, Volume 223, Issue 4, pp 489–499

Balanced placebo design with marijuana: Pharmacological and expectancy effects on impulsivity and risk taking

  • Jane Metrik
  • Christopher W. Kahler
  • Brady Reynolds
  • John E. McGeary
  • Peter M. Monti
  • Margaret Haney
  • Harriet de Wit
  • Damaris J. Rohsenow
Original Investigation



Marijuana is believed to increase impulsivity and risk taking, but the processes whereby it affects such behaviors are not understood. Indeed, either the pharmacologic effect of delta-9-tetrahydrocannabinol (THC) or the expectancy of receiving it may lead to deficits in cognitive processing and increases in risk taking.

Objectives and methods

We examined the relative effects of expecting to receive active marijuana and the pharmacological drug effects using a balanced placebo design. Young adult regular marijuana users (N = 136) were randomly assigned into one of four groups in a two × two instructional set (Told THC vs. Told no THC) by drug administration (smoked marijuana with 2.8 % THC vs. placebo) design. Dependent measures included subjective intoxication, behavioral impulsivity, and decision-making related to risky behaviors.


Active THC, regardless of expectancy, impaired inhibition on the Stop Signal and Stroop Color-Word tasks. Expectancy of having smoked THC, regardless of active drug, decreased impulsive decision-making on a delay discounting task among participants reporting no deception and increased perception of sexual risk among women, consistent with a compensatory effect. Expectancy of smoking THC in combination with active THC increased negative perceptions from risky alcohol use. Active drug and expectancy independently increased subjective intoxication.


Results highlight the importance of marijuana expectancy effects as users believing they are smoking marijuana may compensate for expected intoxication effects when engaged in deliberate decision-making by making less impulsive and risky decisions. Effects of marijuana on impulsive disinhibition, by contrast, reflect direct pharmacologic effects for which participants did not compensate.


