Attitudes on Drug Risk: A lesson from the Len Bias fatality

I have a tendency to refer to data from the Monitoring the Future study with some frequency. Unfortunately I've been too lazy to post the critical data figures for your entertainment. Until today DearReader.
One example of which I am particularly fond, is what I call the "Len Bias effect" on the public perception of "risk" associated with casual use of cocaine. I refer to this so often because of the casual sneering response I (and others of my approximate generation) retain for the "Just Say No" program championed by Nancy Reagan in the mid-80s. The MtF data suggest to me at any rate that our "gut feeling" that these types of programs are stupid should be more nuanced.


One of my uses of the MtF data can be found on the old site in which I wrote:

Is attitude everything? Does a "scared straight" approach really work best? Examine the data in the MtF 2005 full report and you will find that, in general, attitudes toward health risks of a given recreational drug are remarkably stable, even across decades. (You will also find that drug use follows broad trends unlikely to be explained by specific events. This is a caveat to my main thesis.) There is one other notable case in which the perceived risk for a drug (e.g., for "trying it once or twice") was initially low in comparison with most other drugs and underwent a rapid increase in the proportion of people thinking it "risky". For cocaine between 1986 and 1987. Unsurprisingly, the shift in attitudes led to a drop from about 20% of 20-somethings endorsing annual use in the early-mid eighties to about 7-8% in the early nineties. The "why" is material. Two words, Len Bias.

These data are also related, for example, to a comment I wrote in response to a post from Uncertain Chad which appeared to express a not-uncommon skepticism that intervention programs such as "D.A.R.E" and "Just Say No" actually work to prevent or minimize recreational drug use.
The data I'll be presenting today are re-drawn from the tables provided in the MtF publications. The appropriate cites for the current versions (Volume I; Volume II) are

Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2007). Monitoring the Future national survey results on drug use, 1975-2006. Volume I: Secondary school students (NIH Publication No. 07-6205). Bethesda, MD: National Institute on Drug Abuse, 699 pp.

and

Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2007). Monitoring the Future national survey results on drug use, 1975-2006. Volume II: College students and adults ages 19-45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse, 307 pp.

The annual monographs are incremental and a given publication year covers data on the US population up to the prior calendar year; my graphs are about a year out of date so they go up through 2005. This long-running study has made some changes over the years, most prominently the introduction of new survey items. So some drugs have more historical data than others. There have been some minor methodological changes which in some cases affect the data to a noticeable extent. Read the footnotes on the full reports if you are interested but I'm fairly confident I've scrutinized the appropriate places to make sure the major points I'm making are not contaminated by this problem.
First up we have the answers to questions about the relative riskiness of using a particular drug. Here I've pulled out selected data for the fraction of individuals who endorse "great risk" in response to "Q. How much do you think people risk harming themselves (physically or in other ways), if they. . .". These numbers are for "try it once or twice".

And to show that this trend for cocaine generalized across a broader range of adult ages.

Certainly, one can hypothesize until the cows come home about the source of this rather obvious trend in which cocaine was suddenly believed by considerably more people to be risky. One might point to Nancy Reagan's championing of "Just Say No", or the founding of D.A.R.E. in 1983, for example. One might scrutinize popular media. One might hypothesize some larger social or political trends in society. These types of data encourage debate because they are not, of course, anything like a controlled study. Nevertheless, the comparison with trends for other drugs of abuse suggests to me that this situation is specific to cocaine. And it is difficult for those of us who lived through that event to ignore the attention that was garnered by the death of a promising young basketball player on June 19, 1986.
Now, the critical figure for the larger point at hand, I've just pulled from the Volume II monograph itself. This is the corresponding trend in people who endorse at least annual use of cocaine for various age groups.

I won't really belabor this point except to note that we have no similar alterations in the trends for use of marijuana, hallucinogens, inhalants, amphetamines or heroin locked to this timepoint in the mid 80s. Some of these were in long gradual slides that began in the late 70s and some were in level patterns. Many reasonably popular drugs of abuse have much lower prevalence than does cocaine at any single timepoint however amphetamine rates are quite similar and marijuana, of course, is more popular. So it looks like a very drug-specific effect.
I won't go too far into my usual applications of this observation. Mostly since I have before and likely will again in more targeted contexts. My belief is, however, that this reminds us that "scared straight" approaches to preventing (at least casual) drug use work. It is just that the target audience must actually be scared in the sense that they think bad consequences could actually happen to them. Second, this points out that, embarrassingly, highly accurate reflections of the state of scientific knowledge may be beside the point when dealing with public policy goals; the fact that cocaine could cause acute cardiac arrest was no mystery to science at the time.

