In all the discussions about the proposed health care law, it was easy to overlook a statement made by Attorney General Jeff Sessions on March 15: “I think we have too much of a tolerance for drug use – psychologically, politically, morally… We need to say, as Nancy Reagan said, ‘Just say no.’”
It seems obvious. When someone offers you drugs, just say no. Yet research has shown that this slogan and accompanying campaign from the mid-1980s, spearheaded by then First Lady Nancy Reagan, was not only ineffective, it was also closely aligned with the War on Drugs, which gained new traction under President Ronald Reagan. This effort to prevent and reduce substance misuse and addiction focused on white, middle-class children, and wound up demonizing others, particularly African-Americans.
This War on Drugs movement, punctuated by the Anti-Drug Abuse Act of 1986 signed by President Reagan, also brought with it the enactment of mandatory minimum sentences for drug offenses, which further criminalized drug use, even low-level drug offenses. Furthermore, mandates under this act were racially fueled, creating and perpetuating racial and economic disparities in incarceration rates related to drug use and addiction. These disparities continue today.
Attorney General Sessions’ statement aligns with his stated commitment to increase the number of private prisons, as in February 2017, he revoked the directive by President Obama to reduce the number of for-profit prisons. President Obama also was working on reducing prison time for nonviolent drug offenses, moving toward a model of treating addiction more holistically, rather than criminally. Between Sessions’ statements about our country being too tolerant of drugs and his plans to expand private prisons, we appear to be heading back toward criminalizing addiction, rather than treating it.
Ineffective substance misuse prevention strategies
Over the past three decades since the “Just Say No” campaign was initiated, the science behind effective strategies to reduce and prevent substance use initiation has strengthened. The Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention, for example, has a Strategic Prevention Framework that identifies multiple evidence-based prevention principles.
The science has also demonstrated that pure education and knowledge-based efforts, which is the premise of the programs that came out of the “Just Say No” campaign, are not effective. At best, messages that came out of this era are too simplistic; at worst, they demonize people who use illegal drugs, which is shortsighted, given that in 2016, almost half of 12th grade students in the U.S. reported having used illicit drugs.
This tactic also ignores the reasons people start using drugs or become addicted to drugs in the first place, which may include genetics, trauma and other risk factors. That’s why effective strategies must include more than knowledge – they are skills-based, interactive and recognize that different approaches are necessary for different age groups and stages of development.
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Treating drug use and addiction criminally is misguided. Addiction is complicated and getting off of drugs takes more than willpower. Because the brain changes in response to continued drug use and dependence, it becomes very hard to stop. But addiction can be successfully treated through various methods (for example, medication, behavioral therapy, etc.), and should be.
Not the answer for drug use prevention
“Just Say No” is clearly not the answer to the current opioid epidemic, either. Prevention strategies need to do so much more than tell young people to literally just say no to drugs.
This mantra is part of movements that treat addiction as a moral failing rather than a medical and social issue. In my opinion, going back to this philosophy will set the work in substance misuse prevention back decades.
I agree with Attorney General Sessions that we should “just say no,” but I disagree with the target.
We should just say no to antiquated, ineffective and regressive strategies and policies for drug misuse prevention, and to demonizing complicated behaviors that are often initiated out of trauma, for capital gains in the prison system. Sessions, it seems, wants to further stigmatize and criminalize trauma. To this, I just say no.
About The Author
Margie Skeer, Associate Professor of Public Health and Community Medicine, Tufts University