Peter R. Martin: Historical Vocabulary of Addiction, Vol. II

Media

        According to the current electronic version of the Oxford English Dictionary (OED), the noun media was formed within English by conversion and is the plural of the noun medium, which is from the classical Latin medium, meaning “middle, centre, midst, intermediate course, intermediary.”  In post-classical Latin medium “also means…[the] middle term of a syllogism…, intervening substance…, use as noun of neuter of medius, middle, central, intervening, intermediate, moderate, middling…  The plural form media is after the regular Latin plural…  From the plural form media, …a new singular has arisen...” There is still some discussion about whether the word should be considered singular or plural, but plural or singular mean much the same.  As stated in OED, “The treatment of media as a singular noun… is spreading into the upper cultural strata.”

        The first appearance of the noun medium in the English language dates to 1573-74, when it appeared in The evolution of the English corn market from the twelfth to the eighteenth century (Gras 1926):“What mediam [sic] have you made of the price of the severall [sic] sorte [sic] of the said corne [sic].”  This now obsolete usage is defined in OED as: “A geometric or arithmetic mean; an average.” 

        The modern use of the noun medium is exemplified by a well-known quotation from Understanding Media: the Extension of Man (McLuhan 1964): “The medium is the message.”  Marshall McLuhan (1911–1980), who is credited with this quotation, was a Canadian philosopher whose contributions laid the foundation of media studies,or theory, defined in OED as: “analysis of the mass media; study of the media as an academic discipline.”  This field of study focuses on understanding fundamental characteristics of the media that can influence or shape human goals and behaviors and the means whereby these ends are accomplished.  Therefore, media may play an important role in understanding and modifying all motivated behaviors in the modern world, among them addiction.  The role of social learning of various forms  serve as the underpinnings of the dysfunctional behaviors that contribute to development of addictive disorders (DeFeudis 1978). 

        McLuhan’s quotation indicates the very close etymologic and conceptual link between the earlier-used version medium and its more recent equivalent form media.  An example of the first use in the English language of the noun media appeared in a monograph Advertising and Selling (Praigg 1923): “Mass media represents the most economical way of getting the story over the new and wider market in the least time.” The corresponding definition of media in OED is: “The main means of mass communication, especially newspapers, radio, and television, and (from the later 20^th century) content accessed via the internet, regarded collectively; the reporters, journalists, etc., working for organizations engaged in such communication.”  

        In the current world, the concepts represented by the terms medium and media are highly relevant to the field of addiction.  Through social and related learning mechanisms (Bandura and Walters 1963), exposure to these means of mass communication (newspapers, radio, television, and content accessed via the internet, regarded collectively) can potentially influence consumption of alcohol/drugs as well as engagement in many other out-of-control and self-destructive behaviors as those typified by behavioral or processaddictions, e.g. over-eating and gambling.  There is very strong evidence that the veritable leap of gambling into public awareness as a disease (Martin 2021b) is predominantly related to accelerating development of communication media using the internet which has provided the ideal venues for expression of pathological gambling behaviors and their consequences (Fauth-Bühler and Mann 2017).  Under these circumstances, the media serves both to attract attention to the gaming activity via advertising and as the instrument of gambling, meaning that the medium is indeed the message. 

        Advertising in the media at a significant cost to those who wish to publicize their products or services is typically intended for profit of these business enterprises (Rothman 2012).  However, the media can also serve as a very powerful force based in social learning to benefit society wherein the required costs are from the public or philanthropic purse. 

        Just as the actual consequences of the media may be harmful or advantageous to those who are exposed to these messages, the effects can also be intended or unintended.  In unintended effects of media, costs are not typically sustained by an (overtly) interested party or group but occur as part of an independent purpose. For example, it has been found that media messaging can have the unintended result of increasing themes or content related to alcohol or drug use behaviors in popular forms of music (Herd 2005), and thus, a potential stimulus for alcohol/drug use by those exposed to this music. 

