Monday, May 10, 2010

Sincere Efforts Do Not Always Yield Desired Results: A Critique Based On The Montana Meth Project- Kimberly Ann Lobo

Fractured families, overburdened law enforcement, crime, health consequences, rape, suicide and death are just some of the destructive results of drug addiction (1). Methamphetamine (meth) is a psychotic stimulant drug. It has a high potential for abuse and is an FDA approved drug in the United States, under the trademark name Desoxyn (2). Methamphetamine causes a number of physical, psychological and withdrawal effects such as anorexia, hyperactivity, tachycardia, bradycardia, hypertension, hypotension, blurred vision etc (3). The psychological effects include euphoria, anxiety, excessive sleeping, increased appetite and depression (3) (4).

In the United States, Montana has one of the highest per capita treatment admission rates for methamphetamine overdose and its use has a substantial economic impact on the state. About 53 % of children in Montanan foster care are there due to methamphetamine costing the state $ 12 million per year, 50 % of Montana’s prison population are in jail due to meth related crime costing the state $ 60 million per year and 20 % of adults are undergoing treatment for substance abuse are there in treatment for meth related symptoms costing the state $12 million per year (5). The Montana Meth Project, founded by Montana’s software billionaire and rancher Thomas M. Siebel, was instituted in September 2005 as a large scale prevention program aimed at reducing meth use in the state. Although its efforts were aimed in the right direction, it has failed to bring about any decrease in Montana’s per capita meth use. The Montana Meth Project has published their own reports indicating its success, however other published findings from unrelated organizations show that such anti drug campaigns cause no favorable changes in youth drug use and that such campaigns might create a significant norming effect wherein greater exposure to these ads will result in a more positive attitude towards drug use overall (6). There is no evidence that reductions in meth use are due to the advertising campaign. Rates of methamphetamine use have declined in recent years, but dependence and abuse have significantly increased (7).

One of the primary reasons for the failure of the Montana Meth Project was its use of the Health Belief Model which does not account for irrational behavior of individuals and self efficacy, two crucial factors in promoting behavioral change. Despite its documented failure, the Montana Meth Project is still running today.


The Montana Meth Project was founded to educate youth about the risks, health and psychological effects associated with meth use and aimed to reduce meth use throughout the state. The first campaign of the Montana Meth Project focussed primarily on the individual user. This project instituted a statewide advertising campaign distributed via television, radio, print and the internet. Its advertisements featured graphic depictions of the risks and harmful consequences of meth use aimed at warning youth about its dangers (8). As of September 2005, the Meth Project had introduced 71,000 television ads, 64,000 radio ads, 140,000 print impressions and 21,000 billboards (8). With this, a sudden burst of images of young individuals and their nightmarish trappings became omnipresent on the state’s billboards (8). Tom Siebel rocketed into place as the state’s largest advertiser.

The Meth Project was initially declared a great success primarily because of its aggressive approach. Currently, Montana officials are looking for funds to sustain this project and ways to export it beyond the state borders. The Meth Project officials believe that equipping youth with knowledge about the consequences of meth use will reduce the appeal of the drug thus reducing its experimental use in the population.

Critique 1: Misuse of Labeling and Stigma Theory

The Montana Meth Project inappropriately uses Labeling Theory and Stigma Theory to help youth overcome drug addiction. This project uses slogans such as, “My friends and I share everything, now we share HIV and Hepatitis”, “Before Meth, I had a daughter, now I have a prostitute” (8) ,“Before Meth I had a brother, now I have a thief” (8), hitting the site visitors hard in the face.

This project does not consider the fact that social stigma and labeling are some of the biggest hurdles affecting treatment of people (9). Stigma is the use of negative labels to identify a person. Trends have shown that stigmatized teenagers fear facing reality and are hesitant in dealing with their problems and seeking the help they need (10). Society believes that addiction is a blemish or a limitation that is incurable. Fear often forces children to hide the problem from their parents and when parents do find out, stigma makes them feel accountable. The Montana Meth Project appears to be insinuating the same message to the youth. This project, with the aim of bringing about a behavioral change is actually stigmatizing and labeling meth addicts which not only affects them on an individual level but also affects efforts of anti drug media campaigns which are aiming to help the community at large. Research has shown that it is because of stigma that people don’t get treatment, some doctors won’t treat addicts and some families won’t accept their own (11). An examination of the literature on stigma within the drug using population can best be anchored in sociological theories such as the labeling perspective which explains stigma in terms of these processes (12)(13). The Stigma Theory was put forth by Goffman and he categorized stigma as an attribute that is extremely “discrediting” (12). The labeling perspective further argues that the stigmatized person becomes, by virtue of the label, isolated from non-stigmatized groups in society (14). This can severely limit the individual’s ability to fully participate in the daily life of society, such as holding a job, having a home, getting access to any needed services and enjoying mutually supportive relationships with family and friends (15). In effect, the stigmatized individual who is denied legitimate social roles adopts “a deviant social role” (15). This has profound implications for an individual’s view of his or her self. A study on the Psychological Mediation Framework by Mark L. Hatzenbuehler, Yale University has shown how stigma related stress causes elevations in emotional deregulation, social and interpersonal problems and also affects the cognitive process (16). A similar study carried out at University of California, Community Health Department has revealed that depression is strongly correlated with both dimensions of stigma-internalized shame and perceived stigma. Both these dimensions are significant predictors of depression (17). The Montana Meth Project should instead battle with stigma by stopping broadcasting of the negative connotations with words like addict, alcoholic, abuser, thief, prostitute which only strengthen and support stigma by creating negative images.

