Motivation and emotion/Book/2015/Binge drinking motivation in young people

Overview
This book chapter will dive into the realms of what motivates young people to binge drink. Motivation is an interesting area of psychological research. It is an area that has been extensively studied, yet we still have so much to learn about.

This chapter will discuss Fishbein and Azjen's (1975) theory of reasoned action and Azjen's extension of that theory, the theory of planned behaviour. These theories explore three underlying constructs that are antecedent to behavioural intentions (attitudes, subjective norms and perceived behavioural control). With the use of these concepts, this chapter explores what motivates young people to binge drink, and what should be done about this risky phenomenon.

By the end of this book chapter you should be able to:
 * Learning Objectives
 * Define 'binge drinking' and understand its side effects.
 * Explain the theory of reasoned action.
 * Understand the effect that attitudes, subjective norms and perceived behavioural control have in the theory of planned behaviour.
 * Explain what motivates binge drinking in young people.

Definition
Binge drinking is the term used to describe the excessive consumption of alcohol in a single-session (Johnston & White, 2003). This type of drinking is strongly associated with college or university students (Wechsler & Nelson, 2001; Johnston & White, 2003). Wechsler and Nelson (2001) have explained that women who consume four or more drinks and men who consume five or more drinks on one occasion are considered ‘binge drinkers’. This is described as the five/four measure of binge drinking.

Why is it a problem?


It is well known that excessive alcohol consumption poses a significant health risk to individuals and the community. Drinking cost Australia’s health care system $15 billion in 2008 and around 813,000 people were hospitalised as a result of injury or disease attributed to alcohol over a period of 10 years (ABS, 2013). Young people aged 15 to 19 had the highest hospitalisation rates for acute intoxication in 2005 as they consumed large quantities of alcohol that exceed their lifetime risk (ABS, 2013).

Binge drinking is strongly associated with alcohol poisoning, unintentional injuries, suicide and STDs as well as many other conditions (Courtney & Polich, 2009). When young people binge drink it is highly likely that they will engage in antisocial behaviour, including interpersonal violence and drink driving (Courtney & Polich, 2009). As alcohol is associated with these high-risk behaviours, it is a major contributor to the three major causes of adolescents death which are injury, homicide and suicide (National Health and Medical Research Council, 2009).

The Government has implemented a variety of health promotion campaigns to educate young adults and the wider community about the harmful consequences that alcohol can have on an individual’s health (Johnston & White, 2003). However, it is well known that young people continue to engage in the practice of binge drinking despite being informed of these risks. This book chapter will explore two psychological theories and seek to explain why young people binge drink despite being aware of the dangers. For the purpose of this chapter, a young person is someone between the ages of 14 to 24 years of age.

Psychological theories
Wicker (1969) found that attitudes probably do not predict behaviour (Armitage & Conner, 2001). Since this discovery, many social psychologist have sought to refute this claim and have explored the predictive power of attitudes on behaviour (Armitage & Conner, 2001). Two theories which indicate that this is not the case are the theory of reasoned action and the theory of planned behaviour.

The theory of reasoned action


The theory of reasoned action (TRA) was proposed by Fishbein and Ajzen in 1975 and was widely used as a means of predicting behaviour, or for predicting behavioural intentions (Madden, Ellen & Azjen, 1992). This theory made the assumption that the behaviours being studied were under an individual’s full volitional control (Madden et al, 1992). It recognised that in order to predict behavioural outcomes accurately, you need to consider attitudes alongside of other variables (Johnston & White, 2003).

The TRA explained that behavioural intentions immediately precede behaviour and that they incorporate information or views about whether doing something will lead to a certain outcome (Madden et al, 1992). It also believed that there are two main beliefs that are antecedent to behavioural intentions, the first one is described as behavioural beliefs, which influences a persons attitude and the second is described as normative beliefs, which influence a persons subjective norm about completing a behaviour (Madden et al, 1992). Johnston and White (2003) explained that these two beliefs are anticipated to have and indirect influence of behavioural intentions. This relationship can be seen in Figure 3.

