Critique of Anti-Drinking Campaigns That Use Guilt and Shame-Candace Linehan

Introduction

Over one hundred years ago Reverend Henning Jacobson was fined five dollars for refusing the smallpox vaccination in the city of Cambridge. This landmark case, Jacobson v. Massachusetts, is used to demonstrate a state’s ability to use their police power to infringe on an individual’s civil rights in order to protect the greater good. In this case it was an infringement on the first amendment- the right to privacy-by requiring that everyone submit to a vaccination against small pox to avoid a widespread epidemic. To this day we truly do not know the real reasons for Reverend Jacobson’s declination, but they seem to stem from mistrust in the vaccine’s efficacy and general mistrust in the Cambridge Board of Public Health. This case reminds us that resistance to public health initiatives is often neither isolated nor idiosyncratic; but rather can result from a myriad of religious, social and ideological factors (1). In designing a successful public health campaign, one must gain the public’s trust in order to succeed in promoting any type of initiative. For example, during Jacobson’s time there was a grassroots “Antivaccinationism”, movement that stemmed from religious beliefs, concern about civil liberties and skepticism about medicine (1). Furthermore, Jacobson was an immigrant and a Reverend in a minority religion, two factors that may have further alienated him from widespread public health measures (1). Public health and medical officials must appreciate that different social groups view public health interventions from different perspectives; understanding this point is imperative for public health measures to gain acceptance(1).

Today, many anti-alcohol advertising campaigns commit the same fallacy as the Cambridge Board of Health in 1902; they fail to gain the trust of the public. It seems that the creators of these advertisements do not comprehend that attitudes and beliefs of their market. After a ten year decline in alcohol use among American teens, youth alcohol use is again on the rise (2). Alcohol has been linked to nearly 79,000 deaths in the United Stated per year (3) and is an especially significant problem at universities where it contributes to about 1,700 student deaths, 600,000 injuries, 700,000 assaults, 90,000 sexual assaults and 470,000 cases of unprotected sex (4). New research suggests anti-drinking ads that use guilt and shame in their messages actually lead to increased alcohol use (2). This new study comes from Northwestern’s Kellogg School of Management and involved polling 1,200 undergraduate college students about their drinking behaviors. Those students who were exposed to anti-alcohol ads that employed guilt and shame tactics reported that they would be more likely to binge drink (2). The reasoning behind this focuses on something called “defensive processing” when a person reacts adversely to a particular message that provokes guilt and shame (2).

Guilt and shame are common features of PSAs used by the National Institutes of Health and the Centers for Disease Control (2). Their current advertising campaigns about responsible and appropriate alcohol use have failed to gain the trust of viewers and have been shown to cause even more alcohol misuse. The public health and marketing communities expend considerable capital on these campaigns and have long since suspected that they were less effective than hoped, stated Adam Duhacheck, co-author of the Northwestern study (2). The concept of behavioral capability is part of the Social Cognitive Theory, it describes the knowledge and skill to perform a given behavior-in the case of anti-drinking ads it would be the behavior of not drinking alcohol. Shame and guilt advertisements offer no solution for behavioral capability to change drinking habits, they simply show the problem. Campaigns that employ strategies to control excessive or illegal drinking, or even recalling instances when the temptation to engage in risky drinking behavior was avoided may provide a pathway to reducing these undesirable behaviors more effectively (5).

Critique Argument 1- campaigns use guilt and shame to assuage youths from drinking

Shame is the tendency to feel bad about oneself following a specific event. It appears that individuals who are prone to shame when dealing with a variety of life's problems also may turn toward alcohol and other drugs to cope with this emotion (3). Defensive processing explains that an individual reacts adversely to messages that provoke feelings of guilt and shame, this reaction is heightened in those who were already feeling guilt sentiments for other reasons (2) During the Northwestern study, subjects were asked to reflect on a moment of shame or a moment of guilt that they had experienced and then view two advertisements. These ads depicted a person crouched over a toilet bowl after imbibing too much and one that focused on the impact that excessive drinking can have on loved ones, such as a car accident (2) The guiltier the participants looking at the guilt laden ads, the more likely they were to drink and similarly with the shame group. Those experiencing the most guilt or shame were also least likely to think that excessive drinking could lead to negative implications in their own lives, such as getting sick or in a fight,(2) and the consequences only befall other people(5). Furthermore, those who may have already had alcohol related transgressions are particularly vulnerable to the backlash these ads might cause since the shame and guilt message is felt more personally (3).

