This article summarizes a symposium organized and cochaired by Maria Testa and presented at the 2005 Annual Meeting of the Research Society on Alcoholism, in Santa Barbara, California. The symposium explored issues relevant to understanding the function of placebo conditions and to interpreting placebo effects. Cochair Mark Fillmore began with an overview of the use of placebo conditions in alcohol research, focusing on methodological issues. Jeanette Norris and her colleagues conducted a review of studies examining placebo conditions among women. They conclude that expectancy effects are limited to a few domains. Maria Testa and Antonia Abbey presented papers suggesting that placebo manipulations may result in unanticipated compensatory effects in actual or hypothetical social situations. That is, placebo participants may compensate for anticipated cognitive impairment through vigilant attention to situational cues. John Curtin's research suggests that the compensatory strategies of placebo participants appear to involve a sensitization of evaluative control, resulting in improved performance. Kenneth Leonard provided concluding remarks on the meaning of placebo effects and the value of placebo conditions in research. KeywordsAlcohol Drinking; Placebo Effect; Methods THE PLACEBO EFFECT is intimately tied to the concept of expectancy that arose out of the need to specify an internal (i.e., cognitive) representation of the learning experience (Bolles, 1972;Tolman, 1932). When an association between 2 events is learned, the first event is said to elicit an expectancy of the second event. Moreover, once learned, the expectancy itself can elicit the associated outcome, and thus expectancies are considered to be an important determinant of behavior (Kirsch, 1999).The placebo has a long history as a control-comparison condition in studies of drug effects on behavior (Kirsch, 1999). Early medical reports of the beneficial effects of placebos led to considerable interest beyond their use as control conditions. In particular, the placebo effect

Objective-Past alcohol administration research has produced mixed findings regarding the role of acute alcohol consumption on sexual decision making. The purpose of this study was to evaluate a more complex theoretical model that places alcohol's acute effects in context, through the inclusion of background measures as well as affective and cognitive responses to the specific situation.Method-College students (90 men, 90 women) completed a survey that included measures of individual difference characteristics and past experiences; approximately 1 month later, they participated in an alcohol administration study. Participants were randomly assigned to one of three drink conditions (sober, placebo, alcohol), after which they read a story about a couple that wanted to have sex, but had no condoms available.Results-In hierarchical multiple regression analyses, acute alcohol consumption significantly predicted participants' perceived likelihood that they would have sex without a condom in such a situation; an earlier step included gender, impulsivity, self-reported alcohol expectancies, frequency of heavy drinking, lifetime number of sexual partners and frequency of condom use. There was no significant effect associated with the expectancy that one had consumed alcohol. Neither was there a significant interaction between drink condition and self-reported alcohol expectancies.Conclusions-Through the inclusion of measures of individual differences and responses to the specific situation, this study provides a more nuanced understanding of the factors that affect college students' sexual decision making, compared with laboratory studies that examine the effects of acute alcohol consumption in isolation. Alcohol consumption explained a significant yet relatively small amount of variance. Researchers need to consider the broader context to understand how intoxication influences sexual decision making. (Douglas et al., 1997;Lewis et al., 1996). HHS Public AccessIntoxication was identified early in the AIDS epidemic as a contributor to risky sexual decision making (Leigh and Stall, 1993). Heavy drinking and sexual risk taking frequently co-occur. This is a particularly serious problem on college campuses where, depending on the type of school and location, approximately 20% to 50% of students are likely to be heavy drinkers (Vicary and Karshin, 2002). Of a national sample of college students, 10% reported that during the current academic year there had been at least one occasion when they had not used protection during sexual intercourse after drinking alcohol (Wechsler et al., 2002).Over the past decade, researchers have moved from simply documenting the general association between alcohol consumption and risky sexual activities to posing more sophisticated research questions and employing methods that better address issues of causality (for reviews of this literature, see Cooper, 2002;. Conflicting findings have required the development of more sophisticated theories that focus on both the types of individuals a...

