Challenging Dogma - Fall 2009

Monday, December 21, 2009

Improving Drug Education: Why the Reality Tour Does Not Work

– Brandy Wyant

A recently implemented intervention, the Reality Tour takes groups of mostly high school-aged students and their parents on a specially staged tour through their local jail. The program features an actor portraying a heroin user get arrested, booked, and strip-searched in the actual jail setting where it would occur. It also screens the film Heroin Kills, and then it shows this in action when the actor overdoses and passes away. The Tour concludes with the mock funeral of the overdose victim (1, 2). The Tour’s creators hope that teenagers who see what could happen to a heroin addict will choose to abstain from heroin. Since 2003, a growing number of mostly mid-Atlantic regions have implemented the Reality Tour at local jails and courthouses. The sponsoring organization, CANDLE, Inc., hopes to go nationwide with the Tour (3). But is it an effective intervention for the public health problem of heroin abuse among adolescents?

Several social sciences theories find fault with different aspects of the Reality Tour. First, though the Tour is conducted on groups at a time, it is an intervention delivered at the individual level. It seeks to influence each student in turn to abstain from drug use. This is a weakness, because an individual’s behavior is profoundly affected by the groups he or she belongs to. According to social expectations theory, individuals behave in a way that conforms to the group’s norms (4). No amount of Tour-going will change a student’s behavior if that student ends up in a heroin-injecting peer group. Instead, the intervention should encourage that group to adopt different norms, ones that reject drug use within the group. Social expectations theory proposes that individuals learn what is expected of them through portrayals in mass media (4). In the case of the Reality Tour, the students are not shown behavior they should emulate. In fact, they are shown the opposite; a peer shoots up and dies. This must be how the Reality Tour expects them to behave, because it provides no alternative image of a person their age. An intervention supported by social expectations theory would instead demonstrate to its audience that their peers do not consider heroin use acceptable. For instance, smoking rates dropped in the U.S. in response to indoor smoking bans; “smoking bans also change social norms about smoking and motivate smokers to reduce their consumption or quit completely” (5). The bans offered proof that smoking was not socially acceptable. The Reality Tour does not make such a connection with teens’ social groups and heroin use.

Furthermore, the Tour targets teenagers who are not and will never be in a high-risk peer group along with those who will. In casting its net so broadly, the intervention treats all its subjects as if they shared identical social norms. Perhaps a given social group in the school, the basketball team or the marching band for example, has more use-friendly norms. The intervention should treat this group of students as a unit rather than as individuals. Similarly, the Tour could increase its effectiveness by considering social network theory. According to the theory, clusters of individuals tend to change behavior simultaneously (6). In this case, the intervention seeks to prevent unhealthy behavior rather than to change it. Therefore, the focus is on changing opinions about drug use, but the same principles apply. An intervention could thus target those at the center of each network with the understanding that behavior change will diffuse through the rest of the network. The Reality Tour does not make this differentiation, instead targeting individuals at random with regard to their status in the social network. If this random selection of students results in only one or two students per social network in attendance, the Tour’s chances of changing the behavior of any of the networks is minimal.

Contrary to what social science theory explains about group behavior, the Reality Tour makes no attempt to change social norms among high school students or to target social networks. Rather, it employs a scared-straight strategy intended to shock individual students into abstaining from drugs. In a talk given about the Tour, former Deputy Warden Jimmy Gregg of the Allegheny County Jail in Pittsburgh said, “If we can reach one young person, it’s all worth it” (2). This attitude openly admits that the Tour does not seek to change group behavior. While Mr. Gregg’s spirit is admirable, if this intervention only impacts one young person, we will still have a problem of drug abuse among high school students. Surely he would appreciate an intervention that successfully targets whole social networks of students instead.

Second, a major focus in this intervention is avoiding death, a stance that is the equivalent of promoting health for health’s sake. For such a program to work, its audience would need to be not only concerned with its own health, but also concerned with its own long-term health. Researchers have demonstrated that individuals vary greatly in the amount of consideration they give to their behavior’s long-term consequences (7). It is fair to assume that not many individuals make decisions based on distant health consequences, even when those consequences include death. For example, smokers and fast-food lovers abound in our society even in the midst of education about these vices. It is the same principle with heroin use; many of the consequences seem far off in the midst of the high after a hit or when a student is contemplating injecting heroin in order to rebel. Even when an intervention seeks to promote healthy behavior, it can use insights from research such as marketing theory to more effectively deliver the message.

