Experimental and Clinical Psychopharmacology 2014, Vol. 22, No. 4, 307–315

© 2014 American Psychological Association 1064-1297/14/$12.00 http://dx.doi.org/10.1037/a0036921

The Relationship Between Alcohol Cues, Alcohol Expectancies, and Physical Balance Cathy R. Cox and Erin A. Van Enkevort

Joshua A. Hicks

Texas Christian University

Texas A&M University

Marielle Kahn-Weintraub and Amanda Morin This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Texas Christian University Although previous research has shown that beliefs about alcohol (expectancies) are associated with alcohol-consistent, nonconsumptive behavior (e.g., aggression; Friedman, McCarthy, Bartholow, & Hicks, 2007), no research has examined the effects of such expectancy on physical balance. The purpose of the current research was to test the association between alcohol cue exposure and feelings of imbalance. Study 1 showed that participants exhibited poorer balance in the presence of alcohol-related pictures compared to neutral (e.g., juice) or no pictures. Study 2 found that people exhibited a heightened accessibility of alcohol-related thoughts following a manipulation where they felt imbalanced (i.e., rocking on a wobble board) versus balanced. Study 3 showed that people with higher positive expectancies about alcohol reported a greater number of alcohol-related thoughts after they were made to feel imbalanced (vs. balanced). Implications of this research for alcohol expectancies, embodied cognition, and psychomotor functioning are further discussed. Keywords: alcohol, balance, embodied cognition, expectancies

For instance, a common expectancy regarding alcohol use is that it will increase individuals’ sexual desire (e.g., Brown, Goldman, Inn, & Anderson, 1980; Fromme, Stoot, & Kaplan, 1993). In two experiments, Friedman and colleagues (2005) found that following exposure to alcohol-related words (vs. neutral words), men rated women as more physically attractive if they believed that alcohol increases sexual desire. In another series of studies, Freeman, Friedman, Bartholow, and Wulfert (2010) examined the connection between alcohol expectancies and social disinhibition, and reported that participants exposed to images of alcohol (relative to control beverages) were faster to generate free associations to provocative (e.g., prostitute, feces, thong) than neutral words (e.g., elephant, computer, weather). The results of previous research demonstrate that the expected effects of alcohol engender a tendency to act in accordance with those expectations (see also, Friedman, McCarthy, Pedersen & Hicks, 2009; Moltisanti, Below, Brandon, & Goldman, 2013). Although these studies provide evidence that alcohol-related cues influence nonconsumptive behaviors, there are some limitations to this work. First, a majority of this research has relied on self-reports that assess people’s evaluation of other target individuals (e.g., attractiveness, aggressiveness; Bartholow & Heinz, 2006; Friedman et al., 2005). As Freeman et al. (2010) noted, this overreliance on self-reports has the potential to increase demand characteristics with participants guessing hypotheses and confirming predictions. More research is needed to rule out this possibility. Second, although research demonstrates that alcohol cues influence both consumptive (e.g., Goldman, Darkes, & Del Boca, 1999; Jones, Corbin, & Fromme, 2001; Sher, Wood, Wood, & Raskin, 1996) and nonconsumptive behaviors (e.g., Friedman et al., 2005, 2007), what is less clear is the role that alcohol expectancy

Alcohol expectancies are mental representations associated with one’s beliefs about the effects of alcohol consumption on cognition, attitudes, and behavior (Goldman, 2002; Leigh, 1989; Stacy, 1997). Previous research demonstrates that alcohol-related stimuli (e.g., exposure to words such as wine and beer; Kramer & Goldman, 2003) or outcome-related stimuli (e.g., exposure to words such as horny, talkative, and funny; Roehrich & Goldman, 1995) can influence a host of consumptive and nonconsumptive behaviors. For example, Bartholow and Heinz (2006) found that participants exposed to alcohol advertisements rated the behavior of a target person as being more hostile compared to participants who were exposed to neutral advertisements. Similarly, when people were subliminally exposed to alcohol-related words (vs. neutral words) they behaved more aggressively toward a confederate (Friedman, McCarthy, Bartholow, & Hicks, 2007). Adding to these findings, research has shown that alcohol cue exposure can influence behavior in expectancy-consistent ways.