So, how do aspects external to this model affect behaviour? Madden et al (1992) explained that other variables will influence behavioural intentions only if they influence an individual's attitude or subjective norm. Although this is the case, many psychologists have sought to investigate the effect that other variables may have on behavioural intentions. For example, Gorsuch and Ortberg (1983) proposed that the TRA should be expanded to include the influence that moral obligation's have on behavioural intentions and Azjen (1985) proposed that it should be expanded to consider the effect that perceived behavioural control could have on behavioural intentions, and behaviour.

The theory of planned behaviour


The theory of planned behaviour (TPB) has been described as an extension to the TRA (Armitage & Conner, 2001; Johnston & White, 2003). The TRA was limited to predicting behaviours that were under an individuals full volitional control. However, the TPB extended this theory to include the prediction of behaviours that are not under an individual's full volitional control (Johnston & White, 2003). Similar to the TRA, the TPB explains that the performance of a behaviour is determined by that persons intention to perform that behaviour (Norman & Conner, 2006). However, in the TPB a persons intention is influenced by three constructs which, in turn, all interact with each other (Norman & Conner, 2006). These three constructs are attitude, subjective norm and perceived behavioural control as demonstrated in Figure 4.

Attitude
The first construct is a persons attitude towards a behaviour. A persons attitude consists of their overall evaluation of performing the behaviours, and whether this is a positive or negative evaluation (Armitage & Conner, 2001). Behavioural beliefs affect a young persons attitude, and has an indirect effect on a behaviour (Norman & Conner, 2006).

Subjective norm
The second construct is a persons subjective norm. This is an individual's perception of the social pressure that is operating from others and their normative beliefs about engaging in that particular behaviour (Armitage & Conner, 2001). Norman and Conner (2006) explained that this social pressure may be influencing an individual to perform, or not perform a behaviour. Furthermore, they explained that if this pressure if coming from a significant other, they are more likely to perform, or not to perform the certain behaviour. A persons subjective norm has an indirect effect on behaviour, as it influences behavioural intentions.

Perceived behavioural control
The third construct is an individual's perceived behavioural control. An individual's perceived behavioural control is how they perceive the difficulty of performing a particular behaviour (Norman & Conner, 2006). This perception could be that the behaviour is relatively easy, or that it will be very difficult. A persons perceived behavioural control includes both internal and external control factors (Norman & Conner, 2006). An example of a persons internal control factor is a perception of their skills. An example of a persons external control factor, is the environmental constraints in place. Unlike the other two constructs, an individual's perceived behavioural control has both an indirect influence on behavioural (through behavioural intentions) and a direct influence on behaviour.

                                    Case Study  Imagine a young female goes out for dinner for a friend's 21st birithday. All of her other friends are drinking, and encouraging her to have a drink too. Her perceived behavioural control would be very low as she would feel that she would not have a strong influence over the situation. However, she may have a negative attitude towards binge drinking on this occasion as she has an assignment due tomorrow. The subjective norm to drink in this situation would also be high as her close friends are trying to influence her, and she has developed normative beliefs about having a drink with friends for their birthday. This would be a common situation that young people encounter, particularly when they are at college or university.

The introduction of this third construct allows the TPB to predict behaviours that are not under an individuals full volitional control (Armitage & Conner, 2001). In situations where there were environmental, or other constraints, the TRA failed to predict behaviour as the mere intention to complete that behaviour was insufficient because of other constraints operating at the same time (Armitage & Conner, 2001). Armitage and Conner (2001) explained that these constraints are different for each individual and are based on their perception of being able to complete the certain behaviour.

Researchers are always looking for new ways to expand on existing knowledge. Many propose that perceived behavioural control has two concepts antecedent to it:
 * The first concept is self-efficacy. This relates to a persons confidence in their ability to perform a particular behaviour (Norman & Conner, 2006).
 * The second concept is perceived control beliefs. This relates to how a person perceives their control over performing a particular behaviour based on a more generalised view including the consideration of environmental factors (Norman & Conner, 2006).

Ajzen (1985) explained that perceived behavioural control, attitudes and subjective norms all interact when predicting behaviour. He went on to explain that, depending on the situation and circumstances, one construct may have a stronger influence on intentions then another. For example, in a situation where normative beliefs are very strong and influential, perceived behavioural control may have less of an impact on behavioural intentions. You can see first hand in the Case Study how the TPB has a direct influence on young people engage in the practice of binge drinking and how it is these three underlying constructs in the TPB (attitude, subjective norm and perceived behavioural control) that motivate young people to binge drink.

