The Think Drink Effect- By G. Alan Marlatt and Dammaris J.

Roshenow We know him and try to avoid him at parties: the fellow who after a few drinks suddenly turns into a pawing letch or a would-be Sugar Ray. The belief that people become sexually aroused or aggressive after drinking is deeply entrenched, so much so that we suspect the lout at the party is just using alcohol as an excuse. He’s not really that far gone. Before reading on, ask yourself what your own beliefs are about how alcohol affects you. Does it make you feel more sociable and extroverted, or more withdrawn? Do you believe alcohol makes you feel more relaxed? More or less sexually aroused? More prone to angry outbursts? We now have the first solid evidence that psychological processes have a much—or more—to do with some drinking behaviors than do the physical effects of alcohol. In a series of experiments with a unique "balanced placebo" design, psychologists have shown that people will act in certain stereotypical ways when they drink, even if they are drinking tonic water but have been told they are drinking vodka and tonic. In other words, the think-drink effect is as dramatic as a placebo’s seemingly miraculous curative power. The studies strongly suggest that cognitive processes—our beliefs about how people are supposed to act when drinking—influence our reactions to alcohol in ways we have previously failed to acknowledge. For example:

Men who believe that they have been drinking alcohol become less anxious in social situations even when they have not been drinking the real thing. Women, strangely, become more anxious. But both types of response are determined by expectation (beliefs, hopes, fears) about what happens when people drink.

Many experts believe alcoholics develop a craving for liquor after just one or two drinks because a small amount of alcohol triggers a physiologically based addictive mechanism. However, studies show alcoholics experience the same craving after one or two placebo drinks. Even more surprising, alcoholics report little or no craving when they are given drinks containing alcohol that they believe are nonalcoholic.

Men become more aggressive in laboratory situations when they are drinking only tonic but believe that it contains vodka. They also become relatively less aggressive when they think they are drinking only tonic water, even though their drinks actually contain vodka.

Men also tend to become more sexually aroused when they believe they have been drinking the real thing—even when they’re not. Women report feeling more aroused when they believe they have been drinking alcohol, but curiously, a measure of their vaginal blood flow shows that they are physically becoming less aroused. Mental Set and Setting Observers of various drug subcultures have frequently mentioned the role played by expectancy (mental set) and situational factors (setting) in a "high". Andrew Weil, in his pioneering book The Natural Mind suggested that marijuana users did not need the substance to get high. "Pharmacologists do not understand," Weil wrote , "that all psychoactive drugs are really active placebos since the psychic effects arise from consciousness, elicited by a set and setting, in response to physiological cues. Thus for most marijuana users, the occasion of smoking a joint becomes an opportunity or excuse for experiencing a mode of consciousness that is available to everyone all the time, even though many people do not know how to get high without using a drug."

subjects were divided into two groups: expect drug/receive drug and expect drug/receive placebo. Pilot testing revealed that drinker could tell a mixture of one part vodka to five parts tonic water with no more than 50 percent accuracy or chance odds. In this sense. The cue effects are the same regardless of the pharmacological properties of alcohol. we have tried to control not only for the subjects’ expectancies but for possible investigator biases. Since expectations could play a part in both of the conditions – all subjects expected the real drug – the chemical effects alone could not be measured with any certainty. Using this balanced-placebo method. investigators for the first time could separate out the independent effects of psychological processes (beliefs about whether the substance ingested is active or inert) from the pharmacological properties of the drug (whether it is actually active). In the early 1970’s. expect placebo/receive placebo.Because our exposure to drinking models present both in real life and in the media. for example. expect placebo/receive drug. expect drug/receive placebo. in which both the placebo and the active drug could be administered under conditions in which the subject expects to receive an inert substance. (The method works best when drinks are chilled and a squirt of lime juice is added. Thus the traditional two-group design was expanded in the 1960’s to include four alternatives: expect drug/receive drug. Very little attention was paid to mental set and setting in early investigations of alcohol and other drug use by humans. as long as the people involved believe they are really drinking liquor. Traditional placebo-drug studies were not able to isolate the pharmacological effects of a drug that were independent of expectancy. researchers in our lab at the University of Wisconsin and another group at Western Michigan University independently rediscovered the balanced-placebo design and applied it to studies of drinking. In these experiments. Alcohol is frequently consumed in relaxed convivial settings in which sexual advances. we have come to expect that people will sometimes do things under the influence of alcohol that they would never do otherwise. We tried to choose a drink for our studies that most people would already be familiar with. alcohol acts as a cue for sexual behavior. John Carpenter of Rutgers University first suggested the use of an "anti placebo" procedure. are appropriate.) Most of the studies reviewed employed these beverages. . we have employed a double-bind strategy in which neither the researcher nor his subjects know who is drinking alcohol and who is not until the data have been compiled. To prevent the researcher from subtly influencing the results. but one that could not easily be distinguished from a placebo drink. both of which make it harder to detect the vodka taste. In a typical experiment.

