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

Introduction:
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.


Background:
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.


Conclusion:
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.



References:

1. Nutt D, King LA, Saulsbury W, Blakemore C (March 2007). "Development of a rational scale to assess the harm of drugs of potential misuse". Lancet 369 (9566): 1047–53. doi:10.1016/S0140-6736(07)60464-4.PMID 17382831
2. Erowid Methamphetamines Vault : Effects http://www.erowid.org/chemicals/meth/meth_effects.shtml
3. Dtar, Richard. Medical Toxicology. Lippincott Williams & Wilkins. pp. 1074. ISBN 978-0781728454.
4. "What are the signs that a person may be using methamphetamine?" The Methamphetamine Problem: Question-and-Answer Guide. Tallahassee: Institute for Intergovernmental Research. 2009. Retrieved 2009-08-13.
5. Montana Department of Justice and the Montana Meth Project, The Economic Cost of Methamphetamine Use in Montana, 2009
6. Hornik, R., Maklan, D., Cadell, D. et al. (2003). Evaluation of the National Youth Anti-Drug Media Campaign: 2003 report of findings.
7. Drugs, Money, and Graphic Ads: Winslow et al. 2007.
8. The Montana Meth Project http://www.montanameth.org/About_Us/results.php
9. Ban Ki-moon op-ed (2008, 6th August), 'The stigma factor', The Washington Times
10. Stigma, social support, and depression among people living with HIV in Thailand Li Lia,*, Sung-Jae Leea, Panithee Thammawijayab, Chuleeporn Jiraphongsab, and Mary JaneRotheram-Borus a Center for Community Health, Semel Institute, University of California, Los Angeles, CA, USA;Thai Ministry of Public Health, Bureau of Epidemiology, Bangkok, Thailand
11. Anna Scheyett, The Mark of Madness: Stigma, Serious Mental Illnesses, and Social Work, Retrieved: February 2007
12. Erving Goffman, Stigma: Notes on the Management of Spoiled Identity, Prentice-Hall, 1963, ISBN 0-671-62244-7.
13. Bruce G. Link and Jo C. Phelan , "Conceptualizing Stigma", Annual Review of Sociology, 2001, p.363
14. Clinard, Marshall B. And Robert F. Meier. 1992. Sociology of Deviant Behavior {eighth edition}. Fort Worth: Harcourt Brace Jovanovich College Publishers.
15. Kallen, Evelyn. 1989. Label Me Human: Minority Rights of Stigmatized Canadians. Toronto: University of Toronto Press.
16. How does sexual minority stigma "get under the skin"? A psychological mediation framework. Mark L Hatzenbuehler; Department of Psychology, Yale University, P.O. Box 208205, New Haven, CT 06520, USA. mark.hatzenbuehler@yale.edu
17.Stigma, social support, and depression among people living with HIV in Thailand Li Lia,*, Sung-Jae Leea, Panithee Thammawijayab, Chuleeporn Jiraphongsab, and Mary JaneRotheram-Borus a Center for Community Health, Semel Institute, University of California, Los Angeles, CA, USA;Thai Ministry of Public Health, Bureau of Epidemiology, Bangkok, Thailand
18. Molitor F, Truax SR, Ruiz JD, Sun RK. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. Western Journal of Medicine 1998;168:93–97.
19. Effects of “Dual Focus” Mutual Aid on Self-Efficacy for Recovery
and Quality of Life Stephen Magura*, Charles Cleland, Howard S. Vogel, Edward L. Knight, and Alexandre, B. Laudet.
* National Development and Research Institutes, Inc., New York, NY
Published in final edited form as:
Adm Policy Ment Health. 2007 January ; 34(1): 1–12.
20. Rescripting Early Memories Linked to Negative Images in Social
Phobia: A Pilot Study;Jennifer Wilda⁎, Ann Hackmannb, and David M. Clarka; Institute of Psychiatry at King's College London;University of Oxford.
21. Effective Strategies for Preventing Substance Abuse Among Children and Adolescents;Francis K. O. Yuen a;John T. Pardeck a; School of Social Work, Southwest Missouri State University 901 South National, Springfield, MO 65804, USA Early Child Development and Care, Volume 145, Issue 1998 , pages 119 – 131
22. Rosenstock IM (1966), "Why people use health services", Milbank Memorial Fund Quarterly 44 (3): 94–127, PMID 5967464
23. Glanz K, Lewis FM, Rimer BK. "Health Behavior and Health Education" (2002) ISBN 0787957151
24. Ogden J. (2007). "Health Psychology: A Textbook" ISBN 9780335222643
25. Essentials of Health Behavior-Social and Behavioral Theory in Public Health-Mark Edberg.
26. Blackhart, G. C., & Kline, J. P. (2005). Individual differences in anterior EEG asymmetry between high and low defensive individuals during a rumination/distraction task. Personality and Individual Differences, 39, 427–437.
27. A Social Neuroscience Perspective on Adolescent Risk-Taking
Laurence Steinberg Department of Psychology, Temple University. Published in final edited form as:Dev Rev. 2008 March ; 28(1): 78–106. doi:10.1016/j.dr.2007.08.002.
28. Farrell, Albert D., Danish, Steven J. (1993). Peer Drug Associations and Emotional Restraint: Causes or Consequences of Adolescents' Drug Use?. Journal of Consulting and Clinical Psychology, Vol. 61, issue 2.
29. Corrigan, P.W. (in press). Empowerment and serious mental illness: Treatment Partnerships and community opportunities. Psychiatric Quarterly.
30.Does Place of Education Matter? Contextualizing the Education and Health Status Association Among Asian Americans
31. Ross CE, Wu C-L. The links between educational attainment and health. Am. Soc. Rev.1995;60:719–45.
32. Feinstein JS. The relationship between socioeconomic status and health: A review of the literature. Milbank Q. 1993;71:279–322.
33. Alford, B. A. & Beck, A.T. (1997). The integrative power of cognitive therapy. New York: Guilford Press. 197p.
34. Mark Edberg, Essentials of Health Behavior- Social and Behavioral Theory in Public Health, 51-54.
35. Positive youth development in the United States-University of Washington http://aspe.hhs.gov/hsp/positiveyouthdev99/preface.htm.
36. Fishbein, M., Jamieson, K., Zimmer, E. von Haeften, I., & Nabi, R. (2002). Avoiding the boomerang: Testing the relative effectiveness of anti-drug public service announcements before a national campaign. American Journal of Public Health, 92, 238-245.

The D.A.R.E. Program for Adolescents: Ineffective Long-Term Intervention – Jackie Liu

