Challenging Dogma - Fall 2011

Friday, December 23, 2011

Everyone Likes to Think They are a Doctor: The Disconnect Between Message and Viewer – Korene Stamatakos

While overall use of illicit substances continues to decline, use and misuse of prescription drugs has stayed high. In 2010 an estimated 2.4 million Americans used prescription drugs non-medically for the first time within the year.

Prescription drug use had the highest rates of use among Americans, second only to marijuana. However, initiation of non-medical use of pain relievers actually exceeded initiation of marijuana among individuals ages 12 and over (2.4 vs. 1.4 million). (1)

More adolescents (ages 12-17 years old) initiate prescription drug use than any other age group. Furthermore, among adolescents, “past year use” increases steadily with age. In 2005, 2.1 million teens abused prescription drugs, and youth ages 12 or 13 were more likely to use prescription drugs non-medically than any other drug. (2)

Not only is prescription drug use increasing among adolescents, this group is also especially vulnerable to the consequences of prescription drug abuse. Twelve to seventeen year olds who reported non-medical past year use of prescription drugs were more likely than any other age group to meet the criteria for dependence or abuse of prescription drugs. Early initiation also affects the likelihood of dependence later in life: According to Substance Abuse and Mental Health Services Administration’s report, Misuse of Prescription Drugs: Data from the 2002, 2003, and 2004 National Surveys on Drug Use and Health, adult users are twice as likely to meet the criteria for dependence of prescription drugs if they first non-medically used a prescription drug before age16. (3)

In addition, many adolescents cannot grasp the dangers inherent in using prescription drugs. In 2007, there were more deaths from prescription opioids overdoses then from from heroin and cocaine combined. (4) According to The Partnership for a Drug Free America’s Partnership Attitude Tracking Study, “one-third of teens in the U.S. (7.3 million or 31%) believe that there is ‘nothing wrong’ with using prescription medications without a prescription.” Furthermore, “nearly three out of 10 teens (6.8 million or 29%) believe that prescription pain relievers—even if not prescribed by a doctor—are not addictive.”(5)

The number one way in which teens obtain prescription drugs non-medically is through friends. They also report taking them from friends or relatives without asking.(6) Sixty-two percent of teens say prescriptions are easily obtained through their parent’s medicine cabinets.(7)

The Campaign: Everyone likes to think they are a doctor

Recently, Tufts Health Plan along with CVS Caremark developed a campaign to reduce medication sharing. The commercial is aimed at adults and portrays a middle-aged couple trying to figure out how to best treat the wife who believes she has strep throat. In this commercial, the husband is looking in the master bathroom’s medicine cabinet pulling out prescription bottles as he says, “Hang on. I’m sure I’ve got something here”. He comes out, throws one bottle at her, and says, “Try these”, and then throws another and says, “or maybe these”. Looking at the bottle the wife asks, “do I take these before or after I eat?”. He responds, “During? Take those during…”, and walks over to read the description on the bottle himself. Once he reads the bottle he says, “Take those after”. The words, “Everyone likes to think they are a doctor” come up on the screen and a voiceover states, “Only take medications prescribed to you, and always carefully dispose of outdated medication. Tufts Health Plan and CVS Caremark, working together to keep you healthy”. It ends with the husband running out of the bathroom saying, “Don’t take those. They are for the cat.”

Although this media campaign will cause most audiences to giggle, it will not bring about the desired actions from the consumer. This campaign is faulting in three main areas, optimistic bias, psychological reactance, and cognitive dissonance, causing it to be ineffective and lacking persuasion. This paper will present these three theories and show they should have been taken into consideration when creating the campaign. It will also present a more effective way of disseminating this important message.

Optimistic Bias

Although this message may elicit a laugh, the laugh is because of the ludicrous nature of the scenario. It is aimed at catching the viewer’s attention and does that well. However, in the process, it keeps the viewer from being able to relate. This campaign’s message of don’t share medication, comes across loud and clear. The problem is that the audience leaves without a real reason to act accordingly.

