The Problem, the Ploy and the Paralogism: Methamphetamine use in Montana and the Montana Meth Project- Lisa Sunner
Methamphetamine use is a growing public health issue in
A 2007 report, and a follow-up in 2008, published by the Montana Attorney Generals Office in collaboration with the MMP, highlighted encouraging results of this campaign. Findings showed that attitudes are changing, public awareness is ‘very high’, and perceptions of a ‘great risk’ of the negative effects of meth use are increasing (5). Most importantly, meth use appears to be declining among teens and adults according to workplace drug testing statistics. However, these findings have been challenged- some sources accuse these data of being intentionally misrepresented (1,12). Objectively determining the efficacy of the MMP campaign is of prime importance because its price tag is high. Initially funded solely by Siebel the project has since earned public funds, 2 million in April 2007, $500,000 the following October and an additional $916,500 by December. Seibel is currently proposing a $40 million annual budget for the project from the state (1,6,7). Its escalating cost and questionable efficacy is making the campaign increasingly controversial and in need of evaluation.
To this end, the use of social science research can provide a relevant and objective perspective through which the Montana Meth Project can be examined. From a modern public health perspective, the Montana Meth Project does not represent the true power of public health programs and does not demonstrate encouraging progress in
Advertising Alone Does Not Change Behavior:
Large anti-drug media blitz campaigns utilizing advertising theory, the idea that one can create a mass consumer by controlling the desire for a product, are unfortunately as addictive as the drugs that they aim to condemn even though very few have been successful in demonstrating behavior change. Advertisement makes a promise and support that promise through visual media. The MMP ads promise that trying meth, even once, will have ruinous consequences, a claim that is supported by dramatic images of methamphetamine users and their behavior. President Clinton spent billions on a similar anti-drug media blitz in the mid-90s that failed in raising awareness of the negative effects of drug use and also succumbed to fraud (8,9,11). Representative John Mica R-Florida, said of Clinton’s campaign “This…whole program of advertising and bringing awareness to the youth...about the perils of using drugs is not working as well as we would have hoped”(9). Social science research gives credibility to these assertions showing that reliance on advertising campaigns alone can increase awareness but have “little to no effect” on behavior (10).
Although, advertising theory, when properly informed and executed, has a role in improving the ability of public health campaigns to raise community awareness and concern however it most likely cannot, as the Montana Meth Project asserts, account for reduction in the numbers of methamphetamine users. The state attorney general’s report downplayed the increasingly exorbitant costs incurred by correctional services, hospitals, workers compensation and unemployment, numbers that don’t add up when considered as a whole. Workplace survey data on the prevalence of meth use are suspect because many serious users are likely unemployed and claims that meth-related admissions to treatment centers are decreasing are countered by the fact that incarceration rates are increasing (5). These misrepresentations illustrate that merely re-packaging of old methodology in flashy and expensive media does not make an approach efficacious. According to social scientist, Jeff Linkenbach at Montana State University “the notion that saturated public awareness equals success is a characteristic of a private advertising agency perspective…[which is] strikingly different from the broad-based approach required by a public health issue stemming from social and economic ills, not a mere lack of awareness”(11). Objective interpretation of the numbers in the report indicates that public health problems are closely related to factors such as law enforcement, health structures and public policy. Although advertising theory is a powerful social science tool for impacting attitudes it should not be applied without proper research and it should especially not be confused as a substitute for programs that more directly address behavior change and the multiplicity of contextual issues surrounding health.
The Theory of Planned Behavior is Outdated:
As the state suffers, the Montana Meth project clings to interventions based on behavior change models that are insufficient. Public Health professionals have, for years, argued that the concepts of traditional behavior change models, including the Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB), are incomplete frameworks for explaining health behavior (12). The TRA/TPB focus on three specific factors of behavior change: attitude, subjective norms, and behavioral intention (19). Ingham (1993) likened the habit of returning to traditional models to “squeez[ing] into clothes they….wore when they were much younger (and presumably thinner)…the results of such attempts [are] far from comfortable even if success were somehow achieved” (14). Drug epidemics are often the result of a combination of individual, social, cultural and structural level factors. These large-scale and difficult health issues are then forced by the majority of public health practitioners to squeeze into behavior models that are solely individual and lack mechanisms for conceptualizing the complexity of the problems. TRA/TPB are meant to be utilized as frameworks for creating public health interventions and not as strict methodology and the application of these models should be supplemented with a broader knowledge of public health theory.
For example, in contrast to the insight from the TRA/TPB models, people often act in un-healthful ways despite knowledge of the negative consequences, a concept completely ignored by the MMPs campaign. Acknowledging this phenomenon is essential to creating a feasible public health message.
