Challenging Dogma

Sunday, May 6, 2012

The Unintended Consequences of Addressing Binge Drinking Using Affective Norms – Natasha De Marco

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as consuming five or more alcoholic beverages in two hours for men and consuming four or more beverages for women (1). The NIAA also reports that approximately two of every five college students of all ages report engaging in binge drinking at least once in the past two weeks (2). Some of the negative health outcomes that are associated with binge drinking include unplanned pregnancy, sexually transmitted diseases, liver damage, neurological damage, and cardiovascular diseases (3). Specifically for college students, binge drinking has been shown to be associated with academic consequences, such as poor grades, low Grade Point Average, and missed classes, as well as secondhand effects (4). These secondhand effects include physical and sexual violence, property damage, and disturbances that prevent sleeping or studying (4-5). Binge drinking among college students has been nationally recognized as a public health problem in need of effective campaigns and interventions.
The Social Norms Theory has been utilized by university administrators and student-run organizations to reduce binge drinking among the student population. Social Norms Theory, also known as the Social Expectations Theory, is based on the fact that people in groups organize their exchanges with each other within mutually understood rules which provide definitions of acceptable behavior, predictability in what each member of a group is expected to do, and understanding of what each can anticipate from the others (6). The Other Hangover, a student-run anti-binge drinking campaign at the University of Minnesota, addresses binge drinking using group affective norms. Group affective norms are referred to those norms that develop within groups and govern the experience, management, and use of affect within the group (7). One of The Other Hangover’s print media was an anti-binge drinking billboard erected atop a popular bar near the University of Minnesota campus (8). This billboard depicts a group of friends casting disapproving looks onto their friend, who will be referred to as the male student, who they label as “wasted” and “The Creep” as he tries to make conversation with a girl by putting his arm around her. The text in the bottom-left corner of the billboard reads “Don’t over do it” which emphasizes that students should consume alcohol in moderation.
            The Other Hangover campaign addresses anti-binge drinking from the perspective of social consequences. Specifically, the billboard tackles the social norm of which someone’s risky behaviors as a result of binge drinking is being unacceptable in the group dynamic. “Unacceptable” is evident by the group’s negative reactions and shaming onto the individual for partaking in binge drinking. Unfortunately, this act of shaming through affective norms has unintended consequences. Through Social Reaction Theory, Psychological Reactance Theory, and Cognitive Dissonance, the individuals targeted for this campaign are not likely to change their drinking behavior from binge drinking to moderation.
Social Reaction Theory/Labeling Theory
            Social Reaction Theory describes that an act is deviant when people notice it and then take action to label it as a violation and apply appropriate sanctions (9). The Other Hangover billboard uses the group of friends to carry out the Social Reaction Theory. The group of friends notice that their male friend approached a woman in an unfavorable fashion after he has been binge drinking. The group then labels the male friend as “The Creep” and applies the sanction of expressing disapproving emotions at his behavior.  Labeling the male friend as “The Creep” is ineffective at changing this male’s behavior of over-consuming alcohol. First, the male student is likely to adapt to the identity of “The Creep” as a result of the self-fulfilling prophecy concept. What the self-fulfilling prophecy does is label someone and then have that person treated as if that label were correct (10). Over time, a hastily assigned label may become an accurate description of this person (10). Although the billboard shows evidence that the binge-drinking male is acting in accordance to the label “The Creep” by the uncomfortable reaction of the girl who he has wrapped around his arm, this label is potentially toxic to the male’s future self-esteem. The male could adopt this label of “The Creep” as his identity, which would imply that he would continue to binge drink. In other words, the male has realized his self-fulfilling prophecy as “The Creep” as a result of his group of friends attributing his unfavorable behavior to his binge drinking. According to the Social Norms Theory, the group can now predict that any subsequent event in which the male binge drinks, he will engage in risky behaviors that exemplify his label as “The Creep.” The presence of this label perpetuates the male’s current behavior of binge drinking. This unintended effect of the billboard deviates from the goal of reducing binge drinking among college students at this University.
