Motivation and emotion/Book/2020/Pill-testing motivation at music festivals

Overview


Pill-testing is a harm-minimisation service through which people planning to consume illicit drugs can anonymously have their pills analysed to avoid any harmful effects from unknown substances. It originated in the Netherlands in the early 1990's, due to a growing trend of young persons consuming ecstasy at music festivals and dance raves. It has been effectively facilitated at events across Europe, Americas and New Zealand but not in Australia as it is met with much conflicting arguments for and against it.

This chapter explains the motivations behind pill-testing engagement at music festivals through the use of research, motivational and social theories.

Focus questions:
 * Why do people consume illicit drugs at music festivals?
 * What is pill-testing?
 * Which theories best explain the determinant behaviour(s) in engaging in pill-testing?
 * What are the recommendations to motivate people to engage in pill-testing at music festivals?

Illicit drug use at music festivals


Music festivals are large social events that can run from one day to over two weekends. It is largely an event where people gather to listen to a line-up of local and international music artists. It has increasingly become a popular event amongst young adults, with the average age of attendees being 22.4 years (Hughes, Barratt, Ferris, Winstocke & 2019).

However, music festivals have also become a global trend to binge or consume recreational drugs particularly ecstasy, as it is somewhat considered within the social norm to consume illicit drugs at music festivals. Unfortunately, this has resulted in many drug-related deaths at music festivals due to consumers not knowing the true substances within their pills or "double dropping". The motives behind these behaviours have been due to fear of being caught by Police or due to consumers seeking more influence from the pill. An outline of the epidemiology and types of illicit drugs can be accessed from the book chapter "Illicit drug taking at music festivals".

As a result, many countries across the globe have implemented a harm-minimization strategy called pill-testing.

Case study 1

 * Alex's story:

19-year-old Alex Ross-King attended the music festival FOMO in Sydney on the 12th January 2019. In preparation for the festival, Alex consumed three-quarters of an MDMA pill and was “pre-loading” on alcohol on the mini-bus to the music festival. Upon arrival, Alex’s concern of getting caught with her two other MDMA pills grew when she sighted police. To avoid getting caught, Alex “double dropped” her pills before entry, which she had never done before (Thompson, 2019).

By early afternoon, Alex's friends found her underneath a tree sweating and very intoxicated. Alex was sent to the medical tent where the medics reported she had a rapid and irregular pulse, her body temperature reached 41 degrees Celsius and was kicking and screaming (Thompson, 2019). She was then admitted to Westmead hospital around 5pm and shortly after went into cardiac arrest. After four hours of attempted resuscitation, Alex was reported dead at 9:15pm (McGowan, 2019).

Following Alex’s death, her mother Jen Ross-king has been advocating for a widespread change in drug policy at music festivals in Australia and has been urging for NSW Premier Gladys Berejiklian to implement this change (Sas & McKinnell, 2019). Despite this, the Premier is still against pill-testing, criticising that it will give a "green light” to drug consumption and ultimately have an opposite effect in reducing drug-related deaths (Lewin, 2018).


 * What do you think?:
 * Do you agree or disagree that pill-testing will give the wrong message to drug-consumers?

Definition
Pill-testing is a harm-minimisation service that aims to reduce the dangerous effects associated with consuming an illicit drug by analysing illicit substances at venues, festivals and other locations (Butterfield, Barratt, Ezard & Day, 2016; Murphy, 2020). To encourage people to make informed decisions on their drug usage, participants are provided with information and counselling based on their drug test result. (Pill testing, 2019).

Pill-testing originated in the Netherlands in early 1990s and is a part of their official national drug policy (Groves, 2018). It was developed as a response to the increasing trend of ecstasy being consumed by young persons at festivals and dance raves (Groves, 2018). Since then, multiple countries have implemented this harm-minimisation service positively and with success (Murphy, 2020)

However, it is met with much controversy in Australia, as critics voice concerns of the services giving people the wrong message (Zhuang, 2019). NSW Premier Gladys Berejiklian advocates against the service, as she claims it will give people a green light to taking drugs and provide a false sense of security (Lane, 2019). This is despite multiple countries who support and have implemented this harm-minimisation service with success across Europe, Americas and New Zealand (Murphy, 2020).

