Evaluating the relative effectiveness of three aversion therapies designed to reduce craving among cocaine abusers

Abstract

Crack cocaine use and dependence has been steadily increasing since the mid-1980s. Treatment approaches vary from simple psychotherapy to intensive medication regimens. One clear phenomenon that has been implicated in the continued use and abuse of crack cocaine is craving. Craving is believed to be a response that has been conditioned with previous drug using episodes, and is elicited by environmental cues. The current study investigated the use of three aversion therapies (chemical, covert sensitization, and faradic) designed to eliminate craving for cocaine. Seventy subjects were randomly assigned to one of three aversion treatments or a relaxation control condition. Results indicate that aversion therapy reduces crack cocaine craving. The use of aversion therapy as an adjunct to traditional treatment programs for reducing craving is discussed.

Single-Case Evaluation Designs for Practitioners

“…Unfortunately, aside from Bordnick et al (2004), these designs have not appeared in published studies since first being presented to the field in the early 1980s. It is not clear whether this lack of use is due to unfamiliarity with the designs, misunderstanding of the designs, or difficulty in conducting multiple assessments before and after treatment.…”

A comparison of therapies for the treatment of drug cues: Counterconditioning vs. extinction in male rats.

“…For example, in studies of aversion therapy, drug-related cues (e.g., a cocaine-like powder) have been paired with injections of emetic drugs or with mild electric shock applied to the wrist (Bordnick, Elkins, Orr, Walters, & Thyer, 2004; Frawley & Smith, 1990, 1992; Smith & Frawley, 1993). It is hard to interpret the results of these studies because either they did not include control groups at all (Frawley & Smith, 1990, 1992; Smith & Frawley, 1993) or they did not include control groups exposed to the cues without the aversive US, thus making it impossible to separate the effects of extinction from counterconditioning (Bordnick et al, 2004). Despite this lack of conclusive experimental evidence for its effectiveness, counterconditioning is used as a treatment for cocaine craving in some drug rehabilitation clinics (e.g., Schick Shadel Hospital, Seattle, WA).…”

Amelioration of sexual fantasies to sexual abuse cues in an adult survivor of childhood sexual abuse: A case study

“…This investigation suggests that self administered aversive treatment may effectively ameliorate unwanted sexual fantasies of CSA survivors: as initial unwanted sexual arousal decreased, sense of control increased and guilt/shame decreased. The decrease in sexual arousal replicates the effectiveness of aversive treatment with other difficulties such as cigarette and drug use (e.g., Bordnick, Elkins, Orr, Walther, & Thyer, 2004;Miller, Wilbourne, & Hettema, 2003, Tiffany, Martin, & Baker, 1986) and extends its effectiveness to the amelioration of unwanted sexual fantasies to abuse cues in a CSA survivor. As the impact on arousal persisted after the participant stopped self-delivery, it does not seem likely that the effect was due to distraction or response competition.…”