Past sexual victimization has been identified as a predictor of women's sexual risk-taking. In order to develop effective prevention and treatment programs, research is needed that examines perpetrators' characteristics. Thus, the goal of this study was to examine predictors of men's willingness to use coercive strategies to obtain sex without a condom. Male college students (n = 72) completed a survey that assessed past sexual assault perpetration, hostility, past misperception of women's sexual cues, usual alcohol consumption, and usual condom use. One month later, they participated in an alcohol administration study and watched a video about a couple in a consensual sexual situation. Participants were asked to evaluate how justified they would be in using a variety of coercive strategies to make the woman have unprotected sex. In hierarchical multiple regression analyses, there was a significant main effect of past perpetration such that men who had previously committed sexual assault felt more justified using coercive strategies to obtain unprotected sex than did nonperpetrators. Acute alcohol consumption did not have a main effect; however, it interacted with hostility and misperception. Among participants who consumed alcohol prior to watching the video, the greater their preexisting hostility, the more justified they felt in using coercion. Similarly, the more frequently drinkers had misperceived women's sexual intentions in the past, the more justified they felt in using coercion. Based on these findings, several specific suggestions are made for prevention and treatment programs, including targeted communication skills and normative feedback interventions.

Objective-The effects of alcohol consumption, alcohol expectancy set and self-reported alcohol expectancies on college students' perceptions of a potential date rape situation were examined. It was hypothesized that the effects of alcohol consumption on perceptions of the likelihood of forced sex would be mediated by cognitive factors and perceived sexual arousal.Method-90 female and 90 male college students were randomly assigned to drink alcohol, a placebo beverage, or a nonalcoholic beverage. Participants read a story about a couple that had been drinking together at a party. The story ended with the woman saying "no" to sexual intercourse and the man exerting verbal pressure.Results-Participants' alcohol consumption during the study, self-reported alcohol expectancies, attitudes about casual sex and usual drinking on dates had significant effects on their perceptions of the story. Participants' alcohol expectancy set and gender did not have significant effects on perceptions of the likelihood that the male character would force the female character to have sex.Conclusions-Intoxicated participants perceived the woman in the vignette as being more sexually aroused and the man in the vignette as behaving more appropriately, and both of these variables were negatively related to ratings of how likely it was that forced sex would occur. These findings highlight the importance of mediating cues in intoxicated decision making.

Determining alcohol's precise role in sexual risk taking has proven to be an elusive goal. Past research has produced mixed results, depending on characteristics of individuals, their partners, and the situation, as well as how the link between alcohol consumption and sexual behavior was assessed. In this study, cross-sectional predictors of the frequency of condom use were examined for 298 heterosexual college students at a large urban university. In hierarchical multiple regression analyses that controlled for frequency of condom use when sober, alcohol expectancies regarding sexual risk taking and self-efficacy regarding condom use when intoxicated were significant predictors of frequency of condom use when intoxicated. These findings highlight the importance of targeting beliefs about alcohol's disinhibiting effects in STD-and HIV-prevention programs. Keywordsrisky sexual behavior; condom use; alcohol; STD and HIV prevention; college students Approximately 19 million STD infections are diagnosed annually in the United States, and almost half occur among individuals between the ages of 15 and 24 (Weinstock, Berman, & Cates, 2004). At least half of all new HIV infections in the United States are estimated to occur among people under the age of 25, with African Americans disproportionately affected (Centers for Disease Control and Prevention, 2004). Rates of heterosexual transmission have been increasing, particularly among young women (Centers for Disease Control and Prevention, 2004).Nationally representative surveys of college students suggest that many engage in high-risk sexual behaviors. Approximately 80% of college students have engaged in sexual intercourse, yet only about one third report that they regularly use condoms (Douglas et al., 1997;Wechsler et al., 2000). About one quarter of college students report having had six or more lifetime sexual partners (Douglas et al., 1997), and 6% report having had more than one partner in the past 30 days (Wechsler et al., 2000). Self-reported lifetime rates of STD infections range from 12% to 25% among sexually experienced students (Cooper, 2002) HHS Public Access Mixed Evidence Regarding the Relationship Between Intoxication and Risky Sexual BehaviorAcute alcohol consumption impairs higher-order cognitive processing and activates relevant expectancies (Curtin & Fairchild, 2003;Fillmore & Blackburn, 2002;Fromme, D'Amico, & Katz, 1999;George & Stoner, 2000). Thus, sexual encounters that take place when individuals are intoxicated are expected to involve more high-risk sexual behavior because of drinkers' diminished decision-making capacities, coupled with their beliefs that intoxication reduces their sexual inhibitions. Despite the large body of theory and research that supports this hypothesis, delineating alcohol's role in risky sexual behavior has been more challenging than originally anticipated (for reviews see Cooper, 2002; HalpernFelsher, Millstein, & Ellen, 1996;Weinhardt & Carey, 2000). Personality traits, such as impulsivity and sensation seek...