Acceptance of the Harm Minimization Message in London Clubs and Underground System

Drugs: education, prevention and policy, Vol. 6, N o. 3, 1999

Acceptance of the Harm Minimization Me ssage in

London Clubs and U nderground Syste m

PATRICK BRAN IGAN & KAYE WELLINGS

Health Prom otion Rese arch U nit, London Schoo l of Hygiene & Tropical Medicine, London,

UK

ABSTRACT H arm m inim ization strategies recognize that risk behaviours m ay be

dif® cult to elim inate com pletely, and therefore, aim to minim ize the potential hazards

associated with drug use rather than regulating use itself. The merits of harm reduction

strategies as public health measures have been extensively debated. Although the

approach has gained credibility in speci® c areas (e.g. needle exchange schemes) it is still

somewhat controversial when applied to other areas of drugs prevention work. This

paper explores public acceptability of the harm minim ization approach using evidence

from the evaluation of the London D ance Safety campaign. This initiative acknowledged

the appeal of drug use from the young person’s perspective as well as its potential

medical, social and legal consequences. Pocket-sized booklets were distributed in clubs

and posters were displayed on the London underground and bus system . The anticipated

public opposition to the intervention failed to m aterialize , despite high awareness in the

target and non-target groups. Dem and for the cam paign m aterials from the non-target

group of parents, and others, was unexpectedly high. Well-m anaged drugs interventions

prom oting harm reduction have the potential to offer proven bene ® ts, with m inimal costs

in terms of public resistance.

Introduction

This paper explores acceptance of the harm reduction approach by London

clubbers. Harm reduction strategies offer a pragmatic yet compassionate ap-

proach to reducing the harmful consequences of addictive behaviour for both

drug users and the communities in which they live (Marlatt, 1996) . The focus is

on mitigating the harmful consequences of substance use rather than on elimi-

nating use altogether. The strategy accepts the existence of a range of drug use

behaviours along a continuum of risk, while recognizing abstinence as an ideal

outcome. Consensus has now emerged with respect to the following premises of

harm reduction:

· Illicit drug use is inevitable in any society in which there is access to such

drugs.

· Illicit drug use produces varying degrees of social and personal harm.

Correspondence to: Patrick Bran igan, Health Promotion Research Unit, London School of Hygiene &

Tropical Medicine, Keppel Street, London WC1E 7H T, UK. Tel: 0171 927 2672 .

ISSN 0968-7637 (print) ISSN 1465-3370 (online) /99/030389-10 Ó 1999 Taylor & Francis Ltd

Dru

gs E

du P

rev

Pol D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Bat

h on

11/

02/1

4Fo

r pe

rson

al u

se o

nly.

390 P. Branigan & K. Wellings

· Drug policies should ideally be pragmatic. Policies and programmes to reduce

harm must be assessed on their actual consequences, not their symbolism.

· The health of drug users and the community is best served by an approach

that integrates rather than isolates the drug user.

· The complex relationship between drug use and harmful outcomes necessi-

tates multifaceted interventions (Des Jarlais , 1995; Erickson, 1997).

Although harm reduction has gained credibility in speci® c areas (e.g. needle-

exchange programmes) it is still controversial when applied to drug educa-

tion (Erickson, 1997). A number of frameworks for harm reduction approaches

to drugs education have been put forward (Cohen, 1993) . Applied pragmati-

cally, these offer drugs education to achieve a reduction in risk, rather than

counselling against use. The goal is to provide accurate and credible information

that will promote responsible behaviour. This approach acknowledges the

appeal of drug use from the young person’ s perspective at the same time as

recognizing the potential medical, social and legal consequences. It is rooted in

an appreciation of adolescent psychosocial development, in which curiosity, a

willingness to experiment and the de ® nition of personal boundaries come into

play.

The London Dance Safe ty Campaign

The London Dance Safety campaign was initiated by the 26 London Drug Action

Teams (DATs), set up by the government to act as local taskforces in the

National initiative, `Tackling Drugs Together’ (HMSO, 1995). The funding came

from the Drugs Challenge Fund, with 40% of the total costs provided by private

sector sponsorship, in this case free poster advertizing space donated on the

London Transport systems by TDI Advertising.

The impetus for the intervention came from a growing recognition that use of

recreational drugs had become increasingly common in London dance venues

(Forsyth, 1996; Release, 1997) , and that the circumstances of such use were likely

to increase the role of adverse consequences. The aim of the campaign was to

minimize harm through information in a format, and via a medium, acceptable

to a target audience of London clubbers. The style of the campaign was designed

to encourage a thirst for up-to-date, accurate knowledge to accompany the

launch of the London Drug Policy Forum (LDPF) licensing guidelines, in

December 1996.

