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Mike DeVillaer Manager, Provincial Projects Centre for Addiction and Mental Health (CAMH) & Dept. of Psychiatry and Behavioural Neurosciences Faculty of.

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Presentation on theme: "Mike DeVillaer Manager, Provincial Projects Centre for Addiction and Mental Health (CAMH) & Dept. of Psychiatry and Behavioural Neurosciences Faculty of."— Presentation transcript:

1 Mike DeVillaer Manager, Provincial Projects Centre for Addiction and Mental Health (CAMH) & Dept. of Psychiatry and Behavioural Neurosciences Faculty of Health Sciences, McMaster University Glamourization of Drug Use and Prevalence of Drug Problems AMHO Annual Conference May 28 2013

2 Fully-inclusive Disclosure No part of my work has been funded by any of the following industries: Tobacco Alcohol Pharmaceutical Drug cartels

3 [I am] “…a hardened and shameless tea drinker…” Samuel Johnson English writer, 1709-1784

4 Points to be made 1.drug promotion, drug use and drug problems are widespread in Ontario 2.most of the harm is associated with the use of tobacco & alcohol 3.the way these products are promoted appears to be a factor

5 Cultural Context for Drug Problems: Drug Use as Lifestyle

6 “…sex n drugs n rock n roll are all my brain n body need…” Ian Dury, English rock & roll artist, 1977

7 “When I read about the evils of drinking, I gave up reading.” Henny Youngman, British-American comedian

8 “In wine there is wisdom, in beer there is strength, in water there is bacteria.” David Auerbach, 2002 Canadian writer

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10 Real People Real Problems

11 Societal Purposes of Drug Use

12 Drug Use: Mixed Messages ? Buy Online ! Click Here.

13 Dangerous Drugs or Dangerous Decisions ?

14 Overview of Drugs & Other Problem Substances

15 Ethanol

16 Health Medication

17 Tobacco Cigarettes (Nicotine)

18 Cannabis

19 Opioids & Opiates

20 Stimulants

21 Hallucinogens

22 Inhalants

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24 Estimating Prevalence of Drug Problems

25 6 Indicator Types for Drug Problems 1.Economic costs 2.Drug use 3.High-risk behaviour 4.Adverse consequences (morbidity) 5.Drug dependence 6.Death (mortality)

26 Indicator Type #1: Costs to the Economy

27 Economic Costs of Drug Problems in Ontario, 2002 = $14,300 million Rhem et. al. (2006) The Costs of Substance Abuse in Canada in 2002. Canadian Centre on Substance Abuse.

28 Indicator Type #2: Drug Use

29 Surveys of Drug Use in the General Population CAMH Monitor eReports Addiction and Mental Health Indicators Among Ontario Adults ________________________ 1977- 2011

30 Prevalence of Drug Use in Past Year Ontario Grades 7 – 12 (2011) CAMH: Drug Use Among Ontario Students, 1977-2011 (2011)N = 9288

31 Prevalence of Drug Use in Past Year Ontario Grades 7, 9, 11 (1977 - 2011) CAMH: Drug Use Among Ontario Students, 1977-2011 (2011)N: 2013 - 4669

32 Prevalence of Drug Use Among Ontario Adults (18+ yr) CAMH (2011). CAMH Monitor eReport: Addiction and Mental Health Indicators Among Ontario Adults, 1977-2009.n: 1047-2627

33 Indicator Type #3: High-risk Behaviour

34 Risk-Level Alcohol Consumption Among Ontario Adults, 2009 CAMH (2011). CAMH Monitor eReport: Addiction and Mental Health Indicators Among Ontario Adults, 1977-2009. n: 2037

35 Prevalence of Drinking & Driving Among Adult Licensed Drivers (2009) Source: CAMH (2011). CAMH Monitor eReport: Addiction and Mental Health Indicators Among Ontario Adults, 1977-2009. n: 2037

36 Indicator Type #4: Adverse Consequences

37 The Continuum of Adverse Consequences Continuum of frequency & severity of consequences At one end: typically high dose & frequency; reckless behaviour horrendous consequences weekly or even daily At the other end: excessive or reckless use is extremely rare only embarrassing incidents with benign consequences Many degrees of adversity in between these extremes