19 responses so far

  • Without delving into the data too much, a personal empirical observation: when Len Bias died, the cocaine link was quite a shock (to the public) relative to today. So many celebs are kicking off due to various drugs today, it is almost mindnumbing. As a result, I doubt that a Len Bias cocaine death would have the same impact today (if it did indeed contribute causally to the post-1986 data above).
    Of today's ODs, I can only think of Heath Ledger's death as being somewhat unique in getting adults to think more about Rx drug abuse and the mixing that goes on, especially among adolescents (Robo-tripping, diphenhydramine, etc.).
    As you point out, we (well, you and your colleagues) can do all the science we can but making the consequences of drug abuse pertinent to the general public (and kids, especially) sadly seems to require such high-profile incidents.

  • PhysioProf says:

    "Robo-tripping"
    WTF?

  • pat says:

    I think "Robo" means Robitussin.

  • PhysioProf says:

    Kids try to get high on Robitussin!? What the fuck ever happened to just raiding your parents' liquor cabinet and smoking some doobs?

  • Becca says:

    Is it just me, or is the first year people rate cocaine as more dangerous also the first year the survey has data for crack?
    Could it be that if you've just asked people about crack, they think of cocaine as more dangerous?
    I think the later jump for MDMA is interesting too.

  • DrugMonkey says:

    when Len Bias died, the cocaine link was quite a shock (to the public) relative to today. So many celebs are kicking off due to various drugs today, it is almost mindnumbing. As a result, I doubt that a Len Bias cocaine death would have the same impact today (if it did indeed contribute causally to the post-1986 data above).

    let's recall however that people, even famous ones, had been OD'ing on drugs forever. a clue is provided in your memory of the whole yuppie/cocaine/materialism thing as well as in the "riskiness" data prior to Bias. There seems to be a certain level for "most drugs" settling in around 50% endorsing risk of "once or twice" experimenting. cocaine was way below this prior to Bias and came up to match the rest of the pool. so in some senses the judgment of "risk" was unusually low for cocaine. perhaps this is the only way such a prominent event could have similar effect.
    the MDMA data, interestingly, show a similar lower-than-average number of people viewing MDMA as risky, followed by a noticeable change starting about 2001. there were no domestic fatalities that I recall. the UK had the Leah Betts thing in 95 but I don't recall that really penetrating the US media and the timing is off. my subjective recollection is that there was no massive shift in the popular media coverage of MDMA either but that's a little project for another day...

  • DrugMonkey says:

    Is it just me, or is the first year people rate cocaine as more dangerous also the first year the survey has data for crack?
    Could it be that if you've just asked people about crack, they think of cocaine as more dangerous?

    An interesting thought. You've exhausted the degree to which I've poured into methodology but it would be hard to believe the question order is not counterbalanced. But I don't know for sure.
    More generally, was this the point that the public realized that "crack" was cocaine and therefore risks were similar? The officious blah-blah does seem to tie the "crack epidemic" start to about 1984 so the timing is close enough but still. Such a big change in one year?

    I think the later jump for MDMA is interesting too.

    ahh, yes. as do I! I was actually saving that for a second post but the temporal linking of attitudes toward "risk" and annual prevalence is there too. In this case however, the "risk" numbers came up the year after a big jump in annual prevalence. there are also some funky cohort effects.

  • JYB says:

    I remember reading in the book Made to Stick a study of "The Truth" ads vs. "Think, Don't Smoke" ads. The Think, Don't Smoke ads were created by the tobacco companies. I think the gist was that the Truth appealed to emotion while the Thinking ads appealed to your brain. The Truth ads reduced smoking while the thinking ads increased it. The problem with most anti-drug campaigns is that they try to appeal to your rational side.

  • I mentioned diphenhydramine above as well and, sure enough, PharmGirl just tipped me off to this Benadryl nightmare at the Sweet Hill (OR) High School.
    At high doses, diphenhydramine's central antimuscarinic effects become apparent as hallucinations but this is a terribly risky approach. Suppression of parasympathetic drive to the heart can cause tachycardia and lead to fatal cardiac arrhythmias.

