Programs only produced small effects, but are justifiable as per their cost-effectiveness

Healthy Harold

Government allocates additional school funding to educate children about drugs.
Inefficient unless there are safeguards to prevent the misappropriation of funds, and that support is given to teachers for the delivery of education material.

Programs exist from third-party agencies who have been trained to do these educational talks.

Ineffectiveness of Prevention Programs

If you knew the harm you would choose the behaviour less frequently

Risks to users are often greatly exaggerated (scare mongering) in terms of their addictiveness and damage. Often, youth who observed peers smoking marijuana without any (apparent) immediate harm would quickly disregard (and in the future, ignore) any provided information

Modern prevention strategies provide accurate information, as to not be discredited in the future; which also helps youth make rational choices through training self-efficacy and their ability to resist peer influences.

"Just Say No"

US prevention campaign launched by First Lady Nancy Raegan, as part of the war on drugs in the 1980s-1990s.

It was difficult to evaluate the efficacy of the campaign

Project ALERT

Launched in the 1980s, it provided experimental evidence that training in the ability to "say no", does have some small efficacy in pushing back the age of drug use onset.

Based on social influence models to promote the benefits of the non-use of drugs

The project only seemed to work while it was running, as after children moved into high school (no longer in the scope of Project ALERT), any gains had vanished. However, it does help to push back the age of onset

Project DARE

Drug Abuse Resistance Education

Created in an effort to reduce drug use, gang membership and violent behaviour

Delivered in schools by police officers, however there seemed to be no significant effect

Project Keepin' it REAL

Refuse Explain Avoid Leave

Adaptation of Project DARE.

Helps students assess the risks associated with substance abuse, enhance decision making and resistance strategies, improve antidrug normative beliefs and reduce substance use. It takes a culturally grounded approach, incorporating traditional ethnic values and practices that forbid/deter substance use

Meta-analysis of Programs

What's the crucial element that successfully reduced short term drug use during these programs?

  • Knowledge programs - Scare tactic
  • Affective programs - Improve emotional risk factors (without reference to drugs)
  • Peer programs - Knowledge of drug harms in a peer situation

Peer programs were the most efficable! (Tobler 2992, Midford 2010, Cuijpers 2002).
Peer programs worked better when the program leader was a trained mental health professional, as opposed to just a teacher

Cost-effectiveness of Prevention

Caulkins et al 1999 estimated that prevention programs produced a 2.9 - 13.6% reduction in cocaine use. Note that these percentages differ significantly, and the cost-effectiveness of programs are viewed relative to the perception of the reduction as having a low, middle or high effect

Treatment was the most cost-effective
Federal enforcement followed
Then prevention
Increase in minimum sentence duration
State police enforcement
...

Politics and Tough Drug Policies

Treatment or Enforcement?

Changing enforcement policies does not really change behaviours

Caulkins et al 1997 estimated that an additional million of USD spent on treatment would reduce cocaine consumption by 104kg, and that a million of USD on lengthening minimum sentences of dealers would only reduce consumption by 13kg. If a million of USD was used for law enforcement (arrests, confiscation, prosecution), consumption would decrease by 27kg.

Enforcement isn't very efficient.

  • Arrested dealers are replaced by others if the demand remains
  • Breakup of big cartels result in more smaller groups
    • They compete by selling lower prices
    • This causes a higher rate of consumption

If anything, enforcement should attempt to target the demand of drugs, rather than the supply of drugs.

Philosophical Underpinning

  • Consequentialism (Empiral evidence concerning the harms of drug use) vs Deontologicalsim (Kant, behaviour should adhere to moral duty)

Millian Liberalism

The state should only be able to intervene if the individual's behaviour harms others, or if it promotes the behaviour in others

State should intervene in behaviours that cause harm to the individual, because the harms of drug use are undeniable

State should intervene to prohibit behaviour that has been deemed immoral on a community/collective understanding. Intoxication decreases character and dignity.

Deterrence Theory

// Utilitarianism - Bentham and Beccaria

Outcomes - Costs

Utility of a crime: reward * probability of success - disutility
A crime will be committed when the utility of a crime exceeds the utility of the most profitable alternative

States try to reduce drug use by restricting availability, increasing prices, and increasing deterrence

MacCoun (1993) argued that we need a more realistic perspective that acknowledges the limitation of human rationality, and the importance of moral reasoning and informed social control factors in legal compliance.

Annual risk of drug arrest 2% marijuana, 6% cocaine.
This is lower than what people believe it to be.

But this perceived risk had a weak relationship to the consumption of drugs. For people with prior use of drugs, there was an even weaker relationship (Patternoster 1987)

Addicts are less able to incorporate negative consequences into decision making, so fear would have a very weak effect on their consumption

Price

If addicts are rational, they should reduce their drug consumption levels.
Except they're not.

The fact that drug consumption is elastic supports the efficacy of tax and prohibition initiatives.

Affect of policies on on street price

  • DiNardo 1993 - Police enforcement over time or place had little impact
  • Reuter et al 1988 - Miltary controls at the border had little impact

Caulkins and Reuter 1998 - Prohibition accounted for (only) 35% of retail cocaine costs in the US; the rest being independent of prohibition.

Therefore, prohibition variances can only affect (at most) 35% of the retail cost

Informal Social Controls

Rational Choice Theory suggests that people will only not commit crimes if there is swift and effective punishments. However this is overly naive of humanity, and ignores the individual's moral conscience.

Kohlberg's Theory of Moral Development (1971)

  • Preconventional - Most susceptible to deterrence effects, most sensitive to prospective punishments
  • Conventional - influenced by the symbolic status of the law. May be undermined by confirming to counter-cultural norms
  • Postconventional - less concerned with risks, value their internalised beliefs regarding which actions are morally defensible

Laws and the fear of sanction only work on the preconventional group (before they are willing to side-step the law)

Symbolic Threshold Effect

States that demonstrate exemplary behaviour (aren't corrupt, brutal, etc) will have citizens who are more compliant with their prohibitions. Citizens of corrupt states are less likely to comply to policies and regulations

French and Ravens (1959) - Legitimate vs Coercive Power

  • Legitimate Power - where one accepts the legitimacy of state laws
  • Coercive Power - where one seeks to avoid punishment

Legitimate power is thought to be more effective in influencing behaviour.

Forbidden Fruit Effect

(Sort of like the reverse of the Symbolic Threshold Effect)

The illegal-ness of the drug makes it more attractive

Stigmatisation

Social effects / effects on reputation - i.e. loss of relationships, loss of job opportunities, public shaming

Farrington (1977) found that rather than reducing deviant behaviour, stigmatisation following arrest appeared to reduce future legitimate opportunities making deviant behaviours more likely


TLDR

  • Prohibition has a limited impact on reducing drug use
  • Many programs (prohibition, prevention, treatment) influence drug behaviour, but have limited efficacy over time
  • Treatment is the most cost effective