My first overnight study was both extremely enjoyable and very odd. Among other things, the researchers were testing the truth of the old lyrics, “Don’t the girls (and boys) all get prettier at closing time?” Does inebriation cause shifts in our sexual decision making and risk tolerance?
This was my second time screening for this study or for a very similar one with the same researchers and principal investigators (PIs). About a year before I was told I didn’t qualify for the study. Sometimes researchers need to change their inclusion criteria for various reasons including to achieve the full number of subjects needed.
The screening process was very rigorous. I received an EKG, blood test, drug test, and an extensive health screening; all to ensure I was healthy enough to take the FDA approved drug Desoxyn, which is a legal form of methamphetamine used to treat narcolepsy and ADHD, and to aid in weight loss. I also completed various questionnaires regarding drug use, sex, and sexual behavior.
Once these tests were complete, I was ushered into a room with pictures of 30 men and 30 women on a wall. I was told to select which of these people I would have sex with in a casual scenario; pretending I didn’t have a partner, the person was willing, and there was no chance of pregnancy. I picked 6 women from the wall, and out of those 6, I was asked to choose the person I most wanted to have sex with, the person I least wanted to have sex with, the person I thought was most likely to have a sexually transmitted infection (STI), and the person I thought was least likely to have an STI. The person I wanted to have sex with most was also the person I thought least likely to have an STI, and inversely, the person I least wanted to have sex with was also the person I thought most likely to have an STI. The researcher told me my choices would be important during the study protocol.
At the end of the screening two of the principal investigators met with me and we had a pleasant, getting acquainted sort of conversation. They asked me general, informal questions ensuring I was a right fit for the extensive, intense study protocol. I was paid $60 for completing the screening process.
A few days later I got a call informing me I was eligible to participate in the study, which would consist of three sessions lasting about 24 hours each, spaced at least two days apart. I would begin each session in the behavioral research unit and finish down the block in the clinical research unit. This was all completed at the Johns Hopkins Bayview campus in Baltimore, MD.
I was very excited to participate even though I had to do some scrambling to make arrangements for our dog, as my girlfriend, who is now my wife, was in New York at the time for an internship. Like a responsible young male, I agreed to participate before having all the dog sitting plans in order. Luckily, good friends helped out, and I had to beg a stranger for only one of the nights.
The researchers instructed me not to eat in the morning before coming to the lab and assured me I would be able to drive myself to and from the study. When I arrived, they gave me what they called a “jailhouse breakfast”: toast with jelly and juice. I imagine the breakfast was void of fat and protein to improve drug absorption and limit any pharmacokinetic issues. Then, 30 minutes after breakfast, they gave me two large red pills. This was a double-blind study, meaning neither I nor the researchers conducting the session knew on which day I was getting a placebo, a low dose of Desoxyn, or a high dose of Desoxyn. The in-house pharmacists who filled the order were the only ones who knew at the time of administration which dose I received.
After taking the pills, I would have a decision-making task every 30 minutes along with vitals checks every 15 minutes. Every 30 minutes I filled out a Subjective Effects Questionnaire, rating a handful of drug effects I was feeling at the moment. I rated the degree to which I agreed with statements such as, “feel stimulant effect”, “like the drug effect”, and others.
The time in-between vitals and tasks was mine to spend however I pleased. I could read, use my computer, knit, or sit quietly. I was not allowed to communicate with anyone outside the room for a few reasons, mainly because I would be under the influence of a drug that I did not take regularly and could say out of character or inappropriate things. Well, I did communicate with people through my computer, and I remember it feeling extremely pleasurable and rewarding. I can understand why they didn’t want us communicating with others as I was enamored with everyone I was chatting with, and I most likely would not have been as personable and bursting with positive emotion if I had been communicating with them without Desoxyn. To my knowledge, the researchers were not aware I was violating this protocol. I’m not proud of it, but the temptation was too difficult avoid. We are studying imperfect humans after all.
There were a handful of sexually related decision-making tasks scheduled throughout the day. I completed the Sexual Desire Task, Sexual Delay Discounting Task, and Sexual Probability Discounting Task, Sexual Fantasy Task, and the Sexual Arousal and Desire Inventory,
The Sexual Desire Task involved revisiting the wall of photographs of 30 men and 30 women, but this time the individuals were different from those featured during my screening visit. The idea was to see how my choices changed over the high dose, low dose, and placebo days. Would I pick more, fewer, or different people when I received different doses of Desoxyn?
