Abstract: The placebo effect is frequently present in our lives when an expectation, associated with any psychoactive material, leads to subjective and physiological changes. The present work studies the role of expectancies associated with ethanol/alcohol in changes to the subjective state. In experimental situations, we examine how these expectations—with or without social influences—affect participants when consuming alcoholic, pseudo-alcoholic, or non-alcoholic cocktails. Psychological and physical changes can, to a significant extent, arise from an expectation-driven placebo effect. We suggest that expectations of inebriation formed by socialization and experiences can explain most of the behavioural changes following alcohol consumption. These effects seem to be stronger if the alcohol consumption happens in a social context and weaker if it is individually. Regarding the information effect, we suppose that the expectations will positively affect the drunkenness, i.e. toward the placebo “direction”: those who believe they are consuming a non-alcoholic cocktail will be less inebriated than those who know their drink contains alcohol. In this study, we successfully demonstrate the expectation-induced classical placebo effect in the misinformed participants who were, in fact, consuming non-alcoholic drinks. The “social” alcohol consumption further enhances the true or believed effects of the alcohol, and thus the participants reported their subjective feelings in lines with their manipulated expectations. As regards the effect of the alcohol, therefore, many other factors contribute in addition to the alcohol itself, the most important of which seem to be group effect, suggestions and expectations.
Discussion
The present study examined the mechanisms of the placebo effect in relation to alcohol consumption, specifically the effect of aroma or alcohol consumption on self-evaluation of the subjective physical, emotional and social state, in both group and individual settings.
A classical placebo effect was demonstrated in the present study: there was no significant difference regarding social behaviour or subjective feelings between alcohol- and aroma-consuming subjects when they did not know that placebo had also been served, in either the individual or group setting. It seems that it is enough for people to believe they have consumed alcohol to feel inebriated.
The aim of the study was also to clarify the role of group conditions in the placebo effect. Comparing the results of the individual and group settings, regardless of the alcohol content of the consumed cocktail, a social atmosphere intensified the effects of alcohol consumption.
A significant compensation effect was observed with the manipulation of the instructions (believed to drink alcohol/aroma), which was further enhanced by group effects. Because of the consumed amount of ethanol or aroma, theoretically subjects should not have reported feelings of inebriation, but due to strong stereotypes associated with alcohol consumption, regardless of the alcohol content, they “created” physical symptoms when they believed they were drinking alcohol. On the other hand, those who believed they were drinking only aroma, despite the fact that a real rum cocktail was given to them, showed signs of compensation as well, and they claimed to be “more sober” in order to harmonize their beliefs and feelings. We conclude that up to a certain amount of ethanol, subjective feelings of drunkenness are mainly defined by expectations, and expectation-related stereotypes are more powerful in a social than in an individual context.
To summarize, the effect of alcohol can only be partly explained by ethanol, as several other factors—mainly social processes, suggestions and expectations—play an important role in how individuals become inebriated.
Limitations
This study presents the various effects of aroma and alcohol consumption on the basis of self-evaluation of the subjective physical, emotional and social state in group and individual settings in a healthy and young population with no alcohol-related disease or intolerance. Stereotypes, expectations, attitudes and experiences related to alcohol consumption of the tested sample may also differ from those of other populations, precluding wide generalizability of the results.
The relevant tests indicated the suitability of the variables for factor analysis and repeated-measures ANOVA, although the sample size was relatively small, which can also limit broad interpretation.
Finally, due to the small amount of alcohol consumed and the relatively short time intervals, participants only experienced a mild effect, whereas in real-life situations, people usually consume larger amounts and spend more time under those conditions. Although this fact seems to limit the validity of our study, it could still be a good design choice, since in a stronger inebriated state the placebo probably would not work.
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