Drug use, as well as abuse, among adolescents and young adults remains a major public health issue in the United States. Over 20% of 8th graders and 9th graders and over 30% of 10th-12th graders have reportedly used drugs at least once in their lifetime. In 2006, an estimated 38,396 deaths were caused by substance abuse in the U.S. and has increased from previous years (5). Although there has been slight declines in use of certain drugs such as alcohol, hallucinogens, LSD, and even marijuana, prevalence rates for use of prescription drugs has increased because they are deemed the safer drugs by adolescents (9). The fact that a portion of adolescents continue to or are starting to use drugs at as young as 12 years of age suggests that current interventions may not be sufficient.
Drug abuse can lead to deaths from motor vehicle accidents, suicidal actions, intoxication, etc. It can cause negative behavioral changes, mental retardation, psychological disorders, and further permanent distresses that may impair the quality of life. The younger a person starts using drugs, the likelier it is that he/she will have developmental problems (9). Various studies indicate that adolescents who use and abuse drugs are more likely to exhibit deviant attitudes, drop out of school, and become delinquent. Because this is an issue that can have detrimental effects on the functional abilities of the young generations who will be the future, it is crucial that effective public health interventions be in place.
Although there have been numerous campaigns targeted towards the prevention of drug use and abuse among individuals of all ages, statistics as aforementioned over the years indicate only a slight decline in prevalence rates among high school students. Despite the law enforcements in prohibiting the distribution of drugs, individuals under the age of 18 continue to have access to legal and illegal drugs. Adolescents have access to drugs through friends who have access, drug stores, older siblings, parents who use drugs, the internet, etc. Today, approximately 5.3 million Americans from age 12 and over have abused cocaine in their lifetimes (9). Access has definitely increased, and the effected population has increased and is beginning to include much younger children. The effects of drugs are endless and can be detrimental to a child’s physical and mental development, especially when introduced at an early age (9). Again, the prevalence of drug abuse among adolescents emphasizes the need for effective public health interventions in this area. It is critical to educate adolescents on the consequences of drug use and abuse. This is the exact reason for the development of the well-known Drug Abuse Resistance Education (D.A.R.E.) program whose mission is to “provide children with the information and skills they need to live drug-and-violence-free lives” (4) and to help children avoid actions that will lead to drug use.
D.A.R.E. PROGRAM
The D.A.R.E. program was founded in 1983 in Los Angeles and since then has undergone multiple revisions as studies continue to suggest that it is ineffective in decreasing the prevalence of drug use in teenagers (4). Regardless of any negative results from studies, the program has increasingly been implemented in secondary schools in an attempt to intervene drug use with the younger population. It is a program that brings together law enforcement and schools. It is incorporated into the school curriculums to teach young students about the consequences of drug use, how to avoid involvement with drugs, and what appropriate actions to take when in a peer-pressured environment (4). The involvement of law enforcement allows the students to have immediate answers to their questions related to drugs and violence. The program’s curriculum consists of a series of lessons taught over the span of 10 weeks, one class per week, and focuses on understanding the consequences of drug use, examining the students’ beliefs regarding drug use, developing communication and resistance skills, and making good life choices (3). The lessons are typically taught by police-officers who are able to respond to students’ questions about crime and drugs. The officers are required to undergo 80 hours of training in child development, classroom management, and communication skills prior to working for the D.A.R.E. program (4).
Although this program has been implemented into roughly 80% of the school districts in the country, it does not show promising results in positively changing the perspectives adolescents have on drugs. One article compiled results from multiple studies and concluded that while the D.A.R.E. program may reduce drug use in its students, the effects do not last (1). The revised program remains flawed because it instructs adolescents and young adults on what not to do, it ineffectively delivers its intended message, and it fails to consider the background of its audiences. When reviewing the program and its structure, it is obvious that several social health theories are already violated by the curriculum itself. Further examination of the program in the context of these theories may provide a better solution to revising and improving the program for future generations of adolescents and young adults.
D.A.R.E. ENCOURAGES REBELLION
The D.A.R.E. program simply educates the adolescents and young adults by using their curriculum to introduce the horrors of drug use and abuse and to show how to say “no” to drugs. Ironically though and of course, unintentionally, it dares its students to try drugs and to think about drugs because the program is saying their bodies will not tolerate the effects (8). Though the program’s abbreviation was likely meant to be used in slogans such as “DARE to resist drugs and violence”, that one word could also be easily manipulated by high school students to “DARE to use drugs”. To the targeted population, the lessons may seem as an effort to take away their potential freedom. Before attending any D.A.R.E. lectures, they may probably have never been exposed to drugs or information about drugs. In those situations, the program would be essentially teaching the students what drugs are, what the effects are and then telling them that is what they should stay away from. For those who have already been exposed to drugs, the program may be completely ineffective. Drug users have personally experienced the effects of drugs and believe the drugs help them feel happier, more confident, and have more control. The program’s messages of staying away from drugs would therefore be interpreted by that particular group as taking away their freedom and enjoyment.
The psychological reactance theory states that an individual will rebel against an instruction if it threatens to take away their freedom (13). This is exactly what the D.A.R.E. program does. It instructs the students on what not to do. The theory also implies that a person will rebel against what they are being told to do by doing the opposite, which in this case would be to use drugs (13). The program would seem to take away the freedom for not only the current drug users but also the newly informed. Adolescents do not enjoy being told what to do and so by teaching them to stay away from drugs, it is taking away their freedom to decide on their own. Even at a young age, children become more curious and interested in what they are not allowed to do and will find ways to do it secretly. They are unlikely to consider the consequences of their “banned” action because they are still at a developmental stage during which they are curious about everything. The organization of the D.A.R.E. program completely violates the psychological reactance theory and studies evidently show how drug use has increased among this young population (8).
D.A.R.E. MESSAGES ARE NOT GETTING THROUGH
At their age, it is unlikely that these adolescents have ever been exposed to drugs. The D.A.R.E. program may actually be the first exposure and leads them to thinking more about drugs. Most people will not look into something unless they were exposed to it. Adolescents today are not going to randomly search a topic online unless they heard about it on the media or from their friends. By informing them about drugs at an early age will only stimulate their curiosity about the issue and cause them to conduct their own research via friends or online. Their understanding will then be corrupted if their friends mention anything positive about using drugs such as increased popularity in school or the feeling of freedom and control. The D.A.R.E. program is flawed in the sense that it initiates its efforts at the wrong time and its target population may not be ready for the information it delivers (1).
For middle school and high school students, role models are usually their older siblings, parents, and occasionally teachers. Any officer in law enforcement is probably the last person these students will look up to because of the association with crime and punishment. This structural part of the program can be related to the marketing techniques of businesses. The basic marketing theory states that you must first recognize your target population as a collection of people, rather than many individuals (15). The D.A.R.E. program does approach groups of students and attempts to change the “herd” at the same time, but like most public health interventions, it is thrusting upon the students a product and trying to sell it. It attempts to sell “anti-drug actions” but it is unsuccessful because it is not what the students want at that age. Businesses successfully sell their products by first figuring out what their target consumers are interested in and what product they can develop to sell to these consumers. The D.A.R.E. program needs to do more research on the adolescents and young adults before trying to tell them what not to do.
In terms of marketing, the D.A.R.E. program fails to convey the message in a way that appeals to its audience, the students. Having a lecture presented by a uniformed police officer may not be the best idea because it gives them the feeling that they have done something bad (1). Furthermore, if it is the first time a student is hearing about drugs, it is unlikely he/she will care, and the lack of any interaction during the lessons simply adds to the boredom among the students (1). As mentioned in an article about the ineffectiveness of this program, the students will probably “tune out” the words coming from the authoritative officer (1). Therefore, having a police officer present the information is not the best way to market their product of not using drugs.
D.A.R.E. FAILS TO RECOGNIZE ALL SAFETY CONCERNS
In middle and high school, students are concerned about not having friends and not fitting in with the right groups. Short-term or long-term health is probably the least of their worries. Chances are they do not even know what simple diseases are. The program is being implemented in the wrong setting. Interventions should be designed with the needs of the population in mind. Schools are using the program as a way to intervene and prevent drug abuse in young adults by educating them about the terrifying consequences before they consider using drugs. But the problem is the program facilitators are not doing prior research on what it is the students are interested in at their age. Sure, the program tries to respond to the peer pressure and the need to fit in by emphasizing that it is OK to say no to drugs, but this fails to solve the problem of peer pressure which is prevalent in all environments and especially important during secondary school.
Adolescents who refuse to use drugs and are able to escape peer pressure may not be able to escape any bullying due to their refusal (6). Safety in this case is a major concern that the program neglects to consider for those who do in fact say no to drugs. It does not address the current needs of these children, adolescents, and young adults. Needs of each different age group will vary and the curriculums should not be the same for everyone. According to the Maslow’s hierarchy, safety of one’s own body is on the same level as one’s health (14). Peer pressure threatens the immediate health of one’s body and yet, the D.A.R.E. program warns that drugs threaten the long-term health of one’s body. It is not hard to conclude that adolescents will probably be more concerned about their current health when they encounter peer pressure.
Certainly, the program does not consider the various backgrounds of these young individuals when telling them to stay away from drugs. A majority of the adolescents who use drugs come from families with low-income, unstable families, and other settings that may contribute to depression and lead to use of drugs as the solution to their problems.
IMPROVING THE PROGRAM
The D.A.R.E. program’s past revisions were a response to the studies that proved its ineffectiveness in minimizing drug abuse and use in children and adolescents. The program remains flawed as the prevalence of adolescents using drugs has not diminished across the country. Some studies even suggest that the programs might have actually increased the use of certain drugs because it increased the students’ curiosity about drugs and resulted in earlier experimentation with drugs (12). It seems that even a new addition known as D.A.R.E. Plus program has not yet shown improvements, except that it was more effective than the original D.A.R.E. program in reducing tobacco use (10). However, based on the aforementioned social theories, the program can be further modified for the better and perhaps become a strong contributor in preventing drug use and abuse in children and young adults.
A main modification to the current D.A.R.E. programs across the country that should be considered is the entire curriculum and how it is executed. By correctly interpreting and applying the psychological reactance theory to the structure of the curriculum, the program would be able to better grasp the attention of its students. The purpose of the lessons should not be to lecture adolescents and young adults on what not to do, but rather to tell them what they should do. Currently, the lessons emphasize the intolerance of drugs by the adolescents, which can make them rebel and want to prove that they can tolerate the effects of the drugs (8).
The program should also employ the marketing and advertising theories in order to make its product appealing to the middle-school and high-school students. Thorough research should be conducted to figure out what it is these students at their age want and will accept. For example, it would be helpful to learn what they are interested in, their family backgrounds (general idea), and the ways in which they fulfill their needs. The program is promoting health and long life, which are not necessarily the most important things in an adolescent’s life. The D.A.R.E. program should also structure their curriculums by the age groups or grades, because each age group is on a different developmental stage and their thoughts and interpretation of one simple message may differ. For instance, eighth graders are going to think differently than ninth graders even if the age gap is small simply because they are in two separate environments. A message that may seem straightforward and easy to follow for one group may seem complex and overwhelming for another.
When a company markets its new products, they create numerous unique advertisements and commercials depending on who their targeted consumers are. They are not promoting their products with just one universal advertisement. Another reason the D.A.R.E. program curriculums should be different for the grades is most students attend the same middle school for 6th, 7th, and 8th grades and if the program runs for all three groups, most students would be sitting through the same presentation three times. By the second and third time, they already know what the presentation is about and the communication becomes less effective. One study that focused on the effectiveness of the D.A.R.E. and D.A.R.E. Plus programs in middle and junior high school found that more than 94% of the students had already been exposed to the program’s curriculum, which could explain the lack of changes in drug use and violence in the schools studied (10). In contrast, successful companies typically design new advertisements and commercials periodically to keep their consumers attentive. This is a technique that may benefit the D.A.R.E. programs since it is taught starting from the 5th grade through high school.
Another modification that could be increase the effectiveness of the program is the gap between the lecturer and the students. The idea of having an officer deliver the important message of “Don’t use drugs” is not going to appeal to all the adolescents and young adults. The information should be provided by someone who the students will listen to and can relate to, especially at their age. The design of the lessons and the messenger who communicates the information are all part of the marketing concept of packaging and putting things together (15). Imagery is a powerful tool that, when applied at the right time and place, can change the way groups of people react to a product. It is a concept that is ubiquitous in the business world and has proven successful. For example, Nike’s commercials often features sports celebrities, commercials for beauty products typically include famous actresses, etc. These are the ways in which brand name companies gain new consumers and keep current and past consumers. The consumers are interested in what the company has to offer because of the core values associated with the products. Again, the D.A.R.E. program promotes health to adolescents whose most important core values probably do not include good health. The current D.A.R.E. programs should be redesigned to tell these young individuals what to do rather than what not to do, to focus not so much on the “zero-tolerance” and also to tell them through the voice of an influential person (10). For high school students, the program could recruit current high school students who have successfully quit the use of drugs and who are able to relay the D.A.R.E. message to students of their own age.
The last area in which the D.A.R.E. program is flawed is its attention to the peer pressure that exists in schools today. Peer pressure is almost always a challenge for adolescents and young adults. Students in both middle and high schools ridicule their peers for being different, smart, poor, overweight, etc. Thus it is not surprising that kids would get teased by their peers after refusal of using drugs. The lessons on peer pressure advise the adolescents to report any abuse from their peers to authoritative personnel but that is something most adolescents will not do, especially if they know they will only get into more trouble with their peers if they tell. Bullying in school is another issue that cannot go unnoticed. Adolescents are highly susceptible to the psychological effects of verbal bullying, which very often results in deaths (11). Hence, drug abuse prevention programs like D.A.R.E. must take into account the obstacles that a student must face before they tell a student it is ok to say no.
CONCLUSION
The D.A.R.E. program should be modified and continue to be used because it has already established its name in most of the school districts in the U.S. It is a program that is well-known and if a revised version becomes effective, it can easily be used in the schools. The problem with the current programs is not that they lack the resources or research; there is definitely a vast amount of literature available on it. The problem is they are not able to translate the results into the implementation of a program that actually works. They are also not reaching the targeted population the right way. In other words, research results are not effectively taken into account in the clinical settings. Nevertheless, if the D.A.R.E. programs were to be reconstructed for each grade level, then more research may need to be performed. Public health interventions should conduct research among each and every grade in middle school and high school and then go onto constructing a program that is tailored to each groups’ needs rather than putting together a program first. Changing this long-term drug abuse prevention program so that it has customized curriculums for each grade may be time-consuming and challenging but would be a worthwhile investment. This particular drug abuse prevention program remains ineffective but can benefit from the psychological reactance theory and use of the marketing techniques that have worked for most successful companies.