So, what motivates binge drinking in young people?
Johnston and White's (2003) study found that an individual's attitude, subjective norm and self-efficacy were strong predictive factors of binge drinking intentions in young people. They explained that these three factors predicted 69% of the variance in behavioural intentions for binge drinking. Norman and Conner's (2006) study also yielded similar results, explaining that the TPB is extremely effective in predicting an individual's intention to engage in binge drinking. They found that attitude, self-efficacy and perceived control were the strongest predictors, explaining 66% of the variance when predicting binge drinking intentions. Other studies have also reported similar results. Furthermore, these studies encouraged the use of the TPB to predict binge drinking intentions among young people (Armitage, Conner, Loach & WIlletts, 1999; Conner, Warren, Close & Sparks, 1999; McMillian & Conner, 2003; Schlegel, d'Avernas, Zanna & DeCourville, 1992).

A study by Coleman and Cater (2007) found that young people's motives to drink can be individually based, socially based and peer influenced. These results reflect the three constructs contained in the TPB that are thoroughly discussed throughout this book chapter (attitude, subjective norm and self-efficacy). One of the most concerning aspects in that study was regarding young people's attitudes, with a majority who just want to 'drink to get drunk'. Other reasons that young people engage in binge drinking are that they want to gain confidence, be friendly, use alcohol as a stress relief and to lose control (Engineer, Phillips, Thompson & Nicholls, 2003). All of these elements are reflective of an individual's attitude towards binge drinking. It is important to note that the two studies discussed in this paragraph are based on university students in the UK (e.g Coleman & Cater, 2007; Engineer et al, 2003). While it is recognised that these societies are constructed differently, both Australia and the UK have a serious problem with young people binge drinking. There is reason to expect that the motivations of young people in Australia can be compared to those in the UK.

Although the TPB has been used many times to predict binge drinking in young people, it appears that it may be less effective for younger problem drinkers (Norman & Conner, 2006). Although this is the case, there were still significant predictors of intention and having a low perceived behavioural control, explaining 22% of variance. The TPB however has also explained 34% of the variance for problem drinkers in another study discussed by Norman and Conner (2006), which also found a negative relationship between perceived behavioural control and binge drinking. Although there is normally a positive relationship between perceived behavioural control and binge drinking, the negative relationship in this instance for young people engaging in problem drinking is probably because these are both negatively evaluated behaviours (Norman & Conner, 2006).

The TPB does not account for past behaviour and Norman and Conner (2006) flagged this as an issue. They explained that past behaviour has been one of the strongest predictors of future behaviour. This may be because past behaviour may have provided individuals with feedback that specifically has an effect on their beliefs and attitudes regarding the future behaviour or secondly, because past behaviour may become habit and be performed after receiving certain environmental cues with little conscious effort (Ouellette & Wood, 1998). These two explanations would undermine the effects of the social cognitive variables contained in the TPB. However, it is highly unlikely that young people would be binge drinking out of habit, as most health behaviours are not performed out of habit, even for adults (Norman & Conner, 2006). A study by Collins and Carey (2007) found that their model that excluded the effects of past behaviour fit better with the TPB then the model that included it. Therefore, it is concluded that the consideration of past behaviour alongside the TPB in predicting young peoples motives for binge drinking is unnecessary. A young person's past behaviour would only influence their intentions to binge drinking if it influences one of the three constructs of the TPB.

Attitudes, subjective norms, and perceived behavioural control all have an indirect influence on a young persons intention to binge drink. These studies demonstrate how how these intentions result in young people binge drinking, explaining it up to 69% of the time (Johnston & White, 2003). Therefore, these three underlying constructs results in young people being motivated to binge drink, and this is reflected through their attitude and belief that it is fun to drink to get drunk. If we want to change this dangerous phenomenon and stop antisocial behaviour from occurring, we have to intervene to change a young person's attitude, their subjective norm and encourage behavioural control in a culture where high alcohol consumption is strongly associated with socialisation.

