Drug and Alcohol Review (1991) lO, lO7-113

Evaluation of a strategy for changing group stereotypes of the heroin user

JEFFREY WILKS & DEREK A. AUSTIN

Key Gentre in Strategic Management, Queensland University of Technology, and Depth First Technology, Brisbane, Queensland, Australia Abstract

This study examined characteristics attributed to a person using an illegal narcotic drug (heroin) and sought to change established stereotypes by participation in a group education experience. Prior to the main study, mo Advanced Psychology students generated lists of adjectives they would use to describe a heroin user. The most frequently mentioned characteristics were placed in structured lists as pre- and post-test measures. Both semantic differential and open-choice formats were used. The Prevention Role Play, a recently developed strategy in drug education, was used to challenge the group's stereotypes. Significant shifts in attributions were revealed between the pre- and post-test measures. After the Role Play students reduced their negative stereotype on a number of dimensions though they still described the heroin user as confused, insecure, troubled and lonely. The discussion considers possible strategies for facilitating positive attitude change. [Wilks J, Austin DA. Evaluation of a strategy for changing group stereotypes of the heroin user. Drug Alcohol Rev 1991; lO: 1o7-II3]

Key words: opiate use; heroin; attitudes; students; drug education.

Introduction

When most people hear the word 'drugs' the images that readily spring to mind are those of illegal substances such as heroin, LSD, cocaine and marijuana. The stereotypes associated with these drugs, and the people who use them, are generally negative and well-entrenched within the Australian community [1,2].

In one early study, Douse [3] found that users of narcotics were described by community groups as lonely, depressed, misguided, maladjusted, unreli- able and sick. More recent investigations reveal a similar focus. For example, a majority of North Queensland university students report that they would expect to feel irritated, desperate, afraid, sorry and sad after using heroin. A few positive

effects were also anticipated (fed;rig strong and clever), but these were far outweighed by the expected negative affect [1]. The media advertise- ments developed by the National Campaign Against Drug Abuse (NCADA) reinforce this stereotype of desperation and despair.

One negative aspect of this portrayal is that heroin-dependent persons may be more reluctant to seek treatment as a result. If they do seek help, the care given may be less than optimal if staff have preconceived and negative stereotypes about the drug user [4]. As discussed elsewhere, tertiary students in the helping professions (e.g. psycho- logy, medicine, law and the health sciences) are an important study group since many of these young

Jeffrey Wilks, PhD, Postdoctoral Fellow, Key Centre in Strategic Management, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland, 4oo~, Australia. Derek A. Austin, BA (HoDs), Dip Comp Sci, Consultant, Depth First Technology, ~2 Little Street, Kelvin Grove, Brisbane, Queensland, 4059 , Australia. Preliminary findings from this study were presented at the i8th Annual Meeting of Australian Social Psychologists, Coolangatta, Queensland, May, i989. Correspondence and requests for reprints to Dr. Wilks.

Io7

IO8 sreffrey lllilks ~ Derek ,4. Austin

men and women may later come into professional contact with clients who have alcohol and drug problems [5]. Challenging the stereotypes of these young professionals may help in dispelling some of the myths surrounding their future client's drug use. While it can be argued that tertiary students are a special population, it is also important to recognize that these young people share very similar attitudes and beliefs about illicit drug use with their parents [2], and with adults in the general community [i]. Successful attempts to modify the myths of drug use held by students may also be useful for wider community groups.

In attempting to educate the community and provide a realistic picture of drug users, several strategies are popular. These include films, lec- tures, media campaigns and small group discus- sions. One problem with these approaches is that they are sometimes perceived by the target audience as artificial--talking about people we don't know--and not really challenging existing beliefs or stereotypes. As an alternative, social psychologists are recognizing the potential of role plays as a powerful technique for attitude change in the drug education field [6-8]. The present study used a recently developed technique called the Prevention Role Play in an attempt to change one group's existing beliefs about heroin users. The study extends and validates previous work [8] by introducing additional measures to tap stereo- types;of the heroin user.

Methods

Subjects

One-hundred tertiary students (27 males, 73 females) taking an advanced course in social psychology participated in the study. Males were, on average, 24.7 years of age (range I8-42) and females averaged 25. 3 years (range i8-5o ).

Procedures

In the first week of classes students were asked to write down on a piece of paper, five adjectives they would use to describe a heroin user. No informa- tion was given about this question, except that the material would be used later in the semester as data for a research report they would be writing.