The intervention comprised several components, including information dis-

semination aimed at changing behaviour from an individual perspective

through information delivered via posters and lea¯ ets, and a multi-levelled

training programme. By targeting club staff, the intervention acknowledged that

the social context in which behaviours take place is as important as individual

motivation and action. Thus the club environment itself was the focus for

improvements in provision of the means by which harm might be reduced. The

emphasis in this paper is on the broad spectrum strategies, since it is this

component which reached both target and non-target audience, and therefore

had the greatest potential for controversy and adverse public reaction.

Dru

gs E

du P

rev

Pol D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Bat

h on

11/

02/1

4Fo

r pe

rson

al u

se o

nly.

Acceptance of the H arm Minim ization Message 391

Information via Posters

Individuals were provided with appropriately pitched information in the form

of a booklet and a series of six posters. The campaign philosophy was guided by

the premise that club-goers need accurate information to make informed deci-

sions and minimize risk associated with drug use in the club environment,

rather than strict admonitions to avoid drug use altogether. The messages were

informative rather than didactic, and the language and tone was carefully

pre-tested with focus groups of current London dance club attenders.

The campaign incorporated the characteristic `corporate’ super club ¯ yer look

of clubs such as `Renaissance’ and `Cream’ into the London Dance Safety

campaign posters. Posters were eye-catching, colourful and informative, but

most importantly, identi® able and attractive to clubbers. Broad spectrum infor-

mation delivery methods of reaching the target population were employed, with

10,000 posters targeting six common dance drugs displayed throughout the

London underground and bus system over a 3-month period. The posters

featured the telephone number for the campaign helpline.

Information via Vital Information Pack (VIP) Booklet

Narrow spectrum information delivery methods were also used, in the form of

the booklets targeting dance club attenders, distributed directly by drug out-

reach workers. In total, 150,000 VIPs were distributed throughout London clubs

in a series of London Dance Safety-sponsored club nights across the capital and

across the club scene. Care was taken to ensure that the informational content of

the booklets was appropriately pitched. The VIP contained closely packed,

palatable information on individual dance culture, associated drugs, the law,

® rst aid and useful contact numbers. Facts about staying safe when taking drugs

were highlighted, to enable young people to make informed decisions and dispel

some of the rumours in circulation among club goers. The campaign helpline

number was given in addition to two pages of drug agency and helpline

numbers.

The tone was factual and non-moralistic and information was presented in

such a way as to encourage uptake by the `trainspotting’ ethos of club culture.

This `craving for information’ mentality feeds on the constant ¯ ow of highly

detailed facts and ® gures from club culture-style magazines about music, clubs,

top DJ celebrities and the drug research ® ndings. It is this that ultimately moulds

current and future fashion trends within the scene. The inside cover also

featured an endorsement from Nicholas Saunders, one of dance/drug culture’s

literary heroes, to add additional credibility.

Methods

Attitudes towards and awareness of the campaign among the target group were

evaluated using both qualitative and quantitative survey techniques. A baseline

`pretest’ survey was conducted prior to the campaign launch using a purposive

sample of 90 London clubbers. Following the campaign inception, two post-test

surveys were carried out using purposive samples of 88 and 90 London

clubbers, respectively. Eighteen different night-clubs agreed to participate in the

campaign and respondents were sampled from this range of venues, to represent

Dru

gs E

du P

rev

Pol D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Bat

h on

11/

02/1

4Fo

r pe

rson

al u

se o

nly.


Table 1. Acceptability of the materials

Post-test 1 survey Post-test 2 survey

% Liked the poster designs and approach 87% 85%

(n 5 57) (n 5 60)

% Thought campaign approach was good idea 98% 93%

(n 5 57) (n 5 60)

% Would keep the Vital Information Pack (VIP) 87% 89%

(n 5 88) (n 5 90)

the different music and style genres of London in 1997. A further sub-group of

18 regular London clubbers was recruited for a series of in-depth interviews

probing reception of the intervention in greater depth. Questions were asked

exploring acceptability, appropriateness and usefulness of the materials and on

the way in which the campaign was received generally. Data from the campaign

helpline, correspondence to the Drug Action Teams from the public and media

coverage of the intervention were all monitored for evidence of adverse response

to the intervention in the target and non-target groups.

Results

Attitudes to the Cam paign: acceptance or backlash?

The target group of London clubbers Table 1 shows the quantitative survey results

relating to levels of acceptance to the target audience. A high proportion liked

the poster designs and the approach, which was thought to be innovative and

unpatronizing. Views expressed in the in-depth