Adolescents commonly view themselves as invincible (8). Therefore, avoiding death does not top their list of priorities. Yet the designers of the Reality Tour have decided that avoiding death is a core value of this target population. The Tour attempts to sell this value to high school students, rather than determining what their true core values are. Public health professionals should not “try to sell a program or a policy based solely on the benefit of improving the health of individual members of society” (9). The core values present in the Reality Tour’s message are avoiding death and avoiding arrest. In choosing these core values as the basis of their campaign, the Tour’s creators have falsely assumed that their target audience of high school students shares those core values. The Reality Tour could become an effective anti-drug marketing campaign by first researching the values of its target audience and then selling those back to the audience (10). Currently, the Tour frames abstaining from drugs as something your parents and the jail warden want you to do as well as necessary for avoiding a premature death. This frame does not appeal to the values of high school students such as independence, freedom, fun, and exploration of new experiences. Hence, it is ineffective.

Additionally, the Reality Tour violates advertising theory with its negative promise. Every advertising pitch is centered with a promise to the consumer that the product will fulfill a given need (11). The Reality Tour promises that if you use heroin, you will first get arrested and then die of an overdose. It does not show any of the numerous benefits of abstaining from heroin use. With a target population of high school students, an intervention could have successfully used the positive image of a star athlete. Such an intervention could imply heroin’s deleterious effects on athletic performance with a message, “Athletes are high on winning.” This example is a positive, feel-good message. In contrast, the ultimate negative message is a young person dying of a fake overdose.

A third aspect of the Reality Tour that makes it an ineffective intervention is the context of its message. Specifically, the message is too authoritative, labels its target age group as potential heroin users, and does not provide adequate support for its premise. Considering marketing theory again, the core values of the target population of adolescents certainly do not include obedience to traditional authority figures. Authority figures do not get more traditional than the strong arm of the criminal justice system. Hence, the jailhouse is arguably the last place an anti-drug intervention should occur. Along the same lines, the Reality Tour strongly violates psychological reactance theory. When someone is told to do or not to do something, he or she experiences an emotional response against this threat to personal freedom. To restore the sense of autonomy, he or she will act in the opposite way (12). For example, authority figures such as the jail staff and the parents along on the Tour send the message, “Don’t do drugs.” A teenager acting according to the theory would experience reactance and become inclined to experiment with illegal drugs.

In addition, the intervention violates labeling theory, which argues that when others treat an individual in a particular way, he or she will then tend to behave in that way (13). For instance, when a coach assumes a player will perform well even before the try-out, the coach’s behavior toward the player as a result of this belief creates a self-fulfilling prophecy; the player does indeed perform well. The Reality Tour epitomizes this effect in labeling teenagers as at risk to start using heroin. If the Tour creators did not believe this age group is tempted toward heroin use, they would not have made the intervention so explicitly geared to teens. It follows then, according to labeling theory, that the students on the Tour will internalize this label and view themselves as potential heroin users as well. To overcome this flaw, the Tour could instead model after, which features a core message of “You are nonsmokers” (14). For instance, “Most people your age do not use heroin. To gain acceptance among your peers, you shouldn’t use it, either.”

Finally, the Reality Tour does not provide adequate support for its “Heroin kills” message. Yes, an individual absolutely can overdose and die the very first time he or she injects heroin. However, the odds would not be in that person’s favor. If everyone died following the very first use, there would not be any heroin users around to talk about. A student on the Tour who knows a living heroin user will recognize that what the Tour presents is not reality for that user. The Tour will then lose credibility with that student. This intervention ignores all the other consequences, health and non-health related, that stem from heroin abuse. In doing so, it runs the risk of losing support with the students who have observed such consequences among users. The Reality Tour’s greatest irony is that it is not “reality” at all. It is a staged performance. As soon as a Tour-goer realizes this, he or she may start to wonder, as one would at a movie or play, how much of the presentation was included solely for dramatic effect.

In place of the Reality Tour, efforts should be made to simply improve drug education in schools. The Drug Policy Alliance offers many resources for educators seeking a more reality-based drug education program. However, its research has reached different conclusions than the Reality Tour has about how to implement one. As a pamphlet for educators sponsored by Drug Policy Alliance explains, “most drug education programs are delivered with the assumption that elementary school students can be inoculated against later temptation” (15). The Reality Tour professes this same doctrine, expect with middle and high school students, in that it attempts to make drug abuse look so repugnant that every Tour-goer will renounce drugs for the rest of his or her life. Yet drug education research has, and one’s intuition should, disprove this approach. Instead, schools should incorporate reformed drug education that does not support abstinence alone.