REFERENCES
1. Botvin, GJ. Preventing drug abuse in schools: social and competence enhancement approaches targeting individual-level etiologic factors. Addictive Behaviors 2000; 25, 6:887-897.
2. Carney, JV. Bullied to death: perceptions of peer abuse and suicidal behavior during adolescence. School Psychology International 2000; 21, 2:213-223.
3. D.A.R.E. Massachusetts. Malden, MA: D.A.R.E. Massachusetts. http://www.darema.org/
4. Drug Abuse Resistance Education. The D.A.R.E. Mission. Log Angeles, CA: D.A.R.E. America. http://www.dare.org/home/THEDAREMISSION.asp
5. Heron, M., Hoyert, DL., Murphy, SL., et al. Deaths: Final Data for 2006. National Vital Statistics Reports 2009; 57, 14:1-136.
6. Kheswa, JG. A descriptive analysis of alcohol and drug use amongst adolescents in Soweto. University of Johannesburg 2008.
7. Lloyd, JD., O’Malley, PM., Bachman, JG., et al. Monitoring the future: national results on adolescent drug use. Overview of key findings. National Institutes of Health 2006.
8. Marlatt, GA. & Witkiewitz, K. Harm reduction approaches to alcohol use: health promotion, prevention, and treatment. Addictive Behaviors 2000; 27:867-886.
9. National Institute on Drug Abuse. Drugs of Abuse/Related Topics. Washington, DC: National Institutes of Health. http://www.drugabuse.gov/infofacts/HSYouthtrends.html
10. Perry, CL., Komro, KA., Mortenson, SV., et al. A randomized controlled trial of the middle and junior high school D.A.R.E. and D.A.R.E. plus programs. Archives of Pediatrics & Adolescent Medicine 2003; 157:178-184.
11. Saluja, G., Iachan, R., Scheidt, PC., et al. Prevalence of and risk factors for depressive symptoms among young adolescents. Archives of Pediatrics & Adolescent Medicine 2004; 158;760-765.
12. Wysong, E., Aniskiewicz, R., Wright, D. Truth and dare: tracking drug education to graduation and as symbolic politics. Social Problems 1994; 41, 3;448.
13. Burgoon, M., Alvaro, E., Grandpre, J. et al. Revisiting the Theory of Psychological Reactance (pp. 213-232). In: Dillard, JP. & Pfau, M. The Persuasion Handbook. Developments in Theory and Practice. Thousand Oaks, CA: Sage Publications, Inc., 2002.
14. Hawley, PH. Social Dominance in Childhood and Adolescence: Why Social Competence and Aggression May Go Hand In Hand (pp. 1-30). In: Hawley, PH., Little, TD., & Rodkin, PC. Aggression and Adaptation: The Bright Side to Bad Behavior. Mahwah, NJ: Lawrence Erlbaum Associates, Inc., 2007.
15. Hastings, G., Saren, M. The Critical Contribution of Social Marketing. Theory and Application 2003; 3, 3:305-322.

