17.5.2 Behavioural Intervention Therapies

• Aversion therapy to treat addiction works on the principles of classical conditioning 
• Classical conditioning is used to break the individual’s pleasurable association with the addictive substance and replace it with a negative association
• To try and cure alcohol addiction individuals are given an aversive drug which causes vomiting and makes them feel nauseous 
• The addicted person is then offered a drink smelling strongly of alcohol, which usually results in them vomiting almost immediately
• This aversive treatment is repeated until the individual no longer wants to drink alcohol
• With nicotine addiction the aversion therapy often involves the smoker inhaling cigarette smoke rapidly and so deeply that it makes them feel nauseous

Aversion therapy for alcohol addiction.

• Aversion therapy for gambling often uses electric shock therapy
• The individual creates cards with key phrases they associate with their gambling and cards for everyday statements that are nothing to do with gambling
• As they read through the statements, they self-administer an electric shock for each gambling-related statement 
• The individual sets the intensity of the shock themselves, aiming to make the shock discouraging but not too painful

• Covert sensitisation works in a similar way to aversion therapy by also using classical conditioning, but it is less physically demanding and potentially less physically harmful
• Instead of experiencing real electric shocks or vomiting, the individual imagines how it would feel to experience these, in a process called in vitro conditioning
• The individual is asked to relax and then to imagine feeling nauseous and to imagine themselves vomiting (they may also be asked to picture a rat or snake near/in their drink if they have a specific phobia to aid the aversive imagery)
• The imagined vomiting or unpleasant scene is the unconditioned response
• The individual is encouraged to use a lot of detail in building up these images
• The addicted person is then asked to imagine themselves smoking, drinking, or gambling whilst thinking about the unpleasant images
• The aim is to make the scene as vivid as possible to create a strong association, as it is believed that the more negative the imagined situation, the greater the chance of success in conquering the addiction
• This association results in the addictive behaviour  becoming the conditioned stimulus and the negative feelings becoming the conditioned response

Imagining a spider on your cigarette may be part of covert sensitisation.

• Cognitive behavioural therapy (CBT) is an attempt to change the individual’s thought processes in a person who is in the process of giving up their addiction
• CBT is used to develop coping skills, strategies and the strength necessary to deal with addiction-related cues or triggers, including:
  • Drug-refusal skills - therapy equipping individuals with specific strategies so that they can deal with the physical temptation and the social pressures to take drugs
  • Cognitive restructuring - requires the individual to examine the thought processes that precede their addictive behaviour and with the help of the therapist replace these with alternative thought patterns that do not end in reverting to the addictive behaviour
  • Relapse prevention training - a more long-term technique of preventing a return to addictive behaviour, by supporting the individual’s new thought patterns and focusing on giving them control over their addiction
• Part of CBT is also teaching more general skills, like problem-solving, assertiveness and relaxation, all of which are aimed at relapse prevention

Research which investigates behavioural intervention therapies

• Danaher (1977) tested aversion therapy with smokers, using deep inhalation of the cigarette smoke to induce nausea, but found that this treatment was only effective for some individuals, undermining the classical conditioning premise behind aversion therapy, which would assume universal efficacy
• Carroll et al. (1994) found that the skills individuals learned through CBT for  relapse prevention remained after the therapy ended suggesting that CBT is an effective therapy for addiction

Evaluation of behavioural intervention therapies

Strengths

• Covert sensitisation and CBT avoid the ethical problems of making someone ill or causing them distress that accompany aversion therapy 
• Behavioural intervention therapies can be adapted to suit individual circumstances for all substance and behavioural addictions, and so they are helpful in many situations  

Weaknesses

• CBT considers that the addicted person may have a social life that reinforces the addictive behaviour; aversion therapy and covert sensitisation do not take this into account, but treat the individual in isolation from their social context, thus making relapse more likely in social conditions
• Behavioural intervention therapies treat the behaviour rather than the underlying problem which means that the problem may still be present i.e. other addictive behaviours may replace the one that has ceased (Griffiths, 1995)

Link to Issues & Debates: 

The application of behaviourist principles in aversion therapy is to some extent nomothetic, as everyone is presumed to respond the same way. However, covert sensitisation is more idiographic, allowing for some individual decision in the images that are created by the addicted person. Cognitive behavioural therapy allows the thought processes of the individual to be listened to and moderated, which is an idiographic approach.