Pill-testing serves many benefits. It can be helpful to inform countries of the various and trending drugs and drug markets for risk assessment and management (Brunt et al., 2017). Pill-testing has the potential for authorisations to gain control over a market that is ‘unpredictable and treacherous’ and subsequently offer psycho-education and harm-prevention to the drug-consumer (Brunt et al., 2017). Additionally, it has been proven to lead to less harmful drug taking or lesser and safer drug consumption. However, that is not to say that there aren't any limitations against pill-testing. Thomas (2018) outlines the pros and cons of pill-testing, stating that the main arguments against onsite pill-testing is that the kits are limited in what it can detect, as it cannot detect new drugs on the market. Additionally, they are not always accurate, as proper pill-analysis requires highly sophisticated laboratory equipment.

Forms of on-site pill-testing
There are two services of pill-testing, fixed and onsite pill-testing. Fixed pill-testing is a service at a central location and onsite pill-testing is a service based at venues, festivals and clubs. Both are services where consumers can get the content of their pills tested while remaining anonymous.



The most common method used at these services is reagent testing. This method involves removing a small sample from the pill and mixing it with chemical reagents to produce a colour change (Schneider et al., 2016). This is then compared to a colour chart to indicate which active ingredients the substance might contain (Bright, 2019 as cited in Murphy, 2020).

Despite all the harm-minimisation strategies in place at music festivals across the globe, there are still ecstasy-consumers who have no intent to engage in a pill-testing service or still decide to consume the pill, despite the results of the test. Therefore, this book chapter explores the motivations to engage in pill-testing through the use of research and motivational and social theories, in the hope to understand how to positively encourage the target audience to engage in the service.

Case study 2

 * KnowYourStuffNZ:

New Zealand's KnowYourStuffNZ is a pill-testing services for events around the country. This organisation records all tests conducted so that by the end of the testing season they can analyse trends in participants' responses and drugs in the current market. During their 2019-2020 testing season, they found 86% of the tested substances were consistent with what participants' thought they had, 8% was not consistent, 4% was partially consistent and 2% was inconclusive. The most common substance of the pills tested were MDMA (64%). Of the participants' whose substances were not consistent of what they thought they had, 52% decided against consuming the pill and the other remaining participants reported they would take it. When the organisation asked the participants why they would still consume the pill, only 21 responded their reasoning. Of this group,
 * 76% reported they still considered the substance desirable
 * 14% said they had consumed the pill before with no negative consequences
 * 10% stated they didn't think the substance to be dangerous.

Of these results, the organisation reports that people are still more likely to consume the drug if the test results show the pill contains LSD, cocaine, MDMA or ketamine, but not likely to consume it if the pill contains non-psychoactive substances.

Source: Knox & Double, 2020


 * What do you think?:
 * Has this information influenced or swayed your opinion on pill-testing? Why or why not?

Quiz
Choose the correct answers and click "Submit": {Select all the correct answers: Despite the results of their pill-tests, festival goers in New Zealand reported they would still consume their pill because:} - they did not care + the substance was still desirable + they have consumed the same pill before with no problems - they already paid a lot of money for it + they did not think the substance twas dangerous

{Which of the following is correct for arguments against pill-testing according to Thomas (2018)?} - It is considered 'not cool' to engage in pill-testing + On-site tests cannot detect new drugs on the market - Because participants have stated they don't want to waste half of the contents in their pill - Doesn't enable an opportunity for participants to change their mind and deter from consuming drugs - Participants won't want to engage in pill-testing because it takes too long and might miss some acts

Motivational and Social theories
This section will examine the Theory of Planned Behaviour (TPB), Social Identity Theory (SIT) and Intrinsic vs Extrinsic Motivation in the hopes of providing some explanation for motivations towards pill-testing engagement.