A total of 2o2 different adjectives were gener- ated by students. Among the more frequently

mentioned were: lonely (32 nominations), desper- ate (32), dependent (i6), pathetic (i4) , insecure ('3), alone (~,), lost (io) and sad (io). Following the methodology used in previous studies of ethnic and racial stereotypes [9,1o], and stereotypes of abstainers and heavy users of alcohol [HI, the most frequently used adjectives were assigned to a structured master list. In the main study, students chose from this list five attributes to describe a heroin user. The advantage of a structured list was that the choice of specific attributes was limited and could be compared over time, while an Index of Uniformity or the definitiveness of the stereo- type could also be calculated. The index is the number of adjectives required to account for half of the students' responses each time.

Comparisons of the adjectives generated by students with ones used in a previous study examining stereotypes of a heroin user [8] revealed a number of common descriptors. To test the reliability of the previous findings, the original measure in the form of a semantic differential [see ref I2] was retained. Five new adjectives identified by the open-ended responses were also added to the semantic differential.

In the fourth week of semester students partici- pated in the Prevention Role Play. This technique aims to challenge people's current beliefs about drug use and to show that the pathology of keeping a secret (in this case, a secret about drug use) can tear a family apart. Ideally, there should be two trained facilitators for the Role Play.

The prevention role play

The facilitators begin by informing the group that they wish to form a typical local family, consisting of father, mother, teenage son or daughter (the target child is usually about x 7 years of age), a boyfriend or girlfriend of the target adolescent, and a younger brother or sister (about i2 years of age). Group members of either sex are encouraged to volunteer for these five major roles.

Having established actors in the main roles, the facilitators then ask the group to provide a background for each role. For example, the father must be given a name, age, occupation, hobbies, interests, and personal characteristics in keeping with a father in a typical local family. Similarly, a complete character for the mother must be developed. The group also decides whether their

Ghangdng stereotypes of heroin users Io 9

typical teenagers are still attending the local high school or have moved into the workforce.

All group members participate in this character development process and it usually turns into a very funny and enjoyable part of the exercise. Many interesting stereotypes and personal beliefs emerge from the group. One of the facilitators records information about the characters on a blackboard for all to see, while the other monitors time and guides the process of role definition. A description of the characteristics generated for family members in the present study is presented in the Appendix.

As the actors are placed in their roles they sit around a table situated in the centre of the room. The rest of the group sit in a large circle and become the wider community. The roles of next- door-neighbour, extended family members, friends of the main actors, workmates, peers at school, police and other key community figures are allocated to the large group. This ensures that all members participate throughout the Role Play.

Scene I

The facilitators stress that this family is typical of families in the local area. The one thing they do every week, however, is to get together for dinner on Friday night. This is a firm commitment. The facilitators then ask the family members to act out a typical Friday night dinner together. This will run for about IO minutes and it gives the actors a feel for the roles they are adopting. At the end of the scene the facilitators may ask the family members, and the larger community, what they thought of the scene. For example, was it typical of a local family?

Scene 2

In the second scene the facilitators introduce a secret into the family. It can be any secret, but drug use works well. Heroin use, in particular, tends to be very powerful. It establishes a fast pace, with plenty of audience participation and interest.

The facilitators announce that the older son or daughter has been to a party the previous Saturday night and has tried his/her first shot of heroin. No one else knows about this. The family are asked to act out the scene of dinner the following Friday night. Again the scene will run for about io minutes. At the end the facilitators ask the group

about any changes they noticed between the first and second scenes.

Scene 3

In the third scene the facilitators state that it is now 6 months later and the son or daughter has a heroin habit which is costing $5 ° per day. The family again role plays the Friday night dinner. Changes in social relations, conflict about money and household items going missing, deterioration in health and lack of interest in activities are some of the issues that often emerge in this scene. The community are also willing to report noticing differences in the functioning of the family.

Scene 4

The fourth and final scene of the Role Play takes place r2 months later. At this time the son or daughter had a heroin habit costing between $200 and $300 per day. The boyfriend or girlfriend may have been told, but at the beginning other family members have not been told about the secret. The Friday dinner is acted out. This is usually a very powerful scene and the facilitators must carefully monitor the actors to ensure that no one is negatively affected. At the end it is helpful for the facilitators to instruct the actors to bring the secret out into the open (if they have not already done so). The views and support of the larger commu- nity are critical at this point.

Debriefing

Drawing together all the thoughts, ideas and emotions generated by the Role Play takes time and skill. This is one reason that two trained facilitators are recommended. It is important during the debriefing to stress that the secret, rather than the drug itself, was the main problem that caused so much destructiveness within the family. At the same time, the use of heroin in the play provides an excellent opportunity to challenge many negative stereotypes about drug users. After all, each group creates its own 'local family' so there is a sense of familiarity with the characters and this makes the drug problem more personal.