Critique 2: Failure to depict behavior youth would want to model-Use of negative imagery
The Montana Meth Project uses negative imagery to educate youth about the risks associated with meth use. One television commercial opens with an image of students walking down a typical high school hallway. A teenage boy’s voice talks over the picture saying, "This is the high school he dropped out of" (8). The scene changes to show an area of ground under the bleachers. The voice says, "This is where he beat up his best friend” (8). Images of a fight between two teenage boys flash across the screen and then disappear. The scene transitions to show the pair of rusty scissors he used to dig imaginary bugs out from under his skin to the isolation room in a mental institution where he now spends 23 hours a day. Finally the narrator of the story, a teenage boy, appears on camera. He looks up and says: "...and this is what I said, when he told me he was going to try meth." The boy falls silent and just stares into the lens (8). While this commercial is a true story, it represents such an extreme that most teens viewing it will be unable to identify with the situation and will not think it could ever happen to them. This kind of television ad fails to connect with its target audience.

Fear mongering has been widely used to strengthen the anti-drug propaganda. Another Montana Meth Project advertisement is set in a filthy restroom reading “No one thinks they would lose their virginity here-Meth will change that” (8). This statement is bold, brazen and quite shocking. While it is appropriate to educate youth about the dangers and risks associated with meth use, this message and the way it is portrayed is ineffective. Youth of today would have difficulty in relating to such images and messages. This kind of negative imagery can reduce self efficacy of youth and can come in the way of them making a behavioral change. A study on the Effects of “Dual Focus” Mutual Aid on Self Efficacy for Recovery and Quality of Life has shown that self efficacy is crucial in the recovery process (19). Theory and prior research with people receiving help for substance abuse also suggests that self efficacy is an important factor in improving subjective quality of life (19).

Rather than using self efficacy the Montana Meth Project uses bold, ugly and gruesome imagery to actually bring about a behavioral change in youth. Images alone cannot bring about such behavioral changes. By improving their self efficacy, youth can be empowered to avoid the use of meth. Trends have shown that use of negative imagery and scare tactics to influence behavior in youth is often ineffective and can lead to defiant and resistant behavior (20). Negative images are found to be an important causal factor in social phobia (20). Unpleasant images can be linked to personal experiences, negative experiences, images and memory distress (20). In the Montana Meth Project, most of the commercials are exaggerated and education through exaggeration is an ineffective way of informing the public and in particular youth.

The anti drug media campaign writers fail to take into account truly positive peer pressure which can empower the youth to “just say no” and avoid succumbing to an unhealthy behavior when offered one. Studies have shown that there could be a positive effect against drug abuse among teens whose peers resorted to prosocial behaviors (21). Thus, self efficacy and identification of a positive role model with a focused, determined and motivated attitude can influence youth and enable them to overcome fears, come to terms with reality and identify their strengths, interests and future goals without resorting to drug use (21)

Critique 3:
Use of the Health Belief Model and other individual theories in the Montana Meth Project:

The Health Belief Model has been used as the basis of this anti drug media campaign. The Health Belief Model was developed by researchers of the U.S. Public Health Service (22). The key constructs of the Health Belief Model are given below (23) (24):

Table1: Key Constructs of the Health Belief Model
Constructs Key points
Perceived Susceptibility The degree to which a person feels at risk for a health problem
Perceived Severity The degree to which a person believes the consequences of the health problem will be severe
Perceived Benefits The positive outcomes that would result from the action
Perceived Barriers The negative outcomes a person believes will result from the action