This article was published Online First June 2, 2014. Cathy R. Cox and Erin A. Van Enkevort, Department of Psychology, Texas Christian University; Joshua A. Hicks, Department of Psychology, Texas A&M University; Marielle Kahn-Weintraub and Amanda Morin, Department of Psychology, Texas Christian University. This research was made possible, in part, through start-up funds provided to Cathy R. Cox by Texas Christian University. We thank Ken Leising for his help on a previous version of the manuscript, as well as, Paul Chapelle, Wesley McCoy, and Evan Stelly for their help with data collection. Correspondence concerning this article should be addressed to Cathy R. Cox, Department of Psychology, Texas Christian University, 2800 South University Drive Fort Worth, TX 76129. E-mail: [email protected] 307

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activation bears on psychomotor functioning. One pervasive expectancy regarding the acute effects of alcohol is that it will lead people to feel physically imbalanced (Fromme & D’Amico, 2000). Based on the results of previous research showing that alcohol consumption is indeed associated with physical impairments (Mangold, Laubli, Krueger, 1996; Nieschalk et al., 1999; Patel, Modig, Magnusson, & Fransson, 2010), and the aforementioned research on the effects of expectancy activation on nonconsumptive behaviors, it is possible that exposure to alcohol-related cues may directly influence motor behaviors. Study 1 was designed to test this idea, specifically, whether alcohol cue exposure influences the (in)ability to maintain physical balance. Study 2, in turn, was conducted to explore the connection between alcohol cues and psychomotor functioning from an embodiment perspective (e.g., Barsalou, 2008; Niendenthal, Barsalou, Winkielman, Karuth-Gruber, & Ric, 2005). Embodied cognition is the idea that an individual’s thoughts, feelings, and behaviors are influenced by sensory, motor, and perceptual processes (see Meier, Schnall, Schwartz, & Bargh, 2012 for a review). For instance, holding a warm beverage as opposed to a cold beverage increases people’s perceptions of dispositional warmth in another person (Williams & Bargh, 2008) and closeness with significant others (IJzerman & Semin, 2009). In the current research, we further predict to the extent that physical imbalance is associated with thoughts of alcohol, participants will report a greater number of alcohol-related thoughts following a manipulation where they were made to feel imbalanced (vs. balanced). The purpose of the final study was to examine whether individual differences in people’s expectancies about alcohol would moderate these latter effects. People hold certain beliefs about the positive (e.g., feeling relaxed, sociable) and negative (e.g., hangovers, negative health consequences) effects of drinking, and these expectancies affect alcohol-related behaviors (e.g., Critchlow, 1986). For example, research has found that positive expectancies are associated with more alcohol use compared to negative expectancies (Carey, 1995; Chen, Grube, & Madden, 1994; Christiansen, Smith, Roehling, & Goldman, 1989; Fromme & D’Amico, 2000; Fromme et al., 1993; Lee, Greely, & Oei, 1999; Sher et al., 1996; Werner, Walker, & Greene, 1993). This has led some researchers to suggest that positive expectancies are better predictors of alcohol-related behaviors than negative ones (Adams & McNeil, 1991). For this reason, in Study 3, it was hypothesized that participants with stronger positive expectancies would report a greater accessibility of alcohol-related thoughts when feeling physically imbalanced (vs. balanced). Further, the Comprehensive Effects of Alcohol Questionnaire (CEOA; Fromme et al., 1993) was used in Study 3 to assess participants’ alcohol expectancies, with the one of the negative subscales measuring people’s “cognitive and behavioral impairment.” Although one might expect that individuals scoring high on this measure would report a greater number of alcohol-related thoughts in response to being imbalanced, only one item assessed the physical effects of alcohol use (“I would feel clumsy”) whereas the remaining items measured cognitive difficulties (“I would have difficulty thinking”). Thus, we examined whether the Cognitive and Behavioral Impairment subscale of the CEOA would interact with the balance prime to influence thoughts of alcohol but were more tentative about whether significant effects would emerge.

Method Participants Students, in all studies, were recruited from introductory psychology classes and received course credit for their participation. Fifty-nine students (42 females; Mage ⫽ 19.90, SD ⫽ 2.46) participated in Study 1, 80 students (55 females; Mage ⫽ 19.73, SD ⫽ 2.63) completed Study 2, and 106 students (78 females; Mage ⫽ 19.90, SD ⫽ 1.57) participated in Study 3. Five participants were dropped from the final study because of computer malfunctions or they had guessed the hypothesis of the study, resulting in a final sample of 101 students (74 females; Mage ⫽ 19.87, SD ⫽ 1.56).