Scare Tactics Don’t Work:
Scare tactics and stigma theory are also well-known within social science research to be complex and only reasonably effective, tactics for behavior prevention (17). Scare tactic theory use threat and fear, two directly related components, to influence behavior. There are numerous theories describing the technical details as to how fear initiates behavior change, the main one being that the more fear one creates the more persuasive the argument (17). Erving Goffman explained stigma theory as the “public’s attitude toward a person who possesses an attribute that that falls short of societal expectations … [who is] reduced in our minds…to a tainted, discounted [person]”(20). The outcome of stigmatization is status loss and discrimination (20). The MMP campaign is almost completely made-up of scary images and messages that depict people acting in socially and morally undesirable ways as a consequence of using meth. Print ads created by the MMP include messages like “Bucks for Sex isn’t normal, but on Meth it is” with an unsettling image of a girl beneath a male and “No one thinks they’ll try to tear off their own skin. Meth will change that”, with an image of a blood stained razor blade in a bright white sink. Meth users are depicted as gaunt, pale, and covered in sores, making use of the stigma of an ugly appearance. The MMP relies heavily on scare tactics and stigma theory to enforce the belief that methamphetamine use is stigmatizing which the MMP hopes will prevent teenagers from trying meth.
Practically however, in the field, as Mona Sumner of the Rimrock Foundation, a drug and alcohol treatment program in
Immediate Improvements and Future Directions:
The Montana Meth Project should not abandon ship in its endeavor to take action in controlling
The bottom line is that behavior does not occur in a vacuum. Mielewczyk & Willig assert regarding smoking that “…what if ‘smoking’ as pure ‘behavior’ does not exist? What if ‘smoking’ does not, in fact, manifest itself as a distinct, isolated ‘behavior’...what appears to be the same behavioral sequence (e.g. smoking) may form part of a variety of different social and/or cultural practices” (2). This same existential line of questioning and contextualizing of the problem is the critical missing piece of the Montana Meth Project’s approach. Methamphetamine use, and most drug problems, function not as an isolated behavior but instead as part of a “variety of different social and/or cultural practices” and only when it is treated as such will prevention efforts make progress. Immediate improvement of the efficacy of the Montana Meth Project requires integrating social science principles more effectively into the current approaches used by the MMP however; a truly comprehensive campaign would have to also consider and aim to address the larger environmental and structural factors that exacerbate the situation including the effects of policy, rural environment and socio-economics.
Immediately Improving the MMPs Advertisements:
An improved MMP advertising strategy should invest time and money in researching a product and message. In-depth focus groups with the target population in
Implementing sufficient background research would translate the MMP into a more successful advertising campaign because changing health behaviors depends on creating the correct product, advertising appropriate messages (28). The MMP’s product is meth use and the promise is negative consequences. In contrast, the Truth campaign, realized manipulation by corporations, not the dangers of tobacco use, was the “product” and “truth” the realistic message that would change young adult behavior. Ground-level research drawing from social science principles including, marketing: how to appropriately and successfully create and sell a product, anthropology: understanding the “native point of view” of a particular society and psychology: understanding the developmental characteristics of young adults, were successfully applied with impressive results (16,22,23). Investing in getting to know the audience through social science methodologies resulted in a novel product, message and an emphasis on honesty and ultimately, a successful advertising intervention. Pioneers of this type of approach already exist in response to methamphetamine epidemics. The Drug Policy Alliance New Mexico (DPANM) has adopted this approach to its meth epidemic by creating a, now federally funded, youth program to promote science based information and youth participation (27). The program includes a social marketing campaign including media and a discussion guide about methamphetamines. By broadening the scope of the MMP from the surface advertising tactics of product and promise to include social science tactics of marketing, anthropology and psychology the messages will more likely have bang for the buck.
Immediately Improving the MMP’s Theoretical Approach:
An improved intervention wouldn’t rely solely on messages emphasizing individual-level non-contextualized models of behavior but would recognize that higher-level factors (SES, education, environment) influence individual behaviors (23). The MMP should allocate funds to research these associations, specifically within
Assuming that public health issues can be explained and addressed using individual level frameworks and overlooking societal, environmental, cultural and structural factors is an underlying problem within Public Health. A growing body of research is changing this paradigm. This research has found that factors like race and SES independently affect disease outcomes. Similarly, research suggests that race, living in rural areas and low SES are associated with meth use (23,24,25). Some states have already adopted approaches that function on multiple levels. In 2007,
Immediately Improving the MMP’s Reliance on Scare Tactics:
The Montana Meth Project could further improve its advertisements by reducing the dramatic and mis-representative scare-tactics in favor of creating messages that present realistic messages about meth use and positive messages about meth non-use. Prevention does not need to be a message of “don’t- because you’ll die,...ugly” and can instead convey the advertised message “Hey- I’ve tried it, it really wasn’t that great and I stopped because I have plans to someone other than an addict.” Psychology, specifically positive psychology and operant conditioning provide a social science basis for the idea that positive messages and positive reinforcement are effective for increasing desirable behaviors (29). In addition, the benefits in terms of influence gained by presenting messages that match real-life experience are also maintained. The negative effects of methamphetamines should not be ignored- scare tactics can be helpful- however exclusive focus on these dramatized negative messages mis-represent the truth in a very large-scale and visible way (a.k.a. on a billboard) which undermines the message of the entire multi-billion dollar campaign (2,17). Not to be construed as “putting a positive spin on drug use”- the MMP should re-consider the effectiveness of using scare-tactics alone given all that is known in the social sciences about behavior.
