Expectations and substance abuse: Does basic research benefit clinical assessment and therapy?

Implications of two bodies of literature on expectations and behavior change for the treatment of substance abuse disorders are discussed. Findings from studies that have used the balanced placebo design in demonstrating that expectation can influence the use and effects of alcohol have not had a direct impact on clinical practice. It is suggested that these laboratory studies and the recent emphasis on cognitive factors in behavior therapy are correlated coeffects of a more fundamental shift in psychological thinking. However, the balanced placebo design has important implications for the evaluation of therapeutic techniques. Bandura's self-efficacy theory is an example of how laboratory research can benefit the treatment of clinical disorders that bear little resemblance to the conditions under which the theory was originally formulated. Finally, it is argued that appropriate clinical research is needed to bridge the gap between laboratory studies and clinical practice. Reasons for the relative paucity of controlled clinical outcome studies are suggested.