COCAINE CAMPAIGN MESSAGES: ARE THEY CUTTING IT? John B.Davies Centre for Applied Psychology University of Strathclyde

How do you react when someone gives you a directive message which runs counter to your own experience?

Some basic fatality data: Scotland, 2005  Heroin 225  Diazepam/Temazepam 118  Alcohol 116  Methadone 80  Cocaine 38  Ecstasy 17  ETS-related deaths 865  Accidental drownings 62  Road deaths 307  Data from Drug Misuse Statistics, NHS Scot.  Data from Passive Smoking and Associated Causes of Death in Adults in Scotland, 2005 NHS Scot.

It’s a question of rate, of course; not just numbers.  Estimated 45,000 ‘last year’ users; so guesstimated rate is 0.8 per thousand.  Therefore, most users do not have heart attacks.  Surveys suggest there are hidden populations of users who present with no current health problems.

Prevalence x time period (%). (Amsterdam: Frenk and Dar, 2000) Drug Lifetime Last year Last month Tobacco Alcohol Cannabis Opiates Cocaine

Continuation rates (%.)Same source. Drug Lifetime Last year Last month Tobacco Alcohol Cannabis Opiates Cocaine

Can we make some cautious conclusions from these data?  Cocaine use does not necessarily result in uncontrolled or escalating use.  The evidence suggests that of those people who use cocaine, a relatively small percentage get into difficulties. e.g. fatality rate is about 0.84 per thousand users, using SDF’s prevalence data.

So………..  Is a public campaign the only way to tackle this?  Is a public campaign the best way to tackle this?

It depends what you are trying to achieve…  Are we trying to stamp out cocaine use?  Are we trying to minimise the harm that cocaine use can cause?  Which of these is the more realistic?

Can we make a few more general observations?  The public perception of the severity of risk which drives interventions bears only a slight relationship to the statistical risk.  History shows that this has happened several times before (‘dope’, ‘speed’, ecstasy, heroin, and now cocaine).

There are three issues to consider, with regard to national ‘don’t do it’ campaigns.  Is a national campaign the most appropriate response?  Do they work?  The issue of ‘false positives’.

Is a national campaign the best response?  As the proportion of the total population that forms the ‘target audience’ gets smaller, so the cost per effective unit gets higher.  What’s the rationale for saying the target audience is the whole population?

Do they work?  Do they reduce prevalence?  ‘Evidence based’: how good is the evidence?  In general terms, how good is the evidence that drug education reduces levels of use?

Are there possible unwanted side effects?  False positives: arousing an interest where there was no interest before.  What happens when false positives exceed the population base rate?

How well does the message match the reality?  Most cocaine users do not die, have heart attacks, or turn into dangerous paranoid criminals.  For a smaller proportion of users, things turn nasty/dangerous, and this is a real problem.

So what makes the most sense?  Interventions that target those who most frequently get into difficulty.  Interventions that look at the social world in which people live and move.  Interventions for those who need interventions.

What’s the place of public campaign messages within this system?