Challenging Dogma - Spring 2008

...Using social sciences to improve the practice of public health

Monday, April 21, 2008

Losing the War on Drugs: A Critique of “Above The Influence” – A National Youth Anti-Drug Media Campaign – Angela Fan

Adolescent substance abuse is a major national public health problem in the United States. It is “a leading cause of teen death or injury related to car accidents, suicides, violence, and drowning” (1). Although the most recent Monitoring the Future study by The National Institute on Drug Abuse shows a decline in alcohol and other drug use among U.S. teenagers, the number of teens who drink and use drugs still remain high (2). According to this study, 47 percent of all American high school seniors in 2007 have tried an illegal drug by the time they have finished high school. Furthermore, the Centers for Disease Control and Prevention recently reported that 26 percent of adolescents ages 18 to 20 reported episodic heavy or binge drinking in 2005 (3). Among youth, the use of alcohol and other drugs has been linked to unintentional injuries, physical fights, academic and occupational problems, and illegal behavior. Long-term alcohol misuse is associated with liver disease, cancer, cardiovascular disease, and neurological damage as well as psychiatric problems such as depression and antisocial personality disorder. Drug use contributes directly and indirectly to the HIV epidemic, and alcohol and drug use contribute to infant morbidity and mortality (3). Due to the high prevalence of teenage drug usage, many anti-drug campaigns have been launched in an attempt to alleviate this problem.

“Above The Influence” is a National Youth Anti-Drug Media Campaign conducted by the Office of National Drug Control Policy. The campaign advocates against recreational drug and alcohol use by teenagers in the United States. Since the inception of this campaign in 1998, the program’s goal has been to utilize television and web advertisements to raise awareness to teenagers about the dangers with respect to adolescent drug and substance abuse (4). In doing so, the campaign aims to prepare teenagers to withstand the social pressures of trying these substances. However, the Government Accountability Office released results of a study conducted in 2006, which indicates that the anti-drug campaign not only appeared to have a nominal effect in reducing drug usage, but it may have inadvertently influenced some youth to think that drug usage is quite normal (4).

The “Above the Influence” campaign is unable to effectively reduce recreational drug and alcohol usage rates in American teenagers due to its heavy reliance on a rational model of decision making, its reinforcement of social prejudice and detachment from teenage drug users, and its inability to promote self-efficacy by failing to provide viable solutions to resolve such problems.

The Campaign Heavily Relies on a Rational Model of Decision-Making.

The “Above the Influence” campaign is based heavily on the Health Belief Model, a rational model of decision-making first developed in the 1950s by social psychologists Dr. Rosenstock, Dr. Hochbaum, and Dr. Kegeles (5). The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. The model “assumes that human behavior is determined by an objective, logical thought process” and that increasing knowledge and behavioral intent will lead to behavioral change (5-6). According to this model, changes in behavior depend on four factors: perceived susceptibility (one’s assessment of risk of contracting a certain condition), perceived severity (one’s assessment of the seriousness of the condition and its consequences), perceived barriers (one’s assessment of the influences that discourage adoption of the promoted behavior), and perceived benefits (one's assessment of the efficacy of the advised behavior to reduce the threat of the condition) (6-7).

The “Above the Influence” campaign cites drug facts from various medical sources on its website in an effort to raise awareness to teenagers about the dangers of drug and alcohol abuse (8). The campaign believes that well-informed teenagers will be better prepared to make “smart” decisions to reduce drug usage and to resist negative pressures when they are faced with them. This method fails to recognize that behavioral intent does not always lead to behavioral change. For example, the powers of a drug or alcohol addiction may be stronger than the teenager’s intention and desire to quit, despite the knowledge of harmful consequences.

The campaign also focuses too much on the behavior of the individual decision-maker and tends to overlook the role of other social factors or group-level factors that might deter an individual from making decisions rationally. Albert Bandura’s Social Learning Theory emphasizes the importance of learning by observing and modeling the behaviors, attitudes, and emotional reactions of others (9). Social Learning Theory is based on three basic principles: (a) “observational learning is achieved by first organizing and rehearsing the modeled behavior symbolically before enacting it overtly” (b) one is “more likely to adopt a modeled behavior if it results in outcomes he or she values” and (c) one is “more likely to adopt a modeled behavior if it has functional value” and if the model is similar to and highly valued by the observer (10). Social Learning Theory helps explain how teenagers adopt socially significant forms of behavior such as learning to use alcohol and drugs. If alcohol consumption or drug use is performed by a model at home or in the media, and if such action is portrayed and identified as a desirable action, the probability that substance use will be adopted by the observer is increased.