“Scared Straight” To Juvenile Delinquency – Mary Kowal

Introduction
According to the Merriam-Webster Dictionary juvenile delinquency is “a violation of the law committed by a juvenile and not punishable by death or life imprisonment” (1). This definition encompasses a variety of actions and behaviors that are violations of the law and also ultimately affect health. Scared Straight Programs, jail tours, and similar programs bring attempt to scare “at-risk or delinquent children from a life of crime” (2). These programs that focus on deterrence and shock tactics are inherently flawed and are ineffective. A more reasonable and effective approach is implementing a program that addresses the motives and psychology of adolescent delinquents.
How is juvenile delinquency related to health? Violations of the law for youth include alcohol and drug use, use of firearms, and violence. These are actions and behaviors that can have a significant impact on health. From 1998-2008, 12% of violent crimes were committed by juveniles (3). Additionally, in 2008 21% of liquor law arrests involved juveniles along with 18% of sexual offense arrests, 18% of assault arrests, 15% of forcible rape arrests, 11% of drug abuse arrests, and 10% of arrests for murder involved juveniles (3). These numbers only reflect the numbers of teens being caught and arrested. Drugs, alcohol, and violence are a much wider problem. In the 2007 Youth Behavior Risk Survey, it was found that during the past 30 days 26% of teens binge drank and 29% rode with a drive who had been drinking (4). Additionally, 18% of students surveyed had carried a weapon in the 30 days prior to the survey and 35.5% of students had been in a physical fight in the year before the survey (5). The term “juvenile delinquency” readily correlates with teen health because of things like alcohol, drugs, and violence.
Scared Straight began in the 1970s as a program which inmates serving life terms in a New Jersey prison “scared” at risk youth and delinquents from lives of crime.2 The main objective of this program was deterrence by scare and shock tactics. Teens are brought into prisons through schools or parent initiative and then turned over to the prison guards for a “realistic” experience of prison life. Those in favor of the program (and others like it) believe that if teens experience this realistic view of life in prison they will be deterred from crime (2). However, many have published empirical evidence and data showing that Scared Straight and similar programs are ineffective. A 1982 evaluation found that 41% of Scared Straight attendees in New Jersey committed new offenses and only 11% from the control group (who did not attend the program) committed new offenses. Of eight other randomized trials analyzed, only one program was seen to have a positive result, though statistical insignificant. Overall these trials show that the Scared Straight program can actually increase the odds of juvenile delinquency (2). Despite their inefficentiveness, Scared Straight and other similar deterrence programs are still used in cities across the US today.
Critique 1: Negative Labeling
Labeling theory focuses on the formal and informal “application of stigmatization, deviant ‘labels’ or tags by society on some of its members” (6). This theory is widely used in criminology and sociology. Ronald Akers suggests that designating an individual as deviant or delinquent is not always determined by what s/he has done but rather who they are (6). This is problematic for “at-risk” teens who may come from troubled families or live in rough neighborhoods. While they might not be deviants, they may have a greater chance of being labeled as one simply because of circumstance. The symbolic interactionsim theory holds that those “…stigmatized as deviant are likely to take on a deviant self-identity and become more, rather than less deviant than if they had not been so labeled” (6). If the Scared Straight intervention is given to teens who are “at-risk” but not themselves delinquent, this can have the opposite intended effect. The program is showing them that prison is where they are headed and their life prospects are bleak.
Teens also feel powerless to resist labels applied to them by authority figures – teachers, administrators, and police and prison guards. Unable to fend off these labels, teens often integrate these negative labels into their own self-concept (7). With a negative label forced upon the, delinquency might become a self-fulfilling prophecy for teens that go through Scared Straight and similar programs. Although controversial this idea is very possible given that in randomized studies of both delinquents and non-delinquents, the experimental group that received the intervention did worse in follow-up actions (8). Even in less stressful or consequential settings, negative labels can lead to negative results for the subjects. After responding to a race prime question before taking the GRE verbal section, black participants scored worse than those who were not primed with a race label (9). It is reasonable to argue that a label as strong and as negative as “delinquent” or “deviant” may become self-fulfilling for the teens participating in Scared Straight or similar programs.
The negative labeling of teens in the Scared Straight Programs is one of its worst flaws. It harshly and deliberately labels teens as “delinquent” or “deviant” and expects that this will induce a behavior change. Moreover, authority figures and people in power apply these labels. By mentally and emotionally beating teens down with negative labels and stigmatization they may indeed feel they are doomed for a life of crime and substance abuse. Scared Straight offers no other options for them; it only shows them the negative side of who they assumed to become.
Critique 2: Scared Straight Is Likely to Provoke Negative Reactance
According to Jack Brehm’s psychological reactance theory, “people become motivationally aroused by a threat or elimination of a behavioral freedom” (10). They are then compelled to act in a way that restores that freedom. Reactance can occur in two ways: an individual can attempt to restore freedom by actions, or there can be an increase in the perceived attractiveness of the action or behavior being threatened. Likewise, it is also possible for individuals to attempt to regain a sense of control and freedom by exercising alternate freedoms than those specifically threatened (11). Although a freedom is not specifically being taken away by the Scared Straight programs, teens are told bluntly and harshly not to do certain behaviors. They are told it is not worth the prison time and consequences to do drugs, use alcohol, or commit violent crime. Teens may be motivated to restore their threatened freedom by engaging in illegal and harmful activities.
One factor in reactance is the explicitness of the message (9). This means the degree to which the message is clear about its intent. This factor can provoke reactions both ways, but usually tends to increase persuasion. In the case of Scared Straight, the message is very clear and as well as the intent of the message: delinquency will have serious consequences in your adult life and you should stop now or not even start delinquent behaviors. However, despite the clarity, it is possible in this scenario that even explicitness will not decrease reactance. The Scared Straight message is a firm “no” to alcohol, drugs, and violence. Teenagers may not care that the message is straightforward and unconcealed and instead choose to rebel against this threat to freedom regardless.
The second factor in reactance is dominance. This refers to the amount that the message reveals that the messenger can control the recipient (9). The greater the perceived dominance by the messenger, the greater the level of reactance will be in theory. Again the ideas of power and authority come into play. Scared Straight puts teens in a vulnerable position by showing then a realistic prison experience among prison guards and inmates. In interviews with participants done by James Finckenauer, they reported that the inmates and guards yelled, scared the participants “to death,” and that they were pushed and shoved (8). This shows the subordinate position of the teenagers in the intervention. Because of this decreased role and perhaps feeling of helplessness, teens may be motivated to act in a way that increases their sense of control and also protect their “freedoms.”
The last factor on reactance is the idea of reason. This is the idea that a justification is offered in support of the claim (9). The more reason given, the less reactance is the theory. A the time that Scared Straight began, the only types of prison visiting programs were for college students, and for educational purposes. The Scared Straight program had an entirely different agenda in mind (8). This program was and is about the shock value experience of prison life. As described in Finckenauer’s research, there is no education in the Scared Straight tours. Teenagers are given an experience, not a justification. A program so harsh with no lead up or follow up discussion can leave participants feeling angry or rebellious. Anecdotal evidence shows that many participants did not see how this program applied to them. For these reason, reactance to such tours and programs can be quite high.
Critique 3: Ignoring Motives and Circumstances
The final critique of Scared Straight and similar programs is that they focus on the outcome and not the motives. The programs solely aim to stop juvenile delinquency and scare teens out of illegal actions. However, there is a complex mix of motives and circumstances that lead teens to delinquency. The United Nations 2003 World Youth Report on Juvenile Delinquency notes that many programs to prevent youth crime and illegal activity are poor equipped to address these issues, or do not address them at all (12). Programs like Scared Straight fit into the category perfectly – there is no mention of the reasons behind of delinquency.
Families are a large factor in juvenile delinquency. Youth at risk for becoming delinquent are often raised and living in difficult circumstances. Parent alcoholism, poverty, lack of basic needs, broken families, and abusive home life are just a few of the factors influencing juvenile delinquency (12). Teens learn how to live and interact with society by observing family (13). Family environments can teach teens the wrong messages about interacting in society and what is acceptable behavior. Divorce is one sub factor that can promote an unhealthy family situation and teach dysfunctional behaviors to juveniles because of the lack of stability and concordance. Scared Straight is not a supportive environment in which to learn the “right” behaviors.
Socioeconomic status also plays a role in juvenile delinquency. Some argue that “antisocial behaviors have become entrenched norms within chronically impoverished inner-city environments, so that delinquency and criminality are now endemic facts of life” (13). Teens may feel as though they cannot change their circumstances, particularly if they see their families and neighbors in poor situations. Consumer standards and media pressure push teens to desire a lifestyle that is beyond their means (12). Those who feel that traditional and legal means of making income and advancement will not be successful to them turn to other activities like violent crime and drug dealing. Scared Straight and similar programs do nothing to address the motivations and desires of teens that may be precipitating their illegal and destructive behavior.
Finally, educational experiences factor into juvenile delinquency. Education is influential because it can “shape many youths’ sense of opportunity and self-worth” (13). If teens believe that their educational experience will help them excel, they are less prone to turning to illegal activities to earn money and freedom. However, “academic achievement is considered to be one of the principal stepping-stones toward success in American society” (13). Many teens do not have the opportunity for the same level of education as is required to succeed. Family and socioeconomic factors, as mentioned above, can also contribute to low educational achievement and poor encouragement from educators. Those who drop out of high school and have bad academic performance have higher incidence of delinquency (13).
Just from the examples of family, socioeconomic status, and education it is possible to see how programs such as Scared Straight effectively ignore the root causes of juvenile crime, alcohol use, and drug use.
Proposed Intervention
The proposed intervention does not focus simply on juvenile delinquency, crime and violence, and drug and alcohol use, but is more holistic in its approach to teenage problems and the causes of delinquency. Taking a broad approach to this topic can keep teens health both physically and mentally. The proposal is a based around a series of weekly workshop-style classes throughout junior and senior high school. It is important to begin an intervention early when most teens are not yet delinquent or experimenting with drugs and alcohol. The three overall goals are for teens to increased their decision-making skills and self-control, expand their knowledge of alcohol, drugs, and violence, and to give them concrete skills to use in everyday life.
Classes would be built into the normal weekly schedule for the students in participating schools. While this approach may be effective in a variety of settings, it might be most cost-effective in schools with a large number “at-risk” students. The intervention would be a universal program, meaning that all teens will attend this class regardless of “risk” status. It would be ideal to maintain the same instructor/facilitator as the students moved up in grade levels as this would provide continuity and stability. In addition, the classes would not be a complete top-down learning environment. It should be a non-threatening time for students to hear the instructor, each other, and themselves. At the beginning of the semester the instructor would review the goals of the class (see above) and ask for suggestions for specific workshops and conversation topics. Issues covered in each grade should be appropriate to that level and that stage of development and life.
The goal to increase decision-making skills and self-control can involve lessons, discussion, and practicing. Decisions should range from drugs and alcohol to decisions about life and school work. Some focal points can be narrowing down the real issues, listing one’s priorities, deciding who their decisions will affect, and attempt to project how one will feel at various points in the future from a decision (14). This can empower teens and pre-teens about decisions in their life.
The second goal is to expand knowledge of alcohol, drugs, violence, and crime and also the effects of these. Again these sessions should be a mix of instruction and discussion. Lessons about these topics should come from the instructor, but also the teens themselves. Groups should present on different topics regarding these actions and behaviors and their negative consequences. Facilitated discussions are also appropriate for these topics. This should be a time for confidential and candid discussion among the teens. Discussion topics can include issues related to drug and alcohol use, crime, violence, stereotypes, self-image, methods for quitting substances, and how these issues have touched their lives.
The final goal of this intervention is to give the teens tangible life skills. In addition to decision-making and self-control, there are other important life skills that can impact juvenile delinquency. Workshops can touch on topics to empower teens and give them a sense of control and hope for their future. Issues like study skills, essay writing, finding a part-time job, applying for college and financial aid, and how to cope with stress and peer pressure.
Defense 1: Avoids Negative Labeling and Supports Group Change
The universal approach to this intervention – having all students required to attend these classes – allows for the elimination of negative labeling and supports group change, unlike the Scared Straight programs.
As mentioned previously, there are detrimental effects to negative labeling, namely it can become a self-fulfilling prophecy. The universal approach of this intervention does not allow for negative labeling based on who participates, like the Scared Straight and similar programs. All teens are put in the same boat, receiving the same intervention and support equally. No one is labeled or seen as a delinquent. In fact, teens who go through this intervention can actually be labeled positively – as Resistors, as Successes, as Role Models. The attitude in the class should be one of empowerment and success – that these teens are going places. If other teachers at the school acknowledge this program and its goals, they too can be a part of the positive labeling of their students.
It is also important that the intervention is received among peers. The social network theory is a group-level model that says that behavior is determined by one’s social network. The implications are that the intervention should be delivered at the group level and if you can deliver it to the most connected person, you can influence the most people (9). This effect is shown by the Harvard smoking cessation study that diagrammed participants smoking cessation and their social connections. The diagrams showed how non-smokers and smokers clustered and how the relations change as people quit (15). This same concept can be loosely applied to this intervention. Since all the students in the school get the same intervention, you are likely to hit the key students who have major social connections. If the intervention is positive for them, they can influence a large group. The non-delinquents can potentially have an effect on the delinquents for the better. The idea of the social network theory is that imparting change is easier done on a group-level.
Defense 2: Gives Teens a Sense of Control
The proposed intervention gives teens both real control and a heightened illusion of control in their lives. This is an important counterpoint to the reactance that many juveniles may face when participating in the Scared Straight program.
The program gives the participants real control. They are encouraged to help select workshop topics, and to give presentations. Even facilitated discussion with the instructor posing questions and making suggestions, can make teens fee in control of he situation and avoid reactance (16). They are also given skills that allow them to better manage in life and school such as study habits and writing skills. These factors, combined with decision-making skills, can lead to teens making the decision not to use drugs and alcohol or to commit a crime. They have the knowledge and the tools to control part of their lives.
The factor also falls into line with the Illusion of Control Theory. This theory states that skill-related factors give people an expectancy of success that is “inappropriately higher than the objective probability would warrant” (17). Though theory this sounds negative, it does not have to be. Even if the participants are delinquent or have many risk factors for delinquency, they can be under the illusion of control. Perhaps odds are against them in terms of doing drugs, using alcohol, and committing violent acts. However, this program wants to instill the idea that they can in fact control their lives. Thinking about and practicing decision-making, having group discussions, and improving self-control all can create the illusion that these teens have the ability to control some aspects of their lives. By giving them this illusion of control, even when circumstances and statistics say they will fail, teens can take actual control and make the choice not to do illegal activities.
Defense 3: Addresses the motivations and circumstances
This proposed intervention has better chances of success because it addresses the motivations for juvenile delinquency and the factors that are behind it. The Juvenile Justice Panel’s report on the Interagency Panel on Juvenile Justice highlights successful crime-reduction programs in many countries that focus on the causal factors for juvenile delinquency: unstable home situations, school drop-out rates, skills training, and education (18). This intervention also targets the three critical factors in delinquency that the Scared Straight programs ignore: families, socioeconomic status, and education.
The intervention does not specifically address the role of broken families in juvenile delinquency, but it becomes a support system for the participants. The instructor will in theory stay with the same class of students as they complete the program. Having such a constant presence and mentor in their lives will provide teens with a sense of support and encouragement that they might not be receiving at home, as well as a positive role model. The classroom can also been seen a safe place for learning, expression, and conversation.
The proposed intervention also touches on the idea that socioeconomic status and education play a role in delinquency, as mentioned above. While nothing can change the circumstances in which the teens grew up, this program will allow them to see a successful future for themselves. After completion of the program, teens will have tools, skills, and resources to overcome obstacles they have in their lives. Learning to search for a part time job, to apply for college and financial aid, and to write a good essay gives teens tangible skills they can use to improve their lives. These skills will hopefully give teens another way to achieve their goals instead of delinquency.
Conclusion
When looking at the issue teen health in the United States, one must also look at the issue of juvenile delinquency including alcohol, drugs, and violence. The Scared Straight program and other like it attempt to resolve the issue of juvenile delinquency through deterrence and scare tactics. However, empirical evidence shows these programs are not working and actually increase delinquency. A better approach is a comprehensive intervention that targets all teens, avoids negative labeling, gives teens a sense of control, and addresses the root causes for juvenile delinquency.


