Quick Clips with Dr. Kilmer: 01. Expectancy–Parents Need to “Get This”

In this series we talk with Dr. Jason Kilmer, professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. He specializes in the development, implementation, and evaluation of substance use prevention and intervention efforts on college campuses and among 18–25 year olds.   

While Dr. Kilmer focuses on college campuses, his insights are universal and particularly helpful for parents with teenagers of any age. Share these recordings with your parenting peers as you all navigate this exciting time in human development (ages 14–25) and work to help your kids navigate away from alcohol and other drugs.

This podcast is brought to you by the Substance Abuse and Mental Health Services Administration (SAMHSA). The views expressed here are not necessarily those of SAMHSA or the U.S. Department of Health and Human Services. For questions or comments about this podcast, please contact WhatParentsAreSaying@gmail.com. 

Transcript

Quick Clips with Dr. Kilmer: 01. Expectancy–Parents Need to “Get This” 

[00:00:00] Debbie: Welcome to Quick Clips with Dr. Kilmer. Today we're gonna talk about expectancy or the placebo effect of alcohol. Dr. Kilmer, talk to us about these things. 

[00:00:17] Dr. Kilmer: Well, I love that you asked that question, and the truth is, I could talk about this forever and we'll probably not actually do that, but there are very, very strong placebo effects.

[00:00:26] Most people know the concept of a placebo. From things like medical research where it's a sugar pill. You tell people they're getting a medication, half of them get the medication, half of them get a sugar pill, and if everyone says, wow, I feel better. It probably wasn't the medication, it was the belief that you were taking something that would make you feel better.

[00:00:43] The results in that impact research on placebos have extended to alcohol, and the person who trained me, the person that was my advisor in graduate school, Dr. Alan Marla, is the big name in the person who really innovated. The balanced placebo design where he would not only do a traditional placebo experiment telling people they're getting alcohol, sometimes they get it, sometimes they get an alcohol free drink, but he took it the next step and would tell people, we're gonna give you an alcohol free drink.

[00:01:12] Some of them actually got an alcohol free drink, other people got alcohol. Everyone's over 21. They all do drink. They all sign consent forms that say, if you give me alcohol, I give permission for that. And it allowed him to do research to really look at how much of what people say they get from alcohol truly comes from the alcohol versus the belief that they've been drinking.

[00:01:34] Debbie: So did the results show that it didn't matter much whether a person believed they got alcohol or actually got alcohol? 

[00:01:46] Dr. Kilmer: It showed that the beliefs mattered more than anything else. People that think they're drinking, even when they get alcohol free drinks, they act more outgoing, they act more talkative, more social in general.

[00:01:58] Some people get more flirty even though the drinks are alcohol free. Um, people that don't think they're drinking but actually receive alcohol. In some ways it's a way less entertaining group to watch, but it's almost more impressive because the, the power with which people say, when I drink I get more funny, outgoing, social, and so on.

[00:02:16] They got the alcohol. None of that great social stuff happened. The physical effects of alcohol would kick in, but people would attribute what they were feeling to other things. Alcohol is a depressant. That doesn't mean it makes us sad. It depresses or slows down the central nervous system. So give a room full of people, a depressant, and what do you see?

[00:02:34] People were yawning. People were stretching. People were saying they were tired, but instead of saying, what did I just drink? They blamed it on having a bad night's sleep, a long day at school, or a long day at work and so on. Some people, when they drink. Their face gets red hot, uncomfortable aversive feeling.

[00:02:50] It's called the flushing response. That was happening for some people, but they had attributed it to the room being too hot, and they were taking off sweaters and sweatshirts and asking if we could quit being cheap and turn on the air conditioning. It also wasn't that rare to see people maybe get a little clumsy, but instead of questioning what was in their drink, they were just like, sorry, spilled my drink, and they tried to stay quiet and not cause any more trouble by the end of the hour.

[00:03:11] So Dr. Marlatt's work compellingly showed that. The social or interpersonal things we get from alcohol are much, much more due to where we are, who we're with, and what our beliefs are than what the contents of the Cup are. And you know what I'm always so struck by is people say, do you need research to prove this?