THC Cannabis Expectancy Impulsivity Inhibition Risk taking Sexual risk 


  1. Anderson BM, Rizzo M, Block RI, Pearlson GD, O’Leary DS (2010) Sex, drugs, and cognition: effects of marijuana. J Psychoactive Drugs 42:413–424. doi:10.1080/02791072.2010.10400704 PubMedCrossRefGoogle Scholar
  2. Band GP, Ridderinkhof KR, Van Der Molen MW (2003) Speed–accuracy modulation in case of conflict: the roles of activation and inhibition. Psychol Res 67:266–279. doi:10.1007/s00426-002-0127-0 PubMedCrossRefGoogle Scholar
  3. Bates MN, Blakely TA (1999) Role of cannabis in motor vehicle crashes. Epidemiologic Reviews 21:222–232PubMedCrossRefGoogle Scholar
  4. Bolla KI, Eldreth DA, Matochik JA, Cadet JL (2005) Neural substrates of faulty decision-making in abstinent marijuana users. NeuroImage 26:480–492. doi:10.1016/j.neuroimage.2005.02.012 PubMedCrossRefGoogle Scholar
  5. Brodbeck J, Matter M, Moggi F (2006) Association between cannabis use and sexual risk behavior among young heterosexual adults. AIDS Behav 10:599–605. doi:10.1007/s10461-006-9103-9 PubMedCrossRefGoogle Scholar
  6. Chait LD, Fischman MW, Schuster CR (1985) “Hangover” effects the morning after marijuana smoking. Drug Alcohol Depend 15:229–238. doi:10.1016/0376-8716(85)90002-X PubMedCrossRefGoogle Scholar
  7. Cooper ZD, Haney M (2009) Comparison of subjective, pharmacokinetic, and physiological effects of marijuana smoked as joints and blunts. Drug Alcohol Depend 103:107–113. doi:10.1016/j.drugalcdep.2009.01.023 PubMedCrossRefGoogle Scholar
  8. Costa FM, Jessor R, Fortenberry JD, Donovan JE (1996) Psychosocial conventionality, health orientation, and contraceptive use in adolescence. J Adolesc Heal 18:404–416. doi:10.1016/1054-139X(95)00192-U CrossRefGoogle Scholar
  9. Crowe LC, George WH (1989) Alcohol and human sexuality: review and integration. Psychol Bull 105:374–386. doi:10.1037//0033-2909.105.3.374 PubMedCrossRefGoogle Scholar
  10. de Wit H (2009) Impulsivity as a determinant and consequence of drug use: a review of underlying processes. Addict Biol 14:22–31. doi:10.1111/j.1369-1600.2008.00129.x PubMedCrossRefGoogle Scholar
  11. Dennis ML, Funk R, Harrington Godley S, Godley MD, Waldron H (2004) Cross-validation of the alcohol and cannabis use measures in the Global Appraisal of Individual Needs (Gain) and Timeline Followback (TLFB; Form 90) among adolescents in substance abuse treatment. Addiction 99(Suppl 2):120–128. doi:10.1111/j.1360-0443.2004.00859.x PubMedCrossRefGoogle Scholar
  12. Drummer OH, Gerostamoulos J, Batziris H, Chu M, Caplehorn J, Robertson MD et al (2004) The involvement of drugs in drivers of motor vehicles killed in Australian road traffic crashes. Accid Anal Prev 36:239–248. doi:10.1016/S0001-4575(02)00153-7 PubMedCrossRefGoogle Scholar
  13. Fernandez MI, Collazo JB, Hernandez N, Bowen GS, Varga LM (2004) Predictors of HIV risk among Hispanic farm workers in South Florida: women are at higher risk than men. AIDS Behav 8:165–174. doi:10.1023/B:AIBE.0000030247.00140.62 PubMedCrossRefGoogle Scholar
  14. Fillmore MT (2003) Drug abuse as a problem of impaired control: current approaches and findings. Behav Cogn Neurosci Rev 2:179–197. doi:10.1177/1534582303257007 PubMedCrossRefGoogle Scholar
  15. Fillmore MT, Mulvihill LE, Vogel-Sprott M (1994) The expected drug and its expected effect interact to determine placebo responses to alcohol and caffeine. Psychopharmacology (Berl) 115:383–388. doi:10.1007/BF02245081 CrossRefGoogle Scholar
  16. Foltin RW, Fischman MW, Pedroso JJ, Pearlson GD (1987) Marijuana and cocaine interactions in humans: cardiovascular consequences. Pharmacol Biochem Behav 28:459–464. doi:10.1016/0091-3057(87)90506-5 PubMedCrossRefGoogle Scholar
  17. Fromme K, Katz E, D’Amico E (1997) Effects of alcohol intoxication on the perceived consequences of risk taking. Exp Clin Psychopharmacol 5:14–23. doi:10.1037//1064-1297.5.1.14 PubMedCrossRefGoogle Scholar
  18. George WH, Stoner SA (2000) Understanding acute alcohol effects on sexual behavior. Annu Rev Sex Res 11:92–124PubMedGoogle Scholar
  19. Harrell PT, Juliano LM (2009) Caffeine expectancies influence the subjective and behavioral effects of caffeine. Psychopharmacology (Berl) 207:335–342. doi:10.1007/s00213-009-1658-5 CrossRefGoogle Scholar
