Critique of an Australian Binge Drinking Awareness Campaign in New South Wales
Public health campaigns are an important part of a community’s pursuit to better its citizens’ health. Whether the aim is simply to increase knowledge or to encourage behavior change, public health campaigns use social/behavioral theories to try to construct the most effective message possible. Unfortunately, not all social/behavioral theories are made equal, which means that not all public health campaigns are equally successful in different situations. The Australian “Know When to Say When” binge drinking awareness campaign is a perfect example. According to the campaign’s producers, the New South Wales (NSW) Government, it aims to challenge the community “to consider the amount of alcohol they consume, by placing the spotlight on behaviour that our society erroneously accepts as 'normal' when people drink too much” (13). While certainly an admirable goal, the campaign has some major failings. This paper will examine three major problems behind the “Know When to Say When” campaign and suggest more appropriate methods for each, based on alternative social/behavioral models.
Critique One -The Slogan
The first flaw stems from the campaign’s main slogan of ‘When have you had enough?” That simple phrase is enough to derail any chance of getting the campaign’s message across to its intended audience. While it might seem innocuous on the surface, the slogan has a strong paternalistic, judgmental overtone attached to it. Add in the various follow-ups that NSW has devised: ‘when you get a little silly,’ ‘when you get a little stupid,’ and ‘when you make a mess” with its accompanying “when you just turn in to one,” and the campaign is sure to engender an adverse reaction (13).
This response is explained by Psychological Reactance Theory (PRT). According to this theory, first described by Brehm in 1966, people respond to perceived threats to their freedom by trying to regain control through adverse actions (11). In this sense, freedom is not just a physical reality; it also includes actions, emotions, and attitudes (2). Reactance (opposite reaction) can take many forms, from simply ignoring the message, to belittling or disparaging the source that produced the message, all the way to increasingly engaging in the exact behavior that the message was intended to prevent (12).
One way to elicit psychological reactance is by choice of tone. Using aggressive, dogmatic language gives off a tone of authority that makes the audience feel like children being lectured by their parents (5). This directly threatens freedom of attitude and may be especially detrimental in the case of NSW’s binge drinking awareness campaign because the action that the campaign addresses is already considered socially rebellious. So much research has been done on programs designed to prevent alcohol abuse that authors attempting to review the relevant literature rely on meta-analyses and comprehensive reviews (6; 7). This is pertinent because, despite such a wealth of investment (both mental and financial) into the subject, those in charge of designing new public health campaigns continue to rely on inappropriate social/behavioral theories that continue to elicit this ‘boomerang’ effect of psychological reactance (6).
There is an alternative way to deal with this issue while still using the principles of psychological reactance theory; avoid engendering psychological reactance by toning down the message. Binge drinking may be a dangerous activity and an emotional topic, but presenting it in that way to people already engaging in the activity on a regular basis will not help NSW accomplish its goals. Instead, a better approach would be to generalize the message so that it becomes less accusatory toward the people whose behavior the campaign is targeting. Making sure that the people delivering the message are as similar as possible to the message recipients will greatly reduce the antagonistic tone of the message (8). In addition, telling people something similar to their pre-held beliefs will have positive results and reaffirm their values (8). For example, a more appropriate slogan might be, “You know when you’ve had too much. But do you know what to do about it?” This acknowledges that people are generally smart enough to have a decent idea of their alcohol tolerance, especially if they are frequent (i.e. binge) drinkers. The problem is not that people are unaware of how drunk they can get, it is that they either do not see it as a problem or do not feel they have the power to change their behavior. Altering the tone of the campaign to a subtle, non-accusatory acknowledgement that there might be a control problem, rather than a lack of awareness, not only allows the message to reach a wider audience (for example, those who sit at home alone and get drunk and thus are not featured in the campaign’s social- and family-centered examples), but also presents the opportunity for message recipients to ‘take back control’ of the situation – a central tenet of psychological reactance theory.
Critique Two – Sensationalized Outcomes
The campaign’s second flaw is that it misrepresents and sensationalizes drinking outcomes in both the television advertisement and on the campaign’s informational website. The goal is to convey shameful, socially-inappropriate drunken actions in an attempt to guilt viewers into changing their faulty behavior. The problem is that the negative reactions of others fail to stand out in comparison to the actions of the drinkers. In fact, the television advertisement accomplishes the opposite of its intention; its portrayal of people who have had too much to drink is more fun and amusing than sad and pitiful. It’s easy to overlook any angry, judgmental faces in the background because people watching the advertisement who identify with the scenes are more likely to bemusedly recall a similar episode they had than to feel contrite about that episode.
