The Story of Aversion Therapy for Alcohol Use Disorder

March 17, 2023

On June 30, 2022, Schick Shadel Hospital in Burien, Washington, closed its doors for good. It was the last facility in the United States offering aversion treatment for alcohol use disorder.

Aversion therapy acquired a bad name due to its misuse in deeply unethical conversion therapy attempting to change people’s sexuality—and also thanks to movies like A Clockwork Orange.

Yet there are many stories of people who were failed by all other forms of treatment, opted for aversion therapy, and finally succeeded in their chosen goal of quitting drinking. Some data also support its efficacy. That’s not to say that aversion treatment was the best choice for everyone who wanted to abstain; nor was it relevant to people who wanted instead to moderate their drinking. But different things work for different people, and all ethical therapeutic options should be available for those who wish to use them. The loss of this option is a great pity.

Schick Shadel Hospital used a form of aversion therapy known as conditioned taste aversion. This involved pairing an alcoholic drink with an emetic, so that the patient vomited immediately after swallowing the drink.

Research by John Garcia et al., going back to the 1950s, showed that vomiting and nausea could condition animals to avoid specific foods or beverages, whereas electric shocks were effective in conditioning animals to avoid places. In fact, this is a basic survival mechanism: If an animal eats something toxic which makes it sick, it will learn to avoid eating that same thing in the future.

It was only after less toxic emetics were discovered that aversion treatment for alcohol use disorder became practical.

Since a lot of people throw up after drinking too much, you might be asking why that doesn’t create an aversion to alcohol. The reason is simple: When the brain is sedated by alcohol or another substance, this blocks the formation of conditioned responses.

We knew about aversive conditioning empirically long before we had a scientific theory to explain it. As early as 1786, Benjamin Rush, who had been the surgeon general of the Continental Army during the American Revolution, recommended spiking a brandy bottle with tartar emetic in order to “cure” servants of tippling. However, tartar emetic was too toxic for practical use in treatment. In the 1820s, a certain Mr. Loiseau attempted to set up a “drink cure” institute using tartar emetic in New Orleans; however, the “cure” proved so unreliable and dangerous that Loiseau was forced to leave the city.

It was only after less toxic emetics, such as ipecac, apomorphine and emetine, were discovered that aversion treatment for alcohol use disorder became practical.

The Gatlin Institutes were a chain of facilities that used emetics as a “secret formula” to cure alcohol use disorder; the first Gatlin Institute opened in Denver in 1902. The Neal Institutes were another chain with a similar methodology; the first of them opened in Des Moines in 1909.

Most of these early facilities closed down around the time the US implemented Prohibition in 1920. However, after Prohibition was repealed on December 5, 1933, a number of new alcohol treatment chains using conditioned taste aversion sprang up. These facilities, which also framed their method as a “secret formula,” included the Samaritan Institutions and HALCO Laboratories, among others.

In 1935, chiropractor Charles Albert Shadel (1896-1982) bought the rights to the HALCO treatment for the states of Washington, Oregon, Idaho, Montana and British Columbia. Shadel began offering the HALCO treatment out of his chiropractic office in the Bigelow Building in Seattle, Washington, that year. It was also in 1935 that Shadel hired Walter Lyle Voegtlin, MD, (1904-1975) as part-time medical director. A branch office opened in Tacoma in 1936. And in 1937, Shadel set up the Shadel Sanitarium at 7106 35th Avenue in Seattle. It was incorporated in 1938.

By 1940, Voegtlin was working full-time as medical director of the Shadel Sanitarium. As a scientist, he was determined to put its treatment on a sound scientific footing.

Voegtlin was a meticulous and scrupulous researcher, and other investigators reported similar numbers.

He began by refining the formula for the Shadel aversion treatment—and published it in a medical journal in 1940, since only quacks used “secret formulas.” Voegtlin also began tracking patients’ outcomes going back to 1935. He published his outcome data in medical journals from 1940 to 1950.

Voegtlin’s 1950 article in the Journal of Studies on Alcohol and Drugs was a follow-up of patients treated between May 1935 and October 1948—a total of 4,468 people. Follow-up data were available for 4,096 of them, or 91.7 percent. Of this population, 44 percent were found, through self-reporting and corroboration from family members, to have remained continuously abstinent since their first treatment. Another 878 patients were people who had resumed drinking after their first treatment; 39 percent of those re-treated patients had been abstinent since their latest treatment. When those patients were included, the total current abstinence rate for the 13-year period was 51 percent.

Further analysis found that following their first treatment, 60 percent of patients were abstinent for at least one year, 51 percent for at least two years, 38 percent for at least five years, and 23 percent for at least 10 years. Voegtlin was a meticulous and scrupulous researcher, and other investigators reported similar numbers.

