Lithium aversion treatments with alcoholics.

Abstract

An extensive literature shows that animals can be trained to avoid a flavored substance if sickness follows consumption. These experiments question the use of electrical aversion treatment for alcoholics and offer a strong rationale for the less popular chemical aversion treatment. These studies also suggested the following possible improvements to the design of chemical aversion treatment: (a) Lithium may be the preferred drug with which to produce sickness. (b) The strength of the alcohol-sickness association would be increased by minimizing competing associations between alcohol flavors and eliminating interference from non-alcohol flavors. (c) The sickness should be induced after the patient begins to drink even if this results in a considerable delay between drinking and the peak of sickness. (d) Intoxication may be avoided by having patients consume a small quantity of alcohol but allowed exposure mainly through smell and taste. -- In this study a treatment design incorporating the above main features received preliminary testing with 15 detoxified male-alcoholics. The patients received an average of six alcohol-sickness pairings spaced at least two days apart. Clinical results indicated that single oral dosages of 1500 and 1800 mg. of lithium carbonate were necessary to produce effective aversive reactions. No signs of lithium toxicity developed and serum lithium levels showed these dosages to be conservatively safe. Clear aversions to alcohol developed in 11 of 15 patients even though the alcohol was introduced a considerable time before sickness started. This was supported by reports of nausea and vomiting by relapsed patients and by patients who were inadvertently exposed to alcohol during treatment. The pattern of onset and duration of sickness developed by patients over treatment sessions was also indicative of conditioned sickness. The four patients who did not develop strong aversions to alcohol proved resistant to lithium sickness. A correlation of -.68 between degree of reaction to lithium and rate of excretion indicated a possibility of selecting out these poor reactors. A matched retrospective control group was drawn from 200 previous admissions and a one year follow-up will be reported separately.