while those in the two expect-noalcohol groups were told they would be comparing three brands of tonic water. at this stage of the study. the teams at Wisconsin and Western Michigan were both investigating the so-called loss-of-control drinking of alcoholics. We asked a group of male alcoholics and a matched set of social drinkers to participate in a "taste-rating task" in which they would compare the taste properties of either alcoholic or nonalcoholic beverages. then behavior therapy and other approaches to training the alcoholic to drink moderately are doomed to failure. or social constraints. half of those in the expect-no-alcohol condition also received vodka and tonic. Later on . After the drinking session. stumbling around the room and trying to make a date with our female research assistant. But investigators have offered two competing explanations. Half the subjects in the expect-alcohol condition were actually given vodka and tonic. some of them arrived with the "shakes" and reported craving alcohol. The balanced-placebo design requires that some subjects drink alcohol after being told they will be given a nonalcoholic drink. Three full decanters were placed in from of each subject. What we were really trying to measure in the experiment was the impact of expectancy on how much both groups would drink and whether alcoholics would drink more than social drinkers in the expect alcohol condition. We divided the 32 social drinkers and 32 alcoholics into the four conditions of the balancedplacebo method (see chart at left). The alcoholic men in the study consisted of volunteers who had resumed drinking after leaving a hospital-treatment program for alcoholism. Since our volunteers were required to abstain from alcohol for a least eight hours prior to their appointment in the lab (and had to show a zero reading on our breath-analysis test to prove their sobriety). The results showed that expectancy was the main influence on the total amount consumed by both social drinkers and alcoholics." or inability to moderate further drinking.) If it is truth that alcoholism is a purely physical addiction. we informed all subjects beforehand that they might be receiving alcohol as part of the procedure. For some of the alcoholics subjects the effects were striking. Accordingly. even after consuming the equivalent of double vodkas. That there is a link between alcohol consumption and aggressiveness has been well established by previous studies. guilt. most treatment programs insist upon total abstinence. Subjects in the two expect-alcohol conditions were led to believe they would be comparing three brands of vodka. experimenters have also shown that people’s beliefs about drinking have a lot to do with some drinkers’ aggressive behavior. Subjects who thought they were sampling decanters with vodka and tonic drank significantly more (and later estimated that their drinks contained more alcohol than they actually did) than the did subjects who expected only tonic water – regardless of the actual presence or absence of alcohol in their drinks. some subjects are being deceived. (Thus. from this point of view. Aggression Using the balanced-placebo design. The rest of the subjects were given tonic water. presumably by . Alcohol is assumed to disinhibit the aggressive motivation. of course. But informed consent dictates that they know they may be drinking alcohol since it may affect their physical and psychological functioning. as an assistant of the researcher’s test each that he or she has been randomly assigned to either the group that will receive vodka or the group that will not. the alcoholic has great difficulty in stopping after one or two drinks.We also had an ethical dilemma to resolve. Several other men in the expect tonic/receive-vodka group still showed tremor and described a strong desire for alcohol. The first proposes that an aggressive drive exists in human beings but that its expression is normally inhibited by anxiety. Just a little alcohol is enough to trigger an addictive mechanism that produces craving and an involuntary "loss of control. who was then instructed to sample them on an ad-lib basis in order to make his ratings. According to many authorities. one of the men in the expect-alcohol/receive tonic condition began acting in an intoxicated manner. It was thus essential to test this proposition. At the same time that we first employed this strategy.

