The final model of psychological drug rehab treatment to be considered for the treatment of heroin addiction is aversion therapy. Aversion therapy is an effort to apply “punishment” as a means of reducing the frequency of unwanted behavior. This is a misapplication of learning-theory principles which have consistently found that “punishments” do not cause behaviors to disappear, but rather cause them to stop temporarily while preventing their extinction.
Thus, the behavior returns at a later point with considerable intensity. The most famous advocate of aversion therapy is the author William Burroughs whose addiction to heroin was treated with apomorphine in Great Britain. Aversion therapy has not been attempted widely in this country, and there are no data which support the general efficacy of aversion therapy in any of the drug abuse syndromes.
The practice of aversion therapy is fairly straightforward. The patient is exposed to self-administered heroin which is immediately followed by an injection of apomorphine or succinyl choline. If he is given apomorphine, his heroin injection becomes associated with violent retching and vomiting. Because the apomorphine is paired to the heroin injection, the use of heroin is theoretically associated with an unpleasant experience.
The injection of succinyl choline causes an immediate paralysis of all voluntary musculature including the muscles of respiration. The patient experiences a frightening feeling of being unable to breathe which becomes paired with the heroin.
Experimental psychologists have found that the effective way to cause extinction of a behavior is to prevent the reinforcement of that behavior. The use of succinyl choline includes some risk of accidental death as well as extreme unpleasantness. There is no evidence that either of these treatments works better than the other. They have been paired to the sight and use of the needle as well as the heroin injection, but there is no evidence that aversion therapy is valid. In general, there is no indication for the use of aversion therapy in the treatment of the addict, although there is a need for the continued experimental application of learning theory principles to the treatment of heroin addiction and other drug abuse syndromes.
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