38 Movement on the Continuum can be a lot of movement on the continuum older adolescents & young adults - more time at riskier end as people meet maturational milestones, most move closer to the safe end older adults - more time closer to safer end may be some back and forth over the course of their lives regressions can vary in their cause, length, seriousness and impact

39 What’s a realistic public health goal ? not realistic to permanently steer all high-risk people into the safe end of the continuum maximize the amount of time that people spend at the safer end clinical interventions for those who are unsuccessful

40 Data on Adverse Consequences 1)routinely kept statistical indicators 2)random anonymous surveys of the general population

41 1.3+ Million Alcohol-, Tobacco- & Illegal Drug-Related Hospital Days, Ontario 2002 (17.8% of all hospital days) Rehm J. et.al. (2006). The Costs of Substance Abuse in Canada, 2002. Canadian Centre on Substance Abuse.

42 Legal Consequences of Drug Use

43 407,500 Alcohol & Drug Offences in Ontario, 2002 (53% of all offences ) Rehm J. et.al. (2006). The Costs of Substance Abuse in Canada, 2002. Canadian Centre on Substance Abuse.

44 Prevalence Studies of Adverse Consequences hospital & crime statistics tell us the number of incidents not how many distinct individuals experience adverse consequences need to anonymously survey randomly-selected people on their drug use and consequences

45 Prevalence of Ontario Adults Drinking Harmfully Based on AUDIT Scores (8+) (2009) % of Respondents CAMH (2011). CAMH Monitor eReport: Addiction and Mental Health Indicators Among Ontario Adults, 1977-2009 n: 2037

46 Specialized Addiction Treatment Programs Not representative of the general population Shows us drug problems in their most concentrated form Data collected from DATIS - 159 specialized drug treatment programs in Ontario 2011-12: 103,909 admissions by 65,210 distinct individuals

47 Sex of Admissions to Specialized Drug Treatment in Ontario, 2011-12 CAMH (2012). Admissions to Substance Abuse Programs, 2011-12. DATIS Database (April 28 2012).

48 Age of Admissions to Specialized Drug Treatment in Ontario, 2011-12 CAMH (2012). Admissions to Substance Abuse Programs, 2011-12. DATIS Database (April 28 2012). % of clients

49 Problem Drugs Identified by Admissions to Specialized Drug Treatment in Ontario, 2011-12 CAMH (2012). Admissions to Substance Abuse Programs, 2011-12. DATIS Database (April 28 2012).

50 Social Problems Reported by Admissions to Specialized Drug Treatment Programs, Ontario, 2011-12 CAMH (2012). Admissions to Substance Abuse Programs, 2011-12. DATIS Database (April 28 2012).

51 Health Problem Indicators Reported by Admissions to Specialized Drug Treatment, Ontario, 2011-12 CAMH (2012). Admissions to Substance Abuse Programs, 2011-12. DATIS Database (April 28 2012).

52 Social/Health Problems of Clients in Specialized Addiction Treatment Programs, Hamilton, 1992-4 N = 3038 clients Avg. = 4.2 problems (St. Dev. = 2.5) Addiction Research Foundation (1995). Substance Abuse Treatment in Hamilton- Wentworth: Client Characteristics, 1992-1994. Substance Abuse Monitor, Hamilton.

53 The Health Care System and Drug Problems

54 Source of Problem Drugs for People in Treatment in Hamilton, 1988-93 n=499n=451n=163n=142 Addiction Research Foundation (1995). Substance Abuse Monitor Database. Hamilton.

55 The Health Care System & Drug Problems

56 Indicator Type #5: Drug Dependence “…a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance takes on a much higher priority for a given individual than other behaviours that once had greater value…” The World Health Organization has defined dependence as:

57 Assessing Drug Dependence Alcohol: The Alcohol Use Disorders Identification Test (AUDIT) Nicotine: The Heaviness of Smoking Index (HSI)

58 Prevalence of Drug Dependence Among Ontario Adults (18+), 2009 % of Adults CAMH (2011). CAMH Monitor eReport: Addiction and Mental Health Indicators Among Ontario Adults, 1977-2009 n: 2037