half of the 96 subjects were purposely provoked by a confederate of the experimenters posing as another subject. the legal limit of intoxication in most states). in accord with the balanced-placebo design. In the aggression task.10 percent. gave shocks that were significantly more intense and longer duration to the confederate than did those who believed what they had been drinking tonic water – regardless of the actual content of the drinks. those who consumed alcohol were significantly slower in responding to the confederate’s signals. we also measured how long each of the men took to respond to the confederate’s responses on the decoding task. suggests that alcohol may provide a culturally accepted excuse for engaging in behaviors that are normally unacceptable – including aggression. The one balanced-placebo study published so far supports this alternative explanation. After drinking their beverages.) The results (see the chart below) were clear-cut. Regardless of expectancy. The other half were not provoked. (As in other such experiments. . neglected by researchers but familiar from our opening example.its effect on the higher cortical centers and a corresponding reduction in fear about the consequences of aggression. The second explanation assumes that alcohol has an overall energizing effect on the general activate level of the organism and that drinking will increase the probability of aggressive fantasies and expression of "power needs". As a way of measuring aggressiveness. A third theory. Both provoked and unprovoked men who believed they had consumed alcohol were more aggressive – that is. On the other hand we also found that expectancy had little to do with a person’s reaction time. the confederate appeared to be pained but was not actually receiving the shocks. and each was given two sets of instructions (expect-alcohol or expect –no-alcohol). In the experiments conducted by Alan Lang and others from our research team. who criticized the real subjects’ performance on a difficult task of physical coordination by making a series of sarcastic and belittling remarks. 96 men who were described as heavy social drinkers were given either plain tonic or vodka and tonic (to a blood-alcohol concentration of . all were asked to engage in a learning experiment in which they were able to give shocks of varying intensity and duration to the same confederate when he made mistakes on a decoding task.

This theory and its corollary that people drink more when they are anxious. The women became more aroused. Previous studies have shown every possible result. expectancy shaped their response. a strain gauge was used to measure penile tumescence (which has proven a more reliable measure than self report) . In the first two studies. Wilson and Abrams gave men who were moderate social drinkers a drink containing tonic or vodka and tonic. Two experiments used the balanced-placebo design. the women who were told they were drinking alcohol had significantly faster heart rates. under certain circumstances. or they may have felt that the male confederate would disapprove of their drinking as "unfeminine. In fact. increase arousal or tension. But again. several of them commented that they felt the need to monitor their behavior closely after drinking. In this situation. Drinking is thus reinforced – further encouraged . Three studies of men have been conducted using the balanced-placebo design. while women are turned off. In the first study. In the first experiments Terence Wilson and David Lawson . It is likely that many of us already have fixed beliefs about how alcohol influences social behavior. There are two possible explanations for their reactions. but again. along with increased skin conductivity – both sighs of increased anxiety – than the women who thought they were drinking just tonic. the men who thought they were drinking vodka were less anxious than the others. they asked the men to try to make a favorable impression on a women who was an accomplice of the researchers and offered the men little encouragement.. they may have been anxious about their to exert self-control after drinking. not calmer. Ogden Nash expressed a more contemporary view: "Candy is dandy? But liquor is quicker. In other words. possibly by depressing or tranquilizing the nervous system. To test social anxiety. Previous research had established that heart rate is a reliable way to identify people who are anxious in social situations. Most studies have been aimed at testing the notion that alcohol reduces tension. The women in the study had less drinking experience than the men did and may thus have been have more wary about the effect of alcohol on their behavior. while we may have few or no set expectations about how it affects such things as reaction time." These findings highlight the fact that women generally have different past experiences with alcohol and therefore have different expectancies about the effects of drinking. This experiment was identical to the one Wilson and Abrams did with the men (the women were asked to try to impress a male confederate who acted cool toward them).This finding suggests that expectancies have a strong influence only when people have welldefined beliefs about the effects of alcohol. have become part of the cultural folklore about alcohol. with instruction either to expect alcohol or to expect no the release from tension. both responses may be determined by beliefs about drinking. Wilson and Abrams found that men who believed they had been drinking liquor (whether they had or not ) tended to have slower heart rates when trying to impress the women than did the men who thought they had drunk only tonic water." The verdict of behavioral so far differs for the sexes: men seem to be physically turned on by alcohol. No less an authority of human behavior than Shakespeare wrote that drinking "provides the desire. Sexual Arousal The effects of alcohol on human sexual arousal have been debated for centuries. some supporting the tension-reduction theory and others showing that alcohol may. but it takes away the performance" (Macbeth. unlike the men. Anxiety Research on the relationship between anxiety and drinking is more contradictory. A group of women had exactly the opposite reaction in a follow-up study. Act II Scene 3).

