In the second episode of Freaks and Geeks—Judd Apatow's 1999 cult classic coming-of-age dramedy—younger brother Sam Weir panics when his sister Lindsay agrees to host a party while their parents are out of town. Motivated by fear of punishment and a misplaced sense of chivalry, Sam and his friends switch the party keg with one stocked with non-alcoholic beer. Later in the evening, they emerge from their hiding place and are shocked to find kids slurring their words, stumbling around, and acting altogether intoxicated.
"Are you sure we put out the right keg?" Sam asks his wise-guy friend Neal Schweiber, the keg-swap plan's mastermind.
"Look at them, they think they're wasted," Schweiber says. "That's the placebo effect working for you, my friend."
Irving Kirsch, associate director of the Program in Placebo Studies at Harvard Medical School, says the "Beers and Weirs" plot arc is completely plausible. "When we expect to experience something, that expectation tends to engender, to some extent, that which is expected," Kirsch says. "If we expect to feel pain, that's going to make the pain feel worse ... the stronger we have that conviction, the greater the effect is."
The mere act of a keg stand—even if that keg's pumping out root beer—is enough to trigger a relapse, because those cues are likely to cause cravings in an addict.
The placebo effect in this instance relies on the principles of classical conditioning, which aims to trigger specific actions by associating them with specific cues, as Russian physiologist Ivan Pavlov famously showed in the early 1900s. In his experiments, Pavlov used a bell that chimed before he fed his dogs, causing the dogs to associate the pitch with a meal. In Apatow's "study," red Solo cups and beer bongs have the same effect.
That's why George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, recommends alcoholics avoid party environments early on in their recovery and advises against non-alcoholic beer as a stand-in to distract from the real stuff. The mere act of a keg stand—even if that keg's pumping out root beer—is enough to trigger a relapse, because those cues are likely to cause cravings in an addict.
Cues alone can have a surprisingly strong intoxicating effect, Koob says, pointing to what he calls the "needle freak phenomenon" (PDF), or what a 2001 U.K. study called needle fixation. Heroin addicts who injected “physiological saline, instead of heroin, intravenously would get a brief high because of all the works associated with ingesting the drug," Koob says. What’s more, they found a measurable physiological change—apparently, the process of preparing an injection caused addicts' brains to release opioid chemicals "very similar to morphine," Koob says, similar to the release of adrenaline in a fight-or-flight situation.
From an evolutionary perspective, it’s useful to have a brain that can trick itself into being intoxicated. "If you're fleeing from a bear and you take a nip out of your cask because you would like to have some pain relief while you're climbing up into a tree, your body could suppress that pain whether there's liquor in there or not, to keep you alive," Koob says.
Kirsch compares the Freaks and Geeks party scenario to anti-depressant studies where participants in the placebo group often experience relief of their symptoms, even if the pills they're taking aren't altering their brain chemistry at all. "Placebos as anti-depressants have a very, very large effect on depression," he explains. "They have a very similar effect on brain physiology" to the hypothetical intoxicating placebo—be that a low-alcohol drink or a fake narcotic.
"In either scenario, you're having a suggestive experience, and your behavior then matches the experience that you're having,” he says. What’s causing the experience could be the substance or your expectation of the substance's effect, but regardless, the reaction is objectively real—there are observable physiological changes that scientists can and have tracked. Indeed, studies have logged changes in brain activity in patients unknowingly taking placebos that mirrored the effect of the actual drug.
But the pendulum swings both ways—a fake-drunk subject could conceivably get a fake-hangover, Kirsch says, pointing to the "nocebo effect," where subjects taking a placebo experience negative side effects purely based on pessimistic expectation. In one extreme example, a participant in an anti-depressant trial attempted to commit suicide by overdosing on the pills he had been provided as part of his study.
"He took all the pills in the bottle, went to the hospital and had several physical symptoms consistent with an overdose," Kirsch says. "Doctors pumped his stomach and saw that he was part of a study, so they got in touch with the researchers and found out he was in the placebo group." The pills contained "inert ingredients that would not produce any harm at all, but he had such similar [symptoms] that physicians in the hospital thought it was due to him taking so many pills."
Luckily, the nocebo effect has its limits. A key factor to a placebo intoxication "is the social interaction that drives and sustains it. Often placebo effects are very short-lived," Koob says. So an individual who's high on pure suggestion isn't more likely to get into a car crash than a sober driver.
But sobering up from a suggested high isn't as easy as jolting a hypnosis subject out of a trance with a snap. These are not conscious brain processes that can be controlled. "We're talking about the release of chemicals and neurotransmitters that are—I don't want to say unconscious—but they're in the limbic system. These are elements that are part of our reptile brain,” Koob says.
"Beers and Weirs" (which holds up as a surprisingly accurate case study) also addresses the importance of delusion—one must believe the substance is the real thing for the body to fake an expected effect. In a fake alcohol study, Koob says that “if you actually told the group what they got, it would probably limit the effect.”
At the end of the episode, a barely recognizable teenage Seth Rogen, who was remarkably clear-headed as his peers spilled and puked, admits he knew that the beer was "fake" when Sam clues him in at the end of the night.
"I know," his character Ken Miller says calmly while the rest of the guests scatter at the news that police are en route. "I won 77 bucks playing quarters. This party ruled."