There were an average of 3.5 aversions per person (females more than males), and 70.1% had been present since childhood. DeSilva and Rachman ( 7) published a study of 125 students and hospital employees, 105 (84%) of whom had a history of natural aversions. In fact, spontaneous aversions are common, because the capacity to develop aversions is a biologic defense mechanism. Aversion works to eliminate or reduce euphoric recall by recording new negative experiences with the drug ( 6). He or she may fear the consequence of drinking, just as he or she fears being arrested for drinking and driving nevertheless, he or she still retains the euphoric recall of past episodes of drinking alcohol and hence the craving for the alcohol itself.
Thus, disulfiram does not change the way the addict feels about alcohol. As a result, they have not actually experienced a disulfiram reaction. For this reason, patients today are not given alcohol at the same time that they are prescribed disulfiram. Aversion relies on safe but uncomfortable experiences that can be repeated, whereas disulfiram reactions can be life threatening, even in healthy persons. With disulfiram, alcohol must be absorbed and metabolism begun for it to produce its toxic effect ( 5). In aversion therapy for alcohol addiction, alcohol is not absorbed into the system ( 3). Even worse, alcohol may be used to cure the withdrawal (“hair of the dog”), which ensures that emotionally the patient perceives the alcohol as a solution, not a problem.Ĭontrary to popular belief, disulfiram (Antabuse) is not an aversion treatment. Moreover, the discomfort of a hangover, though logically understood to be the result of drinking, is blamed on “drinking too much” (weakness) rather than drinking at all (disease). However, the hangover is delayed in time from the actual use of alcohol thus, for the alcoholic, who drinks for the immediate euphorogenic effects of alcohol, a hangover often is ineffective in producing aversion because it is delayed in time from use of the substance whose immediate effect was experienced as pleasant or euphoric. In nonaddicted populations, hangovers have been cited as a significant reason to cut down or stop drinking ( 4). Hence, self-esteem is rebuilt by separating the drug from the self ( 3). It is only when the patient is engaging in an old behavior-alcohol or drug use-that he or she experiences immediate and consistent discomfort. While the patient is engaging in positive recovery activities, he or she is receiving immediate positive support for a new way of behaving and thinking. This has a very important benefit to self-esteem. In punishment, it is the individual who receives the negative consequence, whereas in aversion therapy the negative consequence is only paired with the act of using a drug. It is important not to confuse aversion with punishment.
People need care-behavior needs modification. It is first reported to be used in America by Benjamin Rush, a physician, in 1789 ( 2). Aversion therapy provides a means of achieving control over injurious behavior for a period of time, during which alternative and more rewarding modes of response can be established and strengthened ( 1). This treatment is not designed to appeal to the logical part of the individual’s brain, which often is all too aware of the negative consequences of alcohol and other drug use, but to the part of the brain where emotional attachments are made or broken through experienced associations of pleasure or discomfort. Unlike punishments (jail, firings, fines, divorce, hangovers, cirrhosis, and the like), which often are delayed in time from the use episode, aversion therapy relies on the immediate association of the sight, smell, taste, and act of using the substance with an unpleasant or “aversive” experience. Its goal is to reduce or eliminate the “hedonic memory” or craving for a drug and to simultaneously develop a distaste and avoidance response to the substance. ■ AVERSION THERAPY AS PART OF ESTABLISHED CARE FOR ADDICTIVE DISEASEĪVERSION THERAPY AS PART OF A MULTIMODALITY TREATMENT PROGRAMĪversion therapy, or counterconditioning, is a powerful tool in the treatment of alcohol and other drug addiction. ■ DETERMINANTS OF RELAPSE AFTER AVERSION TREATMENT ■ EFFECT OF AVERSION ON URGES TO DRINK ALCOHOL ■ AVERSION THERAPY AS PART OF A MULTIMODALITY TREATMENT PROGRAM
The ASAM Principles of Addiction Medicine 5th Edition 62.
0 kommentar(er)
