Critical Review Of The Montana Meth Project As A Reflection Of Current Drug Policy – Andrew O’Connell
One of the most difficult areas of public health intervention is drug prevention and control. As of 2009 21.8 million Americans over the age of 12 were current (within the last month) illicit drug users, this accounts for 8.7% of that population (1). These numbers are up from 8% in 2008. This trend shows an increase in illicit drug use and illustrates a gap in public health prevention.
Currently one of the most accessible and widely used drugs is methamphetamine or “meth.” Meth is a central nervous system stimulant that can be taken in a number of different ways including smoking and injecting. Meth creates an initial rush that increases a users activity while decreasing their appetite. Long-term health effects include addiction, anxiety, paranoia, and violence. As of 2008, 12.6 million Americans aged 12 or older admitted to trying meth at least once in their lifetime (2).
Because meth is so widely used it is a good indicator of effective public health prevention interventions. And since 2003 there seems to be a national downward trend of new meth users nationwide, from 260,000 in 2003 to 95,000 in 2008. This is very promising data and should encourage public health professionals to continue promoting drug prevention.
The Montana Meth Project
One program that is taking a lot of credit for the downward trend of meth use is the Montana Meth Project. The Montana Meth Project was created by, businessman and rancher, Thomas M. Siebel in 2005. The project is a prevention program that uses a research-based marketing campaign in order to depict meth as a consumer product that is readily available and affordably priced. Their goal is to give the facts regarding meth use to Montana’s youth in order for them to make informed decisions based on perceived benefits versus perceived risks (3). The program has gained national attention and is being funded federally and similar programs are being implemented in multiple states.
The Montana Meth Project takes a lot of credit for decreasing meth use in Montana since 2005. However, there are many reasons why this program is flawed and could be even more effective. The website for the program itself acts as a trophy case and a testament to the “success” of the program and does little to offer immediate accessibility to meth related prevention materials. Even the theories that are the basis for the advertisements in the program are used improperly and could potentially do more harm than good. In order to offer a truly effective campaign the approach that is taken by the Montana Meth Project must be re-evaluated.
When visiting Montanameth.org, the first thing you see is “63% decrease in teen meth use since 2005.” Elsewhere you can read about all the accomplishments regarding the program and in addition there are plenty of places to “take action” or donate to the project. The website also offers links to their award winning advertisements. The biggest issue with the main page for the project is the lack of alternatives and treatment options immediately visible. There is a “Get Help” tab in the upper right hand corner of the page, however this is too little for a campaign that is getting so much attention (4).
One thing that should be taken into question is the validity of the numbers that are presented by the Montana Meth Project. The mission statement that is offered on the front page of the site is, “Montana Meth Project is a large-scale prevention program aimed at significantly reducing first-time meth use…(4).” The project should not limit their focus on new users. One big reason is that these numbers were already on the decline even prior to the program being implemented in 2005. In 2003, the number of new users was 260,000 nationally and by 2005 when the project was implemented it was already down to 192,000 (2). The Montana Meth project takes a lot of credit for the decrease in new users but it seems a national downward trend was already occurring.
With the amount of new users already on the decline the project should work to increase the number of current users seeking treatment. As previously reported there are 12.6 million current meth users in the United States (2). The advertisements that put out by the Montana Meth Project show the dangers of beginning to use meth, but they do very little to encourage current users to seek treatment.
Erceg-Hurn takes a critical look at the numbers presented by the Montana Meth Project, and not all of them should be considered credible. The very first indicator that the projects data is selective is Erceg-Hurn’s discovery that as of 2008 none of the data presented by the Montana Meth Project has gone under peer review (5). This indicates the project is using data that has not been validated. Another basis of the program seems to be raising the stigma of those using meth. Erceg-Hurn actually found that perceived stigma of meth users, along with heroin and cocaine has actually decreased since the program began in 2005. And as for the claim of 63% reduction in teen meth use, Erceg-Hurn actually finds that between 2005 and 2008 there was a actually a 1% increase in lifetime meth use. Erceg-Hurn does indicate that although the projects data may show in actual increase, another set of data from the Montana Youth Risk Behavior Study showed a natural decrease between 2005 and 2007 but indicates that is more likely due to more stringent laws in regards to purchasing cold medicine that is used to create meth, rather than the effectiveness of the Montana Meth Project (5).
Just by looking at the numbers it would seem that the numbers that are being presented by the Montana Meth Project have little validity to them. The project is taking credit for other policy changes and trends that were present before the implementation of the project. The project should be focused more on a quality well rounded prevention program that reaches new and current users, rather than building their own ego. A website that is easy to navigate and offers both alternatives to meth and treatment options for meth would be more impressive than a trophy case.
When developing an effective website to motivate meth prevention, the psychological reactance theory can be very effective in showing how meth can steal control away from the individual. An effective prevention should have a source that allows users to gain information and confidence to fight his or her disease. Giving the user a sense of rebellion towards meth can give them the sense of control that can motivate them to change.
