Intended for healthcare professionals

Sex, Drugs, And Rock And Roll

Depictions of substance use in reality television: a content analysis of The Osbournes

BMJ 2005; 331 doi: (Published 22 December 2005) Cite this as: BMJ 2005;331:1517
  1. Nicole A Blair (nblair{at}, health scientist1,
  2. So Kuen Yue, research project coordinator2,
  3. Ranbir Singh, graduate student3,
  4. Jay M Bernhardt, adjunct associate professor4
  1. 1 Centers for Disease Control and Prevention, Office on Smoking and Health, Atlanta, Georgia, USA
  2. 2 Emory University Career Master of Public Health Program, Atlanta, Georgia, USA
  3. 3 New York University, College of Dentistry, New York, New York, USA
  4. 4 Emory University Rollins School of Public Health, Atlanta, Georgia, USA
  1. Correspondence to: N Blair
  • Accepted 23 November 2005


Objective To determine the source and slant of messages in a reality television programme that may promote or inhibit health related or risky behaviours.

Design Coding visual and verbal references to alcohol, tobacco, and other drug (ATOD) use in The Osbournes.

Review methods Three reviewers watched all 10 episodes of the first season and coded incidents of substance use according to the substance used (alcohol, tobacco, or drugs), the way use was portrayed (visually or verbally), the source of the message (the character in the show involved in the incident), and the slant of the incident (endorsement or rejection).

Main outcome measures The variation in number of messages in an average episode, the slant of messages, and message source.

Results The average number of messages per episode was 9.1 (range 2-17). Most drug use messages (15, 54%) implied rejection of drugs, but most alcohol messages (30, 64%) and tobacco messages (12, 75%) implied endorsements for using these substances. Most rejections (34, 94%) were conveyed verbally, but most endorsements (36, 65%) were conveyed visually. Messages varied in frequency and slant by source.

Conclusions The reality television show analysed in this study contains numerous messages on substance use that imply both rejection and endorsement of use. The juxtaposition of verbal rejection messages and visual endorsement messages, and the depiction of contradictory messages about substance use from show characters, may send mixed messages to viewers about substance use.


Numerous studies have found that alcohol, tobacco, and other drug (ATOD) use is frequently depicted in the popular media, including movies, daytime and primetime scripted television, and music videos.17 Research also suggests that viewing such images in the media can affect the beliefs and behaviours of viewers regarding substance use and that young people are particularly susceptible to these messages.812 Recent studies of young people in the United States, for example, found a direct relation between increased exposure to smoking in movies and having tried smoking8 and initiating smoking in the future.9

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Warning: this programme contains mixed messages that some viewers may find confusing


In the US, about 98% of households have at least one television set.13 A 2004 report estimates that young people aged 13-24 years watch nearly 14 hours of television a week.14 During the past decade, reality television has emerged as a popular genre that allows viewers to watch the unscripted interactions of real people in either everyday or contrived situations. This genre is gaining in popularity and presence. In 2003, six of the top 10 and 11 of the top 20 shows on network television in the US were reality programming. Between the autumn of 2003 and the autumn of 2004, there was a threefold increase in hours of reality programming on US network television, from six hours a week to 18.15

The Osbournes is a reality television show that chronicled the everyday lives of the famous rock star Ozzy Osbourne and his family. From 2002 to 2005 the show aired in the US on Music Television (MTV), a cable television channel aimed mainly at viewers aged 12-34.16 17 In April 2002, The Osbournes became MTV's all time highest rated series, with an audience of 7.8 million Americans.18 The first season of The Osbournes also won an Emmy for outstanding non-fiction programme (reality).19

Because of its proliferation and popularity among young viewers, reality television is an important, but understudied, medium. We analysed the content of the first season of The Osbournes to determine the quantity, source, and slant of messages related to substance use.


We chose to study the first season of The Osbournes, which was originally aired in 2002, because it was available to rent or buy on two digital versatile discs (DVDs) containing 10 episodes, each about 22 minutes long. Three trained coders simultaneously reviewed the content of the episodes related to substance use in real time in the same room. Each coder used a coding template grid to record details about the programme content.

The primary unit of analysis was each substance related depiction, defined as a single mention or visual representation of alcohol, tobacco, or other drugs. Depictions could occur in the forefront, as a part of the story line, or in the background. Alcohol depictions were defined as any visual displays of, or references to, alcoholic beverages or their packaging or marketing. Tobacco depictions were defined as any visual displays of, or references to, cigarettes, cigars, or smokeless tobacco or their packaging or marketing. Drug depictions were defined as any visual displays of, or references to, illegal drugs, such as marijuana, and the illegal use of prescription medications. Content codes captured all incidents and indicated whether the message was visual or verbal and whether it endorsed or rejected use (slant). On-screen presentations were considered endorsing if substance use was connected with rewards or was described in a positive light. As research indicates that a lack of negative consequences increases positive beliefs about substance use,10 11 we coded absence of negative consequences as endorsement. On-screen presentations were considered rejecting if using the substance had a negative consequence or was described negatively. We also recorded the character(s) involved and the time during the episode when the incident occurred.

Of the 91 incidents coded, 74% (67) were coded consistently by at least two of the three reviewers. Of the 24 remaining incidents, discussion after the episode produced a consensus coding.


We analysed data with SPSS 13.0. Descriptive statistics were created to measure proportions by category of substance and format (visual or verbal), slant (endorsement or rejection), and source (character in the show) of message.