  20. Hart CL, GorpW V, Haney M, Foltin RW, Fischman MW (2001) Effects of acute smoked marijuana on complex cognitive performance. Neuropsychopharmacology 25:757–765. doi:10.1016/S0893-133X(01)00273-1 PubMedCrossRefGoogle Scholar
  21. Hooker WD, Jones RT (1987) Increased susceptibility to memory intrusions and the Stroop interference effect during acute marijuana intoxication. Psychopharmacology 91:20–24. doi:10.1007/BF00690920 PubMedCrossRefGoogle Scholar
  22. Hull JG, Bond CF (1986) Social and behavioral consequences of alcohol consumption and expectancy: a meta-analysis. Psychol Bull 99:347–360. doi:10.1037//0033-2909.99.3.347 PubMedCrossRefGoogle Scholar
  23. Johnson MW, Bickel WK, Baker F, Moore BA, Badger GJ, Budney AJ (2010) Delay discounting in current and former marijuana-dependent individuals. Exp Clin Psychopharmacol 18:99–107. doi:10.1037/a0018333 PubMedCrossRefGoogle Scholar
  24. Juliano LM, Brandon TH (2002) Effects of nicotine dose, instructional set, and outcome expectancies on the subjective effects of smoking in the presence of a stressor. J Abnorm Psychol 111:88–97. doi:10.1037//0021-843X.111.1.88 PubMedCrossRefGoogle Scholar
  25. Katz EC, Fromme K, D’Amico EJ (2000) Effects of outcome expectancies and personality on young adults’ illicit drug use, heavy drinking, and risky sexual behavior. Cogn Ther Res 24:1–22. doi:10.1023/A:1005460107337 CrossRefGoogle Scholar
  26. Kelemen WL, Kaighobadi F (2007) Expectancy and pharmacology influence the subjective effects of nicotine in a balanced-placebo design. Exp Clin Psychopharmacol 15:93–101. doi:10.1037/1064-1297.15.1.93 PubMedCrossRefGoogle Scholar
  27. Kirk JM, Doty P, de Wit H (1998) Effects of expectancies on subjective responses to oral delta-9-tetrahydrocannabinol. Pharmacol Biochem Behav 59:287–293. doi:10.1016/S0091-3057(97)00414-0 PubMedCrossRefGoogle Scholar
  28. Lane SD, Tcheremissine OV, Lieving LM, Pietras CJ (2005) Acute marijuana effects on human risk taking. Neuropsychopharmacology 30:800–809. doi:10.1038/sj.npp.1300620 PubMedCrossRefGoogle Scholar
  29. Leigh BC, Ames SL, Stacy AW (2008) Alcohol, drugs, and condom use among drug offenders: an event-based analysis. Drug Alcohol Depend 93:38–42. doi:10.1016/j.drugalcdep.2007.08.012 PubMedCrossRefGoogle Scholar
  30. Lejuez CW, Read JP, Kahler CW, Richards JB, Ramsey SE, Stuart GL, Strong DR, Brown RA (2002) Evaluation of a behavioral measure of risk-taking: the Balloon Analogue Risk Task (BART). Journal of Experimental Psychology: Applied 8:75–84. doi:10.1037//1076-898X.8.2.75 PubMedCrossRefGoogle Scholar
  31. Logan GD (1994) Spatial attention and the apprehension of spatial relations. J Exp Psychol Hum Percept Perform 20:1015–1036. doi:10.1037//0096-1523.20.5.1015 PubMedCrossRefGoogle Scholar
  32. Logan GD, Schachar RJ, Tannock R (1997) Impulsivity and inhibitory control. Psychol Sci 8:60–64. doi:10.1111/j.1467-9280.1997.tb00545.x CrossRefGoogle Scholar
  33. Lukas SE, Mendelson JH, Benedikt R (1995) Electroencephalographic correlates of marijuana-induced euphoria. Drug Alcohol Depend 37:131–140PubMedCrossRefGoogle Scholar
  34. Marlatt GA, Rohsenow D J (1980) Cognitive processes in alcohol use: expectancy and the balanced placebo design. Advances in Substance Abuse: Behavioral and Biological Research, Greenwich, CT: JAI Press 159-199.Google Scholar
  35. Martin CS, Sayette MA (1993) Experimental design in alcohol administration research: limitations and alternatives in the manipulation of dosage-set. J Stud Alcohol 54:750–761PubMedGoogle Scholar
  36. Martin W, Sloan J, Sapira J, Jasinski D (1971) Physiologic, subjective, and behavioral effects of amphetamine, methamphetamine, ephedrine, phenmetrazine, and methylphenindate in man. Clinical Pharmacological Therapy 12:245–258Google Scholar
  37. McDonald J, Schleifer L, Richards JB, de Wit H (2003) Effects of THC on behavioral measures of impulsivity in humans. Neuropsychopharmacology 28:1356–1365. doi:10.1038/sj.npp.1300176 PubMedCrossRefGoogle Scholar
