Some physicians treat alcoholism by a method of conditioning. The essential of such a procedure is to induce in the patient an extremely unpleasant sensation in response to the taste, smell, and sight of alcohol. We will describe the most commonly used method, employing the drug apomorphine. This has only one important medical property: when injected it acts on the brain centres to produce vomiting.
Treatment consists in giving the patient alcohol in conjunction with an injection carefully timed so that nausea begins very shortly after the drink is taken and the patient vomits.
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The procedure is repeated several times in the course of a treatment session and half a dozen sessions take place over the course of about a fortnight. By the end of the conditioning course the patient has built up nauseating associations to the smell, taste, and gastric effects of alcohol. The conditioning stimulus of apomorphine is no longer necessary. He develops nausea whenever he handles a drink. In order to reinforce the conditioning, further treatment courses are advised, initially at six-monthly intervals but less frequently later on.
The treatment is drastic. It can only be administered under strict medical supervision since it is necessary that means should be available for combating collapse in those few patients who may be prostrated by the vomiting. Emetine is another drug sometimes used to induce vomiting.
More recently other agents have been used to produce a conditioned response. Patients have been induced to associate the effects of drinking with the pain of electric shocks or with sudden muscle paralysis which follows the injection of muscle-relaxants of the curare type'.
While the emetic methods are practised widely in, for example, Poland and Russia, 1 clinicians in Britain and in North America have not been drawn to the use of methods which involve submitting their patients to unpleasant and painful procedures. There are other forms of medical treatment, surgery for instance, in which the patient is necessarily hurt but the doctor tries to minimize the pain as much as possible. In aversion treatment the suffering of the patient is deliberately brought about by the doctor. Alcoholics who submit to this treatment must be prodigiously well motivated to overcome their addiction. In Britain it is chiefly practised outside the National Health Service. The chief exponent of aversion therapy in the United States, who uses apomorphine, claims recovery for half his patients, who come mostly from the upper social classes and were able to pay for private treatment. 2
The growing interest and knowledge in the field of behaviour therapy as a whole is likely to lead to a renewal of interest in aversion treatment. There is no doubt that it is quick, that it is safe under controlled conditions, and that it is based on a consistent psychological theory resting on firm experimental evidence. On the other hand, many physicians will continue to find it unacceptable and it ignores all the psychological factors determining alcoholism.