One approach that can help reduce reactance is to increase the perceived similarity between who is delivering the message and who is receiving the message. Silvia found that similarity and liking of the source of the message would increase compliance to a behavior by the user seeking treatment (6). This indicates that the message that is being delivered from montanameth.org should not be coming from a businessman or rancher, but instead a former meth user or someone who was able to abstain completely from using.
In addition to increasing the similarity between the source of the message and the meth user, an effective intervention should display the freedoms and control that is lost by using meth. Brehm and Weinraub who analyzed psychological reactance in two year olds demonstrate this. They analyzed the effects of presenting a physical barrier in playing with a set of toys that is similar to set of toys that was out in the open without any barrier. What they found in two-year-old boys is that when they are told they are unable to have something they pursue it even more (7). This is the basis for psychological reactance. If freedom or control is taken away from an individual, he or she will do whatever it takes to regain that control.
The website of the Montana Meth Project currently is more about their own personal statistics, rather than empowering meth users. An effective intervention should display the freedom that is gained by not using meth and the control that is lost by becoming in addict. This should be done by using true stories of people that have been directly affected by meth and been able to overcome the barriers it creates. Creating a community of anti-meth sentiment with clear ways to receive help would be much more beneficial than promoting statistics.
Health Belief Model
The use of the health belief model is one of the largest flaws in the Montana Meth Project. The health belief model uses a person’s perceived susceptibility in order to predict behavior change. By increasing a person’s perceived susceptibility, while at the same time convincing him or her of the low cost of change, a public health professional can effectively encourage behavior change (8). The issue with the health belief model is that it does not take into account self-efficacy and social factors in predicting behavior.
Critics of the health belief model believe that it inherently does not take into account context of the information that is being presented. In order to effectively deliver a message related to health awareness one must fully take into account “the relationship between health status and historical, social, and political structures (9).” Individual’s who are receiving the message delivered may not raise their perceived susceptibility because it is not presented to the in the correct context.
The Montana Meth Project advertises their approach to marketing as decreasing the perceived benefits of using meth and increasing the perceived risks of using meth.3 This approach only works on the individual level and does not offer any social benefits and does not promote self-efficacy, which are essential for non users to avoid meth and current users to seek treatment. The health belief model can only explain someone’s intent to seek treatment, however it cannot predict action.
Hser, et al, supports this by concluding that many drug users who decide not to seek treatment do so because they have other psychological stress and lack of external support as barriers to seeking treatment (10). A meth user’s social situation and mental status must be taken into account when predicting behavior change. Simply increasing perceived risk is not enough.
Strecher, et al, defines and reviews the importance of self-efficacy. Self-efficacy is the perceived ability to perform a task or behavior.11 In order to increase the probability of behavior change it is important to not only increase perceived susceptibility but perceived self-efficacy. Strecher argues that self-efficacy comes from many sources including personal experience, observation, verbal persuasion, and psychological state of mind. All of these sources must be taken into consideration when encouraging behavior change. Also in order to use efficacy properly a campaign must address a person’s perceived efficacy versus their actual efficacy. Many users may have lower perceived efficacy especially if they don’t have a strong social network. When perceived efficacy is too low, it is beneficial to break the overall goal down into smaller tasks. This causes the perceived efficacy of the smaller tasks to add up to the larger goal (11).
It is necessary for the Montana Meth Project to take into account social connections and efficacy when delivering their message. Simply increasing one’s perceived susceptibility is an incomplete task especially when there is no context to which they can relate too. A proper intervention needs to incorporate a model that takes into account social relationships and works to both educate and build self-efficacy in a user.
It is very important for people thinking about using meth to understand the consequences of using illicit drugs. The health belief model works to increase the perceived susceptibility of using meth however it lacks social level interventions to encourage idea or behavior change. Using advertising and marketing theory would be beneficial in delivering a group level intervention.
One aspect of the Montana Meth Project that can be utilized in a new intervention is exposure. The Montana Meth Project is able to reach their desired target audience 3 times a week to deliver their message of the dangers of becoming a meth user (3). Randolph, et al, considers this one of the most important aspects of delivering an effective public health campaign using social marketing (12). There is no denying how the Montana Meth Project has been able to reach their audience. However, the message they are delivering will not be effective if it does not connect to their target audience. The message that is being delivered needs to stand out amongst other advertising.
Randolph goes on to discuss the importance of framing the issue. Framing the benefits of not using meth can be more beneficial than framing the costs of using (12). An effective campaign should promote the benefits of not using meth rather than striking fear in people by showing the risks of using.
Black, et al, concludes that when marketing for an intervention it is important to promote things such as convenience and affordability, but also goes on to indicate that social support is important as well. He elaborates that attending treatment with social support such as friends may work as a motivating factor to hold the person accountable (13).
A successful intervention should look at the core values of the population in question and offer a means to maintain those core values. In a state like Montana where outdoor activities are prominent, their campaign should encourage outdoor activities with a social group as an alternative to meth use. In addition to the alternatives to meth use, illustrating a social support group involved in similar interests and core values is necessary.
