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How your expectations of a drug affect your intoxication behavior

Photo by Heath Alseike | Flickr | CC BY 2.0

Every halfway experienced psychedelics aficionado is usually very familiar with "set and setting" - the idea that both your own mental state, your ideas and your expectations (set), as well as your social and physical environment (setting) will determine whether your trip will take you to heaven or straight to hell. This concept has been one of the cornerstones of psychedelic practices since it was promoted by LSD guru Timothy Leary in the 1960s and 1970s.

But science has now found that these non-drug influences play an even bigger role than previously thought. They can influence all aspects of your consumption: from how aggressive you become under the influence of alcohol, to your susceptibility to addiction, to how much you feel pain, to the likelihood of dying from an overdose or not. Expectations and environments can either pull you out of your state of total relaxation abruptly or take your high to new heights — and they can change the way your brain processes information along the way.

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According to Ted Kaptchuk, a leading scientist in placebo research and a professor of medicine at Harvard, “It depends on what you aim at. But when it comes to things like mood and occasional drug use, everything indicates that [expectations] are important. "

For one thing, just being aware of whether you are using a drug can directly affect both your experience with it and the way your brain reacts to it. A recent study on smoking behavior shows how profound these effects can really be.

If you gave smokers cigarettes containing nicotine but told them they didn't contain nicotine, it drastically reduced the physical response to the drug in their brains. It almost always made smoking less satisfying because the wrong assumption reduced activity in the areas responsible for the neurotransmitter dopamine, which generates our cravings and our expectation of rewards.

In addition, the false belief that cigarettes were lacking nicotine also influenced smokers' decisions in a stock market game and changed how they valued their winnings. Not only did their expectation of what to expect from the cigarettes affect how they felt while smoking, it also influenced their behavior in relation to reward and motivation afterwards.

"That's a great finding," says Tor Wager, director of the Laboratory for Cognitive and Affective Neuroscience at the University of Colorado, USA, who was not involved in the project himself.

The study's authors are convinced that the data collected will significantly change our understanding of addiction - that is, the realization that the expectation of a drug can have exactly the same effects on the dopamine balance as the drug itself, which in turn leads to psychological aspects of an addiction disease makes decisive. The study states that reducing the "high" based on a false belief about the drug suggests that "although it may be responsible for the physical addiction, unusually often DA [dopamine] is insufficient," to describe the whole range of addiction symptoms. "

Whether or not being drunk in a culture is viewed as shameful or a sign of masculinity is determined by what anthropologists call "drunk behavior."

It is also well known that expectations influence drinking behavior. The ideas of how drunks behave, which are anchored in a culture, influence how people behave when they are properly seated. "There are obviously some individual differences in how people behave when they're drunk, and that's obviously also structured by cultural expectations," said Robin Room, professor of alcohol strategies at the University of Melbourne, Australia .

For example, research has also shown that the idea that alcohol makes you aggressive can affect whether or not people become violent while drunk. Other assumptions about the various effects of alcohol, including whether you associate it with relaxation or stimulation, can also affect how you feel drunk. Whether or not being drunk in a culture is viewed as shameful or a sign of masculinity is determined by what anthropologists call "drunk behavior."

"It varies a lot with the situation within a given culture and with who the one who drinks," says Room, adding gender as an additional factor. So biology, culture, environment and psychology all play one role Role.

Stimulating highs are also changed by expectations. For example, in an experimental group of cocaine addicts (who did not seek treatment for it) who had been given intravenous methylphenidate (Ritalin) with the indication that it would be a stimulant, they found that their brain metabolism was 50 percent higher and the heartbeat was faster than the control group who had been given the same dose of the drug with the remark that it would be a placebo. In addition, the first group reported a 50 percent higher satisfaction with the drug and the general feeling of intoxication.

However, sometimes the influence of expectations can go far beyond the conscious. "There are a lot of modifications in the way medication and drugs work through expectations — consciously or unconsciously," says Professor Kaptchuk.

