This month the world said goodbye to one of the most influential First Ladies to ever occupy the White House. Nancy Regan died at 91 years old of congestive heart failure on March 6, 2016. Regardless of where one may fall on the political spectrum, the impact she had on redefining the role of First Lady, as well as on social policy, cannot be disputed. One of her most notable efforts put substance abuse and addiction center-stage in the national conversation: the “Just Say No” campaign. These three words became a rallying cry during a time when Americans needed to believe they had control over a disease; however, the campaign may have had unforeseen negative consequences as well.
As much awareness as this initiative raised to the escalating drug problem that Americans were facing during that time, and continue to face, it might be time to reassess whether or not the message’s simplicity stands the test of time given what we now know about substance abuse, the conditions that lead to it and the factors that sustain it.
Although “Just Say No” only lived for seven years (1982-1989), those three little words resonated with Americans for many years afterward. At the campaign’s inception, Mrs. Reagan’s knowledge of the substance use problem threatening American youth was largely anecdotal, as several of her friends had children who were battling addiction. Her interest in helping addicts caused her to travel to treatment facilities all across the country, logging over 250.000 miles during her time in the White House in this pursuit. The actual phrase “Just Say No” was born almost by accident when a young woman asked the former First Lady what to do when she was offered drugs. The reply was simply to “just say no”. That exchanged sparked a national phenomenon, leading to the formation of over 12,000 clubs across the United States.
On October 27, 1986, President Reagan signed the “National Crusade for a Drug Free America” anti-drug abuse bill into law, giving “Just Say No” genuine legislative teeth. To the campaign’s credit, the Reagan Foundation reports that “Just Say No” led to a 30 percent drop in cocaine abuse among high school seniors from 1986 to 1987, and that just three percent of American high school graduates in 1987 reported daily marijuana use compared to 10 percent in 1978.
Although it may have struck a blow against substance abuse in the short term, the effects of “Just Say No” appear to have worn off in subsequent years. The National Institute on Drug Abuse’s 2015 Monitoring the Future Survey revealed that daily marijuana use among 12th graders is now more than six percent. For the first time in American History, daily marijuana use is more common than daily cigarette smoking among teens. Four percent of teens still report lifetime cocaine use, and are exposed to new and more deadly drug threats that weren’t even part of the conversation during the “Just Say No” years, such as heroin and prescription opioid abuse.
While drug use appears to be on the decline among the teenage population, it can be argued that this age group, as well as the rest of the country, remains more vulnerable than ever to more serious drug threats. The overdose fatalities that occur in young adulthood are often the result of substance use that originates during teenage years. More than 16 percent of college students report lifetime recreational use of prescription opioids. Addiction to prescription opioids commonly results in heroin dependency because the drug is much more accessible and affordable than drugs like Vicodin™ and OxyContin™. Despite the efforts of yesteryear, children are still having difficulty “just saying no” and are spiraling into addiction as a result. More teens now die of prescription drug abuse than heroin and cocaine combined.
Addiction is a complex and multilayered disease. It’s born from a variety of factors, including genetic predisposition, family history and economic background. The US Census Bureau reports that 3.7 million of those in poverty are in need of treatment for drug or alcohol addiction, but less than a quarter of those actually get the treatment they need. In addition to the clear link between poverty and substance abuse, many use drugs to cope with trauma and will look for an escape wherever they can find it. In recent years, we’ve even seen addiction develop within individuals who started off taking a legitimate supply of physician-prescribed medications; how is one supposed to say no to their doctor?
The “Just Say No” campaign was one of many well-intentioned anti-drug efforts that had a genuine positive impact on many people’s lives; however, it also ignored many cultural elements that lead to addiction in the first place, and may have even contributed to the perception of addition as a moral failing rather than a disease. As the addiction treatment community continues to learn more about the disease of addiction, and makes more inroads toward quality treatment, there needs to be a balance struck between the bold and empowering message of this campaign and an understanding that it’s harder for some to “just say no” than others.