References

1. Merriam-Webster. Merriam-Webster's Online Dictionary. . http://www.merriam-webster.com/netdict/juvenile%20delinquency. Updated 2010. Accessed 4/24, 2010.
2. Petrosino A, Turpin-Petrosino C, Buehler J. Scared Straight and Other Juvenile Awareness Programs for Preventing Juvenile Delinquency: A Systematic Review of the Randomized Experimental Evidence. The Annals of the American Academy of Politicial and Social Science. 2003. http://ann.sagepub.com/cgi/content/abstract/589/1/41.
3. Puzzanchera C. Juvenile Arrests 2008. Juvenile Justic Bulletin. 2009. www.ojp.usdoj.jov.ojjdp.
4. Centers for Disease Control and Prevention. Quick Stats: Underage Drinking. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/alcohol/quickstats/underage_drinking.htm. Updated 2008. Accessed 4/24, 2010.
5. Centers for Disease Control and Prevention. 2007 National Youth Risk Behavior Survey Overview. . 2007. http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbs07_us_overview.pdf.
6. Akers RL. Criminological Theories: Introduction, Evaluation, and Application. 3rd ed. Los Angeles: Roxbury Publishing Company; 2000.
7. Ray MC, Downs WR. An Empirical Test of Labeling Theory Using Longitudinal Data. Journal of Research in Crime and Delinquency. 1986. http://jrc.sagepub.com/cgi/content/abstract/23/2/169.
8. Finckenauer JO, Gavin P, W. Scared Straight: The Panacea Phenomenon Revisited. Prospect Heights, Illinois: Waveland Press, Inc; 1999.
9. Siegel M. SB721 Lecture: March 18, 2010. . 2010.
10. Brehm JW. Psychological Reactance: Theory and Application. Advances in Consumer Research. 1989;16. http://www.acrwebsite.org/volumes/display.asp?id=6883&print=1.
11. Dillard JP, Shen L. On the Natre of Reactance and its Role in Persuasive Health Communication. Communication Monographs. 2005;72(2). classweb.gmu.edu/gkreps/820/009.pdf.
12. United Nations. World Youth Report, 203: Juvenile Delinquency. . 2003. www.un.org/esa/socdev/unyin/documents/ch07.pdf.
13. Martin G. Juvenile Delinquency: Theories of Causation. In: Juvenile Justice: Process and Systems. Sage Publications, Inc; 2005. www.sagepub.com/upm-data/4880_Martin_Chapter_3_Juvenile_Delinquency.pdf.
14. Radical Parenting. Ten Ways to Teach Smart Decision-Making. Radical Parenting Web site. http://www.radicalparenting.com/2009/09/10/teaching-teens-to-make-good-decisions/. Updated 2009. Accessed 4/26, 2010.
15. Christakis NA, Fowler JH. The Collective Dynamics of Smoking in a Large Social Network. New England Journal of Medicine. 2008;358(21).
16. Skager RW. Why Youth Ignore Drug Education and Sanctions against Use: Individual Differences, Mismatched Strategies and Youth Friendly Alternatives. . . www.iirp.org/pdf/Bethlehem_2009.../Bethlehem_2009_Skager.pdf.
17. Langer EJ. The illusion of control. In: Kahneman D, Slovic P, Tversky A, eds. Judgement under uncertainty: Heuristics and biases. Cambridge, MA: Cambridge University Press; 1982.
18. Juvenile Justice Panel. Crime Prevention for Children: Developments and Good Practices. 2009. http://www.juvenilejusticepanel.com/resource/items/I/P/IPJJCCPCJSideEventReportApril09FINALVERSION.pdf.

The Effectiveness Of The D.A.R.E. Program In Adolescents – Jenny Donovan

Introduction:

Almost every person in America has heard the phrase at one time or another, “Just Say No”. Easy enough one might suppose. It really is only three easy to understand words. However, how effective has this slogan really been in preventing drug and alcohol abuse in young adults that went through the D.A.R.E. (Drug Abuse Resistance Education) program in elementary school? Unfortunately, the answer is that the program has not been very effective at all and there are several reasons for that which will be discussed in depth.
It really is not as easy as just saying no. Peer pressure is a real threat and can affect a student’s social standing. While social standing might not seem like that big of a deal to an adult fully confident in their friendships and capabilities, to a teenager that is in the tenth grade who is not sure of anything, and might be viewed as the “slightly awkward” kid in the class, saying no to the cool kid is essentially social suicide. D.A.R.E.’s reliance on this simple mantra is naïve to say the least.
In addition to the “Just Say No” campaign, D.A.R.E. also creates a culture of fear, that maybe the individual is missing out on something. If peer pressure is everywhere, then clearly someone somewhere must be doing drugs or drinking alcohol, and despite what the cartoons and multimedia messages utilized show, the people doing the drinking and doing the drugs are not creepy looking adults. Contrary to the message that officers participating in the D.A.R.E. program want to send, movie stars, models, professional athletes, and musicians, the people their students look up to, are drinking and doing the drugs. Peer pressure originates because a large group of people participates in a certain action. For example, fashion trends result because an influential person decided something was cool or hip and it trickles down to the consumers. The same is true of anything else as is evidenced by the diffusion of innovation theory.
Third, the authority figure telling a rebellious high school student to not participate in some activity is counter-productive. This has been shown in several different types of campaigns such as anti-smoking campaigns, and is another reason that the D.A.R.E. program has proven to be ineffective five years after exposure. (1)
These are three reasons that the D.A.R.E. program has not shown results years after introduction to the curriculum. In this paper these source of failure will be expanded on even more and an alternative to the D.A.R.E. program will be discussed.

Critique Argument 1: “Just Say No”… to self-esteem

As mentioned before, the “Just Say No” mantra leads to a culture filled with peer pressure and an emphasis on how saying no might not be the cool thing. By creating this pressure and unintentional stigma associated with saying no the D.A.R.E. program is actually contradicting their main message of accepting the answer no. For students that actually do say no or avoid situations where they might have to say no, instances of low self-esteem have been reported in the years following an experience with the D.A.R.E. curriculum. (2) This obviously is not the intention of the creators of this educational material, however when any phrase or concept that has a negative association is the focus of a campaign it is more likely to have a negative effect on the outcome.
Focusing on the “no” aspect of the D.A.R.E. slogan implies that somewhere people are saying yes and becoming a part of the crowd, leaving the people that say no on the outside looking in and hoping to be accepted for who they are rather then what they do with their time. Unfortunately in most high schools across the United States it is how students spend their time that defines each person. For example, the star quarterback tends to enjoy more popularity then the star of the chess team or the glee club and it is almost impossible to change that standing without some drastic measure. While this is not always the case and there are exceptions to every rule it was true in my high school and probably a good portion of high schools around the country. There are always the groups of people completely secure in their bodies and groups and they will be anti-drug and alcohol. The people who are insecure and need affirmations from outside sources, those are the people that need to have the focused and prolonged anti-drug and alcohol education. However the programming needs to have a great focus on the positive rather then the negative, just saying yes to positive activities, rather then saying no to negative activities.

Critique Argument 2: Peer Pressure – A very real influence

In the high school and college settings there are at least three different pressures that affect the average student, peer pressure, parental pressure, and self-pressure. The greatest of these three pressures is peer pressure. The D.A.R.E. program focuses not on affecting the pressure coming from a student’s peers but on beating the pressure in general. Because D.A.R.E. does not concentrate on beating the peer pressure it is almost impossible for an insecure student to beat the peer pressure. In addition, the techniques given to students to help arm them against the peer pressure they will encounter are at best week and at the worst a complete joke. Skits and multimedia presentations created upwards of ten years ago do not provide adequate defenses against peer pressures. Ancient movies that depict the addicts and drug dealers as shaggy haired, greasy, older males that skulk in the shadows, preying on innocent children, are inaccurate descriptions. Often times the people that offer drugs and alcohol to teenagers or twenty year olds are other teenagers or twenty year olds, peers that look and act exactly like everyone else minus the substance abuse. If the popular football player is offering the not so popular student alcohol or drugs, the insecure student realizes that taking a hit of marijuana or drinking a beer will not cause a huge decrease in brain cells. It is a false misconception that all people participating in illicit or over the counter prescription drug abuse are all from low socioeconomic homes with criminal pasts. Since the person offering drugs could literally be anyone the D.A.R.E. program needs to stop depicting drug abusers as stereotypical criminals that look rough.
A culture needs to be created where drug abuse is not considered trendy but being drug and alcohol free is considered the hip course of action to follow. Saying no to friends and possible prestige and popularity is not a legitimate decision you can ask impressionable teenagers to implement. Asking students to find activities that promote healthy lifestyles and will still be associated with a good reputation, friendships and life success is more likely to be affective and more probable to lead to greater self-esteem and deeper friendships.