What can be done about it?
There have been many systematic reviews of interventions that have been implemented (see eg., Foxcroft, Ireland, Lister-Sharp, Lowe, & Breen, 2002; White et al., 2010). All of these aim to prevent/stop the misuse of alcohol among young people for long term periods. Many internet interventions have been developed, offering a relevant medium and accessible treatment option for young people (White et al., 2010). Although their effectiveness is questionable as the long term-effects of these interventions do not appear to be effectively evaluated. The Strengthening Families Program (SFP; Spoth, Redmond, Trudeau & Shin, 2001) was found to be the most effective intervention over the long term for preventing alcohol abuse by Foxcroft et al. (2003). This study combined the Strengthening Families Program: For Parents and Youth 10-14 and the Life Skills Training Program to address a large range of factors including, family, peers and schools to prevent alcohol consumption from a young age (Spoth et al., 2001). Although this has shown promising results, ultimately, policy makers need to put more time and money into researching effective interventions that will be able to be implemented in schools across Australia. Although we do note that the Australian Government has recognised the need for this when they implemented the National Binge Drinking Strategy in 2008, young people are still binge drinking at harmful levels in today's society, and this has only got worse over time. From the onset it is clear that more research needs to be done to address this growing problem.

Conclusion
Binge drinking is the excessive consumption of alcohol in a single-session (Johnston & White, 2003). Alcohol consumed in large quantities is harmful to an individual's health, and this type of drinking is associated with how university students drink in Australia. The five/four measure of drinking is generally used to define binge drinking (Wechsler and Nelson, 2001). Binge drinking is strongly associated with alcohol poisoning, unintentional injuries, suicide and STD’s and many other conditions. When young people binge drink they are more likely to be involved in violent activities and antisocial behaviour (Courtney & Polich, 2009).

The theory of planned behaviour (TPB) is an extension of the theory of reasoned action (TRA) and it explains that behavioural intentions are an antecedent to behaviour. According to the theory, behavioural intentions have three antecedent constructs, which have an indirect influence on behaviour. These are attitudes, subjective norms and perceived behavioural control. These three constructs each have an influence on one another, and depending on what particular behaviour the person is going to engage in, one construct may be more prominent and have a larger influence then another construct. Young people have reported that they 'drink to get drunk', gain confidence, be friendly, and that they use alcohol as a stress relief and to lose control. These comments are reflective of a young persons attitude towards binge drinking.

It is necessary that interventions that prolong/prevent the onset of alcohol intake in young people are developed and implemented across all Australian schools, because it is clear from the alarming statistics discussed in this book chapter that what is currently being taught is not enough.

Test your knowledge
Please select the most correct answer. {What is Binge Drinking? - Pre drinking at University before you go out. - Drinking alcohol with your friends. - Drinking heaps of fizzy drink on the weekend. + The excessive consumption of alcohol in a single session.
 * type=""}

{The theory of reasoned action (TRA) made the assumption that a behaviour was: + Under an individuals full volitional control. - Not under an individuals full volitional control. - An involuntary reaction to an environmental event. - A decision that was considered very carefully by the individual.
 * type=""}

{The theory of planned behaviour (TPB) believes that there are three constructs that have an indirect influence on an individuals behavioural intentions, these are: - Thoughts, Attitudes and Perceived Behavioural Control. - Thoughts, Attitudes and Subjective Norms. - Attitudes, Perceived Behavioural Control and Intentions + Attitudes, Subjective Norms and Perceived Behavioural Control.
 * type=""}

{The Theory of Planned Behaviour: - Does not effectively explain Binge Drinking intentions among young people. + Is a useful theory in understanding what effects binge drinking intentions among young people. - Accounts for past behaviour and therefore predicts when young people are motivated to binge drink. - Accounts for past behaviour, and has resulted in it not being able to predict when young people are motivated to binge drink.
 * type=""}

{What can be done to combat binge drinking? - The Australian Government should raise the 'alcopops' tax because it has proven extremely successful. - The Australian Government should pass legislation banning the sale of Alcohol in Australia because of its negative side effects. + More research needs to be done to develop an effective intervention that can be introduced into schools across Australia. - Nothing should be done.
 * type=""}