Two careers beat as one: Trying to get people on and now off controlled substances!

Outdueling alcohol and tobacco with advertising is like bringing a knife to a gunfight.     

For over 25 years, I worked in the creative department at a number of big name advertising agencies. I was (and am) a copywriter by trade and began my career in that capacity, at the Leo Burnett Company in Chicago. During my lengthy tenure at that storied agency I wrote and produced copy for numerous alcohol and tobacco clients, including (in no particular order): the Phillip Morris company (now named Altria Group), Diageo (Wine & Spirits), Anheuser Busch, and the Miller Brewing company. These were and are Fortune 50 multinational companies spending many, many millions of dollars a year on marketing alcohol and tobacco products to any number of audiences, none more coveted than the youngest populations.

      Though federal and state laws were in place regulating the drinking and smoking ages of consumers, by definition mass media easily allowed advertisers to circumvent them. After all, a beer commercial televised on a football game could be seen by adults and children alike. Print media (remember that?) had more discernable target audiences i.e. Playboy and Esquire (adult males) Martha Stewart (adult females), etc. Outdoor adverting (billboards, bus shelters, and the like) had the unique benefit of being able to infiltrate very specific markets via targeted media plans. Putting malt liquor billboards in impoverished urban neighborhoods is a classic and controversial example of how easy it was for advertisers with money to influence the people who could least afford to drink and smoke – economically, sociologically, psychologically, physiologically and even spiritually. But hard times beget hard drinkers and heavy smokers.

      And we all knew it.

      Really, every department in the traditional ad agency (creative, strategy, accounts, media) was built to optimize getting the right messages to the right people. I spent my days crafting copy specifically designed for specific drinkers and smokers, existing and potential. I knew who they were: their age, sex, ethnicity, proclivities and so on. We all did. Our clients paid us to know everything possible about targeted populations. And they had their own people doing the same. Elaborate strategies were developed and implemented to move product. As data became more accurate and actionable, the ability to optimize reach and efficiency grew exponentially. Unsurprisingly, substance abuse disorders among these targeted groups routinely were in excess of national norms. The ramifications were not lost on public servants and various anti-drug/alcohol/tobacco groups.

      Consequently, in order to combat this growing problem, many governmental and societal watchdogs invariably found themselves playing catch up and keep away. Banning outdoor ads near schools and eliminating cigarette ads from many publications were two of the more significant regulatory measures put into place. On another front, groups like Mothers Against Drunk Drivers and the Truth Initiative began calling for more stringent policies while underwriting marketing efforts of their own. Many of their efforts have been successful. For example, most teenagers no longer consider smoking cigarettes a right of passage. But many huge efforts were also huge failures. Recall the “Just Say No!” campaign?  It had the opposite effect on young people, perversely making illegal drugs the definition of cool. Getting folks to try something is a lot easier than getting them to stop. It’s not so much a matter of putting the genie back in the bottle; it’s getting the genie to stop drinking from it!

      Therefore, during our class discussion on prevention strategies for reaching and influencing people with either existing substance use disorders or the potential to develop an SUD, it became painfully apparent that these same strategies were (and still are) employed by advertisers to reach the very same audiences!

      For example: The Diffusion of Innovations Framework i.e. utilizing an influencer to create momentum behind a new idea is among the oldest saws in the advertising tool kit.  E.M. Rogers may have coined the phrase in 1962 but using celebrities to sell goods and services dates back hundreds of years, not long after the printing press was developed.

      The Health Belief Model we talked about (that messages will achieve optimal behavior change if they successfully target perceived barriers, benefits, self-efficacy, and threat) perversely mirrors the most common messaging strategies employed by marketers of beer, wine and spirits: Drink this and you’ll be in with the in crowd. Different agendas. Same conceit. “Good for you” can be spun.

      Advertisers are as interested in the Stages of Change Theory as any drug counselor, assessing someone for the likelihood that they might use as opposed to might not.

      And so on.

      Rules and regulations change. But human nature never varies. The theories driving many of the popular environmental strategies for the prevention of drug and alcohol problems are eerily (and necessarily) similar to the strategic marketing plans for alcohol and tobacco. When anti-groups have the most success effecting the environment via advertising it is when they employ the same levels of creativity, sophistication (and hopefully budgets) as their nemesis do. Like they say: fight fire with fire. Know your enemy.