The Sexual Delay Discounting Task was done on a computer and involved revisiting the individuals I selected and labeled at my screening visit as most and least wanting to have sex with and most and least likely to have an STI. Again, I was given the hypothetical casual sex scenario where I didn’t have a partner, the person was willing, and there was no chance of pregnancy. Using a visual analog scale ranging from 0 – I will definitely have sex with this person without a condom to 100 – I will definitely have sex with this person with a condom, I was asked about my likelihood of using an immediately available condom for each partner condition. Then I was asked about my likelihood of waiting for a condom for 1 hour, 3 hours, 6 hours, 1 day, 1 week, 1 month, and 1 year using a similar analog scale, 0 – I will definitely have sex with this person now without a condom to 100 – I will definitely wait to have sex with this person with a condom. My choices differed significantly based on the partner condition I assigned. The person I most wanted to have sex with and thought least likely to have an STI were closer to the 0 on the scale and while the person I least wanted to have sex with and thought most likely to have an STI was much closer to 100. I also remember my answers changing on the days I received the substance, in that I was more likely to have sex without a condom on those days.
The Sexual Probability Discounting Task was similar to the discounting task, but this trial assessed my likelihood of using an immediately available condom given specified risk of contracting an STI if a condom wasn’t used. For the partner conditions most and least wanting to have sex with, I responded on the scale from 0, meaning “I will definitely have sex with this person without a condom” to 100, meaning “I will definitely have sex with this person with a condom” based on various likelihoods of contraction: 1 in 1 (100%), 1 in 3 (33%), 1 in 13 (8%), 1 in 100 (1%), 1 in 400 (.25%), 1 in 700 (0.14%), 1 in 2000 (0.05%), and 1 in 10,000 (0.01%). I don’t think you’d ever have this type of information available to you while making a sexual decision in the moment but nonetheless it was an interesting question: Does desire mixed with amphetamines create a space where decisions are made even when we fully know the consequences?
At some point during the day, the researchers gave me noise cancelling headphones and a blindfold and asked me to go into a private corner and vividly imagine a sexual experience for the next three minutes. This was a little weird, but for the sake of science, I obliged and headed to the corner. (I had a friend who started the study but quit because of this part.) Immediately after the three minutes, I completed the Sexual Arousal and Desire Inventory, where I indicated how I felt while fantasizing by rating 54 descriptors related to arousal and desire.
The rest of my tasks involved gambling and decision-making regarding money and included the Real Money Delay Discounting task, the Hypothetical Money Delay Discounting Task, Hypothetical Money Probability Discounting Task, the balloon game, and the Iowa gambling task.
The Real Money Discounting task involved sitting at a computer with a coin machine attached and making repeated decisions between a small, immediate amount of money and a larger, delayed amount of money. I’d be offered 5 cents to take immediately, or I could wait 5 seconds for 80 cents. The money would actually be spit out of the coin machine like the old slot machines at casinos after waiting the required time or choosing the immediate reward. The smaller, immediate amount of money and time changed with each iteration in order to determine where my indifference point was, meaning what smaller amount of money seemed subjectively equivalent to the larger delayed reward. The time waiting ranged from 5 seconds to 80 seconds, and I would actually have to wait the length of time without any type of distraction, like my phone, until the money was spit out of the machine. A couple times, I really had the urge to take the smaller amount of money, but throughout the 3 days, I always waited for the larger, delayed reward. I was able to exchange the coins for paper money at the end of the day—I’m sure they did not want to keep replenishing $16 worth of nickels, dimes, and quarters.
Sometimes I think back to this trial and wish that delayed gratification were that simple. Going on social media or eating that entire pizza are a lot easier than writing an article or eating a salad. This trial simplified the act of delayed gratification to the point where it seemed almost stupid to choose the immediate reward.
The Hypothetical Money Delay Discounting task assessed how I valued receiving a hypothetical $100 in the future against a smaller, immediate amount. The time intervals were 1 day, 1 week, 1 month, 6 months, 1 year, 5 years, and 25 years. Would I take $20 now or wait 1 day for $100? Based on my answers, the computer would adjust future questions to find my indifference point. $100 25 years from now almost seems useless compared to $50 today. It would be a lot different if that $100 was a stock that grew over 25 years, but that was not the case.
The Hypothetical Money Probability Discounting Task was similar to the delay discounting task, but instead of time being a shifting variable, probability became the shifting variable. The probability of receiving a hypothetical $100 with odds of 99, 90, 75, 50, 24,10, and 1% were juxtaposed to hypothetical amounts you would get with 100% likelihood. Would you take a definite $40 or a 75% chance of getting $100? I answered a series of such questions until the computer was able to determine my indifference point.
