

There has also been use of emetic therapy - adding drugs that produce unpleasant physical reactions when ingested into food a person eats or beverages a person drinks - as a form of substance use disorder or excessive alcohol consumption treatment. This has caused patients to report lower cravings, but it has not been proven as an effective treatment.

Other studies show that aversion therapy, especially in the “shock” form, can cause physical danger, emotional harm, trauma, and “dehumanization” of clients. Using aversion therapy to attempt to change neurodivergent children, such as those with autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD), can also be unethical and ineffective, as neurodivergence is not a disease and cannot be “cured” through behavioral intervention.

Although some studies may find effectiveness in aversion techniques, experts often recommend considering a more evidence-based approach to treating unwanted behaviors related to mental health conditions or life challenges like addiction.

Can aversion therapy support addiction?

People living with addiction or a substance use disorder may wonder if aversion therapy would be helpful for them. However, according to the Substance Abuse and Mental Health Services Administration (SAMSHA), harm reduction may be a more useful approach for reducing shame in individuals living with addiction.

Shame can cause relapse and halt recovery. Harm reduction programs attempt to reduce shame and take the pressure off of individuals to quit using substances “immediately” without support. Instead, they offer ways for individuals to safely use substances to reduce the impact of harm while providing resources like therapy, case management, counseling, housing support, and guides for escaping unsafe situations. These programs posit that addiction is not a “weakness” or “fault” and that individuals have the power to choose to stop using when they are ready.

Alongside individual therapy with a licensed mental health professional, a harm reduction program may empower individuals using substances with positive reinforcement, patience, and empathy. Humanizing individuals struggling with addiction can be a positive step toward recovery.

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Alternatives to aversion therapy

Aversion therapy is not the only modality that treats substance use disorders, unwanted maladaptive behaviors, and other mental health challenges. Below are three evidence-based modalities that focus on either desensitization or activation of the reward center, that may be beneficial for you.

Cognitive-behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) is often considered the “gold standard” of talk therapy. This modality is adapted to treat mental health conditions like anxiety disorders, depressive disorders, personality disorders, and substance use disorders, among others. In a CBT session, clients work with a therapist on healthy coping techniques to reduce unwanted behaviors.

CBT is based on the presence that thoughts can directly impact emotions and behaviors. By changing thought patterns, clients can start positively reinforcing new behavioral patterns. For example, a therapist might guide clients in reducing limiting beliefs they developed in childhood that could be causing them not to want to make changes in the present. CBT is focused on behavior but does not use punishment like aversion therapy.

Exposure and response prevention (ERP)

Exposure and response prevention (ERP) is a subset of CBT that targets unwanted behaviors, often regarding phobias and compulsions. ERP has been found to be significantly effective in treating specific phobias and obsessive-compulsive disorder (OCD) symptoms.

At the beginning of ERP, clients work with a therapist to list behaviors they want to change and the fears behind them. For example, a client with a phobia of needles may write down all situations with needles that cause fear, as well as the level of that fear, on a scale of one to 100. The therapist can then develop a treatment plan for the client that gradually exposes them to their fear. In this example, the first exposure might involve looking at a needle from afar or thinking about holding a needle. The practice may then escalate. For example, a client may end exposure by getting a saline IV treatment in a safe medical environment. They work up to this step over several sessions.

Eye movement desensitization reprocessing therapy (EMDR)

Eye movement desensitization and reprocessing therapy (EMDR) is a modality that was initially developed to treat post-traumatic stress disorder (PTSD) in veterans. However, it has since been adapted to support individuals with various challenges, including anxiety and phobias. EMDR may also be helpful for those living with substance use disorders who have a history of trauma.

An EMDR therapist uses bilateral brain stimulation techniques like waving a light back and forth in front of a client’s eyes or having them hold hand buzzers (a non-harmful electrical stimulus) to activate both parts of the brain while the client recalls challenging memories or thoughts. This process is thought to reduce these memories' impact on one’s emotions. EMDR has been proven effective and was more effective than CBT in seven out of ten studies for PTSD.

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Support options

It can be challenging to find evidence-based support in your area. If you’re looking to change your behaviors but aren’t sure where to turn, an online platform like BetterHelp may be beneficial. Through an online platform, you can get matched with a licensed therapist and attend sessions via phone, video, or live chat. In addition, you can use resources like weekly support groups and worksheets.

Studies show that online therapy is as effective as in-person modalities. In one study, 71% of participants reported that online therapy is more effective than face-to-face treatment. 100% of the participants found it more convenient, and 80% found it more cost-effective.

Takeaway

Aversion therapy is a modality that has been around since the 1930s and was initially used to cause aversion to alcohol in individuals with alcohol use disorder. In the 21st century, there is insufficient evidence to establish aversion therapy as an evidence-based approach. Instead, alternatives like CBT, EMDR, and ERP may be more effective. Reach out to a therapist in your area or online to develop a treatment plan unique to your situation.
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