Cognitive Dissonance
            Cognitive dissonance theory, expounded by Leon Festinger, posits that individuals naturally seek consistency among their beliefs and opinions (11). When there is an inconsistency between attitudes or behaviors, something must change to resolve the conflict (11). The Other Hangover’s goal for this billboard is for the audience to rationally rectify their dissonance between their current attitudes of binge drinking and their friends’ attitudes of binge drinking.  The campaign assumes that the male student will modify his behavior to consume alcohol in moderation in order to conform to friends’ attitudes, which in turn will alleviate his dissonance.  However, considering that the male student may value the benefits of binge drinking compared to moderate consumption, the male student may be more inclined to abandon this particular group of friends as a way to justify his decision to continue to binge drink as a way of balancing the dissonance. For example, research shows that many students acknowledged that binge drinking has risks, but the students justify that the great memories and stories that come as a result of binge drinking are worth it (12).  In other words, the male student may seek a different group of friends in which he can continue binge drinking because he knows that his attitudes and goals for binge drinking will be consistent with his new group of friends. Furthermore, the male student will not seek to conform to the social norm of his current peer group due to the imbalance of dissonance. Instead, the male student will seek a peer group in which has established that the social norm to binge drink is acceptable behavior and will not be associated with consequences. Once again, much like the unintended consequence of labeling the male student as “The Creep,” he may continue to binge drink as a result of an irrational method in which to alleviate the dissonance between him and his current peer group. The perpetuation of the binge drinking behavior will most likely persist through this ineffective billboard campaign.
            The Cognitive Dissonance Theory implies that the individual is conscious of the dissonance between himself and his peers and is then able to rectify the dissonance in some manner. In The Other Hangover’s billboard, the male student appears unaware of the disapproving looks of his friends and the reaction of the girl after he placed his arm around her. The male has a smile on his face, as if he enjoys how uncomfortable he is making the girl feel. The male student is oblivious to the reactions around him. As a result of this unawareness of the dissonance, the male student is not motivated to change his behavior.  This unconscious realization of the disapproval and shame from the group of friends does not effectively address the change in affirmative norms that the campaign strives to achieve. The underlying assumption of the individual’s awareness of the dissonance according to the Cognitive Dissonance Theory is not met.
Psychological Reactance
            The Other Hangover billboard includes the text “Don’t over do it” to emphasize the underlying message that students should consume alcohol in moderation. Although it appears in smaller-sized text in comparison to the main phrase, it is still an ineffective tool to include when promoting behavior change. This instruction of the “Don’t over do it” text has implications of consequences to the individual as explained by the Psychological Reactance Theory. This theory posits that an individual will experience reactance whenever an individual’s free behavior is eliminated or threatened with elimination (13). In addition, this theory suggests that the more important that free behavior is to the individual, the greater the magnitude of reactance experienced (13). In other words, the students who see this billboard will feel that their freedom to binge drink is threatened. Upon threatened elimination of this freedom, the students are generally more motivated to attempt to regain the lost or threatened freedom by whatever methods are available and appropriate (13). Moreover, telling a student not to drink will have the opposite effect that was originally intended. It can now be anticipated that the student will continue to binge drink or even increase the frequency of his binge drinking in order to regain his freedom that was previously threatened to be eliminated. Not only does this campaign use shame to encourage anti-binge drinking, but according to the Psychological Reactance Theory, this particular message appears to work against the goal to reduce the prevalence of binge drinking among these university students.
            It can be argued that the text “Don’t over do it” could be an effective tool to persuade behavior change in this context. Since the message is being delivered by the male student’s peers, it can be assumed that there is interpersonal similarity between the male student and his peers. Paul Siliva’s experiment on the role of similarity in increasing compliance and reducing resistance supports this assumption. One of the findings of Siliva’s experiment showed that when a threat to freedom was high, people agreed more with a communicator that was similar to them in first name, birth date, gender, and year in school than with the dissimilar communicator (14). However, the “Don’t over do it” message and “The Creep” label work together to make the group more dissimilar from the male student. The group creates a social distance, establishing an “us” versus “him” image. This distance contributes to discrediting the interpersonal similarity between the male student and his group of friends. In turn, the male student will not be as likely to agree with the group’s message to consume alcohol in moderation. The psychological reactance experienced by the male student is a significant contributor to the poorly executed anti-binge drinking campaign by addressing the affective norms of alcohol consumption among college students.