Pre-test measures

When they arrived at the lectur~ hall, students

Ho Jeffrey IgZilks & Derek A. Austin

were requested to choose from the structured list of 26 adjectives, five adjectives they would use to describe a heroin user. Having completed this request, students were then asked to examine the semantic differential items (26 items) and rate a heroin user on each one.

The characteristics presented were: young-old, educated-uneducated, powerful-powerless, re- ligious-non-religious, helpful-unhelpful, industri- ous-lazy, likeable-unlikeable, little-big, reliable -unreliable, friendly-unfriendly, good-bad, at- tractive-unattractive, intelligent-stupid, active- passive, pleasant-unpleasant, strong-weak, under- standing-confused, cheeful-desperate, calm- afraid, glad-sorry, happy-sad, healthy-unhealthy, secure-insecure, rich-poor, normal-different, stable-unstable. Each characteristic was rated on a scale of i -6 (e.g. I=young, 6=old).

Several of these adjective pairs were chosen from the original form of the semantic differential [I2] which found that across studies human judgments were well described by factors of evaluation (e.g. good-bad), potency (strong-weak), and activity (active-passive). All adjective pairs have been previously used in studies examining characteristics of drinkers [i31 and drug users [I,8].

Post-test measures

After participating in the Role Play for about 2 hours students were asked to again choose five adjectives they would use to describe a heroin user from the structured list, and also to complete the semantic differential. The only difference between the pre- and post-test lists was that in the post-test the items in both measures had been randomly assigned to control for possible order effects in presentation.

Results

In the pre-test structured list students most frequently chose the adjectives dependent, insecure, addicted, unstable and desperate to describe a heroin user. The Index of Uniformity showed that students used up to 7.66 adjectives in deciding upon their stereotype. Following the Role Play, there was a large shift in choice, with confused, insecure, troubled, lonely, and helpless being most frequently chosen. The Index of Uniformity revealed that students required a smaller number

of adjectives (6.33) to describe their stereotype after participating in the Role Play. Table x presents these results, and also a breakdown of the most frequently chosen adjectives by males and females.

Table r reveals a number of interesting shifts for males and females. In the pre-test, males most frequently chose the adjectives: dependent, in- secure, addicted, desperate and lonely. Post-test choices favoured the descriptors: confused, in- secure, lonely, troubled, alone and depressed. The Index of Uniformity was also reduced from 7-44 to 5.72 showing that males held a more concise group stereotype after the Role Play.

Females' pre-test choices also focused on the adjectives dependent, insecure, unstable, addicted and troubled. Post-test shifts showed a preference for the descriptors: confused, insecure, troubled, unhappy, lonely and helpless. While the female Index of Uniformity was reduced from 7.31 to 6.22 in the course of the exercise, it was still consider- ably higher than that of males.

A Multiple Discriminant Analysis conducted on student ratings for the pre- and post-test semantic differential items revealed a significant multivari- ate effect for the full sample of respondents (Wilks Lambda=o.62~ F : 3 . 9 6 ; df=25, i59; P<o.ooi) . Table 2 presents the mean ratings and univariate F values for the bi-polar adjective pairs.

Significant shifts occurred on seven scales. After the Role Play students perceived a heroin user as: more powerless, sadder, more passive and poorer. At the same time, positive shifts included perceptions of the heroin user as: more healthy, more educated and a better person. Many perceptions remained the same. For example, a heroin user was viewed as a young person, weak, unstable, afraid, confused, insecure and unreliable.

Discussion

Stereotyping often occurs in the absence of any personal experience with the target individual, group or behaviour. This is particularly true of illicit drug use and drug users [I4]. In the absence of personal experience people form stereotypes based on heresay, sensationalist media presenta- tions and, at the present time in Australia, on a government campaign. In this case, the National Campaign is based on research tapping fairly accurate community perceptions that many heroin users are depressed, unhealthy, frightened and

Changqng stereotypes of heroin users III

Table x. Most frequently chosen adjectives to describe a heroin user.. percentage of respondents by sex

