Recreational settings and drugs: health and social responses

Overview

Key issues

Bars, nightclubs and other recreational venues provide young people in Europe with opportunities to socialise and dance. During the summer months, large music festivals attract thousands of visitors, among whom the use of psychoactive substances is much more common than in the general population. Drug and alcohol use in nightlife settings can be associated with a range of health and social problems, including acute intoxication, unconsciousness and unintentional injury, aggressive behaviour and violence, unsafe sex and sexual violence, and driving under the influence of alcohol or drugs.

Because many of these harms are associated with excessive use on a particular occasion, many responses in nightlife settings aim to promote safer use patterns and improve the safety of people who use substances in these settings.

Response options

Most of the evidence on responses in recreational settings relates to alcohol. Few interventions targeting drug use in recreational settings have been robustly evaluated.

• Prevention or harm reduction information material can be provided to young people in recreational settings. Peer educators may be seen as more credible in disseminating this type of information. These activities can be supported by websites and apps providing more detailed information on drugs, alcohol and related risks, alongside tips on avoiding the harms that can ensue. However, the evidence for behavioural change effects from these informational interventions is scarce.
• Environmental strategies have a better evidence base. This approach includes measures that target factors that promote excessive consumption (e.g. discounted drinks, loud music and poor serving practices) or that create safer spaces and venues (e.g. by reducing crowding, providing chill-out rooms and free water, serving food, and enforcing rules on behaviour and access).
• Drug-checking services enable individuals who might use drugs to have their substances chemically analysed, providing some information on the content of the samples as well as advice, and, in some cases, counselling or brief interventions. These services may also provide valuable opportunities for engaging people who use drugs and for supporting drug monitoring activities.

European picture

• Various environmental approaches, including regulatory measures, are used across Europe to address substance-related problems in nightlife and other recreational settings. These include licensing strategies, regulatory measures against venues that have visible problems, the training of door and security staff, health and safety measures, and training in recognising and responding to drug- and alcohol-related emergencies. Structured evidence-based environmental prevention approaches are now being used in more countries, as are local regulatory coalitions between the police, the nightlife industry and relevant services (prevention and harm reduction).
• Good practice standards on safer nightlife labels and charters, drug checking and peer education are promoted by NEW NET (Nightlife Empowerment & Well-being Network). The STAD in Europe project aims to tackle heavy episodic drinking by restricting the availability of alcohol in licensed premises in nightlife settings and festivals, as well as in other public and private environments.
• Drug-checking services have been established across Europe but do not operate in all countries. These services use a variety of different models, including off-site testing centres and on-site testing at festivals and in nightclubs.

Key issues related to drug use in festivals, nightlife and other recreational settings

Bars, nightclubs and other recreational venues provide young people in Europe with opportunities to socialise and dance. During the summer months large music festivals attract thousands of visitors, among whom the use of psychoactive substances is much more common than in the general population.

In addition to illicit drug use, excessive alcohol use is also common in these recreational settings. A study carried out in nine European cities estimated that over three quarters of visitors to nightlife venues had been drunk at least once in the last four weeks. While not focusing specifically on nightlife and recreational settings, school surveys show that most 15- to 16-year-old students who had used MDMA/ecstasy during the last month had also consumed five or more alcoholic drinks at least once, underlining the strong association between alcohol and some forms of drug use among young people.

Drug and alcohol use in nightlife settings is linked to a number of health and social problems. These include acute health risks and other problems, such as intoxication, unconsciousness and unintentional injury, aggressive behaviour and violence, unsafe sex and sexual violence, and driving under the influence of alcohol or drugs.

Most of these harms are associated with a pattern of bingeing one or more substances, that is, excessive use on a particular occasion. As a result, many responses aim to promote safer use patterns and enhance the safety of people who use substances in these settings. There are also concerns that in many countries drug use in these settings is increasingly viewed as the norm, while the risks associated with drug use are underestimated. Another cause for concern is the growing availability of a wider range of substances, for many of which the content and psychoactive effects are unknown.

Evidence and responses to drug-related issues in festivals, nightlife and other recreational settings

Most of the evidence for responses in recreational settings relates to alcohol use and harms. The body of evidence on the effectiveness of interventions that target drug use in these settings is growing. However, few interventions have yet been subjected to robust evaluation.

Despite these limitations, some lessons from the evidence on responses to alcohol use and harms are likely to be useful when considering drug-related problems.

The Healthy Nightlife Toolbox makes available three databases: evaluated interventions; literature on these interventions; and other literature within the field of nightlife alcohol and drug prevention. The main types of interventions available are described briefly below.