            Affective norms have been addressed in public health campaigns on a variety of public health problems. When they are used to address an individual’s behavior, as opposed to an organization or company, it appears that the likeliness of maintaining the problem behavior increases. Re-framing The Other Hangover’s billboard to include motivation and encouragement to inspire behavior change will address the unintended consequences of labeling, psychological reactance, and cognitive dissonance.
Proposed Intervention
            Improving this billboard involves changing the affective norm from negative to positive. Instead of a group of friends shaming one the male student for his poor decision making, this group of friends will now encourage each other to consume alcohol in moderation. Using the same platform of The Other Hangover’s billboard, all of the existing text would be erased and replaced with “Drinking Buddies: Making Sure the Memories Live On, Without Binge Drinking.” The placement of the group of friends would be described as conversing in a circle with their body language and emotional expressions of happiness, enjoyment, and celebration. Also, all people photographed in this billboard will have an alcoholic beverage in their hands. There would not be selective color on one individual, which was previously depicted on the image of the male student. Instead, the selective color would be applied to the entire group of friends in a setting that can be easily identified as a drinking establishment.
            The use of Advertising Theory is another way in which to define the construction of the new billboard. Advertising Theory is based on the notion that the mass population can be targeted with a uniform message at the same time with a promise, core value, and evidence to support these two components (15). These components of Advertising Theory will allow this campaign to address the affective norm of prevalence of drinking in moderation to change students’ attitudes about consuming alcohol. The core value in this new billboard will change from “isolation” to “acceptance” and “friendship.” In addition, the new billboard attempts to make a positive association between “Drinking Buddies” and consuming alcohol in moderation. This new billboard promises that “drinking buddies” can still have a good time without needing to over-consume alcohol.
With the change of perspective of this new billboard, the Social Norms Theory addresses the popularity of consuming alcohol in moderation among the group of friends. The emotions of happiness and inclusivity in the new billboard illustrate that this group of friends is a model of appropriate behavior and their reward for carrying out the appropriate behavior is to cherish the fond memories of each other’s social interactions. This new billboard eliminates the unintended consequences of the original billboard through methods to eliminate labeling and to reduce the potential for psychological reactance and cognitive dissonance.
Social Reaction Theory/Labeling Theory
            Labeling of individuals or groups can prove counterproductive when displayed in behavior-change campaigns. In order to avoid this, nouns were carefully selected for the text of the new billboard. For example, a label of “drinking buddies” was used for the audience to be able to identify their friends in the context of consuming alcohol. A “drinking buddy” is a neutral label in which the audience can identify their friends, evaluate their drinking patterns, and identify their outcomes from their moderate-drinking patterns. In addition, pairing “drinking buddy” with a positive image of drinking in moderation reduces the risk of the audience to feel labeled as binge drinkers. As a result, the risk for the audience to become susceptible to a negative self-fulfilling prophecy is reduced. Now there should be no suspicion that the audience may continue to binge drink as a result of labeling. Moreover, the new billboard illustrates that the act of drinking alcohol in moderation with others is socially acceptable. This image sends a different message than The Other Hangover’s billboard. There, it was determined that binge drinking was socially unacceptable. By showing an accepting social norm as opposed to a unacceptable behavior, this avoids the possibility that the audience could perceive that they are engaging in a deviant behavior. The risk that individuals are likely to internalize a label, such as deviance, and begin to mold their self-concept to the consequent behaviors has been reduced (16). Overall, the careful selection of words and the positive associations made between the words and the images have contributed to avoiding the mistakes of The Other Hangover’s original billboard. The new billboard uses neutral labeling and positive associations to effectively address moderate consumption of alcohol among college students at this university      
Psychological Reactance
            A positive association between psychological proneness and psychological reactance has been found in assessing the effectiveness of binge drinking campaigns using social norms (17). This implies that students who over-consume alcohol are a delicate population when it comes to encouraging behavior change. Reducing the amount of command-like words is imperative to having an opportunity for the students to change their drinking behaviors. Using terminology like “drinking buddies,” which is something that most likely already exists in students’ vernacular, is an effective way to avoid the students from continuing to binge drink because it provides an opportunity for familiarity.  In addition, using a phrase in which students can attribute to the experiences they desire to achieve when binge drinking would be more likely to be effective when they transpose the message on the bill board to the next time that they consume alcohol.  In other words, the image of the group of friends and text on the new billboard should not invite an opportunity for psychological reactance due to the fact that the new billboard depicts familiarity to the students. The anticipation is to provide a scenario in which the student has found himself before, offering a comfortable setting to try out the new behavior. From the encouragement and support of friends, the student will realize that there is a minimal modification to his behavior that needs to be made.  The next time he is in the scenario depicted in the new billboard, he will be empowered to take the steps to drink alcohol in moderation. As a result, the familiarity of images and text in the new billboard minimizes the burden and reactance to modify the drinking behavior. All in all, considering that the students are already prone to psychological reactance, it is important to display images in which students identify with as embracing their freedoms and independence as college students. Offering a scenario in which they see themselves drinking alcohol with their friends reinforces their freedom to consume alcohol and provides an opportunity for them to be more receptive to the idea of changing their consumption patterns.