Theory of planned behaviour


The Theory of Planned Behaviour (TPB) attributes to the understanding of what influences one's motivation towards pill-testing engagement. TPB is a model concerned with understanding and predicting intention and behaviour. This theory also predicts that the most immediate determinant of behaviour is one’s intention to engage in a activity (Ajzen, 1985; Murphy, 2020). Intention is the motivational drive that encourages a person to make a conscious plan to engage in a certain behaviour (Klag, 2006; Murphy, 2020). Within this model, intention is predicted by three motivational components, which are outlined below;

Table 1:

The three motivational components of TPB. The TPB model has been used to research intentions of certain health behaviours and is one of the few theories that has been used to understand the intention for pill-testing behaviour. Davis and Rosenberg (2016) conducted a study amongst ecstasy-users to examine the strength of association between TPB components and engagement with ecstasy-specific harm-reduction strategies. Their results found that the TPB components significantly predicted intention to engage in pill-testing, with PBC the strongest predictor of intention (Davis & Rosenberg, 2016 as cited in Murphy, 2020). This finding suggests that one's intention to engage in pill-testing is affected by their level of PBC.

Additionally, Murphy (2020) investigated how a pill-testing service might influence intention to use ecstasy and examined how TPB components can predict intention to use either a fixed or onsite pill-testing service. Interestingly, Murphy’s results revealed all three TPB components were significant factors for intention to use a fixed site service, whereas subjective norms were the only significant predictor for motives to engage in onsite service, distinctive from Davis and Rosenberg’s study. These results suggest that the TPB model best applies for motives to engage in fixed site pill-testing, as one is engaging in deliberately planned behaviours, whereas the TPB model is weakest when explaining motives in engaging in onsite pill-testing, as social influences greatly impact motives and intentions. Murphy proposed that when ecstasy-users are at a festival, their motives for engaging in onsite pill-testing is influenced by their social networks and whether they will support engaging in the service. Consequently, these influences are so persuasive they override the components of the TPB (Murphy, 2020). The author concludes that the association between harm-reduction services and social norms is the most pronounced when examining motives to use an onsite harm-reduction service. This suggests that TPB works best to explain motives toward pill-testing when the behaviour is planned, however the model loses its significance when one’s motives are heavily influenced by social influences. As a result, social theories might be best to help explain these motives.

Quiz
{What was the most predictive TPB component for intention to use onsite pill-testing services according to Murphy (2020)? - Attitudes + Subjective Norms - Perceived Behavioural Control
 * type=""}

Social Identity Theory


As music festivals are largely a mass gathering social event, TPB does not clarify the influence that identification to a social group can have over one’s own attitudes and intentions towards pill-testing once inside the festival. Consequently, researchers have adopted the Social Identity Theory (SIT) to explain festival attendees' change in motivation towards onsite pill-testing. According to this theory, humans possess many social identities associated from membership to various social groups that one identifies with (Islam, 2014; Tajfel & Turner, 1979).

This theory proposes that when an individuals' social identity and membership to this group is most salient in a particular social context, their behaviour compliments the groups' norms and are more likely to self-categorise (Brown, 2000). Hynes and Zinkiewicz (2007) note there are particular health-related harm-minimisation strategies that are considered within the social norm for particular social groups, such as sunscreen use and condom use. This exemplifies that engaging in these strategies depends on whether it is supported within social groups and the individuals' strength of social identification with the group.

Personal attributes becomes less influential in intentions to engage in pill-testing once inside the festival and around their social groups. To exemplify this proposition, Murphy's (2020) study proposes that an individual's' perceived social norms with their social group is the most salient feature when predicting the intention to engage in onsite pill-testing. Murphy further suggests this phenomenon explains that most of pill-testing intentions is not an individual decision to engage in pill-testing, but a group decision. McEachan and colleagues (2011) found in their study that subjective norms was the weakest factor associated with intention engaging in health-related behaviours, suggesting that social influences override any personal attributes. Therefore, it also makes sense to suggest that when one is away from an environment where social identity to a particular group is important, one’s personal attributes (i.e., attitudes) are the strongest influencers in engaging in fixed pill-testing.

Quiz
{Results from McEachan and colleagues' (2011) study suggests that ______ __________ overrides any personal attributes + social influences - social identification - social categorisation
 * type=""}

Intrinsic vs Extrinsic Motivation
Intrinsic motivation (IM) and extrinsic motivation (EM) are components from Self-Determination theory (SDT). IM refers to engaging in activities or behaviours that are curiosity driven and intrinsically interesting to the individual, and EM refers to whether an activity or behaviour is engaged for its instrumental outcome or to attain a desirable outcome, not for the enjoyment the activity may produce (Ryan & Deci, 2000).

