Download The Think Drink Effect- By G

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Does it make you feel more sociable and extroverted, or more withdrawn?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."
Because our exposure to drinking models present both in real life and in the media, we have
come to expect that people will sometimes do things under the influence of alcohol that they
would never do otherwise. Alcohol is frequently consumed in relaxed convivial settings in
which sexual advances, for example, are appropriate. In this sense, alcohol acts as a cue for
sexual behavior. The cue effects are the same regardless of the pharmacological properties of
alcohol, as long as the people involved believe they are really drinking liquor.
Very little attention was paid to mental set and setting in early investigations of alcohol and
other drug use by humans. Traditional placebo-drug studies were not able to isolate the
pharmacological effects of a drug that were independent of expectancy. In a typical
experiment, subjects were divided into two groups: expect drug/receive drug and expect
drug/receive placebo. 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.
John Carpenter of Rutgers University first suggested the use of an "anti placebo" procedure, in
which both the placebo and the active drug could be administered under conditions in which
the subject expects to receive an inert substance. Thus the traditional two-group design was
expanded in the 1960’s to include four alternatives: expect drug/receive drug, expect
drug/receive placebo, expect placebo/receive drug, expect placebo/receive placebo. 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, 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, we have tried to control not only for the
subjects’ expectancies but for possible investigator biases. To prevent the researcher from
subtly influencing the results, 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.
We tried to choose a drink for our studies that most people would already be familiar with, but
one that could not easily be distinguished from a placebo drink. 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. (The method works best when drinks are chilled and a squirt
of lime juice is added, both of which make it harder to detect the vodka taste.) Most of the
studies reviewed employed these beverages.
We also had an ethical dilemma to resolve. The balanced-placebo design requires that some
subjects drink alcohol after being told they will be given a nonalcoholic drink. But informed
consent dictates that they know they may be drinking alcohol since it may affect their physical
and psychological functioning. Accordingly, we informed all subjects beforehand that they
might be receiving alcohol as part of the procedure. Later on , 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, at this stage of the study, of course, some subjects are
being deceived.
At the same time that we first employed this strategy, the teams at Wisconsin and Western
Michigan were both investigating the so-called loss-of-control drinking of alcoholics.
According to many authorities, the alcoholic has great difficulty in stopping after one or two
drinks. Just a little alcohol is enough to trigger an addictive mechanism that produces craving
and an involuntary "loss of control," or inability to moderate further drinking, from this point
of view. (Thus, most treatment programs insist upon total abstinence.)
If it is truth that alcoholism is a purely physical addiction, then behavior therapy and other
approaches to training the alcoholic to drink moderately are doomed to failure. It was thus
essential to test this proposition. 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. The alcoholic men in the study
consisted of volunteers who had resumed drinking after leaving a hospital-treatment program
for alcoholism. 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). Subjects in the two expect-alcohol conditions were led to
believe they would be comparing three brands of vodka, while those in the two expect-noalcohol groups were told they would be comparing three brands of tonic water. Three full
decanters were placed in from of each subject, who was then instructed to sample them on an
ad-lib basis in order to make his ratings. Half the subjects in the expect-alcohol condition were
actually given vodka and tonic; half of those in the expect-no-alcohol condition also received
vodka and tonic. The rest of the subjects were given tonic water.
The results showed that expectancy was the main influence on the total amount consumed by
both social drinkers and alcoholics. 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.
For some of the alcoholics subjects the effects were striking. 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), some of
them arrived with the "shakes" and reported craving alcohol. After the drinking session, one
of the men in the expect-alcohol/receive tonic condition began acting in an intoxicated
manner, stumbling around the room and trying to make a date with our female research
assistant. Several other men in the expect tonic/receive-vodka group still showed tremor and
described a strong desire for alcohol, even after consuming the equivalent of double vodkas.
Aggression
Using the balanced-placebo design, experimenters have also shown that people’s beliefs about
drinking have a lot to do with some drinkers’ aggressive behavior. That there is a link between
alcohol consumption and aggressiveness has been well established by previous studies. But
investigators have offered two competing explanations. The first proposes that an aggressive
drive exists in human beings but that its expression is normally inhibited by anxiety, guilt, or
social constraints. Alcohol is assumed to disinhibit the aggressive motivation, presumably by
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".