Successful anti-drinking campaigns need to avoid messages that elicit feelings of guilt and shame. Social Cognitive Theory discusses the concept of reciprocal determinism, that there is an interaction between the person, behavior and the environment where this behavior occurs. When watching advertisements using shame and quilt, viewers completely separate themselves from these situations displayed in the ads since they elicit such an emotional response. The viewers are so upset by the message that they disassociate from the situation leaving the ads message not received. Those experiencing guilt and shame seem to drink more and are less likely to feel that those potential negative outcomes of irresponsible use apply to them. The classic idea that we must shame or guilt the public into behavior change seems to fail when it comes to alcohol use and continued promotion of messages using guilt and shame could cause increased alcohol misuse and further injury.

Critique Argument 2-Campaigns use fear to promote responsible alcohol use

The current dogma in alcohol campaign design seems to stem from the idea that, “if we scare them enough, it’s always going to be a good thing.” (2) Typically ads that use scare techniques cause the viewer to shut down and not process or remember that ad’s message (6). Fear advertising is often used to promote health behaviors such as female self breast examination. A 2004 study investigated the impact that high fear advertising had on college aged women and whether fear motivated them to examine their breasts more regularly. The study found that the accessibility, the retention and recall, of attitudes toward self-examination and breast cancer were faster in a low-fear, high efficacy condition (7). In this experiment, low fear appeal messages were the most effective in attitude accessibility and formation of adaptive behaviors (7). The study showed that fear appeared to negatively impact the health promoting practice for self breast examination.

Arousing fear in individuals in order to spark change is a more complicated process than it was once thought to be. It seems that individuals usually handle fear differently, and also handle fear differently in different situations (7). Furthermore, what causes fear in one person may be ignored by another (7). In some cases fear can be an alluring motivator for those who seek sensation and thrill, especially in adolescents (7).

The Northwestern study shows a far more active response to fear advertising. These advertisements were so relevant to the emotions that the individual was experiencing and so deeply personal that they could not simply dismiss the advertisements; rather, they began to believe they were immune to such consequences that these ads depicted (5). In believing that they are distanced from the consequences shown in the advertisements, the target audience may even drink more after viewing fear ridden ads (6). The research found circumstances where this campaign strategy is not only ineffective, but that it can cause a backlash where people actually drink more than if they hadn’t been exposed the ads (2). Campaign designers need to consider the detrimental effect that using fear advertising can have on the public’s well being, as well as recognize that understanding the target audience’s sentiment about alcohol is imperative for running a successful campaign.

Critique Argument 3-Making misuse of alcohol seem like a youth only issue.

It is useful to consider advertising campaigns aimed at reducing cigarette smoking in youth as they have goals comparable to anti-alcohol campaigns. Similar trends are seen in anti smoking advertising research- some anti-smoking advertisements have an effect of nearly six times that of cigarette advertising (4). The simple visibility, especially in young people, of alcohol can increase the public’s awareness and potentially their use of this substance. Again, showing the backlash effect that poorly constructed, out of touch advertising can have on the youth market. In smoking, as well as in drinking alcohol, advertisements that encourage youths not to smoke, or focus on the short term and long term health effects of smoking are found to be the least effective (4). Also similar to smoking, alcohol is one of the few initiations into adulthood; it symbolizes growing up and maturity, young people are eager to participate in drinking alcohol in efforts to seem more sophisticated and independent (4). Austin argued that a “common mistake in campaign design has been assuming that portraying behavior as bad or unhealthy will cause children to reject it. In fact, the prohibition of behaviors may enhance their appeal to adolescents.

Campaigns that focus on misuse of alcohol strictly as a youth issue can further alienate young people and assure that any anti-alcohol campaign message goes unheeded. Misuse of alcohol is an issue that spans all age, legal and responsible use of alcohol should be marketed to youth as well as adults. Framing smoking as an adult behavior has been shown to make it more appealing to youths (4). Behaviors that are restricted to adults and not adolescents are seen as symbols of adult status and reinforce adolescents’ perception of alcohol use as a sign of maturity (4). Youth may view advertisements showing adults in unpleasant predicaments due to their alcohol use and feel that these situations do not apply to them. Similarly, adults may feel that they are seasoned drinkers and that a hang-over or car accidents are restricted to young, inexperienced drinkers. The defensive processing phenomenon, suggested by the Northwestern study, explains that viewers of these types of advertisements think that they do not apply to them and they are immune to the consequences.

Successful and prudent responsible alcohol use advertising will apply to all drinkers, perhaps even under aged college students. Drinking alcohol on college campuses is a large part social campus life, but blatant and dangerous intoxication does not have to be. Advertising that leaves few viewers out of the target audience can have the most overall impact and be the most recognizable.

