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, 2005. 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) DrugLifetimeLast yearLast month Tobacco 66.6 45.2 40.8 Alcohol 86.1 77.1 69.3 Cannabis 29.2 10.6 6.8 Opiates 7.7 0.7 0.7 Cocaine 6.9 0.5 0.3
Continuation rates (%.)Same source. DrugLifetimeLast yearLast month Tobacco 100 67.5 61.4 Alcohol 100 89.6 80.5 Cannabis 100 36.1 23.3 Opiates 100 27.6 8.6 Cocaine 100 25.6 10.8
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?