The right message can help prevent and combat substance misuse, but it has to be crafted correctly.

“Health communication and media messages are important for public health, but they’re not a cure-all,” says Jessica Willoughby, associate professor and Lester M. Smith Distinguished Professor of Communication in the Edward R. Murrow College of Communication at Washington State University. “Messaging has to be done in conjunction with access to resources. Campaigns are certainly useful, but they cannot work alone.”

Profile head shot of Jessica Willoughby
Jessica Willoughby
(Courtesy Jessica Willoughby/X)

From access to resources to desired outcomes, target audiences, and avoiding stigmatization, there’s much to consider when crafting campaigns about substance misuse and prevention. This is Willoughby’s niche.

“My interest has been very much in harm reduction and helping people find a path to being healthy and well,” says Willoughby (’08 Comm., ’10 MA Comm.), a WSU faculty member since 2014. While her specialties are alcohol and cannabis, strategies could apply to other substances, such as fentanyl. “Fentanyl is more popular in the media right now because there is an increase of fentanyl overdose cases,” she says. “It is problematic, so people are paying attention.”

The fact that people are paying attention could be a good thing. Messaging around substance misuse and prevention might reach more people. Audience is a key factor. “You have to know who you are trying to reach,” Willoughby says. “Your message is very different to someone who is already using than to someone you want to prevent from using.”

Crafting a message and the marketing around it depends on the goal. Is the campaign meant to raise awareness or influence behavior? In prevention, the goal is often simple: Don’t start using a particular substance. “Once someone has started using a substance, it can be very hard to stop, depending on the properties of that substance,” Willoughby says. In a harm reduction strategy, “You might already be using, but can we get you to reduce your use? Or, is there an alternative strategy that could get you to stop using altogether?”

No matter the target audience, Stacey Hust (’00 MA Comm.) recommends market testing for all messaging. “A lot of times health practitioners gathering information on a particular substance feel like they know how or why people use that substance. But they don’t actually talk with members of their target audience. So they don’t truly understand the audience members’ motivations to use the drug or how they are using that substance.”

Profile head shot of Stacey Hust in front of a bookshelf
Stacey Hust (Courtesy Edward R. Murrow College of Communication)

Hust, a professor and associate dean of faculty affairs and college operations at Murrow College, has worked at WSU since 2005. She specializes in health communication, specifically messaging around preventing substance misuse and sexual assault.

In a recent prevention campaign, her team of researchers was “interested in the physical risks that people take when they are inebriated, in order to prevent those behaviors. We drafted a message for members of the Greek community about students who wanted to climb a bus stop (while under the influence) and were quickly reminded that there are not many bus stops on Greek Row,” Hust says.

That prompted researchers to alter their message. Instead of climbing a bus stop, they included the example of car surfing, or trying to ride atop a moving vehicle, “because that was what our male focus-group participants told us they were doing when they got drunk,” Hust says. “By market-testing, we could create a message about being safer while consuming alcohol and communicate it with a particular example that they were familiar with.”

Effective messages might show that “something that feels like one small choice can have long-lasting ramifications down the line,” Willoughby says.

While emotional appeals can be effective, messages of fear don’t always work. They aim to scare people into doing or not doing something, such as saying that using a particular substance even one time can prove fatal.

“If someone is already using and it’s gone OK for them, the message doesn’t really resonate,” Willoughby says. “If you’re going to scare someone out of doing something then you need to make sure you give them information to make them feel empowered.”

Without a call-to-action or way to handle the fear, such as where or how to seek treatment, she says, audiences “are just sort of stuck in this fear moment.”

Still, some of the most memorable substance misuse and prevention campaigns use fear. Consider 1987’s public service announcement comparing the brain to an egg. In the television version, the egg is cracked into a sizzling frying pan, and the audience hears, “This is your brain on drugs.”

More recently, the 2004 “Faces of Meth” project by the Multnomah County sheriff’s office in Oregon features mug shots of real people with repeat arrests. Hust warns, “You don’t want to stigmatize a user because it could have a boomerang effect.” Stigmatization “could turn someone to something harder or different or more harmful. That goes for all substances.”

Services and support should combine with messages. “We have to think not only about the messages we’re creating but the structures that are in place to reduce misuse and help people be successful in seeking treatment,” Willoughby says. “Access to resources has to be part of the strategy.”

The same goes for readability. In general, text shouldn’t be too advanced or too low-level, Hust says, noting, for example, high school and college students don’t process messages the same way. Or if the target audience experiences rates of low literacy, more emphasis might be needed on a campaign’s visual elements. And, Hust says, “You should market-test each aspect with your target audience”—images, color, text—“everything.”

Delivery is also important. “You can’t just put something on the radio or on TV,” Hust says. “You have to know where your target audience is getting their information. Maybe it means putting flyers in public restrooms or in the campus commons.”

Work is ongoing. “You have to gather data on a routine basis in order to create good messages,” Hust says. “Trends in consumption change over time, and you have to adapt and know their motivations for using and how they’re using.”

The bottom line, Hust says, is that “effective health communication messaging can help individuals make positive decisions about their health.”


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Substance use and addiction  (Feature Part 1)

Contingency management works, so why isn’t it being widely used?  (Feature Part 2)

Understanding pain  (Feature Part 3)