The television advertisement depicts 10 different scenes intended to showcase common occurrences for people who frequently over-drink, but the majority of these scenes are highly dramatized and hard to take seriously. This is especially true when considering the cohort of society that usually experiences the highest rates of binge drinking: young adult males. These vignettes – particularly the scenes in which a woman falls down while holding a wine bottle, a woman knocks over people’s glasses at a table as she walks by, someone vomits in a cab, and a man runs into a garbage can on the sidewalk and then kicks it loudly – are likely to be misinterpreted. Instead of eliciting feelings of derision or embarrassment, these scenes are likely to be seen as either funny or, worse, something to which to aspire for people of that gender and age group.
The campaign’s website fares no better, also falling prey to over-dramatization. For example, the page titled, “The numbers behind what we drink” is loaded with all sorts of statistics that are portrayed in a duplicitous way, so as to look more extreme than they truly are. NSW achieves this by leaving out the denominators in many of their statistics. One statistic claims that “There are over 3,000 deaths from alcohol in Australia every year” but it does not include the total number of deaths the country experiences for comparison (13). NSW also tries to make some drinking outcomes seem more severe than they are in reality. When the site states that “70% of the population reported experiencing one of 14 'harms' from a stranger within the last 12 months,” they include in this definition such events as avoiding intoxicated people and places, being annoyed by vomit, and urination or littering (13).While none of those actions or outcomes are pleasant, their inclusion in a list of true harms inflicted by binge drinkers as if they are really that critical to people’s safety and overall well-being is highly suspect. It seems more likely that they added these actions in as a way to increase the acknowledgment of ‘harms’ all the way up to 70% to make the effects of binge drinking on others seem more severe.
Rather than try to scare or shame binge drinkers into lessening their alcohol consumption, NSW should focus on subtle education. Dramatizing statistics and potential consequences of persistent drunkenness will only prompt inattention and/or resistance. Instead, NSW should utilize a tactic proven to counter the undesirable outcomes of both Psychological Reactance Theory and the Theory of Optimistic Bias: similarity. PRT has already been described above. The Theory of Optimistic Bias postulates that individuals tend to incorrectly assume that they are more likely than their peers to experience positive events and – importantly for this paper – less likely than their peers to experience negative events (10). In other words, a person’s perception of his/her own risk differs relative to that of others. A central issue of this theory is the perception of control (just as with PRT), in that the amount of control a person considers himself/herself to have over a behavior directly influences the amount of optimistic bias attached to the behavior (10). Similarity is important to both of these theories because its use has been shown to increase perception of control and lessen the effects of the unwanted behaviors, in this case, reactance and bias (4; 8).
For this campaign, NSW should utilize the concept of similarity by either using real people in their campaigns or at least hiring actors that look more like “real” people. The current cast of characters in the television advertisement is too glamorous, amusing, and good-looking for most people to identify with. While some binge drinkers are likely to resemble the actors in the advertisement, the majority of people are unlikely to conform to such standards. In addition, using true stories of unfortunate or undesirable outcomes resulting from binge drinking will be more likely to elicit a positive response to the campaign than using dramatized, stereotypical situations. When a real person relates a story, the audience is able to see and hear the regret in that person’s face and voice. In the current campaign, the actions are depicted as they happen, with few consequences shown. Seeing five seconds worth of a couple of disappointed children’s faces is not sufficient to convince people that their actions are truly detrimental to those around them. NSW needs to focus its efforts on giving binge drinkers stories and people that they can identify with. Not only will this tactic be more likely to get drinkers’ attention, it also provides a potential sign of hope for those who do not think they are able to stop drinking.
Critique Three – Choice versus Compulsion
The third major flaw of NSW’s “Know When to Say When” Campaign is its framing of the issue. Despite the admirable intention to both increase awareness of and educate about the prevalence of binge drinking in Australia, at no point in either the television advertisement or on the website does NSW address the possibility that parts of their target audience could have an abuse problem that is out of the individual’s personal control. The television advertisement frames binge drinking solely as a personal, planned decision and fails to mention any ways to get help if it becomes more than that. The campaign website fares slightly better through its inclusion of a page of “helpful contacts” that lists numbers for agencies such as regional Alcohol and Drug Information Services and various informational websites. Still, there is no mention of possible compulsion or addiction, even in the description of these resources. If as many Australians engage in binge drinking as NSW claims, there are sure to be a good number of citizens with a true substance abuse problem. This campaign focuses on the hurt drinking inflicts on others around the drinker, but it would behoove the NSW Government to consider the hurt binge drinking inflicts on the drinkers, as well. Alcoholism takes victims on both sides of the battlefield.
