“You encourage people by seeing good in them” – Nelson Mandela
I know that science doesn’t always inform public policy. If so, high schoolers would begin their day later than elementary school children; cursive writing would be taught before print; syringe exchange programs would be the rule instead of the exception; preventive health care would be a right instead of a privilege, etc. So why was I so surprised when I saw billboards popping up along Baltimore’s highways proclaiming “DUI Is for Losers”? (Don’t believe me, see images of the entire campaign for yourself here http://integrateddesignscorp.com/duiloser.html)
Now, don’t get me wrong I’m against drunk driving as much as the next person. No, that’s a lie. I’m against it more than the next person since I’ve seen firsthand the destruction of life and property it’s wrought. Firsthand. And I treat substance-dependent men and women, many of whom have been charged with DUIs at some time in their life. I’ve heard their compelling and, often, tragic stories of loss. I know that driving drunk can cause unimaginable heartache and irreversible consequences.
But ad campaigns that focus their efforts on stigmatizing individuals with substance use disorders rather than the behaviors themselves aren’t productive. I’ve seen several patients who have accidentally killed their loved ones while intoxicated, and been incarcerated for their crimes, but who nevertheless continue to drive drunk. If that degree of loss and consequence doesn’t motivate someone to change, no loss or consequence will.
All parents have heard the adage: “Criticize the behavior, not the child.” The same holds true for clinicians treating individuals with substance use disorders. Behavioral science teaches us to stigmatize the behavior we want to change, but to build up and motivate the individual to change. I assure you that people with substance use disorders have more than enough self-loathing; they don’t need any more from us. In fact, an individual’s negative self attitude and hopelessness only sustains substance use. So name-calling, which is the basis of the “Loser” campaign above, and focusing on “loss and consequences” (http://www.mica.edu/News/Students_Develop_Campaign_to_Curb_Drunk_Driving_Statewide.html) is a misguided strategy to promote change and will be unproductive at best and counterproductive at worst.
What works to motivate change? Helping individuals find positive, rewarding, self-esteem boosting behaviors that can compete with the substance use. Positive “reinforcements” like education, employment, exercise, substance-free recreational activities, and the realization that theirs is a life worth living. We can play a role in this realization and, guess what, it’s not by name-calling and shaming. It’s by recognizing that NOT having a substance use disorder is an unearned privilege and showing compassion towards those who do.
 Smedslund G, Berg RC, Hammerstrøm KT, Steiro A, Leiknes KA, Dahl HM, Karlsen K. Cochrane Database Syst Rev. 2011 May 11
Margaret S. Chisolm, MD
Department of Psychiatry and Behavioral Sciences
Johns Hopkins University School of Medicine