Written for course at Berkeley Extension Certificate Program in the Treatment of Substance Use Disorders

How to save a life.

My philosophy as it relates to recovery has evolved since I first became clean and sober in 2003. While I began (and continue) my path to recovery as a member of Alcoholics Anonymous, I have never completely accepted a number of its foundational tenants. For example, I remain uncomfortable ascribing to the disease model espoused by AA (and elsewhere). I believe each person with a substance use disorder has played as major a role in their problem (routinizing bad decisions), as they will in their recovery (changing the behavior). However, I recognize the usefulness in calling alcoholism a disease in terms of framing the therapeutic aspects of 12-step recovery models and in determining healthcare policies, qualifying for insurance, etc. Like with any disease, I also believe that alcoholism and drug addiction are progressive in nature.

What I most cherish about the program of Alcoholics Anonymous and what I will carry with me into counseling is the knowledge (contrary to some medical opinion) that nothing aids in the recovery of an addict or an alcoholic like another addict or alcoholic. (It’s why I want to be a counselor.) I know there are other modalities and practitioners capable of accomplishing the task. But one is hard-pressed to find a better ally than experience, strength and hope. I am a big believer of therapeutic self-disclosure. As a drug and alcohol counselor, I will establish empathy with my clients while establishing reasonable boundaries.

What I will leave behind from 12-Step recovery vocabulary is the utter reliance on a Higher Power to achieve sobriety. For one thing it would be hypocritical! Additionally, I will be open-minded to harm reduction as an option for certain patients as opposed to total abstinence. And so on. The point is I intend to be a therapist in the modern world… not a book-thumping old timer.

Having been clean and sober for nearly twenty years, I am deeply familiar with the 12-step model for recovery (I actively participate in Alcoholics Anonymous and am grateful for the program) but I also recognize that AA and NA are not treatment programs and that there are other modalities and therapies for helping patients achieve long-term sobriety.

Though I am middle-aged, I feel my message resonates with young people and I am interested in helping them in particular. Part of this reasoning has to do with my own recovery journey and how I have always endeavored to tailor my message to those still raw in their recovery, or even still using. I feel a kinship with individuals who struggle accepting AA’s first step: that of being powerless over drugs and alcohol and accepting that their lives have become unmanageable. Powerlessness is a cop out. We do have power to change the things we can. I did. And I can help others to do so as well. Part of my message will be about healthy replacement strategies for drugs and alcohol, of which there are many.

Additionally, I have always had a tenuous belief in the concept of a Higher Power, let alone one being necessary to achieve sobriety. I have seen too many addicts and alcoholics (and those still not sure) simply turn away from 12-step programs because of the “God thing.” I was and am able to “work around” my own agnosticism and I do not necessarily believe that a spiritual component is critical to recovery. Redefining spirituality for every patient is the start of a discussion not the end of one. Along those lines, I can help patients see the wisdom of 12-Step programs, despite their ambivalence. Statements like this: AA helped me despite my qualms; it might be able to do the same for you. Not this: Without a Higher Power, your chances for sobriety are nil.

As a counselor, I will adhere to the five ethical principles: Autonomy, Beneficence, Fidelity, Justice and Nonmaleficence. Realizing that while each has specificities all are beholden to the other. Indeed, one may be in conflict with another, such as confidentiality and the potential for imminent harm. Untangling a sticky ball requires a measured hand. In a given situation, if right and wrong are not crystal clear, my intent will be to discuss options and scenarios with my peers before acting. I look forward to that collaboration.

In college, I studied journalism. The first thing I learned was that there is always two sides two a story. Likewise there are multiple stories for every individual who suffers from alcohol or chemical dependency. A person’s drug narrative is often shaped by their genealogy as well as environment. Things like family structure (or lack thereof), social groups, ethnic and cultural norms and other issues almost always play a role in the formation of a substance use disorder. How could they not? Therefore, a counselor worth his or her salt must be culturally competent beyond what passes for acceptable in today’s divisive political climate. As I ready myself for work in the field I know this is an area I must continue to develop, letting go preconceived notions I may still harbor and would be harmful to providing exemplary care and therapy.