Field leaders move forward on crafting a public campaign.
For two days in late May, 58 advocates and experts from across the country hashed out approaches to getting Americans and their political leaders and policymakers to view addiction as one of the nation's most pressing health priorities.
Participants, as expected, did not agree on all points during the 2004 Providence Summit on Addiction. Addiction and recovery are complex conditions that defy easy consensus.
But many participants acknowledged a sense of urgency in coming together as a national force. They took the foundation laid at last year's summit--adopting a consensus statement and forming study groups--and added some important and sturdy framing this year.
The National Council on Alcoholism and Drug Dependence, Inc. (NCADD) pledged through its president, Stacia Murphy, to commit money and personnel toward a national public education campaign, and to convene a follow-up meeting. A 10-member steering committee of summit participants was named to continue working with the field to arrive at the next steps of a campaign (see story on page PS8). And a third summit was proposed for next year.
There may be no better time for a public awareness, education or advocacy campaign around addiction disorders and recovery from them. Developments are occurring among ordinary Americans, within the federal government and at levels in between.
In March, U.S. Rep. Jim Ramstad (R.-Minn.) and U.S. Rep. Patrick Kennedy (D.-R.I.) launched the first congressional caucus devoted to addiction disorders.
The recovery community, after a period without a national leader, is strongly back in play with Pat Taylor at the helm of Faces and Voices of Recovery (FAVOR). Both FAVOR and NCADD have fledgling public education campaigns under way.
And public opinion polling this year has found that Americans are expressing "a strong preference for policies that treat addiction as a health issue rather than a law enforcement issue," said Allan Rivlin, senior vice president with Peter D. Hart Research Associates, which conducted a key survey for FAVOR.
"People are looking for a change in attitudes and a change in laws, and we were surprised at the strength of these findings," Rivlin said. "This is really where we get the sense that something is shifting here, that the public is ready for looking at this issue in new ways."
Summit participants heard a plea to set aside historic tensions as they consider ways in which to contribute resources or otherwise add their support to a campaign.
Noting the breadth of groups represented at the summit, Fraser A. Lang, president and co-founder of Manisses Communications Group, said: "Every one of you has an interest in advancing the message of hope and recovery and generating the kind of public and private support that this field needs and deserves to fulfill its mission ...
"But you also may have to take some risks and give some things up in order to be part of a larger whole," Lang continued. "I would remind you that a rising tide lifts all boats. If we can accomplish this, what will happen will benefit not only every organization represented in this room but all the millions of people in this country affected by addiction."
Manisses, with the Brown University Center for Alcohol and Addiction Studies, hosted the summit for the second year. Odyssey Pharmaceuticals again was a major sponsor, joined by Alkermes, Inc., Caron Foundation, CRC Health Corporation, Hazelden Foundation, Phoenix House Foundation, The Change Companies and The Watershed Treatment Programs.
Participants discussed the components critical to a campaign: developing a national message; raising money; designing media and public relations strategies; and compiling research and supporting materials.
Two consultants also weighed in. Rivlin of Peter D. Hart Research Associates presented findings from the company's April survey of 801 American adults about their views of addiction and recovery. The results are useful as the field plans its national message (see story on page PS5).
And Hampton Shaddock, managing director for health care with Burson-Marsteller, a public relations firm, described approaches to launching a campaign, drawing from the national breast cancer awareness movement model. Burson-Marsteller has been working with NCADD on its nascent campaign.
Shaddock told addiction experts that starting a national campaign involves a series of steps: establishing medical need; identifying shared campaign goals; defining target audiences; testing messages that have flexibility and wide acceptance beyond traditional supporters; arriving at a call to action and a public policy agenda to ensure system changes; setting up a range of communication channels to disseminate messages; and displaying commitment, determination and endurance.
"If you're going to do this, be ready to be in it for the long haul," Shaddock said. The most important challenge is getting on the same page, he added.
On that note, seminar participants made progress. They agreed that the field's campaign should increase Americans' understanding of addiction and recovery, with the end goal of changing attitudes and behavior, policies and laws. The campaign must start by targeting the general public and health professionals. Some participants also specified employers, unions and policymakers as audiences to reach.
While most attendees agreed that the campaign coalition needs a framework from which to operate, they appeared divided over whether that would mean creating a new, freestanding entity.
They offered several suggestions around calls to action, with a focus on health as the underpinning. Participants also insisted that the actions have results that can be quantified, regardless of whether those results could be attributed directly to the campaign. Among the suggestions:
* Ingrain a sense of "Do ask, do tell" about substance abuse problems in interactions between patients and health care professionals; such conversations should be a routine and accepted component of high-quality health care. Increase the number of substance abuse screenings done in doctors' offices, emergency rooms, clinics and other health care settings. Incorporate screening in the standards used to evaluate the quality of health plans. Get physician and other appropriate health care groups to require substance abuse training as part of core competencies and certification examinations.
* Increase the number of health insurers and governments that cover addiction treatment in the same way that they cover other chronic diseases.
