Last month, the Centers for Disease Control and Prevention (CDC) launched an advertising campaign aimed at reducing addictions and deaths that are linked to prescription opioids. There are billboards and videos and photographs for people to share on social media. They feature folks like Mike Duggan, who had to drop out of his college classes after becoming addicted to pain medication, and Tamera, who lost her job and home as a result of her addiction. As of September 25th, the campaign is running in Ohio, Kentucky, Massachusetts, and New Mexico, according to the CDC. The agency plans a broader release later.
The campaign suggests the government wants Americans to eschew opioid prescriptions altogether. Its tagline is, "It only takes a little to lose a lot." In his featured ad, Duggan says, "One prescription can be all it takes to lose everything."
In another ad spot, Anne Marie Parado, the real-life mother of a young man who lost his life to opioids, says, "I'm not supposed to be the one to go get his suit and tie and pick which sneakers that I'm going to bury him in." Parado's son, Christopher, died of an opioid overdose when he was 22.
The videos are incredibly moving—and yet, according to nearly every public-health researcher Pacific Standard consulted, they probably won't do much. Why not? Everyone pointed to the same fatal flaw: The ads tell viewers that prescription opioids are a big problem, but don't tell them what steps to take.
"What were they asking people to do?" clinical psychologist Craig Lefebvre asks me, rhetorically, when I interview him. Lefebvre studies public health at the research non-profit RTI.
As Lefebvre and others point out, telling Americans to avoid prescription opioids altogether just isn't feasible. The drugs may, in many cases, be a good choice to treat pain. In fact, advising people not to use opioids at all contradicts the CDC's own "Guideline for Prescribing Opioids for Chronic Pain," which was published last year. The guideline recommends caution, not abstinence. According to the experts Pacific Standard consulted with, people need to learn, say, how to ask their doctor if their opioid prescription is too strong or long-lasting, or how to act if they're worried a friend or family member might have an addiction. The video ads do show a URL at the end, cdc.gov/RxAwareness, but it disappears quickly and there's no indication of what the site offers.
In addition, campaigns that tell people to just not do something, without offering alternatives, don't typically work, argues Bill DeJong, a professor of community health sciences at Boston University. DeJong offers the example of efforts in the United States to reduce drunk driving, which got off to a slow start until a suite of changes in the late 1980s, including the invention of the idea of a designated driver. "It wasn't until there were changes in policy and enforcement, changes in the law, coupled with offering steps you could take to avoid it, like the designated driver, that we got some real change," DeJong says. In 1988, nearly 24,000 Americans died in alcohol-related car accidents. By 1995, that number had fallen to about 17,000; in 2015, it was 10,000, even though the U.S. population had grown by more than 76 million people since 1988.
Psychological theory explains why "Just say no" doesn't work. It's thought that, before they'll change their behavior, most people need to feel empowered to do so. The technical name for the feeling is self-efficacy. Without that self-confidence, the CDC's opioid campaign just makes viewers sad and afraid, emotions they may deal with unproductively. "People might dismiss it. They might say, 'Well, it looks like it's a problem, but it won't happen to me.' Or they may avoid it. 'Oh, I don't want to see this,'" says Vish Viswanath, who studies health communication at Harvard University. "Because you have to cope with it somehow."
Some of the experts Pacific Standard talked with took the stance that the CDC ads would be at least somewhat effective, suggesting the materials could underscore for lawmakers and funders that opioid overdoses are a serious problem, and could build public support for policies aimed at restricting opioid access. DeJong, however, has a harsher opinion. "The campaign isn't going to make a damn bit of difference," he says.
The CDC is one of America's major science agencies. It employs scientists of many stripes, including epidemiologists who do crucial work in tracking drug use in America, which helps doctors and officials stay on top of a fast-changing epidemic. Why, then, would it sponsor an ad campaign that health psychologists don't think will work? The agency's press office didn't fulfill requests for a phone interview about the campaign, nor did it answer questions sent over email. DeJong speculates the problem might be the federal government approaching public service announcements as advertising problems, rather than health-behavior ones. In the past, the government has hired (or received pro bono services from) ad firms to try to discourage Americans from drunk driving and drug use.
America's ad men can indeed be effective at persuading people to change their behaviors—for example, to use body wash instead of soap, or to spritz the toilet before sitting on it. But getting people to be healthier is different. As DeJong puts it: "We don't tell people that you're going to die if you don't use Crest toothpaste."