        Overall greater health-adverse and fewer health-beneficial advertisements were found to be broadcasted on Spanish-language than on English-language television programming which may serve as a commercial determinant of health disparities for Latino populations by Spanish-language broadcasts (DuPont-Reyes, Hernandez-Munoz and Tang 2022).  Additionally, restricting the advertising of distilled spirits has had the effect of shifting consumption preferences of underage drinkers to beer and wine (Mosher 2012).  Subsequently, younger drinkers, as they came of age, continued this preference, thereby greatly reducing market demand for distilled spirits until contravening advertising strategies were eventually employed to reverse this trend. 

        When engaged by corporate entities, media are governed by market forces that define how their uses might be most profitable rather than what serves the health and welfare of society (Millar 2013).  When engaged by the government, foundations, or so-called “good companies,” appropriate media campaigns can be implemented to prevent or diminish a variety of addiction-related behaviors (Martin 2020).  There has been considerable research in the effectiveness of various programs designed to prevent smoking and alcohol and drug abuse (Perry 1987) and the relation between media resistance and drug refusal skills (Epstein and Botvin 2008). 

        To date,  reduction of health risks associated with smoking have been the most successfully implemented (Neeman and Neeman 1975) and alcohol counter-advertising has been somewhat less successful (Agostinelli and Grube 2002).  Thus, the media have the potential to be the instruments of substantial societal benefit (Anderson 1994).  As agents of change, media can shape behaviors relevant to addiction and related health issues (Comello and Slater 2011), and thereby, can influence the prevalence and consequences of addiction-related disorders in the population. 

        The potential for unethical use of media is profound when it is employed predominantly for profit.  Academic studies have demonstrated (Rothman 2012) that media can be instruments of “medicine–industry relationships [which] have worked to the detriment of public health and professionalism by using the tobacco, alcohol, and pharmaceutical industries” to enhance utilization within the population of their manufactured products, the use of which underpin psychopathological phenomena that can coalesce in at-risk individuals to lead to development of addictive disorders.  These industries (Rothman 2012):

        “have appropriated medical authority to improve marketing. They have dispensed research grants, made sizeable gifts to medical institutions, and given sizeable honoraria and consultantships, all as mechanisms of influence. Moreover, these industries have mounted extensive public relations campaigns that appeal to the needs of public health but that, in reality, serve industry's own economic interests.”

        A powerful contemporary example of these phenomena, namely the role played by the medical media in motivating physicians to prescribe first benzodiazepines, and subsequently, opioids has been succinctly documented (Keefe 2021).  

        Even if there is strong scientific evidence of the harmful health effects of certain behaviors like cigarette smoking, it is now recognized that the tobacco industry employed (Brandt 2012):

        “sophisticated public relations approaches to undermine and distort the emerging science…creating a scientific controversy through a program that depended on the creation of industry–academic conflicts of interest. This strategy of producing scientific uncertainty undercut public health efforts and regulatory interventions designed to reduce the harms of smoking.”

        For example, as almost 90 percent of adult smokers start smoking as teenagers, the manufacture and availability on the market of flavored cigarettes provided strong impetus for very profitable media messaging for the tobacco industry directed specifically to those of this very vulnerable age.  In a statement related to the US Food and Drug Administration (FDA) banning of flavored cigarettes, Sen Tom Harkin (D, Iowa) proclaimed (Mitka 2009):

        “Banning  the marketing and use of strawberry, chocolate, and other flavored cigarettes will help slow the rate of addiction among young smokers, prevent disease, and save millions in health care costs down the line.”

        Of course, increases in the use of legally available drugs are vital precursors of the out-of-control and self-destructive use of other drugs of abuse that can lead to indiscriminant use and addiction to illicit substances (Kandel 1975).  Eventually this may greatly contribute to the current public health crisis based on an epidemic of overdose deaths from opioids, benzodiazepine and alcohol (Tori, Larochelle and Naimi 2020).  It is now uncertain what role cannabis advertising will eventually play in the media as this agent (Martin 2021a) becomes more widely legalized in multiple jurisdictions and corporations are formed to profit from the widespread use of cannabis-related products they succeed in bringing to market (Nadelmann 1989).  The challenges of cannabis legalization bears strong parallels with legalization of alcohol following its prohibition (1920 to 1933) in the United States (Hall 2010).  Will the corporate entities that manufacture cannabis products implement media messages for advertising their wares to the populace, or will government attempt to intercede in analogous ways to those used at the end of the 20^th century for distilled spirits and tobacco?