Social Network Theory produces an alternative view where attributes of individuals are less important than their relationships and ties with others within their social network, which essentially means that individuals may indeed behave differently in a group than by themselves (11). According to this theory, an individual’s behavior is governed by the expectations of others in their social networks. A teenager’s pattern of drug and alcohol use can be determined by his or her social network’s pattern of drug use. The campaign’s heavy focus on individual-level risk factors of teen substance abuse rather than on group-level risk factors undermines the effectiveness of this public health intervention.

The Campaign Fails to Be Sensitive to Teen Drug Users’ Needs and Feelings.

The campaign’s goal is to encourage teenagers to stay “above the influence.” The campaign utilizes a series of television, print and interactive advertisements to empower teenagers by encouraging them to develop their own identities and discouraging them from being influenced by negativity. Most of the television ads attempt to provide examples of teenagers who are “above the influence” by portraying teens who demonstrate courage, prudence and strength in resisting peer pressure. Contrarily, these television advertisements inadvertently display discrimination and alienation against teens who are “under the influence.” These harsh advertisements are filled with judgmental, self-defeating and destructive personas, all of which contradict the campaign’s mission. Examining and analyzing some of these television advertisements from the campaign reveals why the campaign fails to achieve its purpose.

One of the television advertisements utilized in the “Above the Influence” Campaign is titled, “Dog.” In this commercial, a pet dog plays the role of a teenage drug user’s friend. The dog expresses to its drug-using friend Lindsey that their friendship has changed ever since she started smoking marijuana. After expressing its feelings, the dog leaves Lindsey behind by casually saying, “I’ll be outside.” Lindsey is then shown to be alone with a look of guilt and shame on her face (12).

Another example of an ineffective television advertisement employed in the campaign is titled, “Whatever.” This commercial focuses on a drug-free, goal oriented teenage boy who takes care of his friends who are missing out on life due to drugs. The driver expresses that he currently does not mind being responsible for his friends. However, the driver expresses that when he leaves for college, his friends will become “somebody else’s problem” (13).

These two examples of television advertisements employed in the campaign fail to recognize the needs and feelings of teenage drug users. The television ads display some type of abandonment, alienation or both. The “Dog” commercial presents judgmental messages rather than expressions of concern for teens’ lives. Already exhausted from self-scrutiny, teenagers may respond to this scorn by putting up defenses or simply shutting out these messages. The campaign needs to find ways to express human compassion and understanding so teenagers are able to feel that they are treated with kindness and respect. On the other hand, the “Whatever” commercial displays an overall attitude of apathy towards the issue of teen substance abuse. The campaign concentrates too much on drug prevention rather than drug treatment. The campaign aims to deter teenagers who have not yet used drugs from trying drugs but offers no remedies to teenagers who are already drug users.

The campaign fails to recognize the relationship between low self-esteem and drug and alcohol abuse. In today’s society, it is difficult for teenagers to gain self-confidence, approval and acceptance. Abraham Maslow’s Hierarchy of Needs Theory proposes that the need for love and belongingness is a fundamental human motivation (14). Maslow’s Hierarchy of Needs Theory states that a person’s higher levels of needs are expressed only after basic/deficiency needs are first fulfilled. High levels of needs or growth needs, such as self-actualization, are the enduring motivations or drivers of behavior. Lower levels of needs, in increasing stages, include: physiological, safety, love/belongingness, and esteem needs (14). Self-esteem is indeed involved in addictive substance use (15). The use of drugs is often used to compensate for low self-esteem and feelings of a lack of control over one’s life. Without addressing the problem of teens with self-esteem, the campaign will have a minimal impact on teenagers who are desperately struggling to meet the basic needs. Rather than showing messages that may hurt self-esteem and alienate teenage drug users, public health interventions should convey messages of support and acceptance to first gain the trust that many teenage drug users are so desperately lacking.

The Campaign Lacks Tools to Promote Self-Efficacy and Fails to Provide Solutions to the Problems of Teen Drug Usage.

Having the strength to resist pressure and rectify bad habits requires confidence, courage, and determination. The campaign merely discusses the tragedy of addiction but fails to provide teenagers with ways to overcome drug addiction or to provide effective ways in promoting self-efficacy among teenagers. Without properly providing the tools to promote self-efficacy, the teenagers receiving drug facts may feel powerless to resolve their drug problems.