Materials and Procedures All studies were conducted in a laboratory setting on an individual basis. Participants were informed that they were taking part in an experiment on the “personality and attitudes of college students.” Following a series of personality questionnaires to maintain the cover story of the experiment (e.g., Neuroticism, Eysenck & Eysenck, 1964; Personal Need for Structure, Neuberg & Newsom, 1993), participants either completed a balance test (Study 1) or a computerized lexical-decision task (Studies 2 and 3). At the end of each study, participants were asked to provide demographic information (e.g., age, gender, and drinking history) and were thoroughly debriefed. The content and order of materials in each study are described below. Study 1. Participants in the first experiment were asked to complete a balance test in the presence of posters that were hung on the wall. Following Bartholow and Heinz (2006; also see Freeman et al., 2010), participants viewed images of either alcohol-related or control beverages. To help mask the pictures, the experimental room was staged with clutter with several mounted wall posters (e.g., music, sports). As each participant entered the room, the experimenter nonchalantly said, “I apologize for the mess in here, we’re sharing the space with some other experimenters.” As part of the study procedure, two posters (16 ⫻ 25 in) hung on the wall in front of the balance apparatus. In the alcohol condition, participants viewed an ice-cold glass of beer and a martini with a bottle of vodka in the background. In the control beverage condition, participants viewed two juice posters (orange and apple). Finally, a third condition was included where no posters were hung on the wall. In both poster conditions, the images were of beverages in isolation and no text was included except for the text on the product labels. The Star Excursion/Y-Balance Test is commonly used in clinical and research settings to assess lower body injury and dynamic balance (i.e., postural control during movement; Gribble, Hertel, & Plisky, 2012). The measure has been shown to have high reliability and validity (see, e.g., Gribble et al., 2012, for a review), with poorer balance reflected in people’s inability to balance on one leg while extending their other leg in different directions (Kinzey & Armstrong, 1998). Given our interest in assessing postural stability, the Y-Balance Test (Danville, VA) was used as the dependent measure in the first study. The test is comprised of a stance platform from which three polyvinylchloride pipes extend in anterior (forward), posteromedial (sideway), and posterolateral (backward) directions (see Appendix). In the current study, each

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ALCOHOL CUES, EXPECTANCIES, AND BALANCE

pipe was marked in 5-cm (cm) increments, and participants were asked to push a mobile block (i.e., reach indicator) with their foot in each of the three directions. Everyone was instructed to stand on the stance platform with their left foot while keeping their right foot slightly raised. Participants then pushed the reach indicator forward, backward, and sideways three times in each of the directions. Following a practice trial, measurements were taken after each reach (in cm). The procedure was then repeated for the opposite leg. Following previous work (Gribble et al., 2012), balance scores were calculated by taking the average of reaches in each of the directions. Study 2. The independent variable in Study 2 involved standing on a wobble board, a 16-inch (40.6 cm) circular board attached to a 3-inch (7.6 cm) ball that tilted at a 15-degree angle, in order to elicit feelings of imbalance (vs. balance). In the imbalance condition, participants stood on the board and rocked front-to-back and side-to-side for 5 min. Conversely, in the balance control condition, blocks were placed under the board to prevent it from moving (see the appendix). The wobble board was used in both conditions to provide a consistent surface for all participants. Following similar procedures, 20 participants in a pilot study were asked to indicate on a 9-point scale whether they felt balanced (1 ⫽ unbalanced; 9 ⫽ balanced) and steady (1 ⫽ unsteady; 9 ⫽ steady; combined ␣ ⫽ .83). The results revealed that participants in the rocking condition experienced greater feelings of imbalance (M ⫽ 3.27, SD ⫽ 1.27) compared to those in the balance condition (M ⫽ 6.56, SD ⫽ 2.08), t(18) ⫽ 6.56, p ⬍ .001, ␩2 ⫽ .72. Immediately after the balance manipulation, participants completed a lexical-decision task to measure the accessibility of alcohol-related thoughts. Participants were asked to determine whether a string of letters formed either a word or a nonword. Participants completed 60 trials consisting of three word types: nonwords (e.g., fraw), neutral words (e.g., picture), and six alcohol-related words (beer, wine, drink, wasted, hammered, and drunk). The alcohol-related words were chosen based on their level of familiarity with college-age samples (Levitt, Sher, & Bartholow, 2009). Following Bargh and Chartrand (2000), scores on the lexical-decision task less than 200 ms and more than 2,000 ms were recoded to 200 and 2,000 ms respectively. This affected 2.8% of the responses. Mean reaction times (RTs) were calculated for the nonwords (␣ ⫽ .96), neutral words (␣ ⫽ .87), and alcohol words (␣ ⫽ .87). In this study, the average letter and syllable length were as follows: alcohol words (Mletter ⫽ 6.38, SD ⫽ 1.50; Msyllable ⫽ 1.81, SD ⫽ .66), neutral words (Mletter ⫽ 5.58, SD ⫽ 1.38; Msyllable ⫽ 1.67, SD ⫽ .65), and nonwords (Mletter ⫽ 5.10, SD ⫽ .94; Msyllable ⫽ 1.45, SD ⫽ .51). Word frequency per million words (SUBTLWF) was calculated for both alcohol (M ⫽ 46.68, SD ⫽ 81.05) and neutral words (M ⫽ 33.87, SD ⫽ 32.21) as recommended by Brysbaert and New (2009). Study 3. The materials and procedures in Study 3 were identical to the second experiment with two exceptions. First, participants were asked to complete the CEOA (Fromme et al., 1993) as an individual difference measure of alcohol expectancies. The scale consists of 38 items with four subscales assessing positive expectancies (Sociability [eight items; e.g., “I would be friendly”], Tension Reduction [three items; e.g., “I would feel calm”], Liquid Courage [five items; e.g., “I would feel brave and daring”], and Sexuality [four items; e.g., “I would feel sexy”]) and three sub-

