Thursday, December 14, 2006

Partnership For a Drugged Up America: JUST SAY NO to Rational Decision-Making - Stanley Mui

Medicine and the invention of more practical pharmaceutical drugs have been credited for the vast improvement of public health. They both have been credited with the decrease in mortality and are used to ease suffering of those afflicted with disease. Besides the advancement of science, there were also the cons of science. Some of the hurdles include the increased number of people living with chronic illness, and the increase in the number of people addicted to recreational and pharmaceutical drugs (8). Public policies were conceived to deal with increasing drug addictions and decrease the appeal of drugs to youth; these policies have not been very effective. The policies have only increased the number imprisoned, and increased the racial disparities in the United States prison system (7). This has lead to the increasing divide between blacks and whites, the rich and the poor.

An example of such an ineffective campaign was the “Just Say No” campaign. This campaign started in the 1980s by then first lady Nancy Reagan (1). With billions of dollars spent on the war on drugs, there has been no decrease in the number of drug use amongst teens. From 1988 to 2001, there was a 5.6% increase (from 22.8% to 28.4%) amongst teens ages 12-17 who have ever used any illicit drugs (2). Needless to say the “Just Say No” campaign has not been an ineffective tool on the war on drugs.


Most of the “Just Say No” campaign is based on the knowledge-attitude-behavior model. In this model, it is believed as more knowledge is accumulated, there will be a change in attitude, leading to a change in behavior (3). This model assumes that a person is rational and, that with a provision of educational material, will gain knowledge and lead to rational decisions. Even with a vast knowledge about a certain behavior, people do not make rational decisions (9). The anti-drug campaigns have been using this model, and its effects have not been as dramatic as hoped.

According to the Webster dictionary, the definition of “rational” is “having reason or understanding.” KAB assumes that by providing people with “knowledge,” rational behavior would ensue. Drug use can lead to changes in brain structure, and improper function in the brain. KAB does not take into account people who are more probable to become addicts. Addiction is defined as uncontrollable, compulsive drug craving, seeking and use even in the face of negative health and social consequences (11). As it can be seen, not everyone can make “rational” decisions. There are other factors that affect one’s judgement.


The “Just Say No” campaign is also based on the health belief model (HBM). HBM is based on three concepts, perceived severity, perceived benefits, and perceived barriers (3). All three are believed to lead a person to a judgement of whether to select a certain benefit that will minimize the perceived threat. Someone will choose the behavior that will maximize benefits when subtracted from the costs (3). From this model, drugs should be on a downward trend. The severity of drugs can lead to life imprisonment and/or addiction, and the barriers are law enforcement and the accessibility to drugs. One would hope that these costs outweigh the benefits of drug use, relief from emotional/physical pain/suffering. Even with negative costs accompanied with drug usage, drug use amongst teens has been up and addiction is still a problem.

Like in KAB, HBM does not take into consideration factors like addiction. It assumes that all people are rational, and decisions are made with the person’s overall health in best interest. In an article by Reyna and Farley, it was shown that adolescents do not have the capability to make good decisions. There are many factors that affect how adolescents come about their decision. Compared to adults, adolescents make bad decisions when they include peer pressure, spur of the moment decisions, and decisions that affect a long-term outcome (12). In KAB and HBM models, it does not take into consideration that the mind set of adults and adolescents are different. Both groups have different decision making processes.

HBM was built on the notion that everyone’s thoughts and rationale are generalized. People are different to a certain degree, and everyone has different experiences that explain their chain of thought and behavior. Another model that “Just Say No” came from is the Theory of Planned Behaviour (TPB). TPB states that people will perform a given behavior if they have an intention to do it. People’s intentions are influenced by attitude towards a certain behavior, subjective norms, and perceived behavioral control (4). Essentially, to change a behavior or an intention, one must change their beliefs. This theory is very similar to HBM, where if people have an intention, they will perform the given behavior. The “Just Say No” campaign follows these theories of thought.


The purpose of “Just Say No” is to use scare tactics to explain the devastating effects of drugs. The primary goal was for kids to just say “no” (9) to any drugs presented to them. By telling adolescents to just say “no”, they will have a drug free life. These tactics have not been very effective in curtailing youth from drug use. Although it has been presented many times to youth that drugs are harmful in relation to health, many youth still experiment with drugs. The “Just Say No” campaign did not take into account a factor that was more powerful, peer pressure (9). By following HBM and TPB, “Just Say No” has failed, because it does not teach youths how to reject drugs when there is peer pressure. When peer pressure is involved in an adolescent’s decision making process, risk weighing becomes obsolete. Desire for acceptance by peers becomes the major decision maker (12). The campaign failed because it bases on individual actions and not on societal influences. Some societal influences also include consequences from “Just Say No.”

Much of “Just Say No” depends on people having rationale and good judgement. During the campaign, there were stricter laws for drug control. Even though the “war on drugs” was being waged, drug use among adolescents did not drop. Besides peer pressure, there are many other factors that play into the rise of drug use. One theory that can be applied to the continuing rise of drug use, can be explained by Protection Motivation Theory (PMT). PMT measures the intention to protect one self. There are two factors that forms PMT, threat and coping appraisal (5). Those with a low protection motivation will result in destructive behavior. In a paper by Wu et al (6), it was found that African American adolescents who live in a negative environment tend to have destructive behavior. Contributing factors to a negative environment include family association with drug activity, and economic status. With adolescents who were poor, dealing with drugs was a motivation to improve economic standings. Even with drug education programs like “Just Say No” being incorporated into the school system, there was a rise in drug related issues. This shows that the program was ineffective and many other factors play into drug activity. Besides weighing recited knowledge about the effects of drugs, there are other factors from society that play a bigger role in drugs.