Self-efficacy beliefs provide the foundation for human motivation, well-being, and personal accomplishment. The concept of self-efficacy is at the core of Albert Bandura’s Social Cognitive Theory (16). Social Cognitive Theory and the concept of self-efficacy emphasizes that a person’s behavior is influenced by the belief that the certain behavior will lead to a desired outcome and that he or she can successfully execute the behavior required to produce the desired outcome (6). According to Bandura, self-efficacy develops from four major sources: performance accomplishment (“successful mastery” of a task), vicarious experiences (witnessing others’ successful completion of a task), verbal persuasion (receiving verbal encouragement from others to overcome self-doubt), and emotional/psychological arousal (responses and emotional reactions to situations) (6). Individuals with a strong sense of self-efficacy are more able to handle challenges and recover quickly from setbacks and disappointments. Individuals with a weaker sense of self-efficacy tend to believe that difficult tasks and situations are beyond their capabilities, focus on personal failings, and quickly lose confidence in personal abilities (16).

The campaign merely provides teenagers with drug facts that are of common knowledge and not very informative. Drug facts and risk factors of drug abuse which are shown as the main features on the campaign’s website attempt to gain credibility by citing the sources of the facts (8). However, these cited sources are useless since no teenager faced with making the decision to use drugs or not will look to an exhaustive report of medical research data to assist them with their decision. This information itself does not provide teenagers with any tools to address their problem of substance abuse or is not enough to promote self-efficacy. Teenagers need to feel as though they can be successful in ceasing drug use and that doing so will lead to positive consequences. Having a problem without a solution is the very basis of depression and self-doubt, conditions that drive teenagers to the numbing effects of addictive substances in the first place. For the campaign to succeed, other factors that improve an individual’s self-efficacy such as encouragement and support from home and school environments are crucial.


Although the “Above the Influence” campaign has made some positive contributions, this public health intervention is unable to effectively reduce recreational drug and alcohol usage rates in American teenagers. The heavy reliance of the campaign on a rational model of decision-making overlooks the role of other social factors or group-level factors that might deter an individual from making decisions rationally. The campaign’s reinforcement of social rejection and abandonment of teenage drug users fails to be sensitive to the needs and feelings of teenagers and teenage drug users. A lack of tools to promote self-efficacy and a lack of viable solutions to resolve their addiction problems leave teens feeling even more vulnerable.

Ways to effectively reduce teenage substance abuse may be to emphasize strong family connections and healthy friendships. Supportive schools and communities are also necessary to build social support as well as the confidence that teenagers need to resist peer pressure to try or use drugs. Community prevention programs that make it difficult for teens to get drugs and alcohol may be effective in decreasing the rate of substance abuse for high-risk teens. Involvement in church activities, sport programs, or youth organizations also help young people feel connected and engaged in activities and social circles that are substance-free.

In today’s society, each teenager has his or her own distinct problems to face and stress to handle. Taking the time to understand the range of needs and problems that teenagers face today may be helpful in creating an effective public health intervention to reduce recreational drug and alcohol use. By talking to teenagers to discover the types of problems, stress, and pressures that induce them to use drugs and alcohol, we may be able to determine the fundamental causes of teenage substance abuse.


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  2. National Institute of Health. NIDA InfoFacts: High school and youth trends. Bethesda, MD: National Institute on Drug Abuse, 2007.
  3. Center for Disease Control And Prevention. Healthy Youth! Alcohol & drug use. Atlanta, GA: Centers for Disease Prevention and Health Promotion, 2007.
  4. United States Government Accountability Office. Contractor’s national evaluation did not find that the youth anti-drug media campaign was effective in reducing youth drug use. Washington, DC: U.S. Government Accountability Office, 2006.
  5. Rosenstock IM. Historical origins of the health belief model. Health Education Monographs 1974; 2:328-335
  6. Salazar MK. Comparison of four behavioral theories. AAOHN Journal 1991; 39:128-135
  7. Campbell C. Health education behavior models and theories. Mississippi State, Mississippi: Mississippi State University Coordinated Access to the Research and Extension System, 2001.
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  9. Defluer ML, Ball-Rokeach SJ. Theories of mass communication (5th edition), Chapter 8 (Socialization and Theories of Indirect Influence), pp. 202-227. White Plains, NY: Longman Inc., 1989.
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  11. Siegel M. Class 3: Models used in public health-Social Network Theory. 1/30/08.
  12. Office of National Drug Control Policy. “Dog.”-Abovetheinfluence: The Ads. National Youth Anti-Drug Media Campaign. Washington, DC: National Youth Anti-Drug Media Campaign.
  13. Office of National Drug Control Policy. “Whatever.”-Abovetheinfluence: The Ads. National Youth Anti-Drug Media Campaign. Washington, DC: National Youth Anti-Drug Media Campaign.
  14. Maslow A. A theory of human motivation. Psychological Review 1943; 50:370-396.
  15. Reasoner RW. Review of self-esteem research. Fulton, MD: National Association for Self-Esteem, 2004.
  16. Pajares F. Overview of social cognitive theory and of self-efficacy. Atlanta, GA: Emory University, 2002.

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