  • Barn Owl says:

    Off topic, but I don't suppose any of you pharmacological capital S-cience capital B-loggers will be attending the American Society for Neurochemistry meeting this week?
    I know, it *is* located in that "sun-scorched hellhole" this year, but I thought it was worth asking. Might live-blog it myself, especially if the autism-related and glial cell biology presentations are good. 🙂

  • Barn Owl, I *love* San Antonio (although I took hell for this post) but won't be going to the ASN meeting. Don't miss Schilo's real German deli near the convention center on East Commerce - a superb mixed sausage platter and Spaten Optimator on tap.
    Oh yeah, the meeting should be good too.

  • Barn Owl says:

    Schilo's is indeed great, Abel Pharmboy...I live (and teach and do science) here in the Alamo City, so it's very cheap for me to attend and present at the ASN meeting this year. I'm also genetically and culturally inclined to enjoy good German food.
    LOL at your Hooter's post; I don't attend the SA Breast Cancer meeting myself (I'm more of a nervous system cancer/sarcoma type), but a number of my colleagues do so every year.

  • Good stuff DM.
    I'd like to add that my skepticism towards the "Just Say No" approach was not from the expectation that it would be ineffective. Rather, it appeared to me that the "JSN" 'mentality' came at the expense of efforts toward (and fiscal support for) a better understanding of addiction and a better treatment of addicts in general.

  • Hello, DrugMonkey,
    I blogrolled you. I don't know your blogroll policy, but I'm assuming that, as a celebrant of Blogroll Amnesty Day, it is liberal. Therefore, may I request a spot on your blogroll? (I'll understand if you say no: my blogs are mostly politically-oriented and I only cover science issues as they relate to human health and consumer rights.)
    I blog at La Casa de Los Gatos and CultureVultures as ThePoliticalCat. Thanks!

  • Very fascinating and an interesting argument to counter those who think that the "War on Drugs" has been a phenomenal success.
    "the MDMA data, interestingly, show a similar lower-than-average number of people viewing MDMA as risky, followed by a noticeable change starting about 2001. there were no domestic fatalities that I recall. the UK had the Leah Betts thing in 95 but I don't recall that really penetrating the US media and the timing is off."
    This is probably a clue... "Ecstasy-related deaths received constant attention from the mass media in the 1990s, far more than deaths involving other drugs or risky sports (Newcombe 1997)."
    http://www.drugtext.org/library/articles/newcombe.htm

  • DrugMonkey says:

    This is probably a clue... "Ecstasy-related deaths received constant attention from the mass media in the 1990s, far more than deaths involving other drugs or risky sports (Newcombe 1997)."
    But it doesn't explain the single-year change in the MtF data. That's what I find so fascinating. Gradual shifts in attitude we might attribute to a constant drumbeat of mainstream media stories with a particular message. A big change from one year to the next suggests, to me at least, something different. As I think I mentioned, it could very well be the case that the US media "message" took a big turn in that year. I've blogged on this before but all the mainstream media I've seen in the past year or so regarding MDMA has been all about the clinical trials with a consistently positive and science-skeptic tone. This, to my eye, reflects the sort of whole-sale shift in approach that might explain, for example, the turnaround in 12th grader MDMA use which had been declining 2002-2005 or so.

  • DrugMonkey says:

    thepoliticalcat quoth: I don't know your blogroll policy, but I'm assuming that, as a celebrant of Blogroll Amnesty Day, it is liberal. Therefore, may I request a spot on your blogroll? (I'll understand if you say no: my blogs are mostly politically-oriented
    Hmm, my blogroll policy, such as it is plods along in the region of "none" and "lazy". As in I hadn't really thought about having a "policy" and I'm not all that keen on some huge blogroll that I have to actually manage.
    I'm down with the link-love but only so far as it is relevant. My Blogroll Amnesty Day post said:

    If it has some thing to do with academic careers, science careers, drug abuse or neuroscience, it may even appear on the Blogroll.

    so let's leave it at this, for now. by all means if you want to be on the blogroll leave a request in the comments somewhere or drop us a line. if it hits the above hot buttons in an obvious way, i'll probably put it up. if it is "political", well, I'll think about it. If I read over some stuff at your place and there is interesting science policy or whatnot, your odds are good. someday, maybe, I'll throw together a subcategory for politics, pure and simple.
    you may also try to bother the PP into editing the blogroll for you, he may be a softer touch on the politics...

  • ddt says:

    I'm sure there are alternatives to the LB vs DARE effect as causing the precipitous decline in usage. Any data on price (my recollection from n=1 is that it was pretty stable or availability (ditto)?

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