Lang’s findings suggest that men whose normal sexual response is inhibited by sexual guilt or social restraints will show the greatest disinhibition effect when they believe they are drinking alcohol. in which they were led to believe they were drinking either vodka and tonic or tonic only . With more complicated motor and cognitive behaviors. may have stronger beliefs about alcohol’s effect on enhancing sexual arousal and/or may exert greater voluntary control over their sexual arousal. of course. In a second study. Most people suspect that men and women differ in their expectancies about the effects of alcohol on sexual responsiveness. women who believed they had been drinking alcohol generally gave self reports indicating increased arousal. studies show little or no effects of expectancy (as in memory tests or other complex cognitive tasks). Mood and Motor Abilities We cannot say. This effect was most pronounced for men who had high scores on a sex-guilt inventory. Thus women who think they have been drinking experience sexual arousal subjectively – but not objectively. Research conducted by investigators at Vanderbilt University showed that . viewed erotic slides that varied in sexual content and were then asked to rate how stimulating they were. Men. whether there was vodka in the drink or not. They speculate that women may simply be more vulnerable to the physical effects of alcohol and/or have had different past drinking experiences than men. They rated the slides as more sexually stimulating if they believed they had been drinking alcohol. Each woman’s sexual arousal was monitored physiologically by the method of a photoplethysmograph. the men who believed they were drinking alcohol were significantly more aroused by deviant sexual stimuli than those who thought what they were drinking was nonalcoholic. However in this and in a related study. male subjects. all were given accurate or false information on blood alcohol levels after breath analysis test. After receiving their drinks and instructions in accordance with the balanced-placebo design. Alcohol itself had no effect on tumescence. It clearly does. But there was not significant difference in arousal in response to the tape portraying normal sex.assigned male social drinkers to one of the two expectancy conditions. since the men can absolve themselves of responsibility for their actions by blaming alcohol for their disinhibited behavior. that alcohol itself has no impact at all on our minds and bodies apart from our beliefs about it. Daniel Briddell and his colleagues at Old Dominion University replicated theses results. In this case. Wilson and Lawson offer a number o possible explanations for the differing male and female reactions. after drinking their beverages. the two groups of women who actually drank alcohol showed significantly reduced sexual arousal during the film regardless of whether they believed they were drinking alcohol. Oddly. a device that assesses changes in vaginal blood flow. the women viewed films with heterosexual and homosexual activity or one with neutral content. Taken together with the results showing greater arousal to deviant sexual stimuli by men who believed they had consumed alcohol. Then. in a third study conducted by Alan Lang. all the subjects watched films that portrayed both heterosexual and homosexual scenes. but with a twist. on the other hand. Finally. These differences were clearly demonstrated in research conducted by Wilson and Lawson. But men who believed they had consumed vodka became significantly more aroused watching the films. in comparison with those who thought they were drinking only tonic – regardless of the actual alcohol content of the drinks. There is an important personal payoff in this process. who did a study with women that was similar in design to the one they had done with men. Expectations do not seem to play a role in their actual physical response. It also seems possible that women may be less accurate than meant in interpreting signs of sexual arousal that arise from within their own bodies. now at Florida State University. In this experiment male subjects were exposed to take materials that depicted heterosexual intercourse or deviant activities such as rape or aggression. To convince them of what they had been drinking.