Proposed Intervention

In order to assimilate a successful public health campaign to encourage responsible and legal alcohol use, we will need to do considerable planning and research. The Ecological Perspective guides this campaign since it takes into consideration the many factors that influence one’s behavior, including community factors, public policy and interpersonal relationships (8). There will need to be significant formative research done prior to the campaign’s release to clearly define as well as understand the target audience. Focus groups and market research can assure that we can promote our message to them in a way that will be well received. Polling various groups about their perceptions, motivations, skills and their social environment will be key to understanding what impacts their behavior surrounding alcohol use (8). A goal of constructing a campaign that can fit several markets will be useful in targeting different demographics of alcohol users (12). A simple, consistent emphasis of a widely held core value will give any campaign and its message a long shelf life. (12) Contemporary health promotion involves more than simply educating individuals about healthy practices; it includes efforts to change behavior as well as the physical and social environment of communities (8).

I propose a public health campaign with a two pronged approach. First, in the form of television advertisements that show people resisting temptation employing humor and catchy elevator music. These ads would show, for instance: a middle aged woman in a department store with one hundred pairs of shoes, a man at a hardware store with one hundred power drills, a young, college-aged, woman at a luxury store with one hundred pocketbooks, another young man at an electronics store with one hundred new video games-all of these people looking pensively at the beautiful alluring products in front of them. The slogan would read, “You know you can enjoy yourself with just one”, and show the happy person leaving the store, whistling along with the catchy music, carrying one of the products- not over indulging by buying several. The ad would later show the same person in a social situation-be it a sports game, a dinner party, a bar- just having one drink, declining a second, and enjoying them self. The ads would remind people that they have the power to resist temptation and show them that they resist other temptations already.

The second part of the campaign would involve partnership with local news broadcasts and an effort to report frequently and consistently on local mishaps involving alcohol. These mishaps could involve motor vehicle accidents, arrests, destruction of property, rape and even fatalities. Honest and open reporting of these local events can raise awareness of the significant impact misuse of alcohol has on the community and its members.

Defense of Intervention: Section 1- Offer positive strategies to control alcohol use- no more shame and guilt

The current trend of using shame and guilt in advertising is not adequately reaching the target audience and potentially exacerbating the problem they aim to fix. Applying the ecological perspective can help emphasize the interaction between; and the interdependence of, factors within and across all levels of a particular health problem (8). A successful advertising campaign needs to account for behavior effecting and being affected by many factors. In the case of alcohol, it seems making people feel shame and guilt about excess drinking fails to help them drink in moderation since it misses the root of why people are drinking in excess to begin with. The Northwestern study gives an example of a way that we can get information from people about their beliefs and emotions about alcohol. Randomized control groups would be incredibly helpful in assuring that the campaign appropriately reaches and respects its target group. Formative research about alcohol beliefs and habits of many different groups can assure that an advertising campaign addresses responsible alcohol use in a way that resonates positively with the public. Armed with information about what effects decision making in those who use alcohol, a campaign could begin to promote behavioral changes specifically designed to support responsible alcohol use.

Rather than use shame and guilt, the proposed campaign uses light humor interlaced with real life situations that appeal to a wide demographic. By enticing the consumer’s sense of independence and prudent decision making, these ads can empower their audience to drink responsibly.

Defense of Intervention: Section 2- Temper scary reality with the idea that it can be avoided

Duhachek offers the tactic of “using the carrot along with the stick” to reduce irresponsible alcohol use (9). In essence, he is suggesting teaching the solution along with discussing the problem. Having coverage of fatalities, arrests, injuries and destruction of property on the news may be a way to honestly show the public the possible repercussions of alcohol abuse. News coverage is typically unbiased, matter-of-fact and open, eliminating any feelings of judgment a viewer might have from the news anchor. Data exists suggesting that news coverage of drinking behavior and negative outcomes related to intoxication can reduce drinking among youths (12). Whether or not this reduction is related to heightened awareness of this issue to policy makers or heightened prevalence in the minds of youth is uncertain.

A partnership between local news stations and this ad campaign would ensure consistent reporting and advertising. Quietly and habitually reporting on local fatalities and injuries result from misuse of alcohol has the potential to raise awareness of the serious consequences of intoxication.

