Anti-drug ads are most effective when showing actual suffering and providing actions to take. Education for prevention campaigns and ads work best when integrated with cessation or help resources like quit-lines or treatment finders. The CDC just launched a campaign, “Free Mind,” to teach youth about the connections between substance use and mental health. Allison Arwady, MD, MPH, director of the CDC’s National Center for Injury Prevention, said, “The goal is to prevent drug overdose by addressing this connection.”
Ranking Best Prevention Efforts
Among the best anti-smoking ads were those from the CDC. “CDC–Tips From Former Smokers,” launched in 2012, featured frightening testimonials from real people living with smoking-caused diseases; every ad carried a quitline/web call-to-action. The measurable impact was 16.4 million quit attempts and more than 1 million sustained quits.
Another “best” anti-smoking youth ad was from the FDA. Called “The Real Cost,” it showed the concrete “costs” of smoking/vaping to appearance and health. It prevented an estimated 380,000 to 587,000 youth from starting to smoke.
Another example, from the American Lung Association—Brooke Shields’ “Smokers are Losers” (1981) ad, with Shields ridiculing smokers, aired widely on TV. While it had very high visibility and sparked lots of discussion, it had no strong behavior-change evidence beyond awareness.
Ads from the Truth Initiative were successful, youth-driven, and edgy in their anti-industry counter-marketing (“Body Bags,” “Singing Cowboy”). They reframed smoking as manipulation by tobacco companies. Multiple longitudinal studies showed that exposure to these ads reduced initiation and led to 450,000 people never starting smoking. TV/radio spots instructed smokers to “relearn life without cigarettes,” and were tied to web tools. It was estimated there were 53,000 quit attempts and about 4,200 additional quits as a result of these ads.
Why Anti-Drug Ads Worked (or Didn’t)
Anti-smoking ads worked when they were credible, emotionally powerful, youth-centered, and supported by strong policy and a quit infrastructure. Anti-drug ads, by contrast, often over relied on fear alone and failed to link viewers to an action.
The “800-Cocaine” campaign (in the early 1980s) worked because it didn’t over-explain cocaine. It simply stated: “Cocaine is dangerous. If you need help, call 800-COCAINE.” Back then, cocaine’s harms were neither understood nor widely covered in the media. Doctors and governmental agencies didn’t realize cocaine was addictive. (We know now.) My colleagues and I launched this national helpline on May 6, 1983. Media outlets broadly announced the service, and I appeared in national media, explaining what ongoing research was discovering about cocaine.
In the late 1970s and early 1980s, cocaine was commonly framed as “nonaddictive,” the “champagne of drugs,” and safe. Which it is not! Organized psychiatry did not even include cocaine as addictive in the psychiatric manual, the DSM. “800-COCAINE” didn’t use sensationalism. It believed callers who said they had a problem and provided accessible help. The helpline’s data, scientific publications, media appearances, and my book 800-COCAINE (Bantam, 1984) helped build a data foundation that would eventually replace the nonaddictive myths.
Common Mistakes With Anti-Drug Campaigns
Most anti-drug ads teach people what they already know (“drugs are bad”). Education for prevention also often fails by not offering a clear next step (speaking with someone with lived experience, offering treatment). By contrast, the PRSA Silver Anvil-winning “800-Cocaine” worked more like a public service announcement than a morality play.
Basketball superstar Len Bias’s sudden and tragic death in 1986 from a cocaine overdose gave a tragic “real face” to the cocaine epidemic, and I appeared frequently in the media, explaining how it could have happened. I emphasized risks for addiction and sudden death with cocaine (cardiac arrhythmias, stroke), as well as chronic psychiatric issues. These medical warnings gave credibility while the national narrative was still forming. I also addressed parents, providing an urgency to talk with their kids about cocaine. So too did the other members of the Partnership for a Drug-Free America (PDFA) expert scientific advisory panel, which included a who’s who of experts like Drs. Herb Kleber, Mitch Rosenthal, Bob DuPont, Lee Robins, Denise Kandel, David Musto, Beny Primm, Joyce Lowinson, Pedro Ruiz, and Charles O’Brien. We explained in plain language cocaine’s addiction liability and health risks, supplied scientific authority, and urged action. The PDFA experts reviewed and made suggestions for advertisements, but also provided facts about cocaine, explained celebrity deaths and addictions reported by the media, and provided rational reasons to stop using cocaine. Shortly after Bias’s death, the most famous anti-drug ad of all time, “This Is Your Brain on Drugs,” was finalized and aired. It used the metaphor of an egg and a frying pan and became culturally iconic by creating almost instant recall among viewers. Still, it supported cocaine overdose emergency reports of real problems, like hyperthermia and seizures. The impact of this PSA is enormous, but it did not reduce teen use, but, it may have accelerated the prevailing adult use trends.
Two Newer Campaigns
The DEA’s response to the fentanyl death crisis, especially among people not intending to use fentanyl, is the One Pill Can Kill (fentanyl/counterfeit pills) campaign, focusing on educating the public about the risks of counterfeit pills containing fentanyl.
One Choice from Drs. Bob and Caroline DuPont’s campaign reinforces an easy-to-understand message of non-use. Non-users as a group have been growing, as the University of Michigan Monitoring the Future studies reported. The One Choice campaign highlights that starting substance use before age 18 leads to a 1 in 4 chance of developing addiction vs. 1 in 25 for those who start (or never use) after age 21.
Summary
Supported by many scientific advisors, PDFA—founded in 1985—created some of the most remembered print and TV anti-drug PSAs of all time. At the time, cocaine and crack cocaine use were rising sharply, and there was widespread fear of a national epidemic. But large-scale studies showed little to no PDFA-related reduction in drug use. Campaigns in 1983, like 800-Cocaine, provided a foundation to understand Len Bias’s death. Experts in the media discussing Bias, celebrity addictions, and deaths all helped accelerate the momentum, and medical experts agreed that cocaine was addictive. Anti-drug ads are most effective when showing actual suffering and providing actions to take.