59 Indicator Type #6: Mortality Drugs play a major role in deaths in Ontario

60 Drug-related Deaths in Ontario (2002) Rehm J. et.al. (2006). The Costs of Substance Abuse in Canada, 2002. Canadian Centre on Substance Abuse. All deaths = 82,234

61 Type of Drug-related Deaths in Ontario (2002) Rehm J. et.al. (2006). The Costs of Substance Abuse in Canada, 2002. Canadian Centre on Substance Abuse. Drug-related deaths = 15,253

62 What have we covered so far ? 1) 1)drug use and drug problems are widespread in Ontario 2) most of the harm is associated with the use of tobacco & alcohol

63 Why Tobacco & Alcohol ?

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66 & Tobacco & Alcohol Ads: glamour & sophistication athleticism & virility romance & sexuality cultural mythology

67 The Engineering of Belief Marketing interacts with mythology is 2 ways: Reinforces the established mythology in adults Introduces mythology to next generation of customers

68 Market Segmenting Study a selected target market Design a campaign that appeals Integrate product and lifestyle aspiration

69 Lifestyle Ads 2 ads 2 brands 2 types of men 2 market segments

70 One Ad, Three Themes 1) athletics 2) nicotine as appetite suppressant 3) romance

71 The Crassly-crafted Message Market Segment: young European women lose some weight no dietary sacrifices a hot western guy

72 An Inside Look at a Tobacco Marketing Campaign R.J. Reynolds Tobacco Co. campaign plan for a new cigarette brand: “Dakota” attained & leaked by The Washington Post, Feb.1990 targeted young, poorly educated, white women "virile females“

73 The Campaign Target women with no education beyond high school women whose favourite pastimes included "cruising", "partying", attending "Hot Rod shows", & "tractor pulls" with their boyfriends favourite television roles are "evening soap opera bitches“ chief aspiration is "to get married in her early twenties" spend her free time "with her boyfriend doing whatever he is doing"

74 Reynolds’ Public Response denied that Dakota was aimed solely at women expressed concern that the plans "represent stolen, proprietary information belonging to R.J. Reynolds, and which would be of great value to our competitors“ Dakota disclosure came just three weeks after R.J. Reynolds was forced, by strong opposition, to cancel plans to test market Uptown, a brand of cigarettes aimed at blacks

75 Marketing Memorandum, stamped "RJR Secret", 1997 "To ensure increased and longer term growth of Camel Filter, the brand must increase its share of penetration among the 14-24 age group which have a new set of liberal values and which represent tomorrow's cigarette business."

76 On the Record R.J. Reynolds 1994 public statement: “…that smoking is a choice for adults and that marketing programs are directed at those above the age to smoke."

77 In 1994, JAMA printed a report that suggests that such campaigns can be very successful

78 JAMA: Smoking Increases 1944 -> 1967, only small increase in the number of teenaged girls who initiated smoking 1967 -> 1973, smoking initiation rates jumped: 35 % among 17 yr old girls 75 % among 15 yr old girls 110 % among 12 yr old girls rates among teenaged boys rose negligibly

79 JAMA: Targeted Campaigns during same 6 yrs, aggressive marketing campaigns mounted for Virginia Slims, Silva Thins, and Eve all brands which targeted female smokers

80 Market Uptake U.S. Centre for Disease Control, October, 1998: 73% increase in # of American teens who became daily smokers since the debut of the Joe Camel ad campaign in 1988 Tobacco Control, Summer 1998: prior to the start of the Joe Camel campaign, Camel’s share of the youth market (ages 12-17) was less than 1% 1.5 yr later, had risen to 8% 5 yr later, had climbed to 13%.

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82 The Evidence tobacco marketing is intended to recruit new users and increase use of tobacco products tobacco companies invest billions in marketing strategies that attract youth the tobacco industry is targeting youth at the point-of-sale point-of-sale marketing increases youth tobacco use tobacco marketing causes youth tobacco use

83 Pop Culture and Smoking I Want to Hold Your Brand…

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85 Report of U.S. Surgeon General Luther L. Terry

86 Industry Response

87 Winds of Change public education campaigns government & class-action lawsuits prohibitions on smoking in public places warning labels & graphic images restrictions on advertising & promotion exposure of the industry’s charitable activity as a strategic veneer of altruism

88 Strategic Veneer of Altruism reputation tarnished by public health exposes retain a favourable presence with the public and the law-makers charitable donations