Coordinated multi-component approaches

Multi-component approaches include a number of parallel strategies such as community mobilisation, staff training and law enforcement. Partnerships between stakeholders can facilitate the implementation of effective nightlife interventions. Such partnerships, between local municipalities, venue owners or managers, the police and health authorities, aim to mobilise communities by raising awareness of particular harms and creating support among stakeholders and the public for preventive measures. The number of evaluated community interventions is slowly growing. Multi-component interventions may have an impact on levels of violence, problem drinking and street accidents. Where this is the case, effective leadership, co-production, continuity of interventions and funding are considered critical for success.

Legislative measures

Problems such as underage drinking, violence inside or outside nightlife venues and drink driving are likely to be best addressed by multi-component community interventions that include prevention services, regulators, the nightlife industry, as well as the policing and enforcement of appropriate regulatory measures. This can include police visits to high-risk nightlife venues, age verification checks on entry, and the use of sanctions (e.g. the revocation of operating licences) to enforce licensing legislation. These measures have been shown to be effective in reducing alcohol-related problems, but their positive effects rapidly diminish if they are not carried out regularly and linked to real deterrents, such as the loss of an operator’s licence for failure to comply. They may also result in the displacement of activities to other locations or settings.

Environmental strategies

Alcohol- and drug-related problems may also be exacerbated by the physical and social environment in which entertainment venues operate. A permissive environment, characterised by, for example, tolerance of intoxicated behaviour, discounted drinks, poor cleanliness, crowding, loud music and poor serving practices, may promote higher levels of alcohol intoxication, and this may also apply to drug use. Environmental strategies for which there is some evidence of a positive impact include creating safer spaces and venues by reducing crowding, providing cool-down or chill-out rooms, serving food, enforcing clear house rules on behaviour, and preventing access to minors. Ensuring that drinking water is available free of charge at venues where drugs such as MDMA/ecstasy may be used is one way to prevent dehydration.

Training of staff and availability of first aid services

Appropriate training for bar servers, door supervisors and other staff in recreational venues combines information and skills building. The areas covered can include alcohol legislation, the psychoactive effects of alcohol and drug use, the links between alcohol and violence, first aid, responsible drinks service (e.g. how to refuse to serve intoxicated customers), conflict management and responding to drug dealing on the premises. Evidence for the effectiveness of staff training in preventing alcohol- and drug-related harm is inconclusive, in part because of the high rates of staff turnover in these venues. Interventions targeting the safety and health of nightlife and festival staff should also be given urgent consideration.

Medical first aid services can result in faster identification of and responses to drug emergencies, potentially saving lives and decreasing transfer time to hospital emergency departments. There are several guidelines for responding to acute emergencies in nightlife settings.

Drug checking

A number of European countries include drug checking as a component of their wider harm reduction strategies, but it is not without controversy (see Spotlight on... drug checking). While checking may provide people who use drugs with some information on the substances they may potentially use, critics fear that consumers may be falsely reassured that tested drugs are safe to use. Commenting on this issue is complicated by the different analytical approaches that are used for testing and the technical difficulties in providing rapid, accurate chemical analysis of the substances and mixtures sold on the illicit drug market.

Nevertheless, drug checking does provide an opportunity for reaching people who do not usually engage with services or see their drug use as problematic. It also furnishes useful information for drug monitoring purposes. Alerts are sometimes issued, for example, when a very high potency ‘brand’ of MDMA pill is detected, although more work needs to be done to understand the behavioural impact of this approach. Given the developments in the European drug market and growing interest in these approaches, evaluating the impact of different models of drug checking should be regarded as a priority.

Education and the provision of prevention and harm reduction materials for nightlife users

Young people who are involved in nightlife activities can be provided with prevention or harm reduction information material, such as brochures and pamphlets on intoxication and related harms. Peer educators may appear more credible in disseminating information on harms and harm reduction to young people in these settings. These activities can be supported by websites and apps that provide more detailed information on drugs, alcohol and related risks, and tips on how to avoid the potential harms involved. The promotion of harm reduction strategies addressing some key harms, such as drink- and drug-impaired driving (designated driver schemes, for example), may also be adopted. However, research evidence suggests that just providing information is not an effective way to reduce drug- and alcohol-related problems, and risk communication approaches still require further research and development.

There is a consensus that it is important to provide reliable information on different substances, their associated risks and ways to minimise harms. However, risk communication strategies need to ensure that the information provided allows people to make choices that minimise adverse consequences, while avoiding any terminology that might make drugs appear more attractive. There is a risk that some people may deliberately seek out substances that have been identified as high-dose or high-potency. Understanding how to communicate risk in a way that has the desired impact on behaviour and avoids unintended negative consequences is thus an important area for future research.

European picture: availability of interventions responding to drug-related issues in festivals, nightlife and other recreational settings

Several approaches are used across Europe to address substance-related problems in nightlife and other recreational settings. A number of European projects have developed guidelines and standards for prevention and harm reduction activities for interventions in nightlife settings.