        Although it may be difficult to demonstrate that alcohol advertising specifically affects the amount of drinking (Smart 1988), there is some evidence that young underage drinkers may be particularly vulnerable to these messages (Aitken, Eadie, Leather et al. 1988).  There has been much interest in understanding and enhancing the profitability of media messaging.  One example is the changing history of using images of women in advertising of distilled spirits during the period 1956-1979 (Marsteller and Karnchanapee 1980).  The involvement of women in advertising progressed from an era of prohibiting inclusion almost completely to frankly utilizing women to promote brands of distilled spirits by incorporating frank sexuality into the message. 

        The recognized power of the media in shaping addictive behaviors, has led to considerable legislative efforts to modulate the character of the messages promulgated and corporate utilization especially with respect to alcohol and tobacco. The best of such legislative directives are based on an understanding of the psychological power of the media as well as its potential to cause harm to health and well-being and the means whereby this is accomplished.  Hence, these legislative endeavors are specifically crafted to mitigate the known and most important attributes of the media message that may result in harm and could produce addictive disorders.  An early example of such legislative directives was formulated by members of the European Community for television advertisements of alcoholic beverages (Anderson and Lehto 1994):

        “(a) it may not be aimed specifically at minors or, in particular, depict minors consuming these beverages

        (b) it shall not link the consumption of alcohol to enhanced physical performance or driving

        (c) it shall not create the impression that the consumption of alcohol contributes towards social or sexual success

        (d) it shall not claim that alcohol has therapeutic qualities or that it is a stimulant, a sedative or a means of resolving personal conflicts

        (e) it shall not encourage immoderate consumption of alcohol or present abstinence or moderation in a negative light

        (f) it shall not place emphasis on high alcoholic content as being a positive quality of the beverage.”

        One need only examine each of the above points to appreciate exactly how specific advertising “hooks” have been targeted by the legistlation with the purpose of minimizing the attraction to at-risk populations of the alcohol product that is being advertised.  Perhaps the legislative goal is to make the cost of advertising prohibitive compared to predicted gains in sales through use of the media. 

        In a recent Delphi panel consensus study of policies and interventions to reduce harmful gambling the significant contribution of media is emphasized (Regan, Smolar, Burton et al. 2022).  Of 103 universal and targeted measures, which were sourced from several key resources and inputs from public health stakeholders, many of those related to the media such as marketing, advertising, promotion, sponsorship, information and education were considered a blueprint for a public health approach to preventing harms related to gambling.

        Advances in neuroscience have led to better understanding of how the media influence brain functions and how to enhance the interest and emotional involvement of the target audience in the media message in question (Zito, Fici, Bilucaglia et al. 2021; John, Freeman, Zurcher et al. 2022).  Consumer preferences in neuromarketing were found to be demonstrable using electroencephalogric (EEG) measures and machine-learning (Byrne, Bonfiglio, Rigby et al. 2022).  Specifically, these involve frontal alerting and emotional regions of the brain which can be characterized by event-related EEG potentials (ERP).  Of note, these are closely related to related functions that were found to be impaired in sons of alcoholics and were demonstrated to be a genetic risk factor for developing alcoholism (Begleiter, Porjesz, Bihari et al. 1984). Consequently, susceptibility to media messages that pertain to addictive behaviors may be related to the capacity of a media message to attract attention.  These messages may serve to overcome alerting deficits that are tied to poor self-regulation and the capacity to practice mindfulness techniques (Zhou, Kang, Cosme et al. 2023).  

        Additionally, susceptibility to social media manifested by checking behaviors in early adolescence may be associated with changes in the brain’s sensitivity to social rewards and punishments and long-term associations between social media use, adolescent neural development, and psychological adjustment may be involved in the ubiquitous influence of the media on development for today’s adolescents (Maza, Fox, Kwon et al. 2023).

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February 2, 2023