This theory demonstrates that IM can explain how an individual may be motivated to engage in pill-testing due to the strength of their intrinsic motivation towards the action. If a person is planning on consuming an ecstasy pill but is curious and intrinsically interested in knowing the substances in their pill, this can motivate the individual to engage in onsite pill-testing. Additionally, EM can explain why ecstasy-users “double drop” before entering a festival due to fear of getting caught by the police. Additionally, people may engage in pill-testing as they may fear the consequences of consuming an unknown substance (i.e., hospitalisation, parental consequences).

To exemplify this, Klag (2006) conducted a study assessing the SDT, TPB and the IM and EM in an attempt to understand and predict the motivational behaviours contributing to retention and treatment outcomes amongst substance-addicts. The author's results revealed that IM was related to more positive treatment outcomes, while EM was strongly associated with more negative treatment outcomes. The author further explains that the more intrinsically motivated participants reportedly felt more competent and in control to perform the requirements of the treatment successfully. Whereas participants who were more extrinsically motivated were affected by family coercion, suggesting that dependent on how the influence is interpreted, social pressures can heavily influence one to be more self-determined and less autonomous. This is in line with the notion that social groups that one identifies strongly with ultimately influences the individuals’ motivation towards the activity or behaviour. Further, EM was found to be strongly associated with a weaker sense of autonomy. When personal autonomy is undermined people perceive their behaviour as being coerced, which in turn reduces their interest and motivation to engage in the activity or behaviour (Klag, 2006).

Suggestions for motivating people to engage in pill-testing
The above theories were examined to help understand and explain why ecstasy-consumers may or may not engage in pill-testing. TPB explains that engagement in pill-testing is determined by the strength of one's attitudes, subjective norms and perceived behavioural control towards the pill-testing. SIT states that how strongly one's social identification with their social group is affects the decision to engage in pill-testing, and whether pill-testing is within the particular groups' social norms. IM explains that engagement in pill-testing is determined by whether the intent is motivated by intrinsic interest or curiosity and EM explains whether it is motivated by social pressures, consequences or attaining a particular outcome.

The common theme these theories are suggesting is that the motivation for pill-testing engagement is largely influenced by social influences. An ecstasy-consumer may plan to engage in pill-testing due to their attitudes and subjective norms towards the service, however these attributes can be overridden if:
 * 1) the individuals' social group doesn't support it,
 * 2) doesn't consider pill-testing within their social norm, or
 * 3) the individual feels as though they are being coerced or pressured to engage in the activity.

Therefore, it is suggested that services motivate ecstasy-consumers to engage in pill-testing and make mature decisions by creating positive social norms within the target social group, that being young adults (Murphy, 2020). Additionally, services should ensure that the pill-testers are not only providing the consumer with the correct counselling, but they are encouraging the individual to make mature and informed decision-making from an non-judgemental stance (Zhang, 2019). This is to ensure that the individual does not sense their autonomy being undermined and their behaviour being coerced from social pressures.

Conclusion


Pill-testing is an important harm-minimisation strategy to inform people of the contents within their pill and to provide them with the accurate information to make mature and informed decisions. Additionally, it can allow authorities to learn and become aware of the new trends of drugs in the market.

This book chapter explored how motivational and social theories can help to predict the motivation towards pill-testing engagement. The TPB model was the most predictable in terms of an individuals' intent to engage in pill-testing, whereas the SIT model was used to explain how the intention can be influenced either way. Since music festivals are largely a social event, the strength of one’s social identity to a particular social group and the social norms within that group heavily influences one’s motives to engage or not engage in pill-testing. What this model suggests is that the decision to engage in pill-testing is not an individual choice, but a group choice.

It has not gone without notice that there is a lack of research in pill-testing motivations and hence more research is required to be conducted, most particularly within Australia. It is highly suggested that researchers directly apply these motivational theories in future studies to determine how to create positive social norms within specific target populations for engaging in pill-testing, keeping in mind to avoid accidentally enforcing external pressure. Additionally, researchers should benefit the pill-testing services by providing recommended strategies. Further, it is emphasised that the pill-testers inform consumers from a non-judgemental and unbiased perspective.


 * Reflective questions!:
 * Would you engage in onsite pill-testing? Why or why not?
 * Which theory do you think best predicts why people do or do not engage in pill-testing?