[00:03:30] The scientists to me will always say yes. Do you need research to have the hunch? No way. We all have that one friend who like two sips in is more giggly and it's like, come on. There's no way that's affecting you already. We can ask people all the time. Have you ever had a bad time at a party? Of course.

[00:03:46] Where were you drinking? Same stuff I have when I have a good time. Really? What was going on? Oh, I was in a bad mood or I wasn't really feeling it, or my friends were in a bad mood. They describe stuff about their mindset and about the environment, not about the contents of their cup.

[00:04:04] Debbie: Hope all parents listening to us are really internalizing what this means. It feels like it's a widespread counter-cultural statement. You know, it feels like we're being told from a social standpoint that we need to drink to have fun. We need to drink to feel good, we need to drink to connect. And what it sounds like this research is saying is that all of that's in our heads.

[00:04:31] So we could just. Put that in our heads and bypass the calories and the cost and the possible hangover the next day, and just possibly be having more fun. Is that a fair assessment? 

[00:04:47] Dr. Kilmer: I think what's, I mean, it's a good summary. I think what's really, really striking is that. We think of people who have said, okay, so I tried to not drink tonight.

[00:04:56] And we'll ask them, well, how did it go? And they're like, I felt uncomfortable. I was just standing there going like, Hey, not drinking. And it's like, why would you stand there? Have a cup in your hand. The key is that cup could be water, it could be soda, it could be, uh, alcohol free cocktail, you know, a mocktail in quotes.

[00:05:11] It could be whatever you want it to be. Much of our comfort socially could have as much to do with having a cup in our hand just as this buffer between us and other human beings. And less to do with the contents of that cup. And so, you know what might be when people say, well I have fun at a party.

[00:05:28] That's probably 'cause it's really fun to say, bye homework, buy stress, be out with the people you're out with. And again, whatever a person's able to do to kind of boost their comfort socially is important. You highlight the important point though, about messaging. People get, yeah. Hey, do you wanna go out this weekend?

[00:05:44] Nah, I'm really, really shy. Well have a drink or two. You'll be less shy. That is not good advice to give someone because not only is there literally no science, just suggest that's gonna make someone less shy, more outgoing, more confident, more social, whatever. But if their, if their concern is, I want to feel like I'm fitting in.

[00:06:02] If you're holding a cup in your hand, honestly, people aren't gonna ask like, Hey, what's in your cup? Whatever it takes for someone to feel personally comfortable can be important because you bring up the important piece of how much of the decision to drink also might then carry with it these different strings attached feeling not great the next day saying or doing things they regret and so on.

[00:06:22] Debbie: Right.

[00:06:26] I wish I could go back and tell my college age self this and my high school age self this for that matter. And I wish that college and high school kids could get this, and I wish we as parents could help them really understand you are. So cool on your own. You're so funny, you're so worthy of connection.

[00:06:50] Um, you know, go have fun. Go experiment. Go explore, go fail, go succeed. Go figure it out. Enjoy life and go get the fullest out of it. And I liked your comment of, you know, the scientist in you says, yeah, we need to research this. The person who's ever interacted with anyone drinking or not drinking, you kind of do know.

[00:07:13] You can sense a lot of that. I love the word expectancy. I wanna start using it all the time 

[00:07:19] Dr. Kilmer: as a person talking to you from Washington State where I think that we, I think it is actually a state law. We need a coffee shop on every block, but we see this with caffeine, honestly. I mean, I mean, think about it.

[00:07:30] You have that moment. You're super tired. They're like, oh, I just need some coffee. Someone takes one sip and they're like, okay, there we go. Now I'm awake. Right. It's like that's literally physically impossible. Right? But we do see placebo effects in other domains, including things like coffee, and so placebos are very, very.

[00:07:46] Powerful, 

[00:07:47] Debbie: real. 

[00:07:47] Dr. Kilmer: You know, I certainly don't wanna be all woo woo and be like in, they're everywhere. They're everywhere you look. That's not true. But there are, especially the research shows compellingly with things like alcohol, there are a strong expectancy effect. 

[00:07:58] Debbie: Thank you so much for those insights.