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MP 3.02.02 Aversion Therapy for Chemical Dependency

Medical Policy
Section
Mental Health
 
Original Policy Date
8/2011
Last Review Status/Date
Created with literature search/8:2011
Issue
8:2011
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

Aversion therapy is an in-patient substance abuse treatment strategy that has been used for many years for alcohol and cocaine dependence at the Schick Shadel Hospitals. The treatment generally includes a 10day in-patient stay during which the patient receives aversion counter conditioning designed to make the sight, smell, taste and thought of the alcohol and/or cocaine unpalatable. Narcotherapy (pentothal interview) is a component of the aversion therapy program designed to gather initial psychological diagnostic information and to monitor the development of aversion to the addictive substances. Under light anesthesia, patients are queried about the level of desire for each type of substance. Aversion therapy with pentothal interview is provided within a comprehensive treatment program that includes detoxification, counseling, addiction education, and introduction to a 12-step program for follow-up care.


Policy

Aversion therapy and pentothal interviews are considered investigational in the treatment of chemical dependency.


Rationale

The components of standard outpatient substance abuse therapy consist of individual, group and family psychotherapy, relapse prevention therapy, and introduction to a 12-step program for follow up. Agonist substitution therapy (methadone or levo-alpha-acetyl-methadol [LAAM]) and medications to decrease the reinforcing effects of abused substances, also known as withdrawal drugs (eg, naltrexone, clonidine/naltrexone, buprenorphine), may also be included as a component of standard therapy.

Long-term outcomes from randomized trials comparing aversion therapy to standard substance abuse therapy are needed to demonstrate the independent contribution of aversion therapy in the overall treatment program. No randomized trials were identified in the published literature.  The only available published evidence consists of outcomes from 2 series of patients treated at Schick Shadel Hospitals:

  • Smith and Frawley reported outcomes for 200 patients randomly selected from a group of patients that completed an initial 10 days of treatment at a Schick Shadel Hospital in 1983. [1] During the initial 10-day hospitalization, patients received 5 days of aversion therapy and 5 days of narcotherapy, given on alternating days. This was followed at 30-day and 90-day intervals with 2-day inpatient admissions for reinforcement treatment consisting of 1 day each of aversion therapy and narcotherapy. Follow up was by telephone interview at 12-months. Of the 200 patients, 20% were lost to follow up. In addition, 22 patients were known to have relapsed prior to the 12-month telephone interview.
  • The same authors followed 156 of 214 patients for 12 months post-aversion therapy. [2] Patients in this cohort were addicted to cocaine alone, cocaine and alcohol, or cocaine and marijuana. As with the first study, there was significant loss to follow-up in this study (36%).

Conclusions concerning the impact of aversion therapy and narcotherapy on health outcomes cannot be reached from the above 2 studies.  Data from these studies are unreliable due to a lack of treatment randomization, selection bias, significant loss to follow-up, and inability to isolate the independent contribution of aversion therapy and pentothal interview from the overall substance abuse treatment program.

 

References:

  1. Frawley, PJ, Smith, JW. One-year follow-up after multimodal inpatient treatment for cocaine and methamphetamine dependencies. J Subst Abuse Treat. 1992 Fall;9(4):271-86.  PMID: 1336066
  2. Smith, JW, Frawley, PJ. Long-term abstinence from alcohol in patients receiving aversion therapy as part of a multimodal inpatient program. J Subst Abuse Treat. 1990;7(2):77-82.  PMID: 2167389

 

Codes

Number

Description

CPT  No Code 
ICD Procedure 94.33
 


Policy History

Date Action Reason
8/2011 Add to Behavioral Health section New policy