Unfortunately, scare tactics are one of the most commonly used methods to influence health behavior, sometimes coined “health terrorism” (2,17). However, the current trend in health education is changing towards programs that focus instead on critical decision making, objectivity and realism- as seen in sex education “if you are going to have sex, use a condom” or tobacco use “if you use cigarettes know that the industry is manipulating you”. For the MMP, the counter-productive results of scare tactics are underscored by the fact that the majority of teenagers in
The Big Picture:
Managing the meth epidemic in
 Erceg-Hurn, D.M. Drugs, Money, and Graphic Ads: A Critical Review of the
3 Goldenstein, S. (Speaker). Bringing
5 Montana Department of Justice. Methamphetamine in
6 Suderman, A. Despite criticism, meth funds advance. The Associated Press 2007. Found at: http://www.montanastandard.com/articles/2007/04/03/state/hjjcjfjgjihbec.txt
7 Funding secured for the Montana Meth Project. Found at: http://www.methproject.org/documents/6-29-07_The_Associated_Press.pdf
8 Francine, K. Clintons antidrug plan: $2 billion ad blitz. Christian Science Monitor, 1998; 90:157, 1.
9 Lewandowski, B. Mismanagment alleged in national anti-drug ad campaign CNN 10/25/2000. Found at: http://archives.cnn.com/2000/ALLPOLITICS/stories/10/05/drug.office/index.html
10 Brickmayer, J. et al. Prevention of Methamphetamine Abuse: can existing evidence inform community prevention? Journal of Drug Education, 2008; 38:2. 147-165.
11 McQuillan, J. What’s wrong with this picture?: Why the Montana Meth Project isn’t all it’s cranked up to be. The
12 Ogden, J. Some problems with social cognition models: a pragmatic and conceptual analysis. Health Psychology, 2003; 22:424-428.
14 Mielewczyk, F., Willig, C. Old clothes and an older look. Theory and Psychology, 2007; 17: 811-837.
15 Hicks, J.J. The strategy behind
16 Hersey, H.C., et al. The theory of “Truth”: how counterindustry media campaigns affect smoking among teens. Health Psychology, 2005;24:22-31.
17 Witte, K., Allen, M. A meta-analysis of fear appeals: implications for effective public health campaigns. Health Education and Behavior, 2000;27:591-615.
18 Wood, E., & Kerr. T. Methamphetamine strategy requires evaluations. CMAJ, 2008;179: 677.
19 Fishbein, M., & Ajzen, I. Belief, attitude, intention, and behavior: an introduction to theory and research. 1975,
20 Stigma & HIV/AIDS: a review of the literature. Found at: http://hab.hrsa.gov/publications/stigma/stigma_defined.htm
21 Piper, B. (2008) A Four-Pillars Approach to Methamphetamine: Policies for Effective Drug Prevention, Treatment, Policing and Harm Reduction. Found at: http://www.drugpolicy.org/docUploads/FourPillarsMethamphetamine.pdf
22- Hahn, RA. Sickness and Healing: An Anthropological Perspective. Chapter 5: Anthropology and epidemiology: One logic or two? (Chapter 5).
23- Shrem, MT., Halkitis, P.N. Methamphetamine Abuse in the
24- Iritani, J., Hallfors, D.D., Bauer, D.J. Crystal Methamphetamine Use among Young Adults in the
25- Lambert, D., Gale, J.A., Hartley, D. Substance Abuse by Youth and Young Adults in Rural
26- Addressing the Methamphetamine Crisis in
27- Drug Policy
28- The Copy Workshop – strategy seminar. Found at: http://www.adbuzz.com/OLD/Strategy.pdf29- Seligman, M.E.P., Csikszentmihalyi, M. Positive Psychology: An Introduction. American Psychologist, 2000, 55:5-14. Found at: http://www.ppc.sas.upenn.edu/ppintroarticle.pdf