Most of “Just Say No” is also based on Control Theory. In Control Theory, it is believed that “social services will decrease levels of deviant behavior by strengthening the bond between the adolescent and society”(14). With stricter laws on drugs, many people were incarcerated or put through drug rehabilitation programs. Even with stricter laws, there was not a decline in drug related issues.

As a consequence of Control theory, there is the labeling of adolescents as “delinquents.” In the labeling theory, adolescents who “labeled” as delinquents will see themselves in a negative context (15). By labeling adolescents from a social construct as “delinquents,” adolescents will choose to engage in activities associated with crime and other delinquents. Self concept is a determinant factor that leads to either delinquency or not. By having a low self concept, adolescents self identify themselves with negative descriptors (16). All this can happen in lieu of self esteem. Adolescents with a high self esteem does not have an affect their low self concept. One of the strongest predictor of behavior in the labeling theory are parents, teachers, and peers (16).


TPB works for certain groups of people, but not to other individuals. An alternative to TPM or the HBM theory of thought will be Cognitive Behavior Therapy (CBT). CBT is different from the previous because its states that if someone wants to change behavior, they must change their interpretations of certain situations. CBT believes that one’s core beliefs are influenced unconsciously by life experiences and it affects how one interprets certain situations (4). Everyone’s core beliefs are interpreted in a different and personal manner. For people to change one’s behavior, CBT requires people to learn and think of new ways to think and interpret situations.
CBT has been shown to work in various other situations involving health behavior changes such as obesity, diabetes, and myocardial infarction. What differs between CBT and TPB are their approach to have someone change behavior. TPB’s approach is by presenting information that will educate and therefore illicit a behavioral change. With CBT’s approach, besides just having information presented, it goes beyond by encouraging people to experiment. By experimenting with different behavioral changes, it generates situations where people can gain experience and make judgements (4). Rather than just presenting information and telling others to “just say no”, CBT suggests that people experiment with different approaches to drugs and peer pressure. One of the limitations with CBT is that it cannot be presented in large groups, but only in small focused groups.

CBT would be helpful in the fight against drugs, because it adds to the “Just Say No” campaign. Rather than relying on scare tactics, CBT relies on educating youth about the effects of drugs. Where “Just Say No” failed in telling youths how to act around drugs, CBT would suggest that youths should make their own decisions. They will be armed with crucial information about dangers and risks of drugs. Adolescents are encouraged to make their own decisions. Many of the lessons learned about drugs can be learned from experimenting. Rather than having been told told that all drugs are bad, the CBT method will have different approaches to education about different kinds of drugs (10).


The “Just Say No” campaign have been based on four different models that they hope will affect people’s behavior with drug use. It is based on the Knowledge-Attitude-Behavior model, the Health Belief model, and Theory of Planned Behavior. All these models are effective in a way, but they are based on individual intentions and rationale. The campaign against drugs must use different models/theories to persuade those who are unconvinced by the ill effects of drugs and its negative aspects. There are many models that may work, but the anti drug campaigns should not rely on only four of the above models. Some suggested models that may work are based on the cognitive behavior theory, and the protection motivation theory. All the theories have been effective in different ways, because it takes a different approach to the drug epidemic. Expanding the anti drug campaign with different approaches will affect many people in different ways. In a way, I believe that the anti-drug campaigns should be run so that it will be personalized. Today’s campaign are too generalized, and there are people who will be unaffected and make health behavior judgements that involves drugs.

3. Baranowski, T., Cullen, K.W., Nicklas, T., Thompson, D., and Baranowski, J. (2003). Are Current Health Behavioral Change Models Helpful in Guiding Prevention of Weight Gain Efforts? Obesity Research, 10.
4. Hobbis, I. & Sutton, S. (2005). Are Techniques Used in Cognitive Behaviour Therapy Applicable to Behaviour Change Based on the Theory of Planned Behaviour? Journal of Health Psychology, 10, 7-18.
6. Wu, Y., Stanton, B.F., Li, X., Galbraith, J., Cole, M.L. (2005). Protection Motivation Theory & Adolescent Drug Trafficking: Relationship Between Health Motivation and Longitudinal Risk Involvement. Journal of Pediatric Psychology, 3, 127-137.
8. Corran, J.J. (2005). Prescription For Disaster: The Growing Problem of Prescription Drug Abuse in Maryland.
10. Beck, J.E. (1998). 100 YEARS OF "JUST SAY NO" VERSUS "JUST SAY KNOW": Reevaluating Drug Education Goals for the Coming Century. Evaluation Review , Vol. 22 No. 1.
12. Reyna, V.A, Farley, F. (2006). Risk and Rationality in Adolescent Decision Making: Implications for Theory, Practice, and Public Policy. Psychological Science in the Public Interest, Vol. 7 No. 1.
13. Reaves, J. (2001). Just Say No To DARE: After years of ignoring the program's failure, DARE's anti-drug mavens design a new curriculum for a new generation of teenagers. Time.
14. Downs, W.R., Robertson, J.F., Harrison, L.R. (1997). Control theory, labeling theory, and the delivery of services for drug abuse to adolescents. Adolescence.
16. Adams, M.S., Robertson, C.T., Gray-Ray, P., Ray, M.C. (2003). Labeling and Delinquency, Adolescence.


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