The above constructs motivate a person to make a behavioral change by an explicit weighing of the benefits and costs of that change in behavior and how that would impact their lives. The Montana Meth Project, in an attempt to use the Health Belief Model, presents the idea that if you view these ads and take into account the severity of risks involved you would rationally make an informed decision and chose not to use meth. This project is based on the assumption that individuals think rationally and that every individual assesses the degree of risk involved in a particular behavior and makes a cost benefit analysis about whether or not they should engage in a preventive or health oriented behavior (25). It primarily focuses on the individual and does not address social and environmental factors (25). Also, this project is based on the assumption that everyone has equal access to and the same amount of information to make rational decisions. Studies have shown that people make poor decisions based on personal experiences. Hence biases creep into the decision making process (26). A study on Confirmation Bias in Psychology by Scott Plous in 1993 show that individuals are willing to assimilate facts that support certain conclusions but disregard other facts supporting other conclusions (26). Additionally, the onset of puberty in adolescence confers an increase in “sensation-seeking, risk-taking and reckless behavior” (27). This study has also shown that it is completely normal for a teen to admire a drug user, take risks and be free to do he pleases (27). Teens also desire to gain attention and popularity among their friends’ circle and may succumb to peer pressures. A study on Adolescents and Peer Pressure has shown that the motivation behind an individual’s risk taking behavior is the need to be accepted and the need to improve ones status among friends (28). This project however, fails to consider the fact that although teens may understand that use of meth is harmful, they may succumb to it based on their own personal experiences and frame of mind.

Designing Better Interventions:
The Montana Meth Project uses graphic depictions of teens prostituting themselves, picking at imaginary insects on their skin, beating up members of their families, going into convulsions, attempting suicide and betraying their loved ones. This has reached over 90 % of teens in Montana (8). The Meth Project claims that it is successful in using ad saturation, gruesome depictions and scare tactics to warn teenagers about risks of meth use (7). For the most part, viewers are told what not to do. The ads fail to improve self efficacy of youth by inflicting stigma on them. Interventions should be designed in such a way so as to improve self esteem and self efficacy and reducing the stigma associated with drug use. These interventions should be targeted at young audiences. Drug addiction afflicts millions of people of all ages and all walks of life. Evidence has shown that adolescents' affiliation with friends who engage in risk behavior is a strong predictor of adolescents' own health-risk behavior, at least for substance use (22)(24)(25). This association likely results from a combination of selection effects (26) wherein adolescents choose friends who engage in similar types of behavior and implicitly or explicitly influence one another to engage in these behaviors (27)(28).

From a public health perspective, drug addiction is associated with a number of physiological, psychological effects and physical effects. The Montana Meth Project certainly has many flaws in their campaign. However, it has at least succeeded in getting public attention. It needs to incorporate interventions into its media campaign designed so as to empower youth overcome drug addiction. Education about the problem is the first step in effective behavioral change. In addition, contact with members of society and identification of a role model will go a long way in improving self efficacy of youth and in changing public stigma associated with drug use.

Defense of Intervention 1: Education
Educating the public about drug addiction is probably one of the simplest additions that can be made to the Montana Meth Project’s anti drug campaign. Education is important in order to bring about behavioral change as this will help reduce the stigma associated with drug use. Since this is the age of the internet, the Montana Meth Project can update its website easily and inexpensively which will reach its target audience. This website can provide information to youth and the public at large about drug addiction. The Montana Meth Project can make DVD documentaries and short films showing how drugs can affect teens and why teens actually turn towards drugs. These films must capture the downside of drug use along with honesty and human dreams that have instant, long lasting and commanding impacts. Broadly changing public attitudes about drug addiction will diminish perceived barriers to seeking help to treat the problem by youth. This will improve compliance with programs aimed at helping youth overcome drug addiction. Education programs can also lead to significant improvement in the attitudes of the public about drug addiction. Results of research on adult Education Strategies have shown that brief education programs have led to significant improvement in public attitudes (29). Research has also shown that education programs help people identify the inaccurate stereotypes about the problem and replace those stereotypes with factual information (29). Thus it is important to increase awareness about negative stereotypes. This can be accomplished by providing basic facts about the problem to an audience or by contrasting myths and facts about drug addiction. Either way, the objective is to provide simple facts so that many of the myths about addiction disintegrate and will also reduce the stigma associated with it. A study on Contextualizing Education and Health Status among African Americans has shown that the education gradient in health is one of the most robust factors in promoting behavioral change, achieving social mobility and reducing inequality (30). Higher levels of education often lead to better employment opportunities, greater economic resources, access to social networks and lifestyles that reduce risk taking behavior all of which result in better health outcomes (31) . Both direct and indirect effects of education on heath have been noted (32). It is important to keep in mind that education alone is not sufficient in bringing about a complete behavioral change. However, it is definitely a first step in the right direction and the Montana Meth Project needs to deliver this message about drug addiction to as many people as possible with the aim of reducing stigma which can then empower youth to eventually make a behavioral change.

