Healthy nightclubs and recreational substance use: From a harm minimisation to a healthy settings approach
Introduction
In the UK alone, approximately 3.5 million individuals go to nightclubs each week (Mintel International Group, 2000). Most of these are younger people and a large proportion of them consume illegal drugs often in combination with alcohol (Measham, Aldridge, & Parker, 2001). The relationship between recreational drug use and dance music events is now well established Release, 1997, Winstock et al., 2001. In the UK, for instance, estimates of ecstasy, amphetamine, and cocaine use in regular clubbers (i.e. attendees at nightclubs) or those travelling abroad to visit international nightclub resorts (e.g. Ibiza) far exceed average levels of consumption by individuals in the general population (Bellis, Hale, Bennett, Chaudry, & Kilfoyle, 2000) (Table 1).
The acute and long-term problems relating to recreational (i.e. ecstasy, amphetamine, and cocaine) drug use are the subject of a wide range of studies Parrott et al., 2001, Reneman et al., 2001 and form the rationale for a variety of health interventions Niesnk et al., 2000, Page, 2000. Thus, ecstasy use has been linked to short-term health effects such as hyperthermia (Henry, Jeffreys, & Dawling, 1992) as well as long-term effects such as memory problems (Reneman et al., 2001). Interventions addressing recreational drug use have often been outreach based (Crew 2000, 2001) and focused on disseminating information on adverse effects of drugs and how to avoid them, problems around combining substances (often drugs and alcohol), and courses of action necessary when acute adverse effects are experienced. However, there is now a growing recognition that the adverse effects of club drugs are strongly related to the environment in which they are used rather than resulting solely from the toxic properties of substances themselves (Calafat et al., 2001). Often, reports of ecstasy-related deaths refer to the temperature of the environment—The most likely cause of death is heatstroke. The temperature inside the club had reached 40 °C (Burke, 2001) or in other instances the lack of basic facilities to redress the effects of dancing and substance use—A number of people complained about lack of water (Bowcott, 2001).
In this paper, we argue that the relationship between the health effects of substance use and the environment in which they are used is much wider than temperature control and access to water and extends across the entire nightlife setting. We explore the wide range of factors that contribute to risk in nighttime environments and describe initiatives that effectively address these issues without curtailing fun. Consequently, we argue that by adopting a broad settings approach (World Health Organisation, 1997) to nightclubs, inclusive solutions to reducing harm in clubs (including that caused by drugs) can be better developed and disseminated. Furthermore, the same approach can also facilitate multidisciplinary involvement in nightlife health, taking health issues solely from health departments and placing the responsibility also in the hands of organisations such as local authorities, police, voluntary organisations, club owners and managers, door staff, and clubbers themselves. Finally, we suggest that with worldwide growth in dance music tourism, this multidisciplinary approach needs to be extended to include travel and tourism organisations and requires collaboration on an international level.
Section snippets
Healthy settings and nightclubs
A healthy settings approach (World Health Organisation, 1997) recognises that the effects of any particular setting on an individual's health are related to the general conditions within that setting, perhaps more than they are to provision of health or other care facilities. The nightclub setting at its most basic is a building that provides loud music, often with a repetitive beat, a dance area that usually has low background light and intermittent bright lighting effects and a licensed bar.
Disseminating knowledge and developing solutions
The use of substances often contributes to the dangers presented within the nighttime environment. Previously, harm minimisation has tended to focus on direct effects of drug use. However, basic measures to alter the environment can substantially reduce substance-related harm. Measures to reduce violence in and around clubs include training and registration of door staff, good lighting around the main entrance, and public transport integrated into the nighttime environment so that individuals
International considerations
The recent clubbing phenomenon probably has its routes in Ibiza where the mix of music (known as the Balearic Beat) and concurrent use of ecstasy rose to popularity (Calafat et al., 1998). Today, travelling in the form of dance music tourism (individuals specifically travelling abroad to attend dance events or choosing to holiday in destinations renowned for their nightlife) is more popular than ever. Major international clubbing resorts include Ibiza in Spain, Rimini in Italy, and Ayia Napa in
Conclusions
Around the world, clubbing is now well established as a major feature of the nighttime environment. It provides a social outlet for millions of individuals every week and developing a popular club scene has reinvigorated many cities bringing money and employment. Substance use in clubs is strongly affiliated with relaxation, exercise (Gaule, Dugdill, Peiser, & Guppy, 2001), and meeting new sexual partners. Whether these pastimes lead to increased well-being or ill health depends on the
Acknowledgements
This paper draws on original research measuring levels of substance use by individuals holidaying abroad. That work would not have been possible without the support of the Health Authorities of the North West Region. In particular, we would like to thank Mr. Rod Thomson and Professor John Ashton whose interest and support for developing a healthy nightlife has been fundamental to this work.
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