Male Female All respondents

Trait Pre Post Pre Post Pre Post

Dependent 41 I5 45 2i 44 19 Insecure 41 52 41 40 41 43 Addicted 37 22 33 14 34 i6 Unstable 22 15 36 i6 32 i6 Desperate 3 ° 15 29 16 29 16 Lonely 26 41 29 33 28 35 Troubled I5 37 3 ° 4o 26 39 Confused 3 ° 63 22 67 24 66 Pathetic 22 1i 25 14 24 13 Unhappy 33 I5 I9 33 23 28 Alone I5 33 25 16 22 2i Depressed 26 33 19 2I 21 24 Needy 26 19 19 15 2 I I6 Weak 22 19 19 2I 20 20 Unfortunate 22 19 I6 I2 18 14 Helpless 22 22 14 33 16 3 ° • Sad I9 4 ix io 13 8 Disturbed 7 15 I5 8 13 IO Sick 1i 7 12 8 I2 8 Stupid II II IO 7 IO 8 Lost I1 II 5 I8 7 16 Neglected 4 IX 7 22 6 19 Poor o 4 7 3 5 3 Nervous o 4 7 8 5 7 Dirty 4 o 3 i 3 i Normal 4 4 3 3 3 3

Index of Uniformity 7.44 5.72 7.31 6.22 7.66 6.33

Percentages rounded to. the nearest whole number. Males, n=27; females, n = 7 3 ~ all respondents, n= ioo .

unattractive young people. While this message is intended to dissuade youth from becoming in- volved in illegal drug use it also has the effect o f perpetuating t h e stigmatized image of the heroin user.

Tertiary students in the present study held many of the same stereotypes that have been identified within the general Australian popula- tion [x-3]. Prior to the Role Play they labelled the heroin user as dependent, insecure, addicted, unstable and desperate. Semantic differential rat- ings portrayed the heroin user as young, but with all personal characteristics related to the negative poles of the rating scales.

Following participation in the Prevention Role

Play, which challenged many of their previous stereotypes, students were more likely to describe the heroin user as confused, insecure, troubled, lonely and helpless. The attitude shift that occurred appears to be very broadly from a stereotype related to the pharmacological effect of the drug (e.g. dependent, addicted) to a constella- tion more related to the perceived psychological inadequacy of the drug user (e.g. troubled, confused). Psychology and social work students' willingness to accept humanistic rather than medical illness explanations for drug abuse [i5] may be reflected in the pattern of attitude change noted here. However, it can be argued that both the pre- and post-test adjective clusters represent

rI2 leffrey l#'ilks ~ Derek A. Aust in

Table z. Semantic differential mean scores for all respondents

Rating r-6 Pre-test Post-test F

Powerful-powerless 4.51 5.oi I3.58"** Healthy-unhealthy 4.99 4.49 9.3 °** Educated-uneducated 3.59 3.28 7-86"* Happy-sad 4.65 5.o4 7.oi** Good-bad 3 .86 3.53 7 .°I** Active-passive 4.zo 4.54 5-37* Rich-poor 4.o3 4.33 4-65 * Industrious-lazy 4.II 4-35 3-73 Stable-unstable 5.i3 4.88 3.64 Calm-afraid 4.75 5.o4 3-44 Attractive-unattractive 4.°3 3.85 2.56 Normal-different 4.I6 4.oo 2.55 Understanding-confused 4-97 5 .22 a-°9 Pleasant-unpleasant 4.o 3 3.9 ° 1.57 Glad-sorry 4.49 4 .66 i-34 Secure-insecure 5 .2I 5.39 x-27 Cheerful-desperate 4-92 4.77 i.o6 Intelligent-stupid 3.95 3.82 o.66 Reliable-unreliable 4.83 4.8x o.6o Likeable-unlikeable 3.71 3.63 °-59 Little-big 3.x2 3.o7 o.3o Religious-non -religious 4.23 4. I7 o. 26 Young-old 2.62 2.68 o.2i Strong-weak 5.o5 5.06 o.o 5 Friendly-unfriendly 3.74 3.72 o.oo

Helpful-helpless was dropped from the analysis due in the questionnaire; number of respondents = xoo.

***p<~o.ooI; **p<o.oI; *p<o.o 5.

to a printing error

negative stereotypes, albeit different ones. To a large extent this result is unavoidable since students were constrained to use the same adjec- tive list before and after the Role Play. Future studies might consider allowing participants to generate their own descriptors in the post-test phase so that new, more positive characteristics might emerge.

Exploratory multiple discriminant analyses were conducted on the semantic differential ratings for males and females separately. The results for both groups were very similar, however, due to the small number of males in the sample multivariate manipulations were not considered statistically stable. Future studies are encouraged to further examine the possibility that sex differences may exist with stereotyped images of drug users, not only in the choice of labels but also in the strength or pervasiveness of the image. As Table i showed,

both males and females used very similar adjectives to describe a heroin user prior to the Role Play, but the male group emerged from the learning exercise with more of a consensus about their stereotype. Females, on the other hand, still considered a larger range of characteristics in relation to the heroin user.