  38. Meda SA, Stevens MC, Potenza MN, Pittman B, Gueorguieva R, Andrews MM et al (2009) Investigating the behavioral and self-report constructs of impulsivity domains using principal component analysis. Behav Pharmacol 20:390–399. doi:10.1097/FBP.0b013e32833113a3 PubMedCrossRefGoogle Scholar
  39. Metrik J, Rohsenow DJ, Monti PM, McGeary J, Cook TA, de Wit H et al (2009) Effectiveness of a marijuana expectancy manipulation: piloting the balanced-placebo design for marijuana. Exp Clin Psychopharmacol 17:217–225. doi:10.1037/a0016502 PubMedCrossRefGoogle Scholar
  40. Metrik J, Kahler CW, McGeary JE, Monti PM, Rohsenow DJ (2011a) Acute effects of marijuana smoking on negative and positive affect. J Cogn Psychother 25:1–16. doi:10.1891/0889-8391.25.1.31 CrossRefGoogle Scholar
  41. Metrik J, Spillane NS, Leventhal A, Kahler CW (2011b) Marijuana use and cessation of tobacco smoking among heavy alcohol drinkers. Drug and Alcohol Dependence 119:194–200. doi:10.1016/j.drugalcdep.2011.06.004 PubMedCrossRefGoogle Scholar
  42. Myerson J, Green L, Warusawitharana M (2001) Area under the curve as a measure of discounting. J Exp Anal Behav 76:235–243. doi:10.1901/jeab.2001.76-235 PubMedCrossRefGoogle Scholar
  43. Nutt D, King LA, Saulsbury W, Blakemore C (2007) Development of a rational scale to assess the harm of drugs of potential misuse. Lancet 24:1047–1053. doi:10.1016/S0140-6736(07)60464-4 CrossRefGoogle Scholar
  44. Ortner CN, MacDonald TK, Olmstead MC (2003) Alcohol intoxication reduces impulsivity in the delay-discounting paradigm. Alcohol Alcohol 38:151–156. doi:10.1093/alcalc/agg041 PubMedGoogle Scholar
  45. Perkins K, Jacobs L, Ciccocioppo M, Conklin C, Sayette M, Caggiula A (2004) The influence of instructions and nicotine dose on the subjective and reinforcing effects of smoking. Exp Clin Psychopharmacol 12:91–101. doi:10.1037/1064-1297.12.2.91 PubMedCrossRefGoogle Scholar
  46. Pleskac TJ, Wallsten TS, Wang P, Lejuez CW (2008) Development of an automatic response mode to improve the clinical utility of sequential risk-taking tasks. Exp Clin Psychopharmacol 16:555–564. doi:10.1037/a0014245 PubMedCrossRefGoogle Scholar
  47. Pope HG Jr, Gruber AJ, Hudson JI, Huestis MA, Yurgelun-Todd D (2001) Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry 58:909–915. doi:10.1001/archpsyc.58.10.909 PubMedCrossRefGoogle Scholar
  48. Rachlin H, Raineri A, Cross D (1991) Subjective probability and delay. J Exp Anal Behav 55:233–244. doi:10.1901/jeab.1991.55-233 PubMedCrossRefGoogle Scholar
  49. Ramaekers JG, Berghaus G, Van Laar M, Drummer OH (2004) Dose related risk of motor vehicle crashes after cannabis use. Drug Alcohol Depend 73:109–119. doi:10.1016/j.drugalcdep.2003.10.008 PubMedCrossRefGoogle Scholar
  50. Ramaekers JG, Kauert G, Theunissen EL, Toennes SW, Moeller MR (2009) Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. J Psychopharmacol 23:266–277. doi:10.1177/0269881108092393 PubMedCrossRefGoogle Scholar
  51. Ramaekers JG, Kauert G, Van Ruitenbeek P, Theunissen EL, Schneider E, Moeller MR (2006) High-potency marijuana impairs executive function and inhibitory motor control. Neuropsychopharmacology 31:2296–2303. doi:10.1038/sj.npp.1301068 PubMedGoogle Scholar
  52. Ramaekers JG, Robbe HWJ, O’Hanlon JF (2000) Marijuana, alcohol, and actual driving performance. Human Psychopharmacology-Clinical And Experimental 15:551–558. doi:10.1002/1099-1077(200010)15:7<551::AID-HUP236>3.0.CO;2-PPubMedCrossRefGoogle Scholar
  53. Reynolds B (2006) A review of delay-discounting research with humans: relations to drug use and gambling. Behav Pharmacol 17:651–667. doi:10.1097/FBP.0b013e3280115f99 PubMedCrossRefGoogle Scholar
  54. Reynolds B, Schiffbauer R (2004) Measuring state changes in human delay discounting: an Experiential Discounting Task. Behavioral Processes 67:343–356. doi:10.1016/j.beproc.2004.06.003 Google Scholar
  55. Reynolds B, Ortengren A, Richards JB, de Wit H (2006a) Dimensions of impulsive behavior: personality and behavioral measures. Personality and Individual Difference 40:305–315. doi:10.1016/j.paid.2005.03.024 CrossRefGoogle Scholar
  56. Reynolds B, Richards JB, de Wit H (2006b) Acute-alcohol effects on the Experiential Discounting Task (EDT) and a question-based measure of delay discounting. Pharmacol Biochem Behav 83:194–202. doi:10.1016/j.pbb.2006.01.007 PubMedCrossRefGoogle Scholar
