International Journal of Drug Policy 15 (2004) 211–213

Short communication

Elevated substance use in casual labour at internationalnightlife resorts: a case control study

Karen Hughes∗, Mark A. Bellis, Mo Chaudry

Centre for Public Health, Liverpool John Moores University, 8 Marybone, Liverpool L3 2AP, UK

Received 28 October 2003; accepted 30 January 2004

Keywords: Drugs; Travel; Ecstasy; Cocaine; Labour

Introduction

Millions of young people holiday abroad for 1 or 2 weekseach year, many of whom select their holiday destinationbased upon a resort’s nightlife (Sellars, 1998). An esti-mated 40% of 18- to 24-year-old holidaymakers from theUK frequently visit nightclubs whilst on holiday (Mintel,2003). Furthermore, substantial numbers extend their timeabroad by mixing holiday travel with paid casual work inforeign bars and nightclubs. Recent studies have identifiedthat young people consume alcohol and drugs at greaterfrequencies whilst on 1- and 2-week nightlife holidays andthat such consumption poses risks to both their short- andlong-term health (Bellis, Hughes, Bennett, & Thomson,2003; Bellis, Hughes, & Lowey, 2002; Smeaton, Josiam, &Dietrich, 1998). However, little is known about the substanceuse of those spending prolonged periods working in foreignholiday resorts. Such individuals are not only exposed to aculture of drug and alcohol consumption for greater peri-ods of time but are also critically placed to influence otherholidaymakers’ behaviour. Here, we compare the substanceuse of young UK tourists working in bars and nightclubs inthe international nightlife resort of Ibiza (Spain) with thatof UK individuals visiting the island solely for vacation.

Methods

Two groups of participants were recruited. Cases wereyoung people working in Ibiza in summer 2002 (n = 92;

∗ Corresponding author. Tel.:+44-151-231-5864;fax: +44-151-231-5873.

E-mail addresses: k.e.hughes@livjm.ac.uk (K. Hughes),m.a.bellis@livjm.ac.uk (M.A. Bellis), chaudry@terra.es (M. Chaudry).

compliance 97.9%) and were recruited at the end of season(September) as an opportunistic sample by a researcher vis-iting bars and nightclubs. Controls were individuals visitingIbiza during the same period but for holidaymaking purposesonly and were recruited at Ibiza airport prior to leaving theisland (n = 868; compliance 92.6%;Bellis et al., 2003). Allindividuals completed an anonymous questionnaire contain-ing basic demographics, reasons for visiting Ibiza and levelsof substance use in Ibiza and the UK. Questions also ad-dressed how many ecstasy tablets individuals take during ausual night of use, maximum number taken on any occasionand numbers considered safe to consume in one night andover a week. Controls visiting Ibiza to work were excludedfrom analyses regardless of whether they found employment(n = 39).

Results

There were no differences between cases and controls forsex (cases 55.4%, controls 60.7% male,X2 = 0.949,P =0.330) or median age (cases 21, controls 21,Z = 0.356,P = 0.722). However, median stay in Ibiza differed dra-matically (controls 7 days, workers 100 days,Z = 16.845,P < 0.001). Cases were also more likely to have previouslyvisited Ibiza (68.9% cases, 55.3% controls,X2 = 6.118,P < 0.05).

Significantly higher levels of tobacco and illegal drug usewere reported amongst cases both in the UK and in Ibiza(Table 1). Cases that used drugs in Ibiza used a greater me-dian number of different types of drugs during their stay onthe island than controls. However, analysis of users identi-fied cases as less likely to use most substances two or moredays per week in Ibiza (Table 1). For ecstasy most casesand controls using in Ibiza used≥2 days a week. Median

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212 K. Hughes et al. / International Journal of Drug Policy 15 (2004) 211–213

Table 1Substance use in UK and Ibiza by casual workers in bars and nightclubs (cases) and holidaymakers (controls)

UK Ibiza

Cases Controls P Cases Controls P

% (number) of respondents who used substancesAlcohol 97.8 (87) 99.0 (815) ns 98.9 (91) 98.4 (807) nsTobacco 74.4 (67) 50.6 (417) ** 79.3 (73) 55.4 (455) **Amphetamine 51.1 (46) 15.7 (129) ** 43.5 (40) 7.4 (61) **Ketamine 51.1 (46) 8.6 (71) ** 70.7 (65) 7.0 (57) **Cannabis 80.0 (72) 45.5 (374) ** 81.5 (75) 34.5 (283) **Ecstasy 87.8 (79) 40.0 (329) ** 91.3 (84) 40.5 (333) **LSD 26.7 (24) 5.4 (44) ** 23.9 (22) 2.4 (20) **Cocaine 80.0 (72) 32.8 (270) ** 87.0 (80) 22.2 (182) **GHB 26.7 (24) 5.0 (41) ** 39.1 (36) 3.5 (29) **

