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

A discussion on the Twitts today returned me to this old post. I can’t believe I’ve never reposted it.

This was originally published on the ScienceBlogs.com version of the blog on 2/292008.

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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.