Balanced placebo design: Revolutionary impact on addictions research and theory

Abstract

Prior to the publication of Marlatt, Demming, and Reid's (1973, Journal of Abnormal Psychology, 81, 233–241) manuscript entitled “Loss of control drinking in alcoholics: An experimental analogue,” the disease model of alcoholism prevailed. Central to the model was the belief that alcoholics suffer from a loss-of-control such that any drinking resulted in unregulated consumption and intoxication. In a masterfully crafted experimental investigation that represented an early use of the balanced placebo design (BPD), G. Alan Marlatt and his colleagues demonstrated that a priming drink of alcohol had no effect on how much alcoholics consumed during an ad libitum assessment of alcohol consumption. Marlatt's publication reflected a departure from conventional wisdom by challenging the strict adherence to the disease model of alcoholism and contributed to advancements in both addictions research and theory. This article is dedicated to describing these advancements including: (1) a revised understanding of the symptomatology and etiology of alcoholism; (2) the development of cognitive-behaviorally oriented alcohol interventions; (3) the effects of alcohol on behavior and the role of alcohol expectancies; (4) the use of the BPD; and (5) the development of behavioral assessment strategies for addictions by innovating in vitro procedures for measuring ad libitum alcohol consumption unobtrusively. In the 40 years since its publication, Marlatt et al. (1973, Journal of Abnormal Psychology, 81, 233–241) continues to have a profound impact on research and theory and is a testament to G. Alan Marlatt's status as a visionary and pioneer in the field of addictions research.

• Balanced placebo design
• alcohol expectancy theory
• loss-of-control drinking
• alcoholics
• alcohol administration
• alcohol interventions