Drug use at licensed premises : prevalence and prevention

Abstract: Background: There are a number of public health concerns related to the use of illicit drugs such as violence, injuries, unprotected sex, and drug dependence. Particularly, there is a strong need to reach adolescents and young adults with drug prevention programs. It is therefore necessary to identify new settings in the community to target young people. The nightlife setting is one arena where many young people socialize, where illicit drugs are available, and where young people are introduced to and start experimenting with club drugs, frequently under the influence of alcohol. However, little is known about the prevalence of club drug use in Sweden. Furthermore, club drug prevention at licensed premises is a new field for intervention research. Objective: The overall aim of this research is to increase knowledge on the prevalence and prevention of illicit club drug use at licensed premises. The thesis investigates methods to measure the prevalence of club drug use and the potential for community- based club drug prevention at licensed premises. Method: This thesis is built around four articles (articles I to IV). Two studies (I and IV) were conducted to measure the prevalence of drug use. Different methodologies (self-report and biological markers) and study populations (staff at licensed premises, and electronic music dance event attendees) were used. To explore the possibilities of conducting community-based club drug prevention work such a program was developed and implemented based on a systems approach to prevention. The multi- component program included community mobilization, drug-training, policy work, increased enforcement, environmental changes, and media advocacy and public relations work. In articles II and III, the effects of this program on doormen intervention rates towards drug-intoxicated guests were evaluated using a pseudopatron methodology with a pretest – posttest (longitudinal repeated measures) design. Results: Drug use among staff and guests at licensed premises was found to be high. Evaluations of the long-term effects of the community-based intervention showed a significant increase in doormen intervention rates towards drug-intoxicated guests. Also, staff reported significantly lower levels of self-reported drug use as well as significantly lower levels of observed drug use among guests at the second measurement. Further, our results indicated that it was feasible to conduct alcohol breath and oral fluid drug testing in a Swedish club setting. Discussion and conclusion: Increased doormen interventions, reduced rates of drug use among staff, and reduced observed drug use among guests suggest positive outcomes of the community-based intervention, as no other explanations for these improvements have been found. The findings demonstrate that the systems model for prevention of substance use was an appropriate model to guide club drug prevention efforts. We successfully used the model to select our intervention methods and implementation strategies.