* Add recovery-related questions to the federal government's annual National Survey on Drug Use & Health to gain a better understanding of recovery and to observe trends.
* Highlight those states that are enforcing or adopting laws that prohibit discrimination against people in recovery.
* Reveal recovery in human terms to drive home the extent to which it is happening and the consequences to society. Juxtapose success stories of people in recovery against discriminatory laws and policies that serve as hurdles to those successes.
* Begin to plan for a comprehensive package of legislation that seeks to end the stigma and discrimination associated with addiction and recovery, along the lines of what the Americans with Disabilities Act (ADA) achieved.
Participants also acknowledged the need to form strategic partnerships with non-traditional groups, to support long-term research about recovery and to raise money to carry out the campaign.
In scripting a national message, attendees struggled with language, but their suggestions coalesced around a few key phrases: "Alcohol and drug addiction affects everyone." "It's treatable and preventable." "It's a health problem or priority that you can and must do something about."
H. Westley Clark, M.D., J.D., M.P.H., director of the Center for Substance Abuse Treatment (CSAT) within the Substance Abuse and Mental Health Services Administration (SAMHSA), observed that from SAMHSA's viewpoint, a message must take into account that alcohol and drug addictions drive behavior.
"That's why our message is a unique message, and why the interventions that we support and articulate have to take in that it is the booze, the drugs," Clark said. "All these other problems are very, very important ... But if you never deal with the fact that this person uses the drugs to cope, uses the booze and becomes addicted to the drugs--if we never deal with that, then our message is going to be lost."
Indeed, some findings from the Hart survey foreshadow the difficulty of crafting a national message that will find broad support. The poll results underscore what experts have known: that Americans hold vastly differing views about the underlying causes of addiction. And they appear divided about the effectiveness of treatment and the ability of people to remain in recovery.
Much polling has been done around the question of whether people believe that addiction, at root, is a disease or a moral failing. The answers depend on how the question is put, Rivlin said, which shows how poorly understood addiction is. If asked if addiction is a disease, more than one in seven people, maybe one in eight, say yes.
But giving a choice between addiction as a disease or health problem and a moral weakness produces "just short of a majority saying they support the disease model, but essentially equal numbers saying it's at least part a moral weakness," he said.
"Most people hold a person who has an addiction responsible for at least part of that addiction. So in our messaging we are a long way from being able to say, 'Addiction is a disease; therefore hold the addicted person harmless for the condition,' "Rivlin said.
Understanding people's thinking about addiction and recovery, including their points of resistance and gaps in knowledge, sheds light on the hurdles that must be overcome, Rivlin said. And it helps explain "why so many people have been at this for so long," he added.
Some participants reminded colleagues of the many stalled campaigns of past years. They noted the potential for redundancy, given the anti-addiction or recovery-oriented campaigns currently underway by NCADD, FAVOR and the White House Office of National Drug Control Policy (ONDCP), to name a few.
And some attendees questioned the idea of getting on board without knowing in advance the specifics of the campaign, including who's running it, or without receiving permission from their own boards of directors.
David C. Lewis, M.D., chairman of NCADD's board of directors, stressed that NCADD is not planning and running the campaign. "The idea was that we would create a template ... and the template would be to welcome in the field to participate in the effort," with each group deciding, after discussing the campaign internally, what it could contribute, Lewis said.
"It's not easy," he added. "We'll have to raise a bunch of money; we're committed to raising part of that money. The start-up part of a sophisticated national public relations campaign is to test out the messages and to have some additional input from the field ... And that's what we're trying to do right now. The steering committee can interact with us and have input--as can anybody else. We are an open book in terms of our interest and involvement in this effort."
Perhaps the most poignant plea to get moving came from Tom McHale, representing FAVOR. On behalf of the people in recovery whom he counsels, he said, "There is a serious importance for this group to come together and build that consensus and move forward. There are too many families that are destroyed, there are too many people that are dying and we can't afford to sit here and twiddle our thumbs while we try to come to a consensus. We need to move and we need to move quick."
McHale brought home what is at stake with each passing day: "Every three months on our highways alone there are more people who die where alcoholism is a factor than died at the hands of terrorists in 9/11. And those deaths are just as violent, just as gruesome and just as brutal to the family members as all those who suffered in the tragedy of 9/11."
RELATED ARTICLE: Ingredients that Could Make a Message
In trying to win public and political support for people who are addicted to drugs or alcohol and for policies that help them, a groundbreaking survey by Faces & Voices of Recovery (FAVOR) offers important guidance.
The findings provide insight into how best to craft the most effective messages or statements around a public awareness and education campaign. FAVOR, the National Council on Alcoholism and Drug Dependence, Inc. (NCADD) and others are planning campaigns, with discussion around whether such efforts might be combined into one campaign.
The FAVOR survey, designed to get at people's attitudes about addiction, stigma and discrimination, contained one set of questions aimed at learning how well various arguments for a new approach to addiction resonate with the general public.
