On embracing the power of the placebo effect

The other day my dog took off after a rabbit. He’s a beagle — that’s what he does.

My instincts kicked in too and I ran after him.

We have a large rose bush in our yard. I jumped over and through it to cut off my dog’s dash toward a nearby grove of trees.

It was a sight to behold.

After emerging with my yelping and rabbit-less beagle, my right shin was destroyed by the thorns of the rose bush.

Okay, it wasn’t destroyed. It was certainly cut up.

I, however, made it out to be a bigger deal than it was — seriously annoying my wife.

My leg could fall off from infection, right? I could bleed out overnight?

24 hours later, there were considerably more cuts than I remembered and there was a sizable rash.

What if my mindset wasn’t doom and gloom?

What if I looked at my leg and said, “That’s no big deal; nothing to see here;” cleaned it up and forgot it even happened?

Science says that the rash and irritation would likely have been less than what it turned out to be.

This is the placebo effect in action — at least a pretty good real life possibility.

Dr. Alia Crum, assistant professor of psychology at Stanford University, says that the placebo effect demonstrates the “sometimes surprising power of our mindsets, our thoughts, our beliefs, our expectations, to produce meaningful changes in the body.”

I was actually in attendance at that talk. A very chatty cardiologist sat next to me. He was having none of it. As I recall, he was “a man of hard science.”

Science is science, right?

Except for when it’s not.

Rory Sutherland, the ad executive and behavioral scientist, details the improved health outcomes of patients who had views of trees or nature when in the hospital in his book, “Alchemy”.

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Both Dr. Crum and Sutherland believe that we could smartly and ethically use the placebo effect to positively impact health and other behaviors.

Sutherland is more contemptuous for rigid medicine types, especially when something “does not work through a known and logical mechanism.”

Each detail the billions of dollars spent when the placebo effect tends to have greater efficacy over new medications and treatments.

Sutherland writes in Alchemy:

“At the moment, we spend many billions of dollars each year trying to improve drugs, but almost nothing, as far as I can see, on the better understanding of placebos; they look too much like alchemy, I guess.”

Some of those billions of dollars are being spent on drugs designed to engage the brain, alter its function, and curb the craving and pleasure aspects of addiction.

This is a new medical approach for addiction care. It is a reaction to nearly 100 years of 12-step facilitated treatment — or therapy supplemented with the 12-steps of Alcoholics Anonymous.

12-step facilitated treatment isn’t exactly Sutherland’s version of alchemy.

Alchemy is the intentional application of an illogical approach where universal laws fail or do not apply.

12-step facilitation operates on the universal rule that every person learns at step one: “it works if you work it.”

For decades, providers and society alike have applied this rule with rigid absolutism.

It continues to fail millions.

Yet, there’s a push to conduct random control trials proving the efficacy of AA.

Why? Simply to prove the AA haters wrong?

Care for addiction and the recovery supports that follow need more alchemy. More magic.

What would happen if a little more creativity was applied?

What if we better understood and more effectively applied psychological or placebo effects to attain desired outcomes?

Or in the words of Dr. Crum:

“What can we do as patients and providers to consciously, deliberately harness that effect to our advantage?”

What if we followed Dr. Crum’s placebo effect playbook?

First, anyone involved in addiction and behavioral healthcare needs to accept that no matter what evidence-based approach is applied, the placebo effect is always an active participant.

This doesn’t make you a bad doctor or therapist or peer recovery specialist.

In fact, it just might enhance the value of your effectiveness.

Embrace it.

Second, be more intentional about its existence.

The placebo effect is just our body and mind acting out its natural abilities.

It is our mindset, or the lens through which we view or perceive treatment.

And it is the social context through which care is delivered.

Social context, however, may be the easiest way for addiction and behavioral healthcare providers to take advantage of the placebo effect and practice a little alchemy.

Providers and recovery specialists need to start from a place of warmth.

What words are you using? How are you saying them?

This isn’t just about using non-stigmatizing and people-first language — that’s the low hanging fruit and a given.

What’s your body language? What are you wearing?

Are you demonstrating confidence and competence?

Are you making an emotional connection?

Are you helping form or frame the right mindset necessary for individuals and families to overcome addiction?

What’s your office look like? Is it disheveled, cold, unwelcoming, and a mirror of chaos?

Dr. Crum says,

“The effects of these forces, they are not mysterious or magical, they are understandable, measurable, quantified.”

Rory Sutherland on the other hand appreciates the magical nature of psychological interventions. He’d prefer a lot more psychological trickery or psycho-logic, as he calls it.

Economists tell us that humans are rational actors.

Human service systems are built to this standard — that people are rational and logical at every step of the way.

We’re not. We’re highly irrational.

Behavioral economists understand this.

People experiencing addiction — or the effects of transitioning out of the addicted state — are fully engaged in irrationality.

Don’t at me, I’m not being judgey.

Yet, we have designed systems and processes based on pure logic.

The expectation is that since it’s logical, it will be easy for the patient with addiction to grasp and to make better decisions.

This might be partly true. But …

“In human behaviour psychological improvements are the only thing that matters, because we don’t make decisions objectively.”

In other words, recovery specialists, therapists, and doctors are asking irrational people to engage in objective decision making.

This just doesn’t work.

No matter how sound a random control trial of a particular medical or clinical intervention might be — unless it’s rooted in psychology, behavior science, and placebo effects, the desired impact will remain undesirable.

In the words of Rory Sutherland, It’s time to “apply some benign bullshit.”

Intentionally, of course.