The NEW NET (Nightlife Empowerment & Well-being Network) is a European network of community-based NGOs and other professionals acting in the fields of health promotion and nightlife. It supports the implementation of good practice standards focusing on safer nightlife labels and charters, drug checking and peer education. In this context, a safer nightlife label tells consumers if a particular venue is complying with official standards of quality, while a charter covers guidelines agreed to by the relevant stakeholders.

The Club Health project, involving partners from several EU Member States and Norway, aimed to reduce disease (especially in relation to addictions and sexually transmitted infections), accidents, injuries and violence among young people in nightlife settings. It also published a set of standards to improve the health and safety of recreational nightlife venues.

More structured evidence-based environmental prevention approaches are currently being rolled out across Europe, an example being the STAD in Europe project (SiE). Some local regulatory coalitions between the police, the nightlife industry and relevant services (prevention and harm reduction) have been found to have an impact on violence, sexual assaults and hospital admissions in the Netherlands.

Although there is some evidence to support the use of a number of regulatory measures, they appear to be less frequently applied. These include no ‘flat fee’ or happy hours, minimum drink prices, refusing to serve intoxicated persons, mandatory staff training, no access for minors, limiting the density of nightlife venues and restricting their opening hours, and ‘apple juice laws’ — whereby in all drinking establishments the cheapest drink has to be non-alcoholic.

Guidelines for responding to harms in nightlife settings, produced by the Euro-DEN network in collaboration with the EMCDDA, cover the identification of individuals with acute drug toxicity who require clinical assessment in emergency departments, and for whom the emergency services should be called. This enables early assessment and management by emergency services and, if necessary, the emergency department of those at the highest risk of significant morbidity or death from acute drug toxicity.

As highlighted above, a variety of off-site and on-site drug-checking schemes exist in Europe, among the most longstanding of which is the Drug Information and Monitoring System (DIMS) in the Netherlands. This service provides people who use drugs with information on the content of the drug and delivers a harm reduction message, which is based on scientific information on the chemical composition of the drug sample. DIMS also publishes qualitative information on changes in the content of drug samples in the Netherlands.

On-site drug-checking services have been established in a number of EU countries and may provide an opportunity for brief interventions with people who do not usually engage with services or see their drug use as problematic. The Trans European Drug Information project (TEDI), created in 2011, is a network of European fieldwork drug-checking services that share their expertise and data within a European monitoring and information system. TEDI’s main goal is to improve public health and related programmes by providing relevant analytical data. Towards achieving this goal, TEDI has developed a data collection system in collaboration with the EMCDDA to help track the evolution of European drug trends among those using these services.

Implications for policy and practice

Basics

• Provision of environmental prevention to reduce substance-related harm and harm reduction interventions, supported by guidelines and standards, is important.
• The provision of emergency healthcare, linked to emergency departments, is required to deal with adverse events in recreational settings. The European guidelines may be a useful resource here, although establishing national policies supported by guidelines and awareness raising will also be needed.
• Community-based initiatives that deliver a range of coordinated interventions through a multi-agency partnership are likely to be a more effective implementation strategy than developing stand-alone interventions. Such programmes often combine community mobilisation, staff training and enforcement and appear to be effective in reducing violence, problem drinking and street accidents.

Opportunities

• Increase the sharing of good practice and guidelines for prevention to reduce substance-related harm in recreational settings and promote evaluation of their effectiveness.

Gaps

• The evidence on the benefits of providing information to clubbers or on the efficacy of peer education (often harm reduction) is limited. These measures have the potential to be counterproductive, so more research is needed on the most effective ways to present information on risks and encourage safer use strategies, etc.
• Drug-checking services may have the potential to reduce harm and can provide an opportunity for monitoring what drugs are being consumed in a particular setting. However, research is needed into the effectiveness of different models of provision and their appropriateness to different settings.

Further resources

EMCDDA

• Best Practice Portal
• Healthy Nightlife Toolbox
• Monitoring drug use in recreational settings across Europe: conceptual challenges and methodological innovations, 2018
• Environmental substance use prevention interventions in Europe, 2018
• Responding to drug use and related problems in recreational settings, 2012

Other sources

• NEW NET

About this miniguide

This miniguide provides an overview of what to consider when planning or delivering health and social responses to drug-related problems in festivals, nightlife and other recreational settings, and reviews the available interventions and their effectiveness. It also considers implications for policy and practice. This miniguide is one of a larger set, which together comprise Health and Social Responses to Drug Problems: A European guide.

Recommended citation: European Monitoring Centre for Drugs and Drug Addiction (2022), Recreational settings and drugs: health and social responses, https://www.emcdda.europa.eu/publications/mini-guides/recreational-sett….

Identifiers

HTML: TD-08-22-028-EN-Q
ISBN: 978-92-9497-700-7
DOI: 10.2810/667578