Framing Addiction

With the opioid crisis affecting so many communities, my news and social media feeds have been increasingly populated with messaging about addiction from advocates and experts. In hopes of dispelling the dominant frames in public thinking about people with addiction as having made “bad choices,” and having insufficient “will” to recover, I see repeated assertions that “addiction is a disease.”

While true, many non-experts do not fully believe that addiction is a disease. So we must do more to explain the process of disease if we are to hope to change public understanding. Expanding the assertion by saying, e.g., that ‘addiction is a disease that involves altered functioning of the brain’s reward and motivation systems’¹ can be a huge help.

But of course, that’s not the whole story. So I’d like to point you to fabulous resources from The Alberta Family Wellness Initiative. They have put significant efforts into health promotion and disease prevention based on the neurobiology of addiction. They have been collaborating with The Frameworks Institute for many years on effective science translation messaging, as well. It’s really a terrific one-stop shop for both the science, and its translation to the public.

Hope this is helpful!


¹ See: Different Kinds of Addiction

“The Hell of American Day Care” – What’s wrong with this frame?

The cover article of the April 29 issue of the New Republic, authored by Jonathan Cohn, is titled, “The Hell of American Day Care: The Shady Business of Looking After Our Kids,” and has been finding its way, repeatedly, into my social media feed. The investigative piece examines how we have come to a child care “system” with wide state-by-state variation, to put it mildly, in regulations and safety procedures. It offers a historical perspective, as well, on political efforts and social changes that have impacted the development of child care in America. There is a lot to admire in and learn from this piece.

It is also instructive from a framing perspective; its narrative structure presents some challenges in terms of how non-experts are likely to reason about the causes of and solutions to this “hell of American day care.”  If you ever took Journalism 101, you would be familiar with “5 W’s…and sometimes an H,” the concept that stories are complete when they explain the Who, What, When, Where, Why…and How of an event or incident. This piece follows that structure:

Who is this about? Kenya Mire

What happened? A tragic fire at the day-care she’d chosen for her 20-month old daughter, Kendyll, that also killed three of the seven other children there that day

When? February, 2011

Where? Texas

Why? The center director had left the children alone and unsupervised, and the fire started in her absence

How? Directly: Sub-standard regulations and inspections of day care. Indirectly: Lack of public will for the prioritization of quality day care for American children.

This structure also reflects what political scientist, Shanto Iyengar, refers to as an episodic story – one that focuses on an individual case or event. His (and others’) research tells us that when social problems are portrayed with episodic stories, non-experts are far more likely to attribute responsibility for solving the problem to the individuals portrayed – not to policy or public action.

Fortunately, Cohn includes “…and sometimes an H.” He tackles the How with highly contextualized explanations. He presents readers with a historical lens on the issue of child care, so that we have a much better understanding of how we’ve arrived at the child care we have today. He also shows how the system we’ve got was not built in ways that reflect what the science of child development tells us promotes optimal development.

The problem is that all of this great context comes after the organizing frame – the personal tragedy of Kenya Mire – has been vividly set-up; lay publics are likely to think the problem so dire, so widespread (it is titled, after all, the “Hell of American Day Care”), that the best we can hope for is that parents become more informed consumers in the child care market.

We have a presumption, from journalism and from traditional PR, that personalizing news stories about social problems will arouse public support on behalf of those portrayed. But political and framing science shows us that the opposite is true.

That’s why, in my own work, I encourage experts and advocates to work within a different narrative structure, one that answers different questions for their audience, and which makes the public or civic dimensions of issues more visible. I’ll call it, “2 W’s and always an H.” Why does this matter? What‘s the problem or challenge and How can it be solved? When you start with an explanation of Why instead of Who, you give your audience a wider lens on the issue and a stake in its resolution. This template also requires communicators to connect the dots between the problem (the What) and the solution (the How).  This doesn’t mean that you shouldn’t give real life examples of the consequences of the problem  – it just allows you to set in motion a different interpretive storyline, to paraphrase Matthew Nisbet, one that is constructed as shared, not personal, from the get-go.



Who’s responsible for children?

*given the current discourse on all things pre-K, I thought I would repost this piece from last year. as always, hope you find it helpful to your thinking.

I have two questions for you:  Who is responsible for the education of our children? Who is responsible for their development?