After Voegtlin’s first publications, conditioned taste aversion became a very popular treatment for alcohol addiction in the US. Programs were established at Mendocino State Hospital and Woodside Acres Hospital in California; Mount Airy Sanitarium in Denver, Colorado; Queen’s Hospital in Honolulu, Hawaii; Chicago State Hospital in Illinois; the Washingtonian Hospital in Boston, Massachusetts; St. Vincent’s Hospital in St. Louis, Missouri; Meyer Memorial Hospital in Buffalo, New York, the Wallace Sanitarium in Memphis, Tennessee; the Hospital of the University of Virginia; Angelus Hospital in Spokane, Washington; Wisconsin General Hospital in Madison; Winnebago State Hospital, near Oshkosh, Wisconsin; Sheridan County Memorial Hospital in Wyoming; and elsewhere.

In 1942, Shadel opened a branch in the Raleigh Hills neighborhood of Portland, Oregon. In late 1946, the Portland branch was sold to Beryl Stanley Page Miles and two staff physicians, and renamed Raleigh Hills Sanitarium. In the 1970s, Raleigh Hills grew into a chain of aversion treatment hospitals; by 1983, there were 24 branches in operation throughout the country.

In 1964, Patrick Joseph Frawley, Jr. (1923-1998), president of the Schick Razor Company, entered Shadel Hospital to take the aversion treatment for his alcohol problem. Frawley was so impressed by the treatment that he bought the hospital in 1965; it was renamed Schick Shadel Hospital around 1971. Frawley opened a branch in Fort Worth, Texas in 1970; Schick also operated a couple of alcohol treatment units in Los Angeles and Santa Barbara in the 1970s. It additionally ran over a dozen stop-smoking programs in the 1970s and ’80s, which had many elements, including electrical aversion.

The 1976 Rand Report found that all major forms of alcohol treatment, including aversion therapy, were about equally effective, although some treatments worked better for specific categories of people than others.

Its enemies in Washington now advocated that Medicare coverage be cut off, and that only 12-step programs should be covered.

In 1970, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) was established by the Hughes Act, named after Senator Harold Hughes, a member of Alcoholics Anonymous. From the git-go, the NIAAA was dominated by AA members, and in its early years was devoted to promoting the gospel of 12-step recovery—a phenomenon well documented in Nancy Olson’s book With a Lot of Help from Our Friends (2003).

In the late 1970s, the NIAAA and other bureaucrats in Washington, DC, launched a concerted attack on conditioned taste aversion treatment of alcohol use disorder, mischaracterizing it as a new and experimental treatment with no proof of safety or efficacy. Although conditioned taste aversion had been covered by Medicare since 1966, its enemies in Washington now advocated that Medicare coverage be cut off, and that only 12-step programs should be covered. This is documented in House and Senate Subcommittee Hearings which took place on July 15, 1981 and October 15, 1981.

That first attack on conditioned taste aversion treatment ultimately failed. But its enemies were not done. The April 15, 1982 issue of the Los Angeles Times reported that Raleigh Hills was being investigated by the government for Medicare fraud.

In some cases, when a patient resumed drinking, Raleigh Hills sent the patient across state lines to be re-treated, in order to bill Medicare a second time. Although shady practices of this nature were common among alcohol treatment programs of all kinds, Raleigh Hills had been singled out.

The bad publicity took its toll, and in 1983, the chain was sold to Horizon Health Corporation. In 1984, Horizon switched the treatment modality at the Raleigh Hills hospitals from aversion therapy to 12- step, and in 1985 it renamed them Horizon Recovery Centers in order to distance itself from the Medicare scandal.

By 2002, Schick Shadel Hospital was suffering financial problems. Various branches had shut down, leaving only the parent hospital outside of Seattle in operation. In 2003, James P. Graham, a former patient, formed a company and purchased the hospital. He doubled the average patient census and got the hospital back in the black.

In 2011, Ascend Health Corporation, a subsidiary of Universal Health Services, bought Schick Shadel Hospital. Universal Health Services is a typical giant medical conglomerate; in 2020, it was forced to pay the government $122 million for Medicare fraud. Universal Health Services was alleged to have held psychiatric patients against their will and to have sued employee whistleblowers.

During the COVID-19 pandemic, the patient census at Schick Shadel Hospital fell, and Universal Health Services shut it down for not making enough money.



Photograph by Marcelo via Pixnio 

Kenneth Anderson

Kenneth is the founder and CEO of HAMS (Harm Reduction, Abstinence, and Moderation Support), the world's only lay-led, free-of-charge support group for harm reduction for alcohol. He is also the author of How to Change Your Drinking: a Harm Reduction Guide to Alcohol; BETTER IS BETTER!: Stories of Alcohol Harm Reduction; and the book series The Untold History of Addiction Treatment in the United States—which currently consists of Strychnine & Gold (Part One), Strychnine & Gold (Part Two), and From Inebriate Asylums to Narcotic Farms, with more to come.

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