Chemical aversion treatment of alcohol dependence

Chemical aversion treatment is one of the most promising modalities currently available for treatment of alcohol dependence. This review highlights potentially fruitful areas for future investigational efforts and poses a number of specific empirical questions. Investigation of issues delineated in this report would advance understanding of pharmacological aversion therapy vis-a-vis utility and mechanisms of action.

Chemical aversion treatment of alcohol dependence. II. Future research directions for the '90s.

Aversive experiences created in therapies for alcoholism management could not be fully internalized and endured by patients because the aversive agents (electric shock, antabuse, emetics) are not natural. With the use of the natural agent, alcohol, a naruralrejection-response of the human body, emesis, could be induced to hypersensitize a patient to alcohol. An alcoholic aged 62 yr., with 43 yr. of drinking history. after screening was treated with the following hypersensitization technique under medical supervision. Treatment was given in early morning after overnight starvation. During treatment the patient sac with eyes closed to help him internalize the aversive experiences. He was asked to drink a glass of water (200 ml.) slowly sipping and enjoying each sip. This was followed by two more glasses and further doses of water were mixed with increasing quantities of arrack (5, 10, 20, 40, 80, 160, 200, 200 ml.). He drank slowly but continuously. He felt nausea at the introduction of arrack and vomited 12 times during the session of 75 min. with 11 doses. Posttreatment nausea and vomiting persisted for 36 hr. and even liquid inrake was not possible. But there was no dehydration. Aversion to alcohol induced by this treatment resulted in abstinence over 8 mo. To reduce the severity of posttreatment reactions the level of alcohol was slowly raised (10 ml. per dose) for ocher cases. Such a modification was effective when three or four sessions were given on alternate days. Each session was terminated after 12 instances of vomiting (rejection of 1500-2000 ml. of liquid). As sessions progressed onser of vomiting appeared earlier and posttreatment vomiting increased in frequency. The gradual increase in alcohol concentration and the concomminant intensification of nausea and vomiting form a strong conditioning link which sustains the rejection of alcohol. This can be referred to as the development of an experimentally induced allergy to alcohol. A typical patient after such treatment experienced nausea and vomiting on encountering a drunken mn and even the therapist. Development of this new technique was stimulated by a similar hypersensitization technique used in extinction of smoking (1). The effectiveness of these procedures with limited cases requires further confirmation with larger numbers of persons and longer periods of follow-up.

Alcoholism Management: Hypersensitization Technique

The smoker by smoking a cigarette creates a certain level of 'self-induced stress' resulting from oral heat, bitter taste, and bronchio-pulmonary irritation. The termination of smoking a cigarette extinguishes this self-induced-stress and onsets a self-inducedrelief followed by some reduction in the general level of stress that existed prior to smoking. This positive experience of relief from stress has some survival value for the individual and reinforces and maintains the antecedent smoking behavior. The effective way to extinguish smoking is ro thwart or stamp out abruptly and completely the link berween self-induced stress and self-induced relief. Rapid smoking procedures have only required people to smoke 'until' tolerance ( 1, 2 ) . The present technique increases the self-induced stress to a level 'beyond' tolerance without onset of relief. One smokes until smoking is no longer a pleasurable experience. Treatment by this method of a 23-yr.-old male with a 10-yr. smoking history is described here. The treatment was given with the client's consent and after screening in a clinic. He was not aware of the treatment strategy. He was made to relax and to smoke, inhaling each puff and exhaling only through his nostrils while trying to enjoy each puff. He could not retain a feeling of 'pleasure' after the chird cigarette; he coughed on the fifth one, and vomited three times (eighth to tenth cigarettes), and lost consciousness on the fourteenth. The number of cigarettes and minutes per day to fall unconscious were 14/75, 10/36, 8/30, 45/19, 3/12, 2/9, 1/4 over one week. He spontaneously recovered consciousness after 10 to 15 min. The steep decline in the 'cigarette tolerance' was followed by an abrupt reduction in smoking outside the treatment, from 10 (pretreatment) to 1 on the first day of treatment and none from the fourth day onwards. Nonsmoking continued for seven months. Peer pressure to smoke led to a 'pleasureless/blaad' smoking experience. This STOP technique evokes hyper-sensitivity and psychophysiolog~cal inhibiton of smoking. This preliminaty work should be replicated with a large sample of heavy smokers.

Vedagiri Ganesan

Papers

Alcoholism Management: Hypersensitization Technique

Smoking extinction: smoke-them-out-of-pleasure (STOP) technique.

Wcn23-0378 study of clinical outcome and follow-up of male lupus nephritis in a tertiary care center