Defense of Intervention 2: Changing stigma through effective contact with peers and members of society
The Montana Meth Project uses Labeling and Stigma theories to overcome the problem of drug abuse among youth in Montana. This project fails to consider the negative impacts of stigma and labeling, particularly among youth. Health belief theorists have shown that a rational consideration of the costs and benefits of participating in specific treatments will directly impact whether a certain route of intervention is pursued (33). A significant barrier to engaging in behavioral change is the stigma associated with it (33). Stigma has a direct impact on treatment access, participation in substance abuse recovery programs and adherence to medication. Research suggests that many people who meet criteria for treatment, and who are likely to improve after participation, either opt not to access services or fail to fully adhere to treatments once they are prescribed because they are labeled or stereotyped (33). The Montana Meth Project can organize recovery programs for drug users in order to help youth battle with this stigma. Contact with members of society and peers will help in combating this problem of drug addiction. Trends have shown that members of the general public who are more familiar with such problems are less likely to endorse prejudicial attitudes (29). It has also been noticed that members of the public who engaged with a person with an addiction problem as part of an anti-stigma program have shown significant changes in their attitudes about the problem (29). These studies have shown that attitude change which results from contact maintains over time and is related to a change in behavior. Substance abuse recovery programs facilitate contact with members of society who also have similar problems. These programs provide individuals with a platform to share their personal experiences. The issue of stigma will be directly addressed. The speaker will discuss the impact of stigma on his/her behavior change, how stigma made the experience even worse and how they overcame the addiction. In this way the Montana Meth Project can be more effective by bringing about interaction of youth with the community and peers which improves their belief that they are effective in life and they have equal rights just like every other member of society.

Defense of Intervention 3: Improving Self Efficacy among youth
The Montana Meth Project uses individual level models as the basic propaganda strategy in each of its ad campaigns. It fails to focus on the interaction between individuals and their environment and how that can impact behavior. The Social Cognitive Theory (SCT) was developed by Albert Bandura in the 1960s and holds that people learn not only through their own personal experiences but by watching and following the behaviors represented by a person with whom they can identify (34). Self efficacy is an important tenet of the SCT and it is the belief that you are capable of behavioral change. If you believe you are capable of making a behavioral change then you will be more successful in doing so. The SCT can be used to empower youth to avoid drug use. Studies have shown that participating in activities, bonding with friends and family and religion will enable youth to improve their self efficacy and will also build their self confidence and coping skills (35). This will then emulate individuals to model their behavior and shun substance use (35). The Montana Meth Project uses television as a platform to bring about a behavioral change among youth. However, the content of these commercials is what is important. The ads of the project currently fail to connect with youth. Pat Fleming, Director of Salt Lake County’s Division of Substance Abuse in Utah says, "Very few of the meth users actually end up looking the way they do in the Montana Meth Project.” She says, "We know that some kids say, 'Did you see those crazy ads? I use it on weekends and I'm not a meth fiend who's robbing laundry mats or stealing money.’” Thus the Montana Meth Project must alter its commercials in order to deliver the right message to youth. Commercials featuring both celebrities and regular individuals who were into substance use will help youth overcome drug use. These commercials can have the spokespersons talk about their experience with drug addiction, risks involved and how they were able to overcome it. Commercials can also display a list of recovery programs that youth can attend to help them combat this problem and improve their self efficacy.

Messages that target attitudinal beliefs, normative beliefs and self-efficacy beliefs have had promising results in changing behaviors (35). Previously conducted studies have found that friends' prosocial behavior may exert a positive influence on adolescents and perhaps would be related to lower frequencies of adolescents' health-risk behavior which will improve their self efficacy (36). Thus, by improving self efficacy, the Montana Meth Project can empower youth to make a behavioral change and hence enhance the quality of their lives.


The Montana Meth Project began with good intentions to educate youth about drug use. However, the Montana Meth Project’s fear based approach, failure to overcome stigma associated with drug use and use of individual level models render it ineffective in reducing meth use among youth. If millions of dollars are poured into this project, it is important to demonstrate effective results. Irrespective of the results of this campaign, the Montana Meth Project is still active, still being funded and is still targeted towards a young audience. In order to see effective results, previous evidence needs to be considered in this field in addition to developing effective interventions that connect with youth. It is the need of the hour to target this population before adolescents are enticed into unhealthy practices.


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