Portraying a situation that seems preventable, controllable, or unusual lends itself strongly to a viewer’s optimistic bias kicking in. Optimistic bias is when, “people have a tendency to judge their own susceptibility for a disease or other negative outcome as lower than others’ susceptibility.”(8) When an event is controllable people tend to think about the actions they would take to keep a particular outcome from happening. This leaves them feeling better equipped to handle a situation than an unknown other person. (9)

In this campaign the scenario comes across as both controllable and unusual. Most individuals would not view the husband in this commercial as an intelligent individual. A person acting in accordance with optimistic bias, would picture themselves in the situation, but reassess the end result. Feeling that this is a controllable situation and that their susceptibility is lower than others, most viewers probably believe that they know the medications in their cabinet and do not see this scenario as any threat to them. Very few, if any, individuals would see themselves accidently taking the cat’s medication.

Psychological Reactance

Another, very powerful, reaction a viewer is likely to have to this message is psychological reactance. The motivational state of reactance is triggered when a person feels that their freedom is being threatened. “This motivational state will, in turn, lead to a greater valuation of the threatened freedoms, as well as behaviors attempting to protect (or to reestablish) the threatened freedoms.” (10) The powerful words of, “Everyone likes to think they are a doctor” along with the scenario, is reminding the viewer that the doctor is the authority. It is also sending a message to the viewer that the issue with keeping and sharing prescription drugs is that they are not smart enough to read the label correctly. This message is not only threatening their freedom to distribute the medication but also to think for themselves. If viewing this message causes an individual to go into the motivation state of reactance, then the message will have the exact opposite effect. The viewer will in the future be more apt to share medication in order to reestablish their freedom.

Cognitive Dissonance

Because this campaign has already alienated its target audience with a harsh message and an unrealistic scenario, the viewer is prone to trivialization of the message. According to cognitive dissonance theory, a disconnect between an attitude and a behavior causes a negative psychological state called dissonance. We naturally work to relieve this negative feeling, either by changing the attitude or by changing the behavior. (11) This campaign is aiming to present the attitude that sharing prescription drugs is negative. Ideally a viewer who shares their prescription drugs would internalize this attitude and, in this state of dissonance, change their behavior in order to relieve the state of discomfort. However behavior change is not the only way to relieve the state of discomfort caused by dissonance. The other is through attitude change. Because there is no motivation for the viewer to change their actions, trivialization will most likely take place. Trivialization has been defined as “the minimization of the importance of the elements involved in the dissonant relationships. It has been shown to be an alternate mode of dissonance reduction.” (11) If trivialization does occur, the viewer will feel that the message is not important and they will feel no need to follow the associated actions.

The Healthy Waters Campaign: A multi-pronged approach

Solution 1: Optimistic Bias

Individuals tend to be most susceptible to optimistic bias when an event is controllable. For example, people feel that they can control behavior-linked health threats like smoking cigarettes or lack of exercise, and tend to think of themselves as less susceptible than others in the population to the consequences. Research shows that individuals instead see environmental factors, such as pollution, as more of a threat to their health. (12)

The launch of CVS and Tufts Health Plan: Healthy Waters Campaign will take a different spin on optimistic bias. Many people are unaware of how incorrect prescription drug disposal leads to pollutants in the environment. Though this can be a tough campaign for companies like CVS and Tufts to take on, they can become leaders in creating an awareness to action movement in the United States.

Many states are becoming more aware of research showing that flushing unwanted or outdated medication contributes to water pollution and interferes with fish and wildlife. (13) Many states are instituting programs to combat this issue. In fact, in 2005, CVS joined forces with the Northeast Recycling Council, Inc. in South Portland, Maine for a pilot in-store prescription collection program. (14). CVS also has a section of its website to provide consumers with phone numbers for information about proper disposal of medication.(15) These or other helpful resources were never highlighted in their original campaign with Tufts Health Plan.

As part of the Health Waters campaign, CVS and Tufts Health Plan will build on this work and continue to partner with states and community organizations to host similar events. CVS will not only be branding itself as a partner for a safer environment and use optimistic bias to bring people together in the community, the company will also be getting old prescription drugs out of medicine cabinets and out of the hands of youth.

Solution 2: Psychological Reactance

The Healthy Waters campaign will also be designed with a media portion. This will be the most sensitive part of the campaign and careful framing will be needed in order to trigger the motivational state of reactance in favor of the campaign. The media will drive the Healthy Waters campaign to becoming a movement within communities.

This campaign will include several commercials, each portraying an individual helped by the medication they receive. Each will then portray a realistic situation where old medication was not disposed of properly and its consequences. This reminds viewers that medication can heal, but if not taken care of properly can also destroy. The audience will see that their freedom to drink healthy water can easily be destroyed. A two part message will be provided. “Please keep track of the medication in your cabinet and properly dispose of it when it has expired”. Participants will be given a website and phone number to attain more information.