Critique Argument 3: Encouraging Drug Use? – Teenage Resistance

It has been shown that adolescents react poorly to being told what they can and cannot do, specifically when told by an authority figure such as a teacher, a parent, or a police officer. So why do police officers across the United States think that going into classrooms filled with adolescents and telling them that drugs and alcohol is “not cool” and you should “just say no” will work? I am a relatively intelligent young adult with a college education and a job lined up for after graduation. My father tells me constantly that I should save my money; in order to ensure that I have an emergency stash “just in case something happens”. Do I have this emergency stash? Does my sister, who is four years older and has been in the work force that much longer, have an emergency stash of cash? No. Do I know that I should indeed save some of my monthly paycheck each month? Yes. Adolescents know the effect that drugs and alcohol can have on their bodies and minds yet for the same reason I do not save my money, normal high school students tend to rebel from their parents to prove that they can make it on their own.
What is even worse is the association the drugs and alcohol lead to a fun time. Pile that on top of being told you should not participate in that is like being told you are a kid but do not go and have fun. Or a parent telling the story about the one time (or many times) they got stoned and their eventual realization that no matter how much fun they had initially it was a poor choice in the end. Essentially that parent is saying “hey it was fun but I realized doing drugs was not good for my health twenty years from now”. No teenager is looking into life at age 50, they live in the moment, all they hear is the “hey doing drugs was fun” part and ignore the health concerns. This is essentially sanctioning drug use.
In addition to parents telling their kids no, police officers are even more of an authority figure. At my school the officer that came to speak to us was older then my parents by at least 10 years, had a grey hair and was slightly out of shape. He was a nice enough man but not someone I would look to for advice on how to fit in to a crowd or stand out, in a good way, among my peers. Him telling me to not do drugs was like my grandfather telling me drugs are wrong, and he smoked a pack a day and drank like a fish, until he had a stroke. I would imagine that in more suburban towns like my own, the police officer teaching the D.A.R.E. curriculum is pretty similar to my own D.A.R.E. officer. If this is the case, then the officer might as well roll a blunt or hand each student a pack of cigarettes and a light each of them up.

Critique Conclusion

While the D.A.R.E. program, has admirable goals, it has failed to majorly affect the population the officers are attempting to reach. There are several articles that have shown that years following graduation from the program, students are no less likely to have participated in illicit drug use, over the counter drug abuse, prescription drug abuse or alcohol abuse. (1-4)
D.A.R.E. needs to focus on more positive aspects rather then the negative of saying no to peers and to the possibilities that come with joining in and being included in a group of people that you admire. The focus needs to be changed to include participating in other ways and through other activities then drug and alcohol use.
The influence and affect of peer pressure needs to be recognized for what it is, the main act persuading an adolescent to engage in any activity. Whether it is conscious or not, each person runs through the possible pros and cons of an action. These pros and cons may include increased prestige and popularity (quite important in the average adolescent), disappointing their parents or loved ones, future health affects, current health effects and so on. However to most teenagers, one beer or one puff will not lead to disappointed parents, or any major health effects but it’s the one beer or one puff that leads to 2 which leads to 10 which may lead to abuse. Teenagers do not focus that far into the future so it is important to help them realize the short-term effects.
And finally, the means of transmitting the anti drug and alcohol abuse needs to come from a source that is not a parental or authority figure. Being drug free needs to be associated with being trendy and fashionable, a 50-year-old balding man is not the image of cool to adolescents and young adults. It is important to realize these problems and to modify the curriculum to adjust for these predicaments.

Proposed Intervention:

I would propose an intervention that addresses the three critiques discussed above and a few other possible problems not addressed. The D.A.R.E. program has a good message and I would like to continue that message, but instead of saying “just say no”, a tagline of “just say yes to being drug free.” This is more positive and allows students to take pride and ownership in being able to do something that not everyone can accomplish. Second, I would utilize peer pressure but not in pressuring students to do the wrong thing but the correct thing. Utilizing peer pressure is a great way to encourage students to participate in other activities that are not illegal and are good for their health such as sports or healthy eating. I only received the D.A.R.E. education once in my pre collegiate career. How often are life lessons from grade school or middle school really applied in high school or beyond? The answer to that is not very frequently. The anti drug and alcohol abuse needs to be more then a one-time deal. It is important for retention that repetition of the curriculum occurs over several years and at several life stages. Also the vehicle for the repetition should be from people that students look up to and want to emulate. My response to this is to bring in students from local colleges or students from higher grades that are good students, drug free, and popular, the local celebrities, to teach the curriculum to younger students.

Proposed Change 1: Just Say Yes… To being Drug Free

We have discussed in class how being negative is not really motivational. Showing an obese kid with no hope is not going to encourage other obese children to get fit, however showing kids that might not be in the best physical condition having a great time playing outside and exercising is more likely to encourage other children with weight problems that it might be a fun way to help change their body image. The same is true with being drug free. By having a reason to stay drug free, other then doing drugs is bad, people are more likely to stay drug free or get drug free. Encouraging students to find the one thing that is most likely to keep them drug free is a positive way to encourage healthy behaviors.

Proposed Change 2: Peer Pressure – The Motivator

As mentioned previously, peer pressure is a huge factor in encouraging or discouraging a behavior. Students being encouraged to participate in drug and alcohol abuse are more likely to cave to peer pressure and participate in the drugs and alcohol. However if we can contain the peer pressure and focus it on staying drug free then anti-drug and alcohol education can be much more productive. Any factor in adolescents making poor decision can be spun to encourage good decision-making. The D.A.R.E. program underestimates the effect of peer pressure, and my proposed intervention should harness the power of peer pressure to benefit of the anti-drug and alcohol outcomes.

Proposed Change 3: Increased Exposure – Hammering the Point Home

If reducing drug and alcohol abuse is so important to our society, then why do most students only receive D.A.R.E. programming once over the course of thirteen years of public school education? Either the education students are receiving from D.A.R.E. is not as important as one might think, people are naïve enough to believe that one time education at the age of twelve is enough to propel a student into the more formidable years of their life, or the programming is flawed. I would like to think that the programming is flawed because that is more easily fixed then the other two issues. The easy change is to implement supplemental education throughout all age levels. Reinforcing good behaviors leads to adolescents continuing their good behaviors and encouraging those that have “fallen off the bandwagon” to get back on and to get back to drug free status.

Proposed Change 4: Vehicle of Communication… Or Good Role Models

As mentioned previously teenagers are notorious for resisting authority. One way to get the purpose of the education across and to the positive aspects of the curriculum to stick, the vehicle of education needs to be another positive image. The image needs to be a person that the students can respect, relate to, and look up to the type of life style the lead. The perfect examples for this type of role model are either older members of the same community the exhibit admirable qualities and would like to help shape younger students. The older members could be high school seniors teaching classes to freshmen, or college students teaching high school students the improved curriculum. Either way it shows those going through the curriculum that what is being discussed is actually applicable. It is possible to be popular, have a successful life and to be drug free. There would obviously need to be a screening and training process but if adequately done the best teachers will be volunteers and may free up police officers to do more police work.

Conclusion:

While changes are not easy to implement it is essential that a complete overhaul of the D.A.R.E. program occurs if we want to limit the number of young adults with drug or alcohol problems. As a publicly funded program we are currently wasting taxpayer dollars by continuing to implement a program that has been proven ineffective. Change might be difficult but being fiscally responsible and having a direct effect on the youth of America will have a direct effect on the future of the United States.

References

1. Clayton RR, Cattarello AM, Johnstone BM. The effectiveness of Drug Abuse Resistance Education (project DARE): 5-year follow-up results. Prev Med 1996; 25(3):307-18..

2. Lynam, Donald R.; Milich, Richard; Zimmerman, Rick; Novak, Scott P.; Logan, T. K.; Martin, Catherine; Leukefeld, Carl; Clayton, Richard. Project DARE: No effects at 10-year follow-up. The Journal of Consulting and Clinical Psychology 1999; 67(4): 590-593.

3. Ennett ST, Tobler NS, Ringwalt CL, Flewelling RL. How effective is drug abuse resistance education? A meta-analysis of Project DARE outcome evaluations. Am J Public Health 1994; 84(9):1394-401.

4. Ennett ST, Rosenbaum DP, Flewelling RL, Bieler GS, Ringwalt CL, Bailey SL. Long-term evaluation of drug abuse resistance education. Addict Behav 1994; 19(2):113-25.

Is “Above the Influence” Beside the Point? A Closer Look at the Anti-Drug Youth Media Campaign – Liz Faye

There is no question that drug and alcohol use presents a serious challenge for our youth. Almost 30% of high school students report episodic heavy or binge drinking and 20% report marijuana use. And although rates of illicit drug use have decreased, rates of nonmedical use of prescription and over-the-counter (OTC) medication remain high (4). More important are the implications of these behaviors, medically, socially and psychologically speaking. Some of the health implications include hospitalizations and/or death from drug overdose, continued substance abuse/dependence problems as an adult, and one of the biggest problems of drug-related violence and injuries. In summary, when teens and drugs are put together, decisions and behaviors carried out often result in poor health outcomes. And there certainly has been quite the public health response to address these problems, many of which have found it very difficult to effectively connect to their target audience. We have certainly come a long way from the D.A.R.E program although it still exists today, but there are many other interventions and programs that have attempted to adapt their strategy based on the shortcomings of these initial interventions. As psychology and social sciences press on and advance their understanding of what factors are involved in the decisions teenagers make regarding alcohol and drug use, we are seeing many different approaches to the problem. Whereas some programs base their interventions on traditional social theories, others are utilizing more contemporary approaches, such as branding and marketing their message much like the products we buy.

