It was a well-intentioned attempt to show the disturbing effects of drug addiction, a common strategy among law enforcement agencies.
Officials in East Liverpool, Ohio, released photos of a man and woman slumped over in the driver and passenger seats of a car, pale and unconscious from a heroin overdose. The woman’s grandson sits in the back seat, face visible for the world to see.
The images spread through the Internet, inspiring a Wisconsin woman to share a similar scene with a local television station. Video taken on the woman’s cell phone shows a couple passed out in a car from a drug overdose with a toddler in the back seat. Another clip follows of them lying on a grassy sidewalk as Milwaukee firefighters revive them.
There’s no doubt the images are disturbing. But can any good come from sharing them?
On balance, probably not, according to public health experts, prevention specialists and ethicists. Fear may grab the public’s attention, but privacy concerns matter, too, as well as what science says about the effectiveness of such strategies.
Little evidence suggests that using shame or fear is an effective deterrent to drug addiction, which, by definition, is a chronic brain disease characterized by compulsive drug use “despite harmful consequences,” such as arrests, heart attacks, or loss of family support.
If anything, it may have the opposite effect, especially for those depicted, experts say.
Here are some reasons why graphic images showing the harsh reality of drug addiction may do more harm than good, and what can be done instead:
They reinforce the stigma of addiction…
Just like no one eats fried chicken with the goal of heart disease, no one picks up drugs or alcohol to become an addict, said psychologist John Fitzgerald. A series of life events, often beginning in childhood, builds up trauma that leads people to seek comfort through different kinds of risky behavior: alcohol, overeating, even drugs.
A single picture does not tell the whole story of a person’s road to addiction, said Fitzgerald, clinical director of CODA, Oregon’s oldest opioid addiction treatment program. When we glance over images in a news feed and pass judgment without considering the context, we run the risk of becoming numb to the reality that addiction is a disease, not a choice, he said.
“These images perpetuate myths about addiction and create a divide between people who understand this is a treatment issue and people who believe this is a moral issue or weakness of character,” he said.
It takes more than a picture, said Dennis McCarty, a professor at Oregon Health & Science University’s Department of Public Health & Preventive Medicine.
Effective prevention requires communitywide programs that reduce risk factors such as poverty, bad parenting, and lack of access to education, and strengthen resiliency by building a sense of belonging through strong family ties and healthy communities.
For example, in Ohio, initiatives such as the Urban Minority Alcoholism and Drug Abuse Outreach Programs provide children with after-school and summer programs that include tutoring, field trips and other activities that promote self-esteem and positive social relationships, while delivering drug prevention services. For ex-offenders, the program offers needs assessments, job readiness and placement assistance, and mentorship.
It’s just one of many community-based programs having an impact, McCarty said.
… Which promotes shame that can have a marginalizing effect
And, that’s not going to help anyone beat their addiction, experts say. A vast body of research shows that shaming people addicted to drugs sends the message they’re worthless and undeserving of redemption, which can discourage them from trying to stay clean or seek help.
“Shame itself may invoke negative feelings in the individual. It may cause them to feel inferior, inadequate, and potentially a failure,” said child psychiatrist Scott Krakower.
These negative feelings may lead to antisocial behavior, causing them to seek coping strategies such as substance abuse, he said.
Especially in the early stages of addiction, when the chances of turnaround are greater, “it is important to engage the individual in a positive manner, so they can feel comfortable seeking help,” Krakower said.
Campaigns and public service announcements that promote independence and self-worth are more likely to be effective deterrents, especially among children and at-risk populations, he said. One example is “Above the Influence,” a program of the nonprofit Partnership for Drug-Free Kids. It targets teens through PSAs and social media campaigns with a mix of messages dealing with friendship, bullying and substance abuse — but with animal memes and inspirational quotes instead of graphic images.
While it’s too soon to tell how effective they are, it’s a good example of where the research is pointing, Krakower said.
“Teaching people to be more independent, to stand up for themselves, so they feel like they can seek help, those are more effective than scare tactics,” he said.
In fact, the photos might raise curiosity about drugs
The City of East Liverpool said it released the photos to raise awareness of the collateral impact of drug addiction on families, including children.
“We feel it necessary to show the other side of this horrible drug. We feel we need to be a voice for the children caught up in this horrible mess. This child can’t speak for himself but we are hopeful his story can convince another user to think twice about injecting this poison while having a child in their custody.”
But the images may have the opposite effect, especially among adolescents.
A 2008 research paper found that high school seniors who viewed anti-drug PSAs during commercial breaks of an episode of “The Simpsons” were more curious about using drugs than those who did not see the ads.
The researchers behind “The Curiosity-Arousing Function of Anti-Drug Ads” offered a possible explanation: Anti-drug ads “prime” viewers to think about their personal experiences, leading them to become curious about taking drugs to satisfy their interest.
The findings fell in line with previous research suggesting that PSAs may serve to normalize unhealthy behavior and promote competition and imitation from the audience, the authors noted.
Besides, it’s not about the image that really matters, but how we process it. The city of East Liverpool said the photos of the Ohio couple were intended to deter both addicts and potential users. But research suggests that intention matters little if the viewer doesn’t feel vulnerable to the health consequences.
However, evidence suggests that parents talking to children about drugs can have an impact. Partnership for Drug-Free Kids, formerly the Partnership for a Drug-Free America, the group behind the “your brain on drugs” PSAs, brought back the classic advertisement with a new twist that targets parents.
Then, what?
PSAs emphasizing social implications have been found to be more effective than those focusing on physical harms of drug usage. Beyond that, we seem to know more about what doesn’t work than what does.
Evidence of the effectiveness of anti-smoking PSAs provides some cues. But it’s an imperfect comparison because smoking is socially acceptable behavior — though certainly to a lesser degree than it once was — that underwent an image change, said Kathryn MacKay of the University of Birmingham’s Institute of Applied Health Research.
A combination of approaches in recent years has been attributed to an overall reduction in smoking rates, she said: laws restricting where people could smoke, heavy taxation of tobacco, bans on certain kinds of advertising, in addition to health-related PSAs.
“It’s very difficult to disentangle these different approaches, and likely they all worked together better than any single one would or could alone.”
The same may prove true for drug addiction, in which case, maybe some good will come from the photos.
“This could be an opportunity for the [East Liverpool] chief to bring the community together, inventory their resources, select proven prevention strategies with evidence of effectiveness, and implement with fidelity to the tested model,” McCarty said.
“Prevention is complex and cannot be simplified. It is a long-term investment in the health and well-being of a community.”