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scales assessing negative expectancies (Cognitive and Behavioral Impairment [nine items; e.g., “I would have difficulty thinking”], Risk and Aggression [five items; e.g., “I would act aggressively”], and Self-Perception [four items; e.g., “I would feel moody”]). Participants were instructed to answer each item based on the following prompt, “If I were under the influence from drinking alcohol . . .” Responses were made on a 4-point scale ranging from 1 (strongly disagree) to 4 (strongly agree) and scores were calculated by taking the average responses for the 20 positive (␣ ⫽ .90) and 18 negative (␣ ⫽ .89) items (see Fromme et al., 1993; Fromme & D’Amico, 2000 for similar scoring procedures). Second, similar to Study 2, participants were asked to complete a lexical-decision task to measure RTs to alcohol-related words, neutral words, and nonwords. However, unlike the previous study, Study 3 only included alcohol-related words (e.g., whiskey and vodka) to decrease the possibility of activating positive or negative expectancies (e.g., wasted). Once again, scores outside of the range of 200 and 2,000 ms were recoded as 200 and 2,000, respectively (Bargh & Chartrand, 2000). This affected less than 1% of the responses (neutral words, ␣ ⫽ .90; nonwords, ␣ ⫽ .97; alcoholrelated words, ␣ ⫽ .91). The average letter length (alcohol: M ⫽ 5.38, SD ⫽ 1.54; neutral: M ⫽ 5.07, SD ⫽ 1.82; nonwords: M ⫽ 5.10, SD ⫽ .94) and syllable length (alcohol: M ⫽ 1.63, SD ⫽ .72; neutral: M ⫽ 1.64, SD ⫽ .74; nonwords: M ⫽ 1.45, SD ⫽ .51) were also calculated for Study 2. SUBTLWF frequencies were examined for alcohol (M ⫽ 15.44, SD ⫽ 21.33) and neutral (M ⫽ 55.52, SD ⫽ 61.29) words.

Preliminary Results Preliminary analyses were conducted to examine whether participants’ gender and drinking history moderated the obtained results. In Study 1, the two-way interaction between alcohol prime and gender was nonsignificant for all reaches (anterior, postereomedial, or posterolateral) on the Y-Balance Test, Fs ⱕ 1.85, ps ⱖ .17. Further, there was no significant three-way interaction between gender, balance, and word type (alcohol, neutral, vs. nonwords) in Study 2, F ⫽ .37, p ⫽ .69, nor did gender interact with alcohol expectancies and balance conditions in Study 3: positive expectancies, bs ⱕ ⫺30.11, ts ⱕ .52, ps ⱖ .61; negative expectancies, bs ⱕ 30.26, ts ⱕ .68, ps ⱖ .50. With respect to drinking, in Study 1, 54.2% of participants reported drinking at least once a week whereas 59.5% and 66.9% reported doing so in Studies 2 and 3, respectively. Analyses revealed that alcohol frequency did not serve as a significant covariate (ps ⱖ .14) or moderator (ps ⱖ .23) in any of the studies. Finally, participants in Study 1 were asked to report their general activity level (1 ⫽ not at all active; 9 ⫽ very active; M ⫽ 6.98, SD ⫽ 1.86) and whether they participated in activities that have the potential to influence balance: yoga (62.7%), pilates (35.6%), and martial arts (13.6%). Analyses revealed that these variables did not serve as significant covariates (ps ⱖ .27), nor did they moderate any of the obtained effects (ps ⱖ .37).