The Montana Meth Project uses graphic imagery and strong wording in order to depict meth users as prostitutes, thieves, and rape victims. The advertising is shocking to look at and the phrases, such as “Before meth, I had a daughter. Now, I have a prostitute,” are heart wrenching. It seems the project’s main goal is to strike fear into those who are thinking about trying meth for the first time, but what about any of the currently 12.6 million people that have said they have already tried meth (1). The advertising that is used by the Montana Meth Project and subsequently being used by more and more states is creating a truly negative view about meth users. This stigma that is being perpetuated will have a negative effect on the want for current meth users to seek help.
Stigma is very powerful in dictating behavior but it needs to be broken down into two aspects, stigma and discrimination. Stigma itself is the overall negative beliefs that society has towards a group of people. Related to stigma, discrimination is the negative actions towards a specific group (14). It is important to realize that discrimination may not always take place against meth users, but stigmatizing them can be just as damaging. Deacon argues that stigma is drawn from both societal and environmental factors and can be defined as, “1. Illness is constructed as preventable or controllable; 2. ‘Immoral’ behaviors causing the illness are identified; 3. These behaviors are associated with ‘carriers’ of the illness in other groups, drawing on existing social constructions of the ‘other’; 4. Certain people are thus blamed for their own infection; and 5. Status loss is projected onto the ‘other’, which may (or may not) result in disadvantage to them (14).” This definition of stigma does not require any definite act of discrimination in order to cause a disadvantage to the individual. The simple act of applying a stigma creates an “out-group,” which can raise a barrier to seeking treatment. Those that feel as if he or she only uses meth casually and do not want to be categorized as an “addict,” may be more secretive of their habit and avoid any form of treatment.
Using advertisement that harshly stigmatizes meth users can be counter-productive in encouraging treatment for addiction. As described by Radcliffe, et al, stigmatizing an individual can have negative consequences on their quest for treatment. Radcliffe’s study shows that stigma can create a societal group that many users will not want to be associated with. Many meth users are not to the point of prostitution or theft and feel that by admitting they may have a problem they are automatically grouped in with perceived criminals and lowlifes. By seeking treatment users expose themselves to not only their peers, but also themselves. Being categorized in this manner is a huge barrier to overcome in seeking help (15).
Radcliffe goes on to describe treatment programs as perpetuating the stigma of a user. If a user is able to overcome personal and societal barriers and enter treatment, stereotyping continues as they are grouped as addicts in recovery (15). This can have a negative effect in that users will look for support in those they can identify with. It is inefficient for individuals who are experiencing the same troubles to rely on each other for support.
Semple, et al, found similar results in her study on the role of stigma in seeking drug treatment programs. Semple found that those who had entered into the treatment system were more likely to be negatively labeled as a drug addict and had stronger feelings of rejection from their peers (16). Semple indicates that even when users are able to overcome the barriers of stigma that are set in place by campaigns such as the Montana Meth Project, they are magnified when they enter treatment programs and the likelihood of completing treatment is diminished (16).
Going through treatment for substance abuse is one of the most difficult things anyone facing addiction can experience. The Montana Meth Project’s depiction of meth users creates an enormous initial barrier to overcome in order to seek treatment. An effective campaign should empower a user to want to seek treatment by limiting the barrier of stigmatization.
Overcoming the stigma of meth user is the most important aspect of seeking treatment. The Montana Meth Project focuses too much on stigmatizing users in order to create fear in those who were thinking of trying meth. They do a poor job of encouraging those who have already tried meth in seeking help. While you do not want to glorify meth users and create a truly positive stigma of users it is important to show meth users who have risen above the stigma and sought help. Create a community of both meth users and families and friends who support the will to seek treatment.
Semple comes to the conclusion that one important aspect to encourage the pursuit of treatment is to teach proper coping strategies for the stigma of being a meth user. One of the most common strategies currently is avoidance or denial of the problem (16). A campaign should encourage social support as a coping mechanism. This is echoed by Sirey, et al. Sirey concludes that in order to maximize adherence to treatment program limiting the stigma presented by social cues is important (17). Advertisements should be created depicting not just stereotypes of people on meth, but should include families and communities who acknowledge the issue but show complete support.
In addition to family and community support it is important to depict current meth users who are willing and able to stand up against his or her stigma. Deacon presents that stigmatization can be advantageous in creating a strong community. It is necessary to have a group that can acknowledge their stigma and rise above it (16).
The advertisements currently out under the Montana Meth Project should be replaced with true stories of not just meth users who have experienced prostitution and crime but also users who didn’t feel they had a problem and only used occasionally. Not everyone who is a meth user is a prostitute or a thief and by stigmatizing people this way can create a barrier to seeking treatment. In addition to the meth users it is important to show the social network that has helped them in seeking treatment, such as family, friends, and healthcare facilities.
Illicit drug use is currently on the rise in the United States and it is important for public health officials to come up with innovative and effective prevention campaigns. While the Montana Meth Project is gaining national attention it is a flawed program and should be researched further. The program seems to be more worried about personal statistics rather than true case results. The advertisements that are based on the health belief model create stigmas that increase barriers to not only saying no to meth, but also seeking treatment for meth addiction. Future interventions should take these barriers into account and use social support and efficacy to offer alternatives to meth.
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