Respondents who used illegal drugs% (number) of users who use two or more days a week

Alcohol 82.8 (72) 70.8 (577) * 92.3 (84) 97.4 (786) **Tobacco 83.6 (56) 80.1 (334) ns 93.2 (68) 88.6 (403) nsAmphetamine 8.7 (4) 17.8 (23) ns 25.0 (10) 67.2 (41) **Ketamine 17.4 (8) 18.3 (13) ns 27.7 (18) 47.4 (27) *Cannabis 56.9 (41) 44.4 (166) ns 65.3 (49) 77.4 (219) *Ecstasy 39.2 (31) 14.0 (46) ** 83.3 (70) 76.3 (254) nsLSD 0 22.7 (10) * 9.1 (2) 55.0 (11) **Cocaine 19.4 (14) 16.3 (44) ns 35.0 (28) 59.3 (108) **GHB 12.5 (3) 29.3 (12) ns 27.8 (10) 69.0 (20) **

Median (IQRa) number of different illegal drugs used 5.00 (3.00–5.00) 2.00 (1.00–3.75) ** 5.00 (4.00–6.00) 2.00 (1.00–3.00) **

Respondents who used ecstasyMedian (IQR) number of tablets taken in a

usual night when using4.00 (3.00–6.00) 2.50 (2.00–4.00) ** 4.75 (3.00–6.00) 3.00 (2.00–4.00) **

Median (IQR) greatest number of tabletstaken in one night

10.00 (6.50–14.00) 6.00 (4.00–10.00) ** 8.00 (5.00–12.25) 4.00 (2.00–6.00) **

P values refer to significant differences (*:P < 0.05, **: P < 0.01, ns:P ≥ 0.05) between cases and controls. Comparisons between groups utilise chisquare and Mann–WhitneyU tests.

a Interquartile range.

number of ecstasy tablets taken by cases (on a night us-ing) was higher than controls in both locations as was thegreatest number ever taken in one night (Table 1). Casesusing ecstasy considered it safe to take more tablets in onenight (median 5.00 c.v. 2.00;Z = 4.454, P < 0.001) orweek (median 18.50 c.v. 5.00;Z = 5.293, P < 0.001)than ecstasy using controls. There was no significant dif-ference in having seen health information on drugs dur-ing their stay (20.2% cases; 13.0% controls;X2 = 3.328,P = 0.068).

Comments

Young people travelling to nightlife resorts are more likelyto be recreational drug users than equivalently aged individ-uals in the general population (Bellis et al., 2003; Ramsay,Baker, Goulden, Sharp, & Sondhi, 2001). Here we haveidentified that those working abroad are more likely again tobe substance users. Furthermore, for ecstasy, casual work-ers consume more tablets per night when using and considerit safe to consume higher numbers of tablets in one nightand one week than holidaymakers. Psychopathology associ-ated with ecstasy is related to the intensity of dosing (Soar,

Turner, & Parrott, 2001). Consequently, individuals work-ing in international nightlife resorts and regularly consum-ing large doses of ecstasy and other drugs, sometimes overa period of several months, place their short- and long-termhealth at additional risk.

Casual workers at resorts represent a key peer group reg-ularly in contact with holidaymakers and a source of infor-mation on illicit substances. Whether such workers provideholidaymakers with information on accessing drugs or withharm reduction information will depend on workers’ knowl-edge and attitudes towards substance use. At present, how-ever, little health information on drugs appears to be reach-ing this population whilst resident abroad. With drug inter-ventions in international holiday resorts far from compre-hensive, efforts aimed at casual workers may prove most ef-fective as such groups are at greater risk and are well placedto influence the behaviour of others.

Acknowledgements

We thank Mr. Andrew Bennett (HIT), Mr. RoderickThomson (South Sefton Primary Care Trust), ProfessorJohn Ashton (Government Office North West) and Profes-

K. Hughes et al. / International Journal of Drug Policy 15 (2004) 211–213 213

sor Qutub Syed (Health Protection Agency) for advice andsupport.

References

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Bellis, M. A., Hughes, K., & Lowey, H. (2002). Healthy night-clubs and recreational substance use: From a harm minimisationto a healthy settings approach.Addictive Behaviors, 27, 1025–1035.

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Ramsay, M., Baker, P., Goulden, C., Sharp, C., & Sondhi, A. (2001).Drug misuse declared in 2000: Results from the British Crime Survey(Home Office Research Study 224). London: Home Office.

Sellars, A. (1998). The influence of dance music on the UK youth tourismmarket.Tourism Management, 19, 611–615.

Smeaton, G. L., Josiam, B. M., & Dietrich, U. C. (1998). College students’binge drinking at a beach-front destination during spring break.Journalof American College Health, 46, 247–254.

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