“Above the Influence” is part of the National Youth Anti-Drug Media Campaign developed by the Office of National Drug Control Policy. This media campaign is modeled on best practices in the marketing and advertising research industries. Therefore the media they produce and market goes through various levels of research and testing with the intention that such efforts will make the message more effective to the target audience. Many teens and adults alike have been exposed to the ads and commercials produced by the “Above the Influence” campaign since it is part of the largest anti-drug campaign in the nation. The “Above the Influence” campaign has used marketing and advertising to “brand” itself and the message it represents that anti-drug beliefs are favorable to teens and should become the norm. Essentially, the goal of this campaign is to disseminate the message to teens that by choosing not to do drugs, they are putting themselves “above the influence” of peer pressure to make bad choices, with the “bad choices” being drug use. However, studies have shown that the effects of anti-drug campaigns are not only difficult to measure, but in many cases are of little to no avail (8). In lieu of such evidence, one must ask “Is this intervention working?” As part of the largest campaign in the nation, should we continue funding efforts that have proven to be ineffective? While it appears as though the “Above the Influence” campaign has been quite successful in spreading its message to a large audience, I would argue that the message and the brand are somewhat inconsistent and irrelevant to the experience of the target audience. In order to be more effective, efforts must include identifying the flaws in the message using social science theories and reframing both the brand and the message in a way that is more relevant to the experience of teens.

Tell Me I Can’t Do Something and I’ll Try

According to the psychological reactance theory, youth will react against threats to their freedom of choice by experiencing and succumbing to pressure to reestablish that freedom (12). Many of the commercials and advertisements from the “Above the Influence” campaign seem to walk the line between telling teens not to do drugs and telling them it’s their choice. By presenting teens that use drugs as bad decision-makers, the intended or unintended message can become, “Don’t do drugs or else you will be like this kid who makes really bad decisions.” And in some cases, the ads outright tell them they don’t need the drugs. Teens often times feel as though a lot of things are out of their control as they are often told what they need to do on a daily basis. “Turn your phone off. Go to school. Be quiet during class. Do your homework. Be home by 11. Don’t use drugs.” The very nature of adolescence involves a certain lack of control since very few teens are fully independent, as in living on their own and making all of their own decisions. Studies have shown that if you make something forbidden or portray it as bad, it becomes more appealing to teenagers who are often in the most rebellious phase of their life (19). If smoking weed is part of a teen’s daily decisions and these campaigns are telling them they should not be smoking, such a message might further compel them to smoke.

The other unintended consequence of anti-drug campaigns such as “Above the Influence” is that they make drug use among teens seem commonplace. This might give teens the perception that drugs are much more common among their peers than they originally thought. Telling teens to be “above the influence” suggests that the norm among their peers is to use drugs and alcohol, and we’re instead asking them to reject this “common” pressure they are likely to encounter. In a sense, the campaign can be self-sabotaging by sending out this message to a large audience of teens who then come to accept that pressure to use drugs is the norm and that it is to be expected among their population. Therefore saying “no” to this implied norm becomes all the more challenging even though the reality is the majority of teens don’t use drugs or alcohol.

The Assumption of Rational Decision Making

A concern with the “Above the Influence” message is what seems to be an assumption that teens will be able to make rational decisions to not use drugs when faced with the pressure. However studies have shown that when choosing between behaviors, perhaps one less favorable but more desirable than the other (i.e. using drugs with friends versus saying “no”), both teens and adults alike are not likely to make rational decisions on a consistent basis (6). This can be illustrated in everyday decisions. Religion isn’t based on rationality or reason yet so many people adhere to one faith or another. We buy so many products that are not advertised in a way to appeal to our rational side. Nike doesn’t sell sneakers by advertising the practicality of their sneakers and their dual density midsole; instead, they highlight and glorify remarkable feats of strength and athleticism almost leaving the viewer to believe they could achieve the same results or at least be just as cool as the people who do (14 Nike Commercial). Bacardi Mojito certainly isn’t advertising what the rum tastes like specifically and the percentage of alcohol; they show sexy young people partying, dancing and appearing to have the time of their life because they understand that the way to sell their product to us is to sell it to our emotions (3 Bacardi Mojito Commercial). By connecting to the emotions and feelings we desire such as being cool, happy, sexy, popular, etc, they understand that we will link their product to the emotions they evoke.

In one particular “Above the Influence” commercial, they present a teenage boy at a party who is offered marijuana by some other teenager meant to represent the “bad influence”. All of a sudden the teenage boy pauses as his “good” and “bad” shoulder duke it out with the “good” shoulder mentioning how upset his parents and little brother would be and how he could get in big trouble while the “bad” shoulder minimizes the situation and encourages him to go for it. Then it ends by telling him to ignore both “shoulders” and make the decision himself at which point he refuses the joint. The way the situation is presented in this particular commercial suggests that the teenager is able to make a rational decision in the moment when he may feel pressure to do something he shouldn’t do. Such logic seems like a gross simplification of the reality and what teens are experiencing when faced with the decision to use drugs or not. In the same way that products are marketed to us in a way that is emotionally and socially relevant, so aren’t drugs such as marijuana (5). It’s not just about the drug itself, but what it represents to teenagers and until we acknowledge and address the reasons why teenagers want to use marijuana, i.e. what it represents to them, we will not be able to effectively link our message of not using drugs to the emotions and feelings that will condone it. In other words, until you have the right pieces you can’t fix a broken machine. By knowing what emotions and ideals teenagers link to their desire to use drugs, we can try to redirect and relate these emotions to the desired behavior of not using drugs.

What Exactly is the Message and is it Relevant?

It appears as though the “Above the Influence” campaign has a really important message although messages often can get lost in translation by the time they reach the target audience. The campaign seems to focus on two factors: providing information on the different types of drugs and their effects and providing the audience with information on the different types of pressures or influences that can lead teenagers into using drugs. It seems as though the strategy is to inform teenagers of the health implications and dangers associated with drug use and ways to overcome the pressure they may feel to use drugs including things teenagers can say when friends or peers ask them to engage in drug using behavior. Based on the various commercials and advertisements, the message of “Above the Influence” seems unclear and rather vague. “Be above the influence” seems to be the take home message, but as to what those influences are and what you should do to be above the influence is not coming across so clear in the commercials, which seem to be the major source of advertising. More importantly, there is a lack of development linking the message to the brand name “Above the Influence.” Teens are shown what they should not do (drugs) but what are the emotions one is left to have when thinking about this brand?

One commercial shows a young teenage boy playing basketball by himself and his shadow is mimicking him (2). The next scene moves to the side of the court where it shows another teenage boy who appears to be smoking (the assumption is that he is smoking marijuana). The boy playing basketball then leaves the court and his shadow behind to join the kid and a voice-over says, “When you smoke weed, how much of yourself are you leaving behind?” Like this commercial, many of the advertisements seem to end in a very vague manner without any clear take-home message. And if any emotion has been linked to the commercial, it’s sobering, monotone, and anything but provocative. It seems as though the goal is to get the teenage audience who is watching this ad to think about how much marijuana affects their ability to be successful and do the things they enjoy, but this makes a rather big assumption: that the target audience actually cares about this point and is willing to draw the necessary link between smoking marijuana and losing their identity. Studies have shown evidence that anti-drug campaigns may be effective at informing a large target audience and making them accept the fact that drug use is a problem, but there is much less evidence to prove that these campaigns are effective at changing behaviors (8). This commercial is a great example of this trend. “Above the Influence” ads have stepped in the right direction of attempting to brand their anti-drug message, but it is important to commit to the true techniques of branding and marketing in order to be successful and create a clear and desirable message with their brand.

More than the issue of ambiguity, the message “Above the Influence” presents does not seem as relevant to the actual experiences of their target audience. It doesn’t take long before you find the parodies created by teens in response to the anti-drug ads they see. While the focus groups of teenagers and surveys evaluating the effectiveness of these campaigns may suggest that they are in fact having an impact, one has to question the validity of these measures. The “Above the Influence” campaign suggests that according to their research and evaluation studies, their ads are proving to be both representative of their target audience’s experience as well reaching their target audience in a useful way. Although many studies have shown a certain level of reliability in self-reporting, one must consider the potential for bias to occur. Similarly to how risk perception bias can affect an epidemiological study, one must consider that teens that have been exposed to these campaigns are aware of the risks associated with drug use and therefore they are more likely to report the intervention as having a positive impact on their behavior even though it may not necessarily be the case (11). Simply put, the so-called “best practices” methods of research and evaluation that “Above the Influence” is performing to ensure that its brand message is reaching the target audience may not be the most effective method.

There are a couple reasons to suspect that the message is neither relevant nor effective. Many of the studies suggest that the impact of these anti-drug media campaigns has been little to none. And other studies have indicated that even when there is an effect, it is mostly on knowledge and attitudes, but not on behavior. At most, more teens’ attitudes about drugs may change and they may view drugs as being more likely to cause health problems and impact their lives negatively. But this does not translate into changing their behavior, which is ultimately the most important factor. Furthermore, there are studies that suggest these campaigns are having adverse effects and further validating teens’ attitudes towards using drugs (7). More compelling than the studies, however, is the evidence presented by teens, the actual target audience. Sometimes, if you really want to know what teens think, you need to go to them as opposed to making them come to you. Simply put “Above the Influence” in the search bar of YouTube and you will get a multitude of parodies and spoofs created by teens that mock the “Above the Influence” ads (21 Above the Influence YouTube Search). In an age of technology, teens are no stranger to the Internet. They are some of the biggest users of all that new age technology has to offer social and personal communication including Facebook, Twitter, blogging, Skyping, etc. And if these are the places they go to truly express how they feel, one shouldn’t ignore the messages they are inadvertently sending. If there is evidence of teens making fun of these ads and who are simply not buying into its message, these are the very teens that should become the target audience.

This is certainly not to say that the “Above the Influence” campaign has been completely futile in its efforts. It seems worthwhile to address some of the flaws of the campaign since it possesses potential and room to develop into a more effective intervention. “Above the Influence” has created a brand that teens can associate with healthy and drug-free behaviors. They have created not just a concept, but actual products. Teens can go to their website and get involved, create their own videos and express their opinions, listen to podcasts, not to mention connect with other teens going through similar issues. The idea of branding a drug-free message is progressive concept. If retail industries can profit billion of dollars from marketing their brands, it is certainly worth using similar strategies to brand and market a public health message. However, we need to acknowledge the flaws and then come up with practical solutions to address them.

