Do Scare tactics Work in Preventing Substance Use?

A reader recently asked what I thought about a scare tactics campaign initiated by a sheriff in Oregon – see http://www.facesofmeth.us/drugs_to_mugs.html

The literature tells us—and has consistently done so now for years—that scare tactics do not work. This, however, does not mean that there is not a place for such campaigns in what we do as prevention specialists.

First, when the literature tells us that scare tactics do not work, what they report in the discussion of the findings on which the article is based is that individuals who engage in the high-risk behavior to which the scare tactic refers do not change their behavior as a result of the scare tactic. So whether it is a “mug shots” campaign referenced above or, my personal favorite, “this is your brain on drugs” (see http://www.youtube.com/watch?v=qyXFN4ocN_o) neither results in someone doing things differently on Friday night simply because of having watch/seen the PSA on Thursday.

We know that many (most?) high-risk viewers of such PSA find it easy to disconnect. They either mistakenly believe, “Oh, that will never happen to me because…” or “Well he/she/they were just stupid and not careful” or “that is just a stupid video.” Interestingly, the key element in such campaigns is their ability to get folks who watch who are not the subject of the PSA in order to get them to react, which is to say, these are the real intended audience for such PSAs…in the readers note to me, he included the statement, “(It) may be scare tactic – but it sure got my attention sent me.

We, the viewers, are the audience, not the drug users in society. When parents/concerned citizens/conservatives/law abiding adults/victims of drug-related crime/etc. view such PSAs, we are galvanized and tend to demand that something be done. Frequently this “something” is more related to the “supply side” of the drug issue (interdiction) than the “demand” side (prevention and treatment). Yet there is a role for such PSAs to play in the work that we as prevention specialists and concerned professionals do to address the alcohol and other drug problem that exists in our culture.

The literature also tells us that people proceed towards change by passing along a continuum of readiness to make that change. When a high-risk user is in the earlier stages of readiness to change—in the literature this is called a pre-contemplative stage—and exposed to such PSAs, they DO NOT change because of the PSA message. What they may do, however, is take notice and add the information to an archive of stored info on AOD use and perhaps eventually move to the next stage on the continuum…contemplation.

If pre-contemplation is the capital “D” Denial stage, the “I-don’t-have-a-drug-problem-but-a-drug-solution” stage, then contemplation is the small “d” denial stage, a stage where one begins to question if what I am doing might just be presenting a problem. From here individuals work through the successive stages of change until they reach a point of “action” and it is here that the user essentially says, “The war is over, I lost; give me the articles of surrender and I will sign.” I will not bore you with the details of how to get from “pre-contemplation to action,” but suffice it to say that scare tactics may, and I emphasize MAY, play a role.

No one has ever moved from pre-contemplation to action and on to maintenance (maintaining the change once made) without coming to a point of realizing that “to go on doing what I have been doing is more of a hassle than to change.” Our challenge as prevention specialists is to expedite that movement through these stages…and scare tactics may be able to play a (small) role in this movement. What scare tactics cannot do, however, is move someone from pre-contemplation—or even contemplation—to action…it is just too easy to find countless examples of individuals who are not experiencing the “problem” the PSA rails against and to point to them as proof of the PSA’s spurious message.

In closing, I am not “against” scare tactics so much a I do not believe they change behavior. I believe we must first recognize the limitations of scare tactics PSA before even considering their utility.  Second, we need to accept that they are at least as focused on upsetting you and me as they are in trying to influence the behavior of high-risk users—do they intend to get users to stop or “everyone else” to be upset? Third, we need to accept that no PSA or campaign based on scare tactics is ever going to keep someone with a substance use disorder, in and of itself,  from using. There is no “silver-bullet” that will bring down the werewolf of addiction. There is, however, hope that we can affect change and help move someone along the continuum of readiness to change.

To learn more about the stages of readiness to change, visit: http://www.aafp.org/afp/20000301/1409.html

To read more about a comprehensive plan to address high-risk collegiate drinking, which may serve as a model for affecting any high-risk behavior, visit: http://www.robertchapman.net/essays/when_they_drink1.pdf

To read more on my views regarding a more comprehensive understanding of collegiate drinking and my thoughts on what is missing from a comprehensive plan to address such, visit: http://www.robertchapman.net/essays/When_They_Drink2.pdf

What do you think?

Dr. Robert