Study 1 The first experiment examined whether activating alcohol expectancies through an environmental prime would impair physical

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Study 2 To examine the influence of physical balance on alcohol-related thoughts, lexical-decision scores were submitted to a 2 (imbalance vs. balance) ⫻ 3 (alcohol, neutral, vs. nonwords) mixed-design ANOVA, with the second factor being within subjects. The results revealed a significant two-way interaction between balance and words, F(2, 156) ⫽ 6.09, p ⫽ .003, ␩2 ⫽ .07 (see Figure 2 for means and standard errors). Simple main effects revealed faster RTs to alcohol-related words for participants who felt imbalanced than those who felt balanced, F(1, 78) ⫽ 4.18, p ⫽ .04. Conversely, there was no significant difference between balance conditions for neutral and nonwords, Fs ⬍ 1. Looked at differently, within the imbalance condition, faster RTs were demonstrated in response to alcohol-related words than neutral, F(1, 39) ⫽ 9.95, p ⫽ .003, and nonwords, F(1, 39) ⫽ 83.55, p ⬍ .001, which were also significantly different from each other, F(1, 39) ⫽ 51.08, p ⬍ .001. Within the balance condition, however, participants had faster RTs to neutral words compared to alcohol, F(1, 39) ⫽ 3.94, p ⫽ .05, and nonwords, F(1, 39) ⫽ 20.43, p ⬍ .001, which were significantly different from each other, F(1, 39) ⫽ 78.60, p ⬍ .001. Overall, the results of Study 2

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Figure 1. Balance scores in centimeters (cm) as a function of alcohol primes (Study 1). A higher score indicates greater balance. Error bars represent the standard error for each condition. An asterisk (ⴱ) indicates a significant difference between means.

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balance. To test this, separate one-way analysis of variance (ANOVA) tests with condition (alcohol, neutral, vs. none) as the factor were performed on scores from the three reach directions. The results revealed a significant effect of alcohol prime on balance: anterior, F(2, 56) ⫽ 3.83, p ⫽ .03, ␩2 ⫽ .12; posteromedial, F(2, 56) ⫽ 5.17, p ⫽ .01, ␩2 ⫽ .16; and posterolateral, F(2, 56) ⫽ 7.41, p ⫽ .001, ␩2 ⫽ .21. Means and standard errors are presented in Figure 1. Post hoc comparisons showed that participants exhibited greater imbalance anteriorly, posteromedially, and posterolaterally in the presence of alcohol pictures compared to neutral (Fs ⱖ 4.03, ps ⱕ .05) or no pictures (Fs ⱖ 6.94, ps ⱕ .01), which were not significantly different from one another (Fs ⱕ 1). Taken together, these results suggest that alcohol expectancies influence psychomotor functioning by showing that people exhibit poorer physical balance in the presence of alcohol-related cues compared to neutral (i.e., juice) or no cues.

Balance scores in centimeters (cm)

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Figure 2. Reaction times in milliseconds (ms) as a function of balance prime (Study 2). A lower score indicates greater thoughts of alcohol. Error bars represent the standard error for each condition. An asterisk (ⴱ) indicates a significant difference between means.

showed that people who were made to feel imbalanced reacted quicker to alcohol-related words than those who felt balanced. These findings suggest thoughts of alcohol are associated with physical balance, and by inducing a state of physical imbalance, alcohol-related thoughts become more accessible.