Although not explicitly stated, NSW seems to have based its campaign on the Theory of Reasoned Action. This is demonstrated by the campaign’s assumption that 1) binge drinking is an action that can be changed simply by personal intent and 2) that social norms have enough influence to incite change to a person’s behavior. In this social/behavioral theory model, emphasis is placed on attitudes, subjective norms, intentions, and behaviors that are directed at something specific; in this case, binge drinking (1). Intention is the best predictor of behavior and is based on perceived control over that behavior (14). In the case of NSW’s campaign, social norms are displayed through the audience’s negative reaction to the inebriated people in each of the video vignettes. If intention is the best predictor of behavior, then this campaign’s failure to appropriately depict negative social reactions, as explained above, makes it unlikely to provoke an intention to change one’s ways.
In order to address this problem, NSW needs acknowledge that addiction is a potential part of the problem it seeks to address and that intention and social norms are not always sufficient to cause a person to change his/her ways. In this respect, the campaign’s approach is not wrong; it is insufficient. Combining the current method with a second social/behavioral theory would enable to campaign to reach a broader range of ‘offenders.’
For those who find limiting themselves to a few drinks or remaining sober more difficult than the current campaign envisions, the Illusion of Control Theory might be appropriate. The problem with this cohort of drinkers is that they actually do not possess control over their drinking habits. Whether these people already know this or have yet to become aware of it because they have not yet tried to stop binge drinking, this theory focuses on returning a sense of control to those without it.
The Illusion of Control theory is based on the concept that humans desire to find a relationship between behaviors and events and, through manipulation of that relationship, believe they can obtain control over their environment. Conversely, humans detest the loss of this relationship and associated control over their environment and experience negative affects when faced with either the perceived or actual loss of that control (3). In other words, if one already worries that s/he lacks control over a situation – for instance, binge drinking – then attempting to control that behavior and failing will have negative repercussions. This is important, not only because it shows that NSW’s campaign could result in depressive or other ‘negative repercussion’ outcomes for the cohort not in control of its drinking habits, but also because it offers a way of addressing the core problem. The campaign needs to devise ways to give those people back the feeling of control over their addiction. According to Thompson, a good way to increase the perception of control over a situation is to use positive feedback, which emphasizes success, rather than failure (9). This could range from simply encouraging people to seek help and praising those that do, to including actual stories of real people who never thought they had a binge drinking problem until they attempted to stop and what they did to overcome their addiction. As with the other two suggested interventions, the concept of similarity when delivering this message is likely to increase positive reaction to the message because it also imparts a sense of control on the individual receiving the message. Proof that enhancing the illusion of control is beneficial was demonstrated in a study conducted on college students by Alloy and Clements. Results showed that student exhibiting greater feelings of control over the test situation were less likely to experience such severe negative repercussions or become discouraged when the outcome did not develop as they had intended, compared to students exhibiting less feelings of control over the situation (9). Effectively combining the current tactic, which relies on the Theory of Reasoned Action, with aspects of the Illusion of Control Theory would be a much more comprehensive way of addressing this important national issue.
Designing appropriate, effective public health campaigns is something that governments and organizations struggle with the world over. Often, the people in charge of designing these campaigns rely on outdated, inappropriate social/behavioral theory models to frame their products. Sometimes, they do not consult any theories at all. Marketing companies and successful businesses, including such unsavory but persistent public health foes as Phillip Morris, are proof that campaigns based on social/behavioral theories can be wildly successful; they just need to be well-researched and well-targeted.
The key to making NSW’s message an effective one is to make it realistic and palatable for its target audience. This includes not passing judgment on popular behavior, appropriately portraying the reality of unhealthy situations by not over-dramatizing them, and understanding that the target audience is not a single entity that will completely respond to a single message.
The third critique is especially important because, as public health professionals, it is not simply our job to educate; it is our job to help those unable to help themselves. While frequent social binge drinking surely does cause harm to those who engage in it on a regular basis, the majority of offenders will likely grow out of the habit, eventually. It is those who cannot move past the drinking that need the help and the hope the most. All three suggested interventions are likely to speak to alcoholics better than the current campaign, if for no other reason than increasing similarity between the campaign and its audience is likely to heighten awareness of the problem. In addition, by positively educating without judgment and depicting more accurate drinking situations, it is possible that people may begin to identify others in their social circles with a binge drinking problem. Even that circuitous route could engender some positive results through interventions and increased emotional support.
The bottom line is that people are not rational beings and the use of any theory, model, or general assumption that employs the assumption that we are is sure to fail. The NSW Government has the proper intentions but clearly views people as rational enough to view its campaign, absorb the message, and act accordingly. This is not a likely scenario and, until NSW is able and willing to integrate interventions that accept people’s inherent irrationality, its campaigns are sure to fail.
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