Aversion Treatment of Alcoholics by Succinylcholine-Induced Apneic Paralysis; An Analysis of Early Changes in Drinking Behavior

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Abstract
In a clinical trial of an aversive conditioning therapy for alcoholism, the unconditioned stimulus (ucs) was a paralysis and suppression of respiration, induced by intravenous injection of 20 mg. of succinylcholine chloride, and the conditioned stimulus (cs) was the patient's habitual alcoholic beverage. Forty-five inpatients were randomly allotted to one of three groups: conditioning (cs and ucs), pseudo-conditioning (ucs alone), and placebo (cs alone) . Each patient was given a few drops of his favorite beverage in a bottle which he was instructed to look at, smell and taste within 15 to 20 seconds. This routine was repeated 3 times at intervals of 40 sec. before and after the conditioning sequence. The patients in the conditioning group were given the bottle of beverage within 10 sec. of the onset of the ucs; when well timed the patient was in the act of tasting when apnea began. Before and after treatment, a continuous record of five variables was made: galvanic skin response, respiration rate, heart rate, electrocardiogram, and muscle tension. Length of apnea and ratings of degree of fear and speed of onset of fear were determined. The patients' drinking and other behaviors were followed for 3 months after treatment and compared with corresponding behaviors during the 3 preceding months. The following measures of effectiveness of the conditioning sequence were observed. The mean length of apnea in both groups treated with succinylcholine ranged from 12 to 166 and 17 to 164 sec., not significantly different. The mean ratings of degree of fear and speed of onset of fear showed that the two groups treated with the ucs expressed fear more strongly and more quickly than did the placebo group; but the range of ratings of all three groups was alike for both measures. There was no relation between length of apnea and degree of fear; the findings suggested that the critical factor in the traumatic event was not the duration but the onset of the apnea. The rate of spontaneous fluctuation of the gsr diminished in all three groups. Heart rate fluctuation and breathing rate increased significantly (p<.001) in both groups treated with the ucs and decreased in the placebo group, an indication of the anxiety generated by the traumatic event. The follow-up interview data revealed that all groups developed a generalized anxiety response during the period immediately following treatment. Although the symptoms were more common in the two treated groups the greater frequency was not significant; consequently it cannot be assumed that a general anxiety was a consequence of the treatment. Some subjects in all groups experienced a reduction in craving for drinks, complete abstinence for 3 months, and worse hangovers when drinking; but there was no significant difference in the behaviors of the three groups toward drink. Generalized avoidance responses (p<.01) and avoidance of the beverage used as cs (p<.05) were found significantly more often in the two groups treated with ucs and were absent or rare in the placebo group. In both treated groups a significant (p<.001) over-all increase in drive level was observed, manifest as greater restlessness, greater irritability, more energy at work and more fruitful cognitive processes. Because these responses occurred in both treated groups it was concluded that contiguity conditioning alone was not responsible. Of the three aspects of operant drinking behavior investigated-change of beverage, change of drinking pattern, and change of venue-only the latter was significantly altered. Shifts from drinking in bars to drinking at home or from drinking at home to drinking in other people's homes were noted. Statistical analysis of days of abstinence in 3-month periods before and after treatment showed significant (p<.001) improvement in all three groups but no effect attributable to the different treatments was observed. A similar analysis of the amount of alcohol ingested on drinking days before and after treatment showed significant decreases in the two treated groups but not in the placebo group. Improvements at home and at work were investigated as an assessment of over-all clinical improvement. The two treated groups showed an improvement at work; all three, however, showed much the same behavior at home.

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