"We tried six messages, and all of them do very well," says Allan Rivlin, senior vice president of Peter D. Hart Research Associates, which conducted the survey for FAVOR. Rivlin announced some survey results at the 2004 Providence Summit on Addiction, including in the area of messaging.
Three of the six messages resonated especially well among the public, with 63 percent or 64 percent of survey respondents finding each one "very convincing." When adding in those respondents who found the arguments "somewhat convincing," the rates rose to more than 80 percent for the three messages. These messages, with Rivlin's interpretations, are:
* "Addiction to alcohol and drugs is a disease that affects one in 10 Americans. Beyond that, as many as one in four American children are affected by parents or family members with an addiction."
This argument, Rivlin says, "is a good opening sentence" for a campaign, getting broad support across all demographic groups. But it doesn't provide much momentum; "it doesn't move the ball very far down the field," he says.
* "Recovery from addiction to alcohol and other drugs takes time, patience and support. There are many ways that people get the help they need, and we can never give up on helping family members and friends reclaim their lives."
Though the message is tougher to frame this way, it's nonetheless very popular, Rivlin says. "It's designed to pick up the idea that relapse is part of an ongoing condition but [that] we can never ... give up on helping family members. That, I think, is a very effective way to talk about this."
People in recovery, in a 2001 survey also done by Hart researchers, found this message compelling as well, with 79 percent calling it a "very important" argument.
"This is a message that works inside and outside very well," Rivlin says.
* "Breaking the cycle of addiction is critical to a healthy society. It is easier and less costly to treat abuse before it becomes an addiction, and to treat addiction in its early stages."
This message, grounded in economics, ranks highest among conservatives and also appeals to policy-makers and local elected officials, Rivlin says.
Rivlin singles out a fourth message, which is the favorite of people in recovery but which ranks last of the six messages tried with the general public. It states:
* "Millions of Americans are in long-term recovery from alcohol and other drug addiction, and tens of thousands more get well every year. They are living proof that recovery is happening, and that there is a real solution to the problem of drug and alcohol addiction."
Of people in recovery, 84 percent found this to be a very important argument, while only 46 percent of the broader, general-public group agreed it was very convincing.
"At 46 percent, it's still a good message" for the public, Rivlin says, noting that less than one-fifth of the general public found the message unconvincing. "My intuition is that this deserves to have a very large place as we start to talk about things."
All four messages, Rivlin says, have elements that people "are willing to get behind.... There's a role for all four of these ... with greater emphasis on some within the recovery community and greater emphasis on others within policy-maker circles. But I would use components of all of these messages" in a public awareness campaign.
(The other two messages, which about half of the general public and nearly two-thirds or more of people in recovery found convincing, are: Helping people to achieve long-term recovery saves in health care costs, crime and the toll on families; and, Discrimination against people in recovery is unfair and makes their ability to achieve recovery more difficult.)
The general-public survey done in April involved polling by telephone 801 adults nationwide. The 2001 recovery-community poll, which FAVOR also commissioned, surveyed 250 adults nationwide.
FAVOR's leaders have agreed to do added research stemming from the survey findings, according to Pat Taylor, FAVOR's campaign coordinator. The Robert Wood Johnson Foundation is helping to support that effort.
RELATED ARTICLE: 2004 Providence Summit Outcomes
Three sets of actions emerged from the 2004 Providence Summit on Addiction. They are:
* A commitment by the National Council on Alcoholism and Drug Dependence, Inc. (NCADD) to raise $250,000 in seed money for a national campaign designed to raise the visibility of and sense of urgency in addressing addiction treatment and prevention. NCADD also pledged to dedicate a portion of the services of its lobbyist in Washington, D.C., to the campaign.
* The formation of a steering committee to work on refining and advancing the campaign goals.
The committee's members are: Roger Bensinger, president of Bencorp and a member of the NCADD board's communications committee; Linda Hay Crawford, executive director of Therapeutic Communities of America; Pat Ford-Roegner, executive director of NAADAC, The Association for Addiction Professionals; Lewis E. Gallant, Ph.D., executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD); Ronald J. Hunsicker, president and chief executive of the National Association of Addiction Treatment Providers (NAATP); David C. Lewis, M.D., NCADD board chairman and project director of Physicians and Lawyers for National Drug Policy; Carol McDaid, principal of Capitol Decisions; Stacia Murphy, NCADD president; Pat Taylor, campaign coordinator of Faces and Voices of Recovery; and Ivette Torres, associate director of consumer affairs at the Substance Abuse and Mental Health Services Administration (SAMHSA).
* A pledge by summit coordinator Manisses Communications Group to compile a list of efforts currently under way by groups inside and outside the field that might augment the campaign or run counter to it. Also, Manisses will compile a calendar that identifies addiction- and recovery-related events, such as SAMHSA's National Recovery Month every September. The list will represent opportunities to help boost attention to and win support for anti-addiction efforts among the media, policy-makers, elected officials and others.
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|Title Annotation:||changing attitudes and actions about drug and alcohol addiction|
|Date:||Jul 1, 2004|
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