89 Altruism or Public Relations ? Tobacco industry support for the arts & sports: in one year, Imperial Tobacco spent $2 million in donations (Ricard, 2002) spent $40 million in one year publicizing its donations (Montreal Trial Exhibits, 2002)

90 Visible Change 2003 Canadian Federal legislation: one of Hamilton’s theatres for the performing arts changed its name from the “du Maurier Ltd. Centre” to the “Dofasco Centre for the Arts”

91 The Future of Tobacco Products & Advertising Flavoured cigarettes E-cigarettes Use of cigarette package as marketing tool More emphasis on direct marketing More use of proprietary magazines/web sites Smart-phone applications More emphasis on adult venues/event tie-ins More public relations & corporate social responsibility

92 What’s happening in alcohol advertising ? remember "cultural mythology" ? "happily-ever-after" moving up to a higher lifestyle

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97 Athletic Imagery & ?? strong athletic imagery other symbolism ?

98 Subliminal Manipulation or Just a Bit of Fun ?

99 Reality Check: Alcohol does not have much to do with either athletic or sexual prowess Heineken: London 2012 Olympics’ Official Beer Sponsor

100 Not a New Idea ! William Shakespeare had this to say about the effects of alcohol on sexual appetite & performance: “… it provokes the desire but it takes away the performance…” Macbeth (1606)

101

102 Young (Underage) People Increased exposure to alcohol advertising is linked to: earlier initiation of drinking increased drinking among current drinkers increases are sustained

103 Young Adults (Legal Drinking Age) Greater exposure to alcohol portrayals in media is associated with: positive attitudes about alcohol and associated drinking behaviors increased drinking

104 Event Sponsorship As seen on TV, movies, online, busses, bus shelters, billboards and other media: reinforce positive associations with alcohol create unrealistic expectations of the effects of drinking increase consumption in high risk contexts

105 Widespread Consensus Canadian Public Health Association Canada’s Alcohol Strategy (Canadian Centre on Substance Abuse) US Surgeon General American Academy of Pediatrics US Institute of Medicine Center on Alcohol Marketing and Youth World Health Organization All recommend limiting exposure to alcohol advertising

106 Public Health Policy & Treatment Best Practices Public health policy should reflect the data on alcohol promotion and harm What are the implications for the treatment settling ?

107 Cultural Mythology & Reinforcement Expectancies psychologists refer to these beliefs, when held by an individual, as "reinforcement expectancies“ Research: Sandra Brown, Psychology Dept., University of California at San Diego

108 Alcohol Expectancies Questionnaire Alcohol Expectancies Questionnaire (AEQ) has been used to study these expectancies  90 items in six scales  re-test reliability: 0.71  internal consistency: alpha = 0.78

109 Reinforcement Expectancies & Treatment Outcome AEQ Scores as Predictor of Treatment Outcome: 28% of the variance 28% of the variance 57% of the cumulative criterion variance when combined with measures of stress level and social support 57% of the cumulative criterion variance when combined with measures of stress level and social support

110 Reinforcement Expectancies, Drinking Behaviour & Treatment Outcome If you believe that alcohol enhances your sexual, physical, mental, or social functioning, then you are more likely to demonstrate the following: Heavier drinking Adverse psychosocial consequences Poor progress in treatment Poor outcome one year after treatment

111 Stages of Change 1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance

112 Stage 2: Contemplation Ambiguity Relative costs & benefits Impede or delay change

113 The Jig is Up

114 So where are we ? beliefs about alcohol pre-date marketing multiple causes should not assume beliefs are benign should not assume beliefs are benign with whom should the burden of proof lie ? with whom should the burden of proof lie ? priority: private profit or public health ? priority: private profit or public health ?

115 Strategy and Ethics – Interesting Questions restrict ads, or counter them ? New Zealand campaign: young male drinkers market-segmenting strategy poor taste or effective communications ? are there ethical questions ? level playing field ?

116 The Wrath of the Internet

117 The meme wars will continue !

118 Take-home messages drug promotion, drug use, and drug problems are widespread in Ontario most of the harm is associated with the use of tobacco & alcohol the manner in which these products are promoted appears to be an important factor michael.devillaer@camh.ca


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