Alcohol expectancies and sexuality

Alcohol Health & Research World,  Spring, 1991  by Mark S. Goldman,  Laurie Roehrich

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Drinkers' expectancies about the effects of alcohol on sexuality are strongly held. If expectancies represent information stored in memory at early ages, then perhaps the study of memory can lead to methods of prevention and intervention for problems with alcohol.

The ancient Hebrews drank wine and engaged in adultery at Sinai; Bacchus, the Greek god of wine, was thought to provoke licentiousness; the fictional young Elliot kissed his classmate after receiving telepathic signals of drunkenness from his visiting friend, E.T. Indeed, the link between alcohol use and sexuality is so strong in Western culture that it stands virtually unchallenged. The modern view that human sexual responses are largely chemically driven, coupled with the knowledge that alcohol is a chemical agent that may impinge directly on the human sexual system, would seem to support a linkage. But, in Shakespear's words (heard too many times by researchers in this field), "Lechery, sir, it provokes and unprovokes; it provokes the desire, but it takes away the performance" (Macbeth II, 3).

The contradictory effects noted by Shakespear do not appear only in Western cultures. MacAndrew and Edgerton (1969) found that the Tarahumara Indians of Mexico, usually a shy, stoic, introverted people, become boisterous, animated, and sexually provocative at their ritual Tesguinada, or religious drinking party. The extramarital intercourse that commonly takes place at the Tesguinada does not, however, extend to anyone outside the participating group. The ordinarily peaceful Pondo tribesmen of South Africa do not consider their Umjadu (that is, big feast where beer is consumed) to be complete without a fight, but they do not increase sexual activity during the event. How can such inconsistencies be explained? Psychological factors must play a role; after all, psychology has always been an important aspect of sexuality.

The scientific pursuit of psychological mechanisms involved in the alcohol-sexuality relationship starts with a study of the placebo effect (the effect of a nonactive substance on a person who considers it to be active). Until recently, the placebo effect was regarded as a nuisance which could obscure the value of "real" treatments for medical conditions. That the placebo effect might be more than an experimental nuisance, and instead a source of potent physiological consequences, actually had been indicated for some time. Shapiro and Morris (1978) concluded, in their review of medical placebo effects, "For thousands of years physicians prescribed what we know now were useless and often dangerous medications. Today we know that the effectiveness of these procedures and medications was due to psychological factors often referred to as the placebo effect" (p. 370). The placebo effect has been observed in numerous applications of modern medicine, including cancer treatment, surgery, electroconvulsive therapy, and dentistry.

Placebos, which themselves are usually inactive, turn otherwise neutral treatments into potent physiological agents. In the area of human sexuality, the consequences of alcohol use on human sexual response are perhaps even more interesting than the effects of placebos, because the physiological effects of alcohol are routinely negative. That is, by almost all physical standards of human sexual response, the evidence suggests that alcohol impairs sexual response. Using indices of arousal such as penile tumescence, vaginal blood engorgement, and time required to achieve orgasm during masturbation, researchers have found that concentrations of alcohol in the blood of about 0.04 percent to 0.06 percent decrease sexual arousal (Farkas and Rosen 1976; Malatesta et al. 1979). Nevertheless, in response to a questionnaire administered by Psychology Today, 45 percent of males and 68 percent of females stated that alcohol enhanced their sexual enjoyment greatly or somewhat (Athanasiou et al. 1970). These rates have remained consistent over the past 20 years (Klassen and Wilsnack 1986; Leigh et al. 1989).

Basic Findings

In studies of physiological sexual response and alcohol use, which use elaborate experimental controls for placebo effects, self-reports of increased sexual response often have paralleled decreases in actual physical response. These "balanced placebo" studies employ four groups of people (Marlatt and Rohsenow 1980). Two groups are given either alcohol or tonic and are apprised of the contents of the drinks. The other two groups are given the opposite of what they are told they will receive (alcohol or tonic).

The purpose of these groupings is to separate pharmacologic effects from placebo effects. The information given to the subjects (about beverage content) is referred to as the expectancy or expectancy set. Expectancy also can refer to subjects' opinions about specific behavioral effects of consuming alcohol, for example, sexual arousal and reduced anxiety.

In the first balanced-placebo study of alcohol and sexuality, Wilson and Lawson (1976) addressed the question, does alcohol or expectancy most influence sexual arousal? The researchers measured tumescence in male college undergraduates who were observing erotic films. Alcohol levels (for the subjects who received alcohol) were about 0.04 percent. At these levels, alcohol had no effect on tumescence. The expectancy set, however, did cause increased erectile response. A followup to this initial study showed that expectancy could increase other physiological measures of arousal, including heart rate and skin temperature (Briddell et al. 1978).