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. Hes 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 Does it make you feel more sociable and extroverted, or more withdrawn?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 muchor moreto 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 placebos seemingly miraculous curative power. The studies strongly suggest that cognitive processesour beliefs about how people are supposed to act when drinkinginfluence 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 thingeven when theyre 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 1960s 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 1970s, 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 researchers 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 peoples 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 persons reaction time. In the aggression task, we also measured how long each of the men took to respond to the confederates responses on the decoding task. Regardless of expectancy, those who consumed alcohol were significantly slower in responding to the confederates 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, Langs 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 womans 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 alcohols 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 alcohols 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 Pavlovs 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 wasnt 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.