The media campaign will be linked to the disposal days. By making creating an annual disposal day with events around the country, individuals will be empowered to join the movement and become accustomed to regularly cleaning out their cabinet. CVS and Tufts Health plan will become an ally and a resource.

Solution 3: Cognitive Dissonance

Once individuals have internalized their desire for a better/healthier environment cognitive dissonance can be used as an advantage. Once an individual acts in a way that causes cognitive dissonance, they are driven to reduce or eliminate their negative state in one of two ways. The first is “cognitive rationalization” pertains to modifying an attitude to agree with their behavior and the other is “act rationalization” which consists of agreeing to perform a second act that is consistent with the attitude. (16).

In the first campaign the individual had not yet internalize the attitude and are more apt to fall into trivialization of the attitude. Once an individual attends an event or inspects their medicine cabinet they have acted upon the attitude and have become part of the movement. After the movement and events have been institutionalized in a community, the program can use cognitive dissonance as a reminder of their attitude. The Healthy Waters campaign will periodically create Public Service Announcements asking; “Have you checked your medicine cabinet lately?” According to research by asking a question that reminds them that they haven’t acted in accordance with their belief, they will then be driven to act in accordance with their believe in order to relieve the negative feeling of cognitive dissonance. (17)


1. Substance Abuse and Mental Health Services Administration, Results from

the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.

2. Colliver, J. D., Kroutil, L. A., Dai, L., & Gfroerer, J. C. (2006). Misuse of

prescription drugs: Data from the 2002, 2003, and 2004 National Surveys on Drug Use and Health (DHHS Publication No. SMA 06-4192, Analytic Series A-28). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.

3. Colliver, J. D., Kroutil, L. A., Dai, L., & Gfroerer, J. C. (2006). Misuse of

prescription drugs: Data from the 2002, 2003, and 2004 National Surveys on Drug Use and Health (DHHS Publication No. SMA 06-4192, Analytic Series A-28). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.

4. NIH Publication Number 11-4881Printed July 2001, Revised October 2011. Available online at:

5. Office of National Drug Control Policy Executive Office of the President

(2007). Teens and Prescription Dugs: An analysis of Recent Trends on the Emerging Drug Threat. Available online :

6. Substance Abuse and Mental Health Services Administration.(2006)Results

from the 2005 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-30, DHHS Publication No. SMA 06-4194). Rockville, MD.

7. Partnership for a Drug-Free America (2005). The Partenership Attitude

Tracking Study (PATS): Teens in grades 7 through 12 2005. Available online :

8. Branstrom, R., Brandberg, Y. Health Risk Perception, Optimistic Bias, and

Personal Satisfaction. American Journal of Health Behavior 2010;197-205.

9. Harris, P., Griffin, D., Murry, S. Testing the Limits of Optimistic Bias: Event

and Person Moderators in a Multilevel Framework. Journal of Personality and Social Psychology 2008;1225-1237.

10. Wellman, A., Geers, A. Rebel Without a (Conscious) Cause: Priming a

Nonconscious Goal for Psychological Reactance. Basic and Applied Social Psychology 2009; 1532-4834.

11. Fointiat, V., Somat, A., Grosbras, J. Saying, but not doing: Induced hypocrisy,

trivialization, and misattribution. Social Behavior and Personality 2011; 39

12. Branstrom, R., Brandberg, Y. Health Risk Perception, Optimistic Bias, and

Personal Satisfaction. American Journal of Health Behavior 2010;197-205.

13. Frisman, P., Collecting and Disposing of Unused Medication and Recycling

Prescription Bottles. OLR Research Report, 2009

14. Northeast Recycling Council, Inc. Report on In-Store Pilot CVS Mill Creek,

South Portland, Maine. South Portland, ME, 2005

15. CVS Pharmacy. Proper disposal of medication & Sharps;jsessionid=48E92777AC1EFED5BA1EDB4976499763.commerce_102?subtopicName=Proper+disposal+of+medication+%26+Sharps&topicid=400037

16. Marie-Amélie, M., Valérie, F. Self-esteem, trivialization, and attitude change.

Swiss Journal of Psychology 2006; 65:221-225

17. Fointiat, V., Somat, A., Grosbras, J. Saying, but not doing: Induced hypocrisy,

trivialization, and misattribution. Social Behavior and Personality 2011; 39

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