A third theory, neglected by researchers but familiar from our opening example, 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. In the
experiments conducted by Alan Lang and others from our research team, 96 men who were
described as heavy social drinkers were given either plain tonic or vodka and tonic (to a
blood-alcohol concentration of .10 percent, the legal limit of intoxication in most states), and
each was given two sets of instructions (expect-alcohol or expect –no-alcohol), in accord with
the balanced-placebo design. After drinking their beverages, half of the 96 subjects were
purposely provoked by a confederate of the experimenters posing as another subject, who
criticized the real subjects’ performance on a difficult task of physical coordination by making
a series of sarcastic and belittling remarks. The other half were not provoked. As a way of
measuring aggressiveness, 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. (As in other such experiments, the confederate appeared to
be pained but was not actually receiving the shocks.)
The results (see the chart below) were clear-cut. Both provoked and unprovoked men who
believed they had consumed alcohol were more aggressive – that is, 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. On
the other hand we also found that expectancy had little to do with a person’s reaction time. In
the aggression task, we also measured how long each of the men took to respond to the
confederate’s responses on the decoding task. Regardless of expectancy, those who consumed
alcohol were significantly slower in responding to the confederate’s signals.
This finding suggests that expectancies have a strong influence only when people have welldefined beliefs about the effects of alcohol. It is likely that many of us already have fixed
beliefs about how alcohol influences social behavior, while we may have few or no set
expectations about how it affects such things as reaction time.
Anxiety
Research on the relationship between anxiety and drinking is more contradictory. Most studies
have been aimed at testing the notion that alcohol reduces tension, possibly by depressing or
tranquilizing the nervous system. Drinking is thus reinforced – further encouraged - - by the
release from tension. This theory and its corollary that people drink more when they are
anxious, have become part of the cultural folklore about alcohol.
Previous studies have shown every possible result, some supporting the tension-reduction
theory and others showing that alcohol may, under certain circumstances, increase arousal or
tension. Two experiments used the balanced-placebo design. In the first study, Wilson and
Abrams gave men who were moderate social drinkers a drink containing tonic or vodka and
tonic, with instruction either to expect alcohol or to expect no alcohol. To test social anxiety,
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.
Previous research had established that heart rate is a reliable way to identify people who are
anxious in social situations. 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. In other
words, the men who thought they were drinking vodka were less anxious than the others.
A group of women had exactly the opposite reaction in a follow-up study. The women became
more aroused, not calmer, but again, expectancy shaped their response. 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). In this situation, the women who
were told they were drinking alcohol had significantly faster heart rates, along with increased
skin conductivity – both sighs of increased anxiety – than the women who thought they were
drinking just tonic.
There are two possible explanations for their reactions. 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. In fact, several of them commented that they felt the need
to monitor their behavior closely after drinking, unlike the men, they may have been anxious
about their to exert self-control after drinking, or they may have felt that the male confederate
would disapprove of their drinking as "unfeminine." These findings highlight the fact that
women generally have different past experiences with alcohol and therefore have different
expectancies about the effects of drinking.
Sexual Arousal
The effects of alcohol on human sexual arousal have been debated for centuries. No less an
authority of human behavior than Shakespeare wrote that drinking "provides the desire, but it
takes away the performance" (Macbeth, Act II Scene 3). Ogden Nash expressed a more
contemporary view: "Candy is dandy? But liquor is quicker." The verdict of behavioral so far
differs for the sexes: men seem to be physically turned on by alcohol, while women are turned
off. But again, both responses may be determined by beliefs about drinking.
Three studies of men have been conducted using the balanced-placebo design. In the first two
studies, a strain gauge was used to measure penile tumescence (which has proven a more
reliable measure than self report) . In the first experiments Terence Wilson and David Lawson
assigned male social drinkers to one of the two expectancy conditions, in which they were led
to believe they were drinking either vodka and tonic or tonic only . To convince them of what
they had been drinking, all were given accurate or false information on blood alcohol levels
after breath analysis test. Then, all the subjects watched films that portrayed both heterosexual
and homosexual scenes.
Alcohol itself had no effect on tumescence. 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.
In a second study, Daniel Briddell and his colleagues at Old Dominion University replicated
theses results, but with a twist. In this experiment male subjects were exposed to take
materials that depicted heterosexual intercourse or deviant activities such as rape or
aggression. Oddly, 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. But there was not significant difference in arousal in response to the tape
portraying normal sex.