In another study just published by Kaptchuk and his colleagues, 49 people learned to associate images of certain faces with either high or low heat pain inflicted on their forearms. Once this connection was learned, the sight of the faces associated with great pain made moderate pain worse — the faces associated with mild pain relieved pain.

This finding alone was not particularly surprising: after all, previous studies had already shown that things that are associated with something unpleasant increase pain, whereas those that are associated with pleasant things increase well-being. What was notable about the study, however, was the fact that even if the participants couldn't actually see the faces - the images were covered so that they couldn't be consciously recognized - the moderate pain from the "painful" faces was worse, than the harmless ones.

The participants' brains were subconsciously conditioned to predict whether a particular face would mean more or less pain. And that is exactly how their brains reacted, even if they could not consciously recognize the faces, and aggravated the pain, as they had learned to do.

Rats repeatedly given drugs such as heroin in the same cage are more likely to die from high doses if given later in a different setting.

This type of subconscious conditioning not only affects pain, it changes many of the other ways you respond to drugs. Research done on both rats and humans suggests that tolerances for drugs like heroin and prescription pain relievers are, to some extent, dependent on environmental factors. Rats repeatedly given drugs such as heroin in the same cage were more likely to die from high doses if given later in a different setting. In humans, this effect could be responsible for some otherwise mysterious overdose deaths that occur when people take their normal dose in a new location. This knowledge could open up new ways and possibilities in the prevention of overdoses.

"It's a form of conditioning," says Wager, "you're aware of some aspects of it, and not others." The formation of tolerance for a drug, of which one needs more and more to achieve the same state of intoxication, is therefore not only pharmacologically but also psychologically determined. In part, your brain relies on the clues in your subconscious that have to do with where, how, and with whom you normally consume this drug in order for tolerance to take hold.

Bizarrely, expectations can both increase and decrease feelings of intoxication. In the case of cocaine users given Ritalin, expecting a drug made them feel better. On the other hand, the expectation that one has of a drug when one takes it in a place where one has already done so often can increase the tolerance towards the drug and reduce its effect. In fact, sometimes this effect is so powerful that consuming the drug of your choice in an unfamiliar situation can literally kill you.

"Some placebo effects reflect the intoxication experience, but a whole series of others are only there to prepare the body for the upcoming and counteract this reaction", says Wager. And nobody can really say what ultimately determines which effect will prevail.

The question of which person is more likely to become addicted to alcohol or other drugs also seems to be strongly influenced by set and setting. A series of experiments in the 1970s in which rats were placed in a stimulating environment with other rats and lots of toys ("Rat Park") showed that they consumed significantly less morphine than rats that were given alone A better social and physical environment made rodents less susceptible to addictive behaviors — and the same seems to be true of humans too.

In fact, even after the researchers had forced them into physical addiction and taught them that drinking water containing morphine would relieve their withdrawal symptoms, the rats at Rat Park consumed eight times less of the drug than the cage rats, whose lives resembled solitary confinement .

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A study published in June found very similar effects with cocaine. Mice that were given extra incentives - such as looking for extra rewards like candy - were less likely to develop a strong preference for a chamber in which they could later find cocaine. Other studies have shown that modifications to the experimental setup — whether the animals suddenly come into contact with other animals, change their environment, or the way they are raised — affect whether rats prefer cocaine or candy. This also explains why the media in the 80s demonized crack as the most addictive substance of all, and in 2010 it was demonized by all sugar as at least just as bad.

It is safe to say that the drugs themselves are just one aspect of a complex interplay of causes and effects. If we are to get a better grip on the drug problem, we have to look much further than what is going on in our brains. An addiction is much more than simply exposing your mind to a substance. An addiction has to do with repeating decisions over and over in a complex environment and subconsciously learning to associate the effects of the drug with some form of relief. Conversely, exiting an addiction is also a complex learning process — and it is much easier to do in an environment that provides rich opportunity and warm relationships. In order to effectively combat addiction and reduce the damage caused by drugs, a basic understanding of set and setting is essential.

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