Table 2 Reasons and reported frequencies in each included study for starting ecstasy use, using ecstasy, using more ecstasy, and not ceasing ecstasy use.

Availability/price/quality of ecstasy

(being offered an ecstasy pill, lower cost of ecstasy^E; ecstasy quality... decreased, increased^F; I have more money to spend^I; availability of ecstasy^M; availability ('was there so I tried it')^O; friend offered and felt I could not decline^U)

NN^O

NN^E; 27%^U

NN^E; 21%, 35%^F; 7%^I; NN^M

Changing life circumstances (moving in or out of a certain lifestyle)

(it is part of my lifestyle^I)

14%^I

Curiosity

(out of curiosity, for experimental reasons^A; curious about good experiences of others, general interest in effects of psychoactive substances^K; the hype surrounding ecstasy^L; curiosity^O)

NN, NN^A; NN, NN^K; NN^L; NN^O

Decreased drug effects (e.g. tolerance) or decreased appreciation of drug effects

(needing to take more tablets than used to^F; I need to take more to get the same effects^I; increased tolerance^K)

35%^F; 9%^I; NN^K

Denying or forgetting negative effects

(thinking "that won't happen to me" or "well, everybody else is doing ecstasy, and they're not having any problems", upon hearing about negative consequences^K; unpleasant experiences are forgotten and the excitement of going out and socialising takes over^L)

NN^K; NN^L

Desire to be on the same level as friends (i.e. to be intoxicated in the same way)

(to get into the spirit of the party^H; it makes you sad if you're at a club and you see everybody else is having all this fun and you're not^K; having a shared experience, desire to be on the same level as friends^L; social pressure ("you see friends having a great time and you want to join")^O

NN^K; NN^O

70%^H; NN, NN^L

Ease of administration

(controlled freedom/sense of control, provides fun, confidence and companionship that users seek without negative consequences associated with other drugs, effects preferred to those of alcohol^E; using ecstasy is more convenient than using alcohol^L; ease of use in comparison to other drugs^O)

NN^O

NN, NN, NN^E; NN^L

Enhance energy and dancing

(help you to... keep going on a night out with friends, stay awake^D; to stay up longer, to dance/be more active^H; enable partying all night an makes the fun and excitement of the night last longer^L; staying awake, enhancing dancing, dance energy^M; stimulation^P; dancing^T)

91%, 72%^D; 39%, 57%^H; NN^L; NN, NN, 60%^M; NN^P; 59%^T

Enhance mood (to feel good)

(for fun^A; make yourself feel better when down or depressed, help you feel elated or euphoric^D; enhance mood^L; hedonistic pleasure, for a laugh, loved up feeling^M; positive effects on mood, desire to have fun^O; a desire to feel good^P; fun^T)

NN^A; NN, NN^O

48%, 78%^D; NN^L; NN, 56%, NN^M; 47%^P; 42%^T

Enhance other substances' effects

(improve the effects of other substances, help ease the after effect of other substances^B)

27%, 8%^B

Enhance sex

(enhance feelings when having sex^D; to enjoy sex more^H; increased sexual please, feeling more emotionally connected to partners during sex^O; enhance sex^T; prolong erection, enhance sexual sensations and arousal, unusual/exciting sexual activity^V)

62%^D; 22%^H; NN, NN^O; 29%^T; 10%, 23%, 21%^V

Enhance social interaction

(help you to... enjoy the company of friends, feel more confident or more able to talk to people^D; affirmation of friendships, ecstasy facilitates particular social activities^E; I am more open with people, I am more confident^I; enhancing socialising, for socialising/confidence, to pull/have sex, openness^M; affiliation, being together with other people^P; sociable^T; facilitate sexual encounter^V)

63%, 42%^D; NN, NN^E; NN, 65%, 20%, NN^M; NN, 71%^P; 53%^T; 12%^V

3%, 2%^I

Enhance/change sensory perception

(help make something you do less boring, enhance an activity such as listening to music^D; sensory sensations^E; to alter perspective^M; to produce altered states of consciousness, creative, to enjoy music^T)

36%, 80%^D; NN^E; 47%^M; 70%, 29%, 56%^T

Experienced no or unpleasant ecstasy effects

(ecstasy experience does not live up to expectations^E; not feeling any effect of the ingested ecstasy pills^L; did not feel it the first time^U)

11%^U

NN^E; NN^L

Experienced very pleasant effects

(ecstasy experience is particularly good^L; liked what it did for me, thought subsequent experiences would be same/better than first^U)

93%, 89%^U

NN^L

Fear of health risks

(worrying about... dying from ecstasy, risk of brain damage^F)

1%, 1%^F

Feeling safe about ecstasy contents and ecstasy use setting

(being certain about what is ingested and that an organisation of knowledgeable volunteers is present^G)

19%^G

51%^G

Help lose weight

(help you to lose weight^D)

7%^D

Help you to concentrate, work, or study

(help you to concentrate or to work or study^D)

3%^D

Intoxication, losing inhibitions

(just get really stoned or intoxicated, help you to lose inhibitions^D; loss of inhibitions^E; just to get high/enjoy oneself^H; to lose it (being uninhibited)^M; desire for an altered state of mind ("desire to get screwed up")^O)

NN^O

68%, 50%^D; NN^E; 91%^H; 31%^M

Noticed mood/affective/cognitive changes in oneself

(feeling depressed a few days after use^F)

1%^F

Other's bad experience/death/mood/affective/cognitive changes

(knowing someone who has had a bad experience on ecstasy^F)

1%^F

Own bad experience

(having a bad experience on ecstasy^F)

1%^F;

Positive effects outweigh negative effects

(positive effects seem to outweigh risks; positive effects from use outweigh the negative effects^E; ecstasy use feels too good despite worries about depression^K)

NN^E

NN^E; NN^K

Presence of opportunity

(raves^T)

58%^T

Recreation/relaxation/stop worrying

(recreational purposes^A; help you to... relax, stop worrying about a problem^D; a time out from the normal routine and stress of daily life^K; being at a major dance event, relax or unwind^L; boredom, to switch off/relax, to escape problems/worries/out of boredom^M; boredom, desire to escape^O; relaxation, to party, to have a good time, coping with problems, as a distraction^P)

NN^A; NN, NN^O

30%, 33%^D; NN^K; NN, NN^L; NN, 69%, 32%, 21%^M; NN, 57%, 62%, 11%, 14%^P

Self-medication

(enables socially anxious individuals and/or those with low self-esteem and confidence to fit in with others and have a good time, provides temporary relief from depressive symptoms^O; insecurity^P; personal 'psychotherapy', group 'psychotherapy'^T)

NN, NN^O

6%^P; 42%, 24%^T

Social influence (friends use ecstasy)

(most of my friends take it^I; being with friends who take the drug, desire to continue interacting with an ecstasy-using group of peers^L; because mates take it, peer-group behaviours^M; wanted to be accepted by friends^U)

20%^M; 8%^U

6%^I; NN^L; NN^M

NN^L

Spirituality

(spiritual, close to nature^T)

21%, 23%^T