One reform that should be made is to incorporate what the Beyond Zero Tolerance pamphlet terms “interactive learning.” Interactive learning “covers a continuum of practices, from allowing students to ask questions, to encouraging them to contribute relevant personal experiences, to giving them an active role in setting the agenda. Here, students may also do some teaching themselves and introduce opinions and information that conflict with what the text or teacher asserts” (15). This style of teaching addresses many of the problems inherent in the Reality Tour’s approach. Most notably, in allowing students to contribute personal perspectives, interactive learning acknowledges the individuality among them. This individuality includes each student’s membership in various social groups. To make this improved intervention even more congruent with social network theory, the education program could take place on a cluster within the network. Students involved in the same extracurricular activities are more likely to be within each other’s social network, whereas the health class where drug education typically takes place contains a more random sampling of students. As discussed earlier, individuals in the same cluster in a social network change behavior simultaneously. Therefore, the intervention will be more effective centered within a team or club. In addition, in order to change the group’s social norms as per social expectations theory, the program will necessarily need to reach all the group’s members. This will be easier done if the program has access to each of them, and the intervention will ensure at least this if conducted on a socially interconnected group.

Along with the interactive learning style just described, a new intervention should also address the Reality Tour’s flaw of promoting health for health’s sake. This could be achieved through the introduction of a program similar to into the school’s curriculum. Throughout its site, features advertisement-like messages that use images and text to make smoking look less attractive for non-health related reasons. For example, one such ad draws a parallel between the methane that comes from a cigarette and the methane that comes from a cow (14). Making this connection appeals to values of the target population such as personal image and appearance. The site also prominently announces its goal to “take back control of the health and minds of youth from any influence of Big Tobacco” (14). Portraying tobacco companies as a power-hungry tyrant utilizes the target population’s value of rebellion against oppressive authority figures. A similar site dealing with heroin use could be created and implemented along with the classroom discussions. As discussed above, the improved education program will also avoid labeling the students as potential heroin users through a site like

Another of the Reality Tour’s problems, the context of its message, is addressed with an education program that discusses the facts of drug use rather than solely discouraging it. An intervention can mitigate psychological reactance by decreasing the educator’s dominance over the target audience (16). In the Reality Tour setting, the students on the Tour are in the presence of both their parents and jail staff. They are outnumbered by authority figures, and therefore may easily experience reactance to the anti-drug message. To mitigate reactance, the new drug education campaign should include an element of peer-led education. Peers are viewed as equals, and this will give more credence to their message. Students could volunteer to lead sessions in the new education program, or could act as peer-educators simply by participating in discussions. If a student has a personal experience with drug use and is willing to share this, it would contribute much to the program. His or her story may lack the elaborate scene of the Reality Tour, but nonetheless have a greater impact on the audience because it is coming from a peer. Upon hearing how a peer questions the worth of drug use, students begin to consider using socially unacceptable. This fits with social expectations theory’s call to shift the group’s norms.

Similarly, students’ observations of drug use can be utilized in the classroom to garner support for the program’s message. The Reality Tour denies the existence of those who use drugs in moderation or with safety measures such as clean needles and availability of Narcan in case of overdose. A student who has seen such a drug user, or simply a drug user who is not yet dead or in jail, will disregard the Tour’s message as false. A carefully developed drug education program will provide support for its message by presenting the entire spectrum of drug use and abuse. Such an approach, which is honest about drug use and the diverse portraits of a user, fulfills advertising theory’s stipulation that the promise be well supported.

In addition, the improved intervention features a positive message rather than the negative one employed by the Reality Tour. It is more about empowerment, trusting its audience to make the right decision for itself. An honest, reality-based education program provides the complete and accurate information necessary to make this decision. When the intervention encourages the students to take control of their own behavior, it affirms advertising theory, which finds that control can be promoted as a value in a campaign. It also affirms psychological reactance theory in that the audience is not explicitly told which behaviors are desirable. In the case of the Reality Tour, the intervention fails to do even this, instead showing only what behaviors are undesirable.

In conclusion, the Reality Tour’s place in youth drug education can be filled with a reformed drug education program in schools. The new program should involve an interactive learning style in which students are encouraged to question the material presented and share personal experiences. It should also feature a website-based module with an overall message of “You are not heroin users.” Finally, the program should incorporate peer-led sessions and refrain from imposing a single choice of abstinence on the target audience. These changes will result in an intervention against teenage heroin abuse that is more broadly supported by social sciences theory than the existing Reality Tour.


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