In addition, the message of moderation is accompanied with enhanced interpersonal similarity among the group of friends. With students’ baseline proneness to psychological reactance already high, establishing the interpersonal similarity and attraction between the audience and the group of friends will increase the audience’s reception to the new billboard. Interpersonal attraction is positively related to the amount of influence that others have on us in interpersonal exchanges (18). As such, interpersonally attractive others can potential play an influential role in our behaviors (18). This emphasizes the importance for the group of friends to be perceived by the audience as the audience’s close group of friends, a group of people with whom they interact frequently. More importantly, this group of friends must emulate emotions and reactions in a drinking environment in which the audience defines as similar to their own experiences when they consume alcohol with their friends. The new billboard successfully does this by portraying a group of friends enjoying each other’s company, are standing within close proximity of each other, and are laughing and reacting in the same manner. These emotional reactions and social proximity of the people in the new billboard reduces the potential for psychological reactance. The students’ freedoms are reinforced in the billboard and therefore will be more likely to engage and convince the audience to adopt the idea of consuming alcohol in moderation.
Cognitive Dissonance
            The new billboard is an attempt to reduce the potential for the audience to encounter cognitive dissonance. The presence of cognitive dissonance is psychologically uncomfortable and creates pressures to reduce dissonance (19). The Other Hangover’s billboard threatened the identity of the male student. The male student was rewarded with shame from his group of friends. This new billboard will allow the audience to maintain their identity as consumers of alcohol, but request them to reconsider the amount they drink. In return, the audience is rewarded with acceptance and friendship. This is something that is of great value to a college student. As a result, the potential for dissonance among the audience’s identities is reduced because the new billboard rewards the students with something of high value in exchange for their consideration of modifying the amount of alcohol they consume.
            At the same time, the new billboard must still meet the basic assumption of the Cognitive Dissonance Theory in order to be able to reduce the psychological discomfort of cognitive dissonance. Without the presence of some cognitive dissonance, the audience will not have any motivation to seek cognitive consonance, which is innately present in all (19). The audience should be able to recognize through the text “without binge drinking” on the new billboard that some dissonance is apparent. One of the ways to reduce cognitive dissonance in campaigns is to add new cognitions to make existing cognitions consistent (19). By showing a group of friends enjoying themselves with alcohol which is supported by the text that they are drinking in moderation should offer an opportunity for the audience to seek consonance. In other words, this new billboard must address some dissonance between the audience and what they see in the new billboard. However, the new billboard is carefully crafted in a way which reduces the potential magnitude of dissonance by offering a familiar and desired scenario in which college students can relate to. The amount of dissonance that must be reduced is minimal between the audience and what they see in the billboard; therefore, the new billboard is more likely to inspire the behavior change.
            The Social Expectations (Norms) Theory attempts to show that people can use the mass media as sources, either deliberately or without consciousness awareness, from which to acquire guides to appropriate behavior that will help them adapt to the complex world in which they live (6). The new billboard is an effective execution of combining positive, college-specific social, affective norms with the use of mass media to inspire alcohol consumption in moderation. The execution of this new billboard elicits empowerment and motivation to consume alcohol in moderation while still being able to achieve the same desires of why most college students drink alcohol to begin with – to be accepted. The power of positive self-esteem and positive associations with drinking alcohol in moderation addressed simultaneously at the group and individual level should be a method in which stakeholders emulate for their target audiences to achieve successful behavior change outcomes. 
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