The proposed quick and simple public service announcements during this time can help drive home the importance of responsible alcohol use. These ads are especially useful when shown in conjunction with the reality and consequences of alcohol misuse shown on the news. According to the ecological perspective, what people know and think will affect how they act (8). Attempting to change the way people think may be a challenge, providing real facts and stories about tragedies surrounding alcohol abuse will increase public knowledge about the prevalence and gravity of alcohol abuse.

The key to promoting responsible alcohol use is empowering the public with the tools to resist imbibing excessively. Helping the target audience recall an instance when they resisted the temptation to engage in risk drinking behavior may provide a pathway to reducing these undesirable behaviors more effectively (9) Promoting recalling positive memories may be a way to influence public thinking and help people become more proactive in their reasonable alcohol consumption.

The proposed advertisements would show people of all demographics able to resist non-alcohol as well as alcohol temptations. These PSAs begin with the general idea of restraint in spending money, but tie in the idea of restraint in drinking alcohol. Financial restraint, especially in our current economic climate, is a common theme in magazines, news programs and advertisements; nearly every consumer can recall a time when for one reason or another, they had to choose to spend less. By beginning the advertisements with this usual and nonjudgmental premise those who do struggle with alcohol will not feel as judged and may be more receptive to the message. Finally, the PSA’s message is simple and ubiquitous, making it easy to understand and easy to remember-just spend/drink less, you’ve done it before, you can do it again.

Defense of Intervention: Section 3 – Make responsible and legal alcohol use an issue that spans all ages.

Public health campaigns have long attempted to get Americans to stop smoking, not to smoke less, but rather to quit entirely(8). An important aspect about alcohol that sets it apart from cigarettes is that it has a historic place in our society (8). Alcohol is often used to celebrate, relax, unwind and share with friends and loved ones; moderate long term use is widely acceptable. Nearly 90% of those who consume alcohol do so safely (8). There is no safe amount of tobacco, yet some studies have shown that certain amounts of alcohol may be beneficial to one’s health (8).

The most successful anti tobacco advertisements have centered on revealing that tobacco companies have no regard for the wellbeing of their costumers and are purely out to make a profit. The tactic of vilifying the industry, which has been quite successful in anti-tobacco campaigns, may not generate the same type of response from viewers when concerning the alcohol industry. There is less ammunition to generate outrage and anger towards the alcohol industry then there is for the tobacco industry. These advertisements vilifying the tobacco industry are also targeted specifically at young people to try to get them to stop smoking or never start; the ads had less appeal to adult or long time smokers.

Social Cognitive Theory touches on the importance of observational learning as a determinate in behavior change (12). Observational learning is done by many types of audiences, without regard for age. An advertising campaign that showed a person taking part in an easily reproducible action, with a positive outcome, could encourage viewers to take the same action. In this case, the action would be modeling the choice to exercise restraint.

A campaign with a simple and consistent message can be tailored to target different demographics. Such a campaign will be highly visible and employ less outrageous tactics, alienating less and encompassing more of the public. The proposed PSA would show several different types of people, young and old, but maintain the same message. Having the same message of restraint and responsibility shown in advertisements with different people and in varied situations will keep the message easily recognizable and applicable to more viewers.
An ad campaign with a strong core message can be translated to a variety of media and can target varied audiences with little alteration. Showing a still frame of the PSA in magazines or at bus stations with the slogan could trigger the viewer to remember the entire TV ad, again reiterating its message. One aspect of this campaign that would never change would be the background music; this would further solidify the pervasive quality of the advertisements. All of the actors would leave the store whistling the song, perhaps when a viewer heard that song again the message would return to their thoughts. A catchy tune can also linger with a listener for hours, giving the message in the PSA the same staying power.

The focus of an advertisement should not be that certain people need to drink less or not at all; it should be that everyone needs to exercise some restraint. An additional focus on enjoyment rather than excess will especially ring true with many viewers. The Ecological Perspective assumes that knowledge is necessary for, but not sufficient to produce most behavior changes (12). Increased news coverage of the repercussions of alcohol misuse combined with a public health campaign that focuses on self-efficacy and empowerment has the capability to impact health beliefs and behaviors. Research on the target audience of this public health campaign will assure that it addresses alcohol use at many levels, not just with the individual. Not only will the proposed responsible alcohol campaign empower individuals to make good decisions about their alcohol use, it will target the community at large by offering a new social norm (12). These advertisements will show different types of people that are able to drink responsibly in hopes to support all the market audience’s efforts to reduce the temptation to overindulge. By studying campaigns efforts that have failed, such as those who target only one demographic, employ fear tactics or use messages to induce feelings of guilt and shame, this campaign can avoid those pit falls and market a health promotion message effectively and respectfully to a varied market audience.

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