Mechanisms of Perceived Social Norms: The Mediating and Moderating Role of Morality and Outcome Expectations on Prescription Drug Misuse in the Working Population

Abstract

ABSTRACT While the nonmedical use of prescription drugs to enhance cognitive performance (NMUPD-CE) has received increasing media attention and provoked ethical debates, the social drivers of misusing this health-related drug remain understudied. Therefore, this study examined how descriptive and injunctive norms as social influences affect decisions to engage in NMUPD-CE. We tested competing assumptions about whether moral acceptability and positive and negative outcome expectations mediate or moderate the social norms effects. We used data from a Germany-wide, web-based survey with a sample of adult nonusers who were recruited offline (N= 13,443). We found that 62.09% of the respondents indicated at least some willingness for NMUPD-CE. Positive associations occurred between this willingness and both social norms, high positive and low negative outcome expectations, as well as higher moral acceptability. Moral acceptability and positive outcome expectations partially mediated both social norm effects, while negative outcome expectations only partially mediated injunctive norms. Moreover, positive and negative outcome expectations also moderated both social norm effects. This study provides insights into the understanding of social influence in the context of substance misuse and beyond. It suggests that social norms operate via moral acceptability and outcome expectations, while outcome expectations also lead to differential effects of social norms.