Saks and Krupat [7] suggest that role plays are one of the most potent and reliable attitude change techniques. However, they are not without their hazards. Despite the debriefing that followed the present role play, a large number of casualties occurred. For nearly 2 weeks many students were upset. Some came for counselling and spoke of incest, domestic violence, rape and drug problems in their families. It seems that by creating 'a typical local family' the facilitators tap very real and frightening personal experiences. Since such rote plays are often run as a 'one-ofF educational

Changing stereotypes of heroin users Ir 3

exercise in schools and community groups we may not be aware of the unresolved problems we draw to the surface and leave for individuals to cope with by themselves. Being available on campus and having an opportunity during tutorials to fully discuss this experience with students allowed many to address buried issues and fears. In future, however, all facilitators of role plays must recog- nize their professional responsibility to provide planned and adequate follow-up when using this powerful technique.

Having changed students' beliefs about drug use and drug users it is important to also follow up with educational opportunities for understanding the addiction process. Students in this study were given the results of the adjective check-list and semantic differential measures. They then used the library to prepare a detailed empirical report on the exercise. Some students even sought place- ments within local drug assistance agencies. These experiences further highlighted the fact that not all drug users fit the stereotype of desperation and despair portrayed by the media. Nor are drug users a homogeneous group. Hopefully, these insights will assist those students who continue on to a career in the helping professions.

References

It] Grichting WL, Barber JG, Walsh C. The drug offensive at work in North Queensland x986. Townsville: James Cook University of North Queensland, i986.

[2] Wilks J, Callan VJ. Perceptions 0flegal and illegal drugs: comparisons of parents, adolescents and best friends. Drug Alcohol Rev i99o~9i:3H-3x 9.

[3] Douse M. Drugtakers: a study of stereotypes. Ment Health Aust 2972~5:26- 9.

[4] Krivanek JA. Drug problems, people problems. Sydney: George Allen & Unwin, 2982.

[5] Wilks J. Student drinking patterns: experience in an Australian population. Aust Drug Alcohol Rev I986;5:3- 7.

[6] Mann L, Janis IL. A follow-up study on the long- term effects of emotional role playing. J Per Soc Psychol 2968;8:339-42.

[7] Saks MJ, Krupat E. Social psychology and its applications. New York: Harper & Row, 2988.

[8] Wilks J. The prevention role play: an educational strategy for challenging beliefs about drug use. Drug Educ J Aust 2989;3:22- 5.

[9] Katz D, Braly DW. Racial prejudice and racial

stereotypes. J Abnorm Soc Psychol I933;3o:175-93.

[io] Callan VJ, Gallois C. Ethnic stereotypes: Austra- lian and Southern European youth. J Soc Psychol I983;n9:287-8.

[ii] Wilks J, Callan vJ. Alcohol-related attitudes and stereotypes: teenagers in Australia, Papua New Guinea and the United States. J Drug Educ I984;14:119-32.

[12] Osgood CE, Suci GJ, Tannebaum PH. The measurement of meaning. Urbana: University of Illinois Press, x957.

[13] Wilks J. University students" knowledge of alcohol and drink stereotypes. Comm Hlth Stud 2985;9:231-7.

[24] Dean JC, Rud F. The drug addict and the stigma of addiction. Int J Addict 2984;19:859-69.

[25] Engs RC. Drinking patterns and attitudes toward alcoholism of Australian human-service students. j Stud Ale I982~43:527--3L

Appendix

Characteristics attributed to roles

Father, Iohn. John, Johnno to his mates, is a 4u-year- old Railway clerk. He is a short, balding man who enjoys the speedway, horse racing, watching sport on the television and having a few drinks with his mates at the pub.

Mother, Beverly. Beverly is a 4o-year-old housewife. She is fairly robust, enjoys bingo and the soapies. She shops at Kockmans and suffers from severe migraines. Beverly smokes Winfield Blue.

Daughter, Michelle. Michelle is 17 years of age and rides her pushbike to North Rockhampton High School where she attends as a year i2 student. She has a part- time job with Franklins. She has bleached hair and bad acne and likes playing netball. Michelle also likes boys and has a boyfriend Wayne.

Boyft4end, lP'ayne. Wayne is 18 years of age and works at Chippindale Motors as an apprentice mechanic because he is very interested in cars. He drives a Holden panel van and a favourite hang out is the local Mobil. Wayne plays front row forward in football and has long hair. He likes to drink and also smokes Winfield Red.

Sibling, Sharon. Sharon is Michelle's younger sister. She is ra-years-old and is in grade 7 at Frenchville State School. Sharon doesn't like school, but does like rollerskating, videos and is fashion conscious. Sharon is not very smart, but she does have a crush on Wayne.