  57. Richards JB, Zhang L, Mitchell S, de Wit H (1999) Delay and probability discounting in a model of impulsive behavior: effect of alcohol. J Exp Anal Behav 71:121–143. doi:10.1901/jeab.1999.71-121 PubMedCrossRefGoogle Scholar
  58. Sexton BF, Tunbridge RJ, Brook-Carter N, Jackson PG (2000) The influence of cannabis on driving. UK DETR Road Safety Research Report ISSN 0968-4107 Retrieved 11-24-2004 from: www.csdporg/research/TRL477pdf
  59. Shrier LA, Emans SJ, Woods ER, Durant RH (1996) The association of sexual risk behaviors and problem drug behaviors in high school students. J Adolesc Heal 20:377–383. doi:10.1016/S1054-139X(96)00180-2 CrossRefGoogle Scholar
  60. Simons JS, Maisto SA, Wray TB (2010) Sexual risk taking among young adult dual alcohol and marijuana users. Addict Behav 35:533–536. doi:10.1016/j.addbeh.2009.12.026 PubMedCrossRefGoogle Scholar
  61. Stroop JR (1935) Studies of interference in serial verbal reactions. Journal of Experimental Psychology: Applied 12:242–248Google Scholar
  62. Testa M, Fillmore MT, Norris J, Abbey A, Curtin JJ, Leonard KE et al (2006) Understanding alcohol expectancy effects: revisiting the placebo condition. Alcohol Clin Exp Res 30:339–348. doi:10.1111/j.1530-0277.2006.00039.x PubMedCrossRefGoogle Scholar
  63. Vadhan NP, Hart CL, Van Gorp WG, Gunderson EW, Haney M, Foltin RW (2007) Acute effects of smoked marijuana on decision making, as assessed by a modified gambling task, in experienced marijuana users. J Clin Exp Neuropsychol 29:357–364. doi:10.1080/13803390600693615 PubMedCrossRefGoogle Scholar
  64. Verbruggen F, Logan GD (2008) Automatic and controlled response inhibition: associative learning in the Go/No-Go and Stop-Signal paradigms. J Exp Psychol Gen 137:649–672. doi:10.1037/a0013170 PubMedCrossRefGoogle Scholar
  65. Vogel-Sprott M, Fillmore MT (1999) Expectancy and behavioral effects of socially used drugs. How expectancies shape experience. Washington, DC: American Psychological Association. Kirsch, E. I. (Ed.): 215–232. doi:10.1037/10332-009
  66. Wadsworth EJ, Moss SC, Simpson SA, Smith AP (2006) A community based investigation of the association between cannabis use, injuries and accidents. J Psychopharmacol 20:5–13. doi:10.1177/0269881105056642 PubMedCrossRefGoogle Scholar
  67. Wei (1978) Application of an urn model to the design of sequential controlled clinical trials. J Am Stat Assoc 73:559–563. doi:10.2307/2286600 CrossRefGoogle Scholar
  68. Weinstein A, Brickner O, Lerman H, Greemland M, Bloch M, Lester H et al (2008) A study investigating the acute dose-response effects of 13 mg and 17 mg delta 9-tetrahydrocannabinol on cognitive-motor skills, subjective and autonomic measures in regular users of marijuana. J Psychopharmacol 22:441–451. doi:10.1177/0269881108088194 PubMedCrossRefGoogle Scholar
  69. Whitlow CT, Liguori A, Livengood LB, Hart SL, Mussat-Whitlow BJ, Lamborn CM et al (2004) Long-term heavy marijuana users make costly decisions on a gambling task. Drug Alcohol Depend 76:107–111. doi:10.1016/j.drugalcdep.2004.04.009 PubMedCrossRefGoogle Scholar
  70. Wignall ND, De Wit H (2011) Effects of nicotine on attention and inhibitory control in healthy nonsmokers. Exp Clin Psychopharmacol 19:183–191. doi:10.1037/a0023292 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Jane Metrik
    • 1
  • Christopher W. Kahler
    • 1
  • Brady Reynolds
    • 2
  • John E. McGeary
    • 3
    • 4
  • Peter M. Monti
    • 3
    • 1
  • Margaret Haney
    • 5
  • Harriet de Wit
    • 6
  • Damaris J. Rohsenow
    • 3
    • 1
  1. 1.Center for Alcohol and Addiction StudiesBrown UniversityProvidenceUSA
  2. 2.Research Institute at Nationwide Children’s HospitalThe Ohio State UniversityColumbusUSA
  3. 3.Providence Veterans Affairs Medical CenterProvidenceUSA
  4. 4.Division of Behavior GeneticsRhode Island HospitalProvidenceUSA
  5. 5.New York State Psychiatric Institute, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  6. 6.The University of ChicagoChicagoUSA

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