I wonder if you have different answers to these questions – perhaps schools and teachers figure prominently in your response to the first, and parents dominate the second? Certainly as a culture we have wildly different answers to these questions. Americans have no problem assigning responsibility to public institutions for the education of our children. Why, then, is it so hard for us to consider that the entirety of children’s development  – health, social and emotional development in addition to intellectual development- might be aided by the same?

The science has been clear, for decades, about the variety of influences on children’s development – from parents to peers to qualities of neighborhoods to schools to economic stability to social and cultural institutions and norms.  But yes, most scholars do not write for public consumption – so there’s that failure of translation of much of this scholarly knowledge. Further, one can’t underestimate the power of the individualism ideal in American life, and the pervasiveness of cultural (and commercial!) narratives about the familyBut even given those obstacles, why is it so easy for us to see the need for expertise and structure in the realm of children’s education, but not in children’s development?

In legislatures all over the country advocates are fighting drastic cuts and, in some states, wholesale elimination of early education programs, pre-K, subsidies for child care for low-income working families, home visitation services, after-school and youth development programs, mental health services and even eligibility for health coverage. That pretty clearly indicates that while we can understand the value of public investment in the academic proficiency of our children, we don’t yet understand the value of public investment in the overall well-being of our children.

This is precisely why I was pleased to see a policy statement released by the American Academy of Pediatrics asserting the need for “a fundamental shift in the way the general public and policy makers view and invest in early childhood” if we are to hope to address the long-term impacts of “toxic stress” and early adversity.   There is hope – here is developmental science being put to public use!   (N.B. This is what The Center on the Developing Child at Harvard University, in its partnership with the non-profit FrameWorks Institute, has been working on for several years)

And then, an opinion piece from Nicholas Kristof of the New York Times, discussing the importance of the AAP’s release.  It was fantastic to see the importance of early childhood discussed in the pages of the Times, yet I couldn’t help notice how parent-and-child focused Kristof’s take on the issue was –  from how he defined the effects of poverty, to what he cited as causes of and solutions to toxic stress:

Affection seems to defuse toxic stress — keep those hugs and lullabies coming! — suggesting that the stress emerges when a child senses persistent threats but no protector.

Now just to be clear, this is Kristof’s interpretation – “affection” and “hugs” are not mentioned by the AAP. And that is precisely my point. It illustrates how difficult it is for us  – even a journalist as discerning and sophisticated as Kristof – to think beyond the family context alone when considering how best to promote children’s development.  In other words, because we consider child development the jurisdiction of parents, and consider parent effectiveness a matter of will and/or character, it is easier to recommend affection toward a child than it is to consider how early childhood development programs, access to health care, jobs that pay for parents, etc. might intervene to reduce the effects of adversity for entire populations of children.

This is what child advocates are up against in State Houses throughout the country – not to mention Congress: Trying to help policymakers understand that the healthy development of this country’s 75 million children can’t happen by assigning responsibility to families alone – because family well-being isn’t a function of will, it is a function of economic opportunity, access to jobs that pay, health care, education, affordable housing, healthy food, clean air and water.  The problem is, we don’t have a coherent cultural story about those influences, but we certainly have a coherent story about the influence of parents. And, as Daniel Kahneman reminds us,

The confidence we experience as we make a judgment is not a reasoned evaluation of the probability that it is right. Confidence is a feeling, one determined mostly by the coherence of the story and by the ease with which it comes to mind, even when the evidence for the story is sparse and unreliable.”

So what’s the lesson here?  We need to create and consistently articulate an alternative story that is explicit about how child development absolutely depends not just on the context within the home, but on the contexts in which families live (which play no small part in creating that context within the home).  No small undertaking, to be sure. But unless we do, we are asking advocates to go it alone, piecemeal, without coordination, to try to tell whatever story might help on this day in this state in front of this legislature to hold on to, e.g., Smart Start in NC, Healthy Families in California, after school programs in New Jersey, child care assistance in Ohi0, Medicaid in dozens of states and on and on.

I can only imagine what would be possible for our kids, and therefore our future, if we had a national effort that sought to coordinate and shape the work of those advocating for our children’s physical, social, emotional and intellectual development into a big, new, cultural story about our collective, public, responsibility for the well-being of our children.