Study 3 Separate regression analyses were performed on RTscores for each word type (neutral, nonwords, vs. alcohol-related words) as a function of alcohol expectancy (positive vs. negative). For each analysis, balance condition (dummy coded) and CEOA scores (centered) were entered simultaneously as predictors in the first step, followed by the two-way interaction in the second step (see Aiken & West, 1991). The results revealed nonsignificant interactions between balance condition and negative expectancies on RTs for alcohol, neutral, and nonwords, bs ⱕ 10.82, ts ⱕ .85, ps ⱖ .40, R2s ⱕ .01. Further, nonsignificant interactions emerged between balance condition and positive alcohol expectancies on neutral, b ⫽ 21.71 (SE ⫽ 14.90), t ⫽ 1.46, p ⫽ .15, R2 ⫽ .003, and nonwords, b ⫽ 15.58 (SE ⫽ 24.09), t ⫽ .65, p ⫽ .52, R2 ⫽ .005. However, there was a significant condition by positive expectancy interaction on RTs for alcohol-related words, b ⫽ 36.62 (SE ⫽ 16.54), t ⫽ 2.21, p ⫽ .03, R2 ⫽ .05 (see Figure 3 for predicted values at the mean and 1 SD above and below the mean on positive and negative expectancies). Simple slope tests (Rosenthal & Rosnow, 1985) revealed that after inducing a state of imbalance, higher positive expectancy scores predicted faster RTs to alcohol related words, b ⫽ ⫺24.87 (SE ⫽ 12.14), t ⫽ 2.05, p ⫽ .04, R2 ⫽ .04. No such relationship was present in the control balance condition, b ⫽ 11.75 (SE ⫽ 11.24), t ⫽ 1.05, p ⫽ .30, R2 ⫽ .01. To further elucidate this interaction, we examined the effects of condition at ⫾1 SD above and below the mean on continuous positive expectancy scores. At high expectancy levels, feeling physically imbalanced led to quicker RTs to alcohol-related words, b ⫽ 149.95 (SE ⫽ 49.97), t ⫽ 3.00, p ⫽ .003, R2 ⫽ .09. There was no difference between conditions at low expectancy levels, b ⫽ ⫺7.94 (SE ⫽ 50.45), t ⫽ .16, p ⫽ .88, R2 ⫽ .002.

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ALCOHOL CUES, EXPECTANCIES, AND BALANCE

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Figure 3. Reaction times in milliseconds (ms) as a function of alcohol expectancies and balance prime (Study 3). A lower score indicates faster reaction times to alcohol-related words.

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Finally, analyses were conducted to determine whether the Behavioral and Cognitive Impairment subscale interacted with the balance manipulation to influence RTs to alcohol, neutral, and nonwords. These results were nonsignificant, bs ⱕ .645, ts ⱕ 0.43, ps ⱖ .48, R2s ⱕ .07. Moreover, although the results revealed a marginal two-way interaction between balance condition and the one item “I feel clumsy” on the CEOA measure, b ⫽ ⫺93.30 (SE ⫽ 49.52), t ⫽ 1.88, p ⫽ .06, R2 ⫽ .03, simple slope tests showed that the slope in the imbalance condition was negative but nonsignificant, b ⫽ ⫺47.69 (SE ⫽ 36.31), t ⫽ 1.31, p ⫽ .19, R2 ⫽ .02. These results should be interpreted with caution given the combined item nature of the CEOA scale/subscales. The results of the third experiment suggest that although physical balance is associated with thoughts of alcohol (Study 2), these effects are more pronounced among those who hold more positive expectations about alcohol use. Further, whereas the focus of Study 2 was on the accessibility of both alcohol- (e.g., beer and wine) and expectancy-related words (e.g., wasted, hammered, and drunk), the present study found that the balance effects held when only thoughts of alcohol, rather than the consequences associated with drinking, were assessed. Finally, at a broader level of analysis, these findings support the notion that alcohol expectancies are mental representations that influence people’s perception and behaviors associated with drinking (Goldman, 1999; Stacy, 1997; Wiers, Hoogeveen, Sergeant, & Gunning, 1997; Wiers, Van Woerden, Smulders, & De Jong, 2002). Extending the results of previous research, the current findings demonstrate that individuals with greater positive expectancies are more susceptible to thoughts of alcohol when they feel imbalanced.