Finally, in a third study conducted by Alan Lang, now at Florida State University, male
subjects, after drinking their beverages, viewed erotic slides that varied in sexual content and
were then asked to rate how stimulating they were. They rated the slides as more sexually
stimulating if they believed they had been drinking alcohol, whether there was vodka in the
drink or not. This effect was most pronounced for men who had high scores on a sex-guilt
inventory. Taken together with the results showing greater arousal to deviant sexual stimuli by
men who believed they had consumed alcohol, 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. There is an important
personal payoff in this process, since the men can absolve themselves of responsibility for
their actions by blaming alcohol for their disinhibited behavior.
Most people suspect that men and women differ in their expectancies about the effects of
alcohol on sexual responsiveness. These differences were clearly demonstrated in research
conducted by Wilson and Lawson, who did a study with women that was similar in design to
the one they had done with men. After receiving their drinks and instructions in accordance
with the balanced-placebo design, the women viewed films with heterosexual and homosexual
activity or one with neutral content. Each woman’s sexual arousal was monitored
physiologically by the method of a photoplethysmograph, a device that assesses changes in
vaginal blood flow. In this case, 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. However in this and in a related study, women who believed they had
been drinking alcohol generally gave self reports indicating increased arousal.
Thus women who think they have been drinking experience sexual arousal subjectively – but
not objectively. Expectations do not seem to play a role in their actual physical response.
Wilson and Lawson offer a number o possible explanations for the differing male and female
reactions. 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. 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. Men, on the other hand, may have stronger beliefs
about alcohol’s effect on enhancing sexual arousal and/or may exert greater voluntary control
over their sexual arousal.
Mood and Motor Abilities
We cannot say, of course, that alcohol itself has no impact at all on our minds and bodies apart
from our beliefs about it. It clearly does. With more complicated motor and cognitive
behaviors, studies show little or no effects of expectancy (as in memory tests or other complex
cognitive tasks). Research conducted by investigators at Vanderbilt University showed that
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, their performance
was significantly impaired only when they had consumed alcohol. However on a second test
in which subjects had to divide their attention between two complex cognitive task, both those
who believed they were drinking alcohol and those who were actually drinking made more
errors than other subjects. Thus, in this task , the subjects’ motor performances were disrupted
by a belief that alcohol had been consumed as well as by actual consumption of alcohol.
Again, the existence of strong prior beliefs about the effects of alcohol may underlie these
findings. Most people would seem to be relatively uncertain about how alcohol affects
specific motor abilities. 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),
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, like reduced anxiety, increased assertiveness, or
behaviors that are associated with some form of immediate gratification such as sexual or
aggressive acting out. On the other hand, making errors in carrying out a complicated
cognitive or motor act (driving for example) would not be considered desirable, and drinking
would thereby not exert the same reinforcing effect with these behaviors.
Expectancy effects seem to be relatively weak or absent altogether for the mood states that
accompany drinking. In balanced-placebo studies people have been asked to report their
feelings on mood checklists both before and after drinking. Moderated and heavy drinkers
have reported some changes in mood after actually drinking alcohol – they may get happier
say, or more depressed – but expectancy manipulations exert little or no effect in these
experiments. The studies, by their very nature, may make it easier for people to see through
the balanced-placebo deception. Since subjects are asked to be introspective, to closely
monitor their feelings, the may also notice subtle physical changes for their absence) that are
usually associated with alcohol consumption.
Setting factors also exert an important influence on alcohol’s effect on mood states, further
complicating the interpretation of these findings. research has shown, 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. Solitary drinkers describe the effects of alcohol
primarily in terms of physical symptoms (feeling dizzy or numb), in contrast with drinker in
the social setting who describe the effects as psychological or interpersonal in a nature
(feeling more extraverted or friendly), even though the same amount of alcohol is consumed
by all subjects.
It is clear from this research, all of which had been conducted within the last decade, 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. 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.
Considerable research needs to be done in order to identify the underlying mechanisms of the
placebo effects we have described in this article.
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, so the experience d drinker may achieve a conditioned high when present
with the signal or cue properties (sight, smell, taste, and so on) of a drink, regardless of
whether the drink actually contains alcohol.
In addition, another important component would seem to be the attributions we make about
alcohol as the "cause " of certain behaviors ("I wasn’t myself . . "). The ingestion of alcohol
itself seems to produce little more than an indefinite or ambiguous physiological reaction, an
amorphous change in mood, 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, the drinking environment, and personal payoffs than by the physical effects of
alcohol.
Questions:
1. Identify
a. Independent variable
b. Dependent variables
c. Experimental groups
d. Control group
2. Explain the results of the following studies
a. Anxiety
b. Aggression
c. Sexual Arousal
d. Mood & Motor Abilities
3. Do you think there was anything unethical about any of the studies? Support your opinion.