One of the tasks involved inflating a virtual, deflated balloon as much as possible while trying not to pop it. I gradually inflated the balloon by hitting the space bar, knowing that at any time one more tap of the bar might cause the balloon to explode. But, the bigger the balloon got, the higher my score, so long as I stopped inflating before it popped. This really tested impulsivity control. One more, one more, one more kept running through my head during this game.
The Iowa gambling task presented me with four virtual decks of cards on the computer screen, and I was to draw cards from the decks in order to make as much play money as possible. Each deck had good and bad cards that award or take away play money, respectively. The decks were labeled A,B,C, and D, and each deck had a different proportion of rewards and penalties. After picking a few cards from each deck, I’d get an idea of which were going to help me make the most play money, and I’d make sure to pick cards from the good decks.
Except for the Real Money Discounting task, the tasks did not provide a reward aside from the virtual score. Still, I tried pretty hard to get as high of a score as I could.
Once I completed the sessions at the behavioral research unit the researcher walked me over to the overnight clinical research unit. I was introduced to the nurse who would monitor me, and I was escorted to my room, which contained a hospital bed, private bathroom, TV, and Roku. For dinner, I had access to a wide array of frozen meals and other foods and could eat as much or as little as I pleased. The nurse would walk me over to the kitchenette area, I would pick out what I wanted to eat, and then the nurse would bring the food to my room. I was left alone to eat, and then the nurse would come back to keep exact track of my food consumption, recording what I ate and weighing any leftovers to subtract from my total consumption. Also, my movement was being recorded and tracked through an actigraphy monitor on my wrist, like a fitbit or other fitness tracker.
The first day before the walk over to the overnight clinical research unit, I asked for a cigarette. I wasn’t a regular cigarette smoker, and they had made sure to figure that out during the screening process. The research coordinator gave me a cigarette for the walk over, and I thoroughly enjoyed that cigarette as I most likely had been given a dose of Desoxyn that day. The next study session before the walk over, one of the PIs informed me that I couldn’t have a cigarette that day because I wasn’t a smoker and I shouldn’t have been given one the previous session. I remember being very angry and irritated that I couldn’t have one. Combining stimulants like desoxyn and nicotine amplify the stimulant effects, creating euphoric feelings that I was craving based on having done so at the previous session.
I had a blast in my room. I got through almost an entire season of Lost, and I was able to bring my computer and phone as sources of stimulation. Here, I was allowed to communicate with the outside world, unlike during the study sessions. I could leave my room to go into a common room that had a view outside, but I needed to be escorted by the nurse so I didn’t run away or do something harmful to someone else.
At 9:45 pm, a sleep technician placed 20 or so electrodes on my face, head, legs, arms, and chest for a full sleep study. The electrodes were connected to wires for channels of data leading to a central box that relayed all the information to a polysomnogram recording device and computer system. The central box hung around my stomach. A full, overnight sleep study measures brain activity, eye movement, muscle activity, heart rhythm and rate, body position, snore volume, respiratory airflow and effort, blood oxygen saturation, and records a video of your sleep. I really enjoyed the 20 minutes each night of the sleep technician’s placing all of the leads on me and preparing me for the sleep study. We had wonderful conversations, and it was the bulk of my personal interaction for the night. Over the 3 nights, I had 2 different technicians with charming personalities whom I learned quite a bit about life from.
I didn’t have to go to bed at 10 pm, but the lights had to be off, the TV was supposed to be off, and I had to try to sleep. Sleeping was very difficult on two of the nights and I feel sure those followed the days when I was given active Desoxyn. I felt as though I never fell asleep at all on those nights. I think I just tossed and turned until they told me to wake up, but it surely did not feel like I was up for an entire night.
In the morning the sleep technician helped me remove all the leads and then I showered to get all the gunk out of my hair. I was provided breakfast, but I usually didn’t wait to eat it. The researchers then met back up with me and discharged me.
At the end of the third round I was given a check for about $1200 for completing the entire study. Each study day had an amount associated with completion, but completing the entire study was incentivized with a larger payout for completing all 3 days. I had also won about $16 in cash each day during the gambling games. Finally, I received an in-depth report on my sleep during the three nights, detailing when I was in REM sleep, deep wave sleep, and so on. This study was an absolute blast and helped me pay rent that month.