Making “Above the Influence” a Bull’s Eye:

Proposal for a Campaign Overhaul

It’s time for the “Above the Influence” campaign to switch gears and step up to the next phase. Much like Honda doesn’t try to sell a 2004 Civic in 2010 or a department store doesn’t sell last years winter catalogue as the days get longer and warmer, we need to sell the 2010 version of “Above the Influence” and our target audience needs to be aware that it is in fact the newer version. If we are going to be a brand, we have to commit fully to being a brand and all the work it entails. Since many of the problems with the campaign involve the message, it is important that the message be the main area of improvement as we develop the newest model of “Above the Influence”. Three areas of improvement I would focus on include: utilizing less conventional research methods to determine what the target audience wants, revising the brand name to establish the upgraded version, re-framing the campaign to market a more relevant and “sellable” perspective.

Fight Fire with Fire

Teens comprise one of the largest populations targeted by marketing industries, including those for alcohol and illicit drugs. It’s a simple fact for most products that if you appeal to teenagers and young people, your product will sell more successfully, specifically products that can be represented as part of our deepest emotional wishes and desires – to feel loved, important, attractive, popular, rich, etc. One needs to look no further than the tobacco industry that has used such techniques to aggressively market towards teenagers and young adults over the years (5). And now that their marketing strategies are open for the public to see, it is clear that they invested quite a bit of the money and time into getting into the mind of our collective youth. What makes them tick? What do they want? How can we make our product line up with their desires?

We need to adopt similar strategies. This is not to say they we completely disregard the conventional means of public health research such as literature reviews, formal qualitative and quantitative studies. However, we need to invest much more of our time into unconventional strategies much like the “Truth” campaign. The “Truth” campaign determined that the current anti-tobacco strategies were not effective, so they knew that had to try something else. One of the main tickets to their success was using unconventional means to get inside the heads of youth and create compelling advertising from those insights (7). I propose that in a similar manner to the “Truth” campaign, we conduct more informal qualitative studies using young adult interviewers in places where youth feel comfortable, such as malls, skate parks, food establishments, etc. Interviewers should use the language of the youth even if this means bad language so they can be seen as peers. The bottom line is trust will lead to real answers (7). Through these studies, we should determine what the youth care about, what are their values, what do they like to do, what are their concerns. The focus should not be about drugs, but overall what does a teen think about on daily basis.

Give Me Something Shiny and New

“Above the Influence” campaign may run into the “so-last-year” problem as a brand. With ads that have produced a very similar message over the years, once the target audience is uninterested or bored with a brand, it is very difficult to restore interest unless the brand goes through a makeover of some sort. Brands have to keep reinventing themselves and marketing the newest version to keep up with the competing brands. Cars get sleeker, faster, more efficient, while clothing and apparel follow the latest fashion trends. Teens are exposed to at least 3000 advertisements everyday with many of these advertisements targeting their population specifically (18). So, a brand must really stand out and present its own case to compete with their interests. I propose that “Above the Influence” either change its name or come out with a “line” that has a more provocative identity.

Marketing experts claim that often times what you say is more important than how you say it (15). Blackberry has many different phones and the names convey a certain emotion or are familiar and descriptive– Pearl, Bold, Storm, Curve. Nike says “just do it”, Lance Armstrong says “live strong”, the Army says “be all that you can be,” while M&M’s assures you that it “melts in your mouth, not in your hands.” These are all action-oriented slogans and “Above the Influence” just isn’t cutting it. The “Above the Influence” campaign needs to come up with a slogan. The best ones are short, powerful summations used alongside a brand’s logo (9). “Above the Influence” is a pretty well recognized brand among teens, and as part of the qualitative research in the first step, it would be invaluable to keep record of the language teens use and words they identify with in order to come up with a catchy slogan. Another option is to simply create an action-oriented slogan, such as “Above the Influence: Stand Out” or “Above the Influence: I Dominate”. The point is the slogan does not need to mention anything about anti-drug values. Instead action-oriented and sensational words that give the target audience a feeling of power, control, and motivation can go a long way to link the brand with something positive that the teens are more likely to respond to.

Time to Replace the Big Thick Glasses with Color Contacts

After doing the necessary research and upgrading the brand, it’s time to reframe the context in which the campaign presents the new and improved intervention. Some key objectives that have been identified in developing a framing strategy for public health programs include presenting a unified, coherent core position on the program that is consistent with the core values of the target audience, evoking visual images that appeal to the core values, implying as a solution the program being marketed (17). The core values of teens are greatly influenced by a number of factors, including the family, social and cultural context. Currently, “Above the Influence” ads have framed their message in a way that highlights the loss associated with using drugs, which in turn is supposed to persuade teens to not use drugs. “Don’t do drugs or you will lose yourself.” The way the message is presented makes it seem as though you lose something regardless of which behavior is chosen. If one is to do drugs, they will lose their identity. If one is to keep their identity, then they must lose the drugs. We must first start by re-framing this lose-lose situation into a situation in which core values are reinforced by buying into “Above the Influence.”

One study in particular has identified the following lessons from social marketing to teens: teens change rapidly, and therefore correct segmentation by age is essential; teen opinions are very strong and they want to be listened to, not talked at; rebellion and independence from authority is a strong motivator; embedding messages in other content is better than straightforward, hard sells; social networks may be more important than generalized “coolness”; brands are important—a brand represents something they come to trust (18). Therefore, “Above the Influence” needs to create a coherent, core position that reflects these sentiments – “Above the Influence doesn’t care what your parents say or what the teacher says, we care about what you have to say”. With ads being one of the main interventions provided by this campaign, it would seem favorable to work on creating images that reflect teens’ feelings about rebellion and authority. The ads can take an active role in minimizing the role of authority in the decision to not take drugs. The ads could highlight less conventional role-models and other teens that have chosen to “Dominate” and be “Above the Influence”. A young female mountain biker popping a wheelie, an avid skateboarder mid-ollie, a talented graffiti artist in the middle of a masterpiece, guitar player rocking out in his band – these are images that can be inspiring to teens. Seeing images of other in action, doing what they love to do can inspire them to focus on things they may be good at or skills they too can develop if they see more examples.

Certainly the interventions I mentioned here do not come without a fair set of challenges. In order for the campaign to appeal more to teens and speak in their language, it is likely to face opposition by parents, teachers, and authority figures who may not feel comfortable with the implication that their opinion does not count. Minimizing their role is likely to bring resistance to such an idea. But if it works, that is the ultimate goal. If taking these steps results in the “Above the Influence” campaign becoming more successful at reaching out and grabbing teens so they can find ways to express their individuality and have experiences without using drugs, the resistance is likely to subside. “Above the Influence” campaign has to be smarter, sexier, and more creative at selling its message. To be regarded as the solution to drug use among teens, “Above the Influence” has to think outside the box and create an environment that encourages teens to express themselves, have great experiences, become empowered and fulfill their potential through other means than drugs without actually telling not to use drugs. This campaign has to be just as desired as the new iPhone, or at least that should be the goal. In summary, it’s time to upgrade to a newer model with “cooler” features.

References

1. Above the Influence Campaign website URL: http://www.abovetheinfluence.com/

2. Above the Influence Ads URL: http://www.abovetheinfluence.com/the-ads/default.aspx?path=nav%23

3. Bacardi Mojito Commercial http://www.youtube.com/watch?v=O0rx1srLsh0

4. CDC statistics on alcohol & drug use among youth URL: http://www.cdc.gov/healthyYouth/alcoholdrug/index.htm

5. Cummings, KM et al. Marketing to America’s Youth: evidence from corporate documents. Tobacco Control. 2002; 11:i5-i17.

6. DeMartino B et al. Frames, biases, and rational decision-making in the human brain. Science 2006; 313:684-687.

7. Hicks JJ. The strategy behind Florida’s “truth” campaign. Tobacco Control. 2001; 10: 3-5

8. Hornik R et al. Effects of the national youth anti-drug media campaign on youths. American Journal of Public Health. 2008; 98:2229-2236

9.Klein K. Slogans that are the real thing. BusinessWeek Online file:///URL/http/::www.businessweek.com:smallbiz:content:aug2005:sb20050804_867552.htm

10. Langer, EJ. The illusion of control. Journal of Personality and Social Psychology 1975; 32:311-328

11. Logan DE et al. Social desirability response bias and self-report of psychological distress in pediatric chronic pain patients. Pain. 2008; 136:366-372.

12. Miller CH et al. Psychological Reactance and Promotional Health Messages: The Effects of Controlling Language, Lexical Concreteness, and the Restoration of Freedom. Human Communication Research. 2007; 33:219-240

13. National Youth Anti-Drug Media Campaign website URL: http://www.mediacampaign.org/

14. Nike Commercial http://www.youtube.com/watch?v=rHHMaiNyztk

15. How to build great campaigns (Chapter 5). In: Olivgy D. Confessions of an Advertising Man. New York: Atheneum, 1964, pp. 89-103

16. Rains S, Turner MM. Psychological Reactance and Persuasive Health Communication: ATest and Extension of the Intertwined Model. Health Communication Research 2007; 33:241-269

17. Marketing public health – an opportunity for the public health practitioner (Chapter 6). In: Siegel M, Doner L. Marketing Public Health: Strategies to Promote Social Change (2^nd edition). Sudbury, MA: Jones & Bartlett Publishers, Inc., 2007, pp. 127-152

18. Smith WA. Social Marketing: an overview of approach and effects. Injury Prevention. 2006 June; 12(Suppl 1): i38–i43.

19. Steinberg L. Risk Taking in Adolescence: New perspectives from Brain and Behavioral Science. Current Directions in Psychological Science. 2007; 16:55-59

20. Wikipedia: Framing (social sciences) URL: http://en.wikipedia.org/wiki/Framing_%28social_sciences%29

21. YouTube Search : Above the Influence Commercial URL: http://www.youtube.com/results?search_query=above+the+influence+commercial&aq=0