Considerable research needs to be done in order to identify the underlying mechanisms of the placebo effects we have described in this article. Again. . for example that the effect of drinking on mood is very different depending on whether the drinker is alone or is interacting with others in a social situation. in contrast with drinker in the social setting who describe the effects as psychological or interpersonal in a nature (feeling more extraverted or friendly). the subjects’ motor performances were disrupted by a belief that alcohol had been consumed as well as by actual consumption of alcohol. increased assertiveness. the existence of strong prior beliefs about the effects of alcohol may underlie these findings. to closely monitor their feelings. Thus. further complicating the interpretation of these findings. and drinking would thereby not exert the same reinforcing effect with these behaviors. the may also notice subtle physical changes for their absence) that are usually associated with alcohol consumption. Expectancy effects seem to be relatively weak or absent altogether for the mood states that accompany drinking. Moderated and heavy drinkers have reported some changes in mood after actually drinking alcohol – they may get happier say. Setting factors also exert an important influence on alcohol’s effect on mood states. in this task . making errors in carrying out a complicated cognitive or motor act (driving for example) would not be considered desirable. they will attempt to compensate for whatever loss of skill may ensue by devoting extra care and attention to the task. The studies also suggest that expectancy effects are strongest for behaviors that are believed to be positive or desirable for the drinker. or more depressed – but expectancy manipulations exert little or no effect in these experiments. On the other hand. Early indications suggest that classical conditioning may play a role in the process: just as Pavlov’s dogs learned to salivate at the sound of the bell that had been previously associated with a food reward. Most people would seem to be relatively uncertain about how alcohol affects specific motor abilities. both those who believed they were drinking alcohol and those who were actually drinking made more errors than other subjects. their performance was significantly impaired only when they had consumed alcohol. smell. by their very nature. and so on) of a drink. so the experience d drinker may achieve a conditioned high when present with the signal or cue properties (sight. even though the same amount of alcohol is consumed by all subjects. all of which had been conducted within the last decade. or behaviors that are associated with some form of immediate gratification such as sexual or aggressive acting out. Furthermore other research suggests that when people expect to perform a complicated task after drinking alcohol (such as driving a car home from a party). taste. Solitary drinkers describe the effects of alcohol primarily in terms of physical symptoms (feeling dizzy or numb). regardless of whether the drink actually contains alcohol. may make it easier for people to see through the balanced-placebo deception. Since subjects are asked to be introspective. It is clear from this research. like reduced anxiety.when one group of subjects was asked to perform a pursuit rotor task (a demanding test of motor coordination) 30 minutes after drinking alcohol or placebo drinks. research has shown. More than 25 published studies that use the balance-placebo design have replicated the expectancy effect with a variety of social and affective responses that were previously thought to be influenced primarily by the physiological or chemical properties of alcohol itself. that cognitive processes exert a powerful influence on our drinking behavior – both in the beliefs that we hold about the expected effects of alcohol and the attributions we make about alcohol as an agent that enhances certain behaviors or "disinhibits" the expression of others. In balanced-placebo studies people have been asked to report their feelings on mood checklists both before and after drinking. However on a second test in which subjects had to divide their attention between two complex cognitive task. The studies.

Do you think there was anything unethical about any of the studies? Support your opinion. Explain the results of the following studies a. Anxiety b. Control group 2. the drinking environment. . Experimental groups d. Questions: 1. Identify a. "). another important component would seem to be the attributions we make about alcohol as the "cause " of certain behaviors ("I wasn’t myself . . Independent variable b. The ingestion of alcohol itself seems to produce little more than an indefinite or ambiguous physiological reaction. Sexual Arousal d. Aggression c. Mood & Motor Abilities 3. an amorphous change in mood. and personal payoffs than by the physical effects of alcohol. at least at the dose levels most social drinkers are accustomed to. The interpretation or "framing" of this diffuse reaction appears to be more influenced by our prior beliefs.In addition. Dependent variables c.

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