Discussion The current research is the first to examine the interplay between alcohol cues, alcohol expectancies, and physical balance. Specifically, Study 1 showed that participants exhibited greater imbalance in the presence of alcohol pictures compared to neutral or no pictures. Further, Study 2 demonstrated that inducing a state of physical imbalance increased the accessibility of alcohol-related thoughts, whereas Study 3 showed that these effects were specific to individuals who have greater positive expectancies regarding alcohol. Interestingly, in all three studies, results were found regardless of people’s self-reported alcohol consumption, suggesting that even nondrinkers strongly associate alcohol with physical imbalance. These findings support previous research showing that exposure to alcohol cues influence perceptions and behaviors consistent with the expected effects of alcohol consumption (Bartholow & Heinz, 2006; Friedman et al., 2005, 2007). The current studies extend this work to an unexplored area of nonconsumptive behavior: physical balance. Further, by manipulating (Studies 2 and 3) and measuring (Study 1) physical balance, these findings provide support that the behavioral effects of alcohol priming do not result from demand characteristics (Freeman et al., 2010). There was no consumption of alcohol during the current studies and there was no reason to believe participants expected to consume alcohol. Consequently, these results suggest that alcohol cues activate mental representations of the expected effects of alcohol consumption, and thereby engender a tendency to act in accordance with the content of those expectancies (Goldman, 1999; Stacy, 1997).

The findings from Study 3 also complement other research showing that individual differences in people’s expectations about alcohol influence social perception and behavior. For example, Friedman and colleagues (2005) showed that male participants with stronger expectancies that alcohol reduces tension were more likely to interact with a female stranger under relatively stressful circumstances following the presentation of alcohol-related words versus control (beverage) words. Building on this work, the present research showed that the association between memory representations of drinking and its expected outcome effects are bidirectional: Expectancy cues may lead to greater alcohol consumption, just as feeling imbalanced leads to greater expectancy consistent behavior, in this case, production of alcohol-related words during free association. Although these findings shed light on the relationship between alcohol expectancies and behavior, they are limited by a number of factors. First, although our participants did not express any suspicion about the relationship between the alcohol posters and the balance test in Study 1, researchers should explicitly ask whether participants were aware of the alcohol-related stimuli (manipulation check). Second, the alcohol stimuli in all studies were mostly associated with heavy drinking (e.g., vodka, whiskey). In light of previous research showing that expectancies can vary by alcohol level (Connors, O’Farrell, & Pelcovits, 1988; Southwick, Steele, Marlatt, & Lindell, 1981), the current results may not emerge with lighter drinking situations (e.g., cocktail, champagne) as compared to heavier ones. Third, positive expectancies were only found moderate the results of Study 3. This was somewhat unexpected given that one of the negative expectancy subscales involves cognitive and behavioral impairment (e.g., “I would be clumsy”). Despite the null findings for negative alcohol expectancies (and alcohol use itself), the current results are consistent with research showing that alcohol behaviors are associated more strongly with positive compared to negative alcohol expectancies (Chen et al., 1994; Fromme et al., 1993; Lee et al., 1999; Sher et al., 1996). Future research should continue to examine the role of individual differences to see whether balance effects are specific to all manner of alcohol expectancies (e.g., a psychometrically sound measure of balance related alcohol expectancies). A final limitation of the present research is that it did not assess potential mediators. Schneider and colleagues (2013) showed that participants reported greater feelings of ambivalence when asked to physically move side-to-side versus up-and-down or standing still. In addition, research has found that people often hold ambivalent attitudes toward alcohol (Cameron, Stritzke, & Durkin, 2003; Conner & Sparks, 2002; Graham, 2003; Leigh, 1989). It could be that participants in Study 1 responded to alcohol posters with greater ambivalence and this heightened ambivalence led to poorer performance on the balance task. However, the results of Study 2 go beyond Schneider et al.’s (2013) findings to show that people reported a heightened accessibility of alcohol-related thoughts after experiencing a state of imbalance. Future research should continue to examine the association between alcohol cues and postural sway while considering how thoughts of ambivalence might affect this relationship. Despite these limitations, the current research builds on previous work on alcohol expectancy activation to demonstrate that psychomotor movement is affected by alcohol-related cues. These results have implications for a variety of behaviors; for instance,

ALCOHOL CUES, EXPECTANCIES, AND BALANCE

exposure to alcohol advertisements on roadways may trigger mental representation of being “drunk,” increasing the likelihood of getting into an accident. Further, in the case of substance use, although individuals may actively avoid alcohol-related information, they may still be vulnerable to influences from their external environment (e.g., TV, magazines). Overall, the current findings suggest that the effects of alcohol-related cues on behavior are subtle but far-reaching, emphasizing the importance of continued research.

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Appendix

Materials Used in Studies 1, 2, and 3

Received November 20, 2013 Revision received April 8, 2014 Accepted April 10, 2014 䡲