We identified 91 depictions of alcohol, tobacco, and drug use in the 10 episodes of The Osbournes, with an average of 9.1 depictions per episode (range 2-17) (see for further details). Alcohol messages were most prevalent (52%), followed by drugs (31%), and tobacco (18%). More drug related depictions were rejections of use, but most alcohol and tobacco depictions implied endorsements. Table 1 shows the frequencies of depictions, by substance type and slant.

Table 1

Comparison of category of alcohol, tobacco, or drugs with slant of depiction

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Most drug depictions (24/28) and more than half of alcohol depictions (24/47) were conveyed verbally, whereas 69% of tobacco depictions (11/16) were displayed visually. Among the 38 visual depictions of substance use, 95% (36) were endorsements of the substance and 5% (2) were rejections. Among the 53 verbal depictions, 64% (34) were rejections and 36% (19) were endorsements. Among the show's primary and secondary characters, Ozzy participated in the greatest number of depictions (36%, n = 33), followed by incidental friends and family members (18%, n = 16), Sharon Osbourne (wife) (15%, n =14), Jack Osbourne (son, aged 16 at the time) (12%, n = 11), and Kelly Osbourne (daughter, aged 17) (8%, n = 7). Ten additional incidents (11%) were noted that were not attributed to an individual but rather to the environment (for example, a bottle of wine sitting on a counter or martini glasses and a shaker in the background). Source participation in endorsements and rejections of substance use varied with each member of the show. Outside of the general “friend” category, which included numerous incidental characters, Ozzy contributed the greatest number of endorsements (primarily for alcohol) and rejections (primarily for alcohol and drugs). Table 2 shows the relation between substance type, message slant, and message source.

Table 2

Number of incidents related to use of alcohol, tobacco, or drugs by source, substance, and slant

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MTV's reality show The Osbournes contained numerous messages related to the use of alcohol, tobacco, and other drugs, with more depictions implying endorsement than rejection of use. Depictions of use also varied by presentation and source. Together, these variations in depictions of use may be sending contradictory or mixed messages to viewers about the risks of substance use. We analysed the content of only one reality television programme, and future research should examine the effect of other televised mixed messages on substance use, particularly on highly impressionable young viewers.6 812

One important finding is that almost all rejections of substance use were verbal, whereas most endorsements were visual. Example verbal incidents included a friend stating that he does drink alcohol (endorsement) and a conversation between Sharon and her daughter Kelly in which she advised Kelly not to drink that evening, to which Kelly replied she would not because she was the designated driver (rejections). Visual incidents included observed consumption of tobacco or alcohol (endorsements) and a scene in which Ozzy found a pack of cigarettes, held them up to the camera, and commented negatively about smoking (visual and verbal rejection). Research on media and persuasion indicates that visual depictions may be more powerful and persuasive than verbal depictions20 21 as they allow viewers to connect with characters at a deeper level than can words alone21 and allow behaviours to be more easily modelled and copied.20 21 In The Osbournes, the balance between messages that endorsed and messages that rejected substance use was tilted in favour of endorsements. Because most endorsing messages were visual and most rejecting messages were verbal, however, the effect of the endorsing messages on viewers may be further strengthened because of the greater impact on viewers of visual compared with verbal presentations.

Another important finding relates to the mixed messages about substances from many of the show's characters. Although nearly all drug related depictions from the main character, Ozzy, reject the use of drugs (he is an acknowledged former addict), his depictions of alcohol and tobacco use are more evenly mixed. For example, in one episode he is observed lecturing his children about not drinking (verbal rejection), but in another episode he is seen drinking wine (visual endorsement). Ozzy speaks on camera about not smoking (verbal rejection), but then the viewer is exposed to a photograph of him as a young man holding a cigarette (visual endorsement). Research shows there is the potential for people to adopt the attitudes and imitate the behaviours of celebrities.20 22 Young people are particularly susceptible.6 812 22

Methodological issues

Our study had several limitations. Firstly, we considered only one full season of one highly rated reality programme. Depictions of substance use are likely to vary greatly from show to show within this genre and, possibly, from season to season of the same show. Secondly, although we analysed the content related to substance use, we did not assess the effects of the show on viewers' knowledge, attitudes, or behaviours related to substance use. Thirdly, because of a low incident count for some scenarios (for example, visual rejection) we could not carry out tests of significance. Finally, we used the terms “endorsement” and “rejection” of substance use to describe the slant of each depiction as perceived by the coder; in some instances the words and behaviours in the show did not explicitly endorse or reject substance use and a subjective determination was made.


Reality television shows contain messages about substance use and many of these messages may be contradictory or mixed. Because these messages are delivered on television by celebrities or recognised individuals, their effect on young audiences may be greater than that of family or members of the community.22 Producers and participants in reality television shows should be aware of their contradictory messages and that visual depictions may encourage unhealthy behaviours.

Embedded Image A detailed summary and description of each episode can be found on


We thank William T Marx for providing support in identifying and accessing relevant literature.


  • Contributors NAB conceived the idea for the study, developed the coding sheet for analysis, participated as a coder, and is the primary author and guarantor. SKY participated as a coder, entered the data, and conducted the statistical analysis. RS conducted the literature review and participated as a coder. JMB provided critical input for all aspects of the study and paper.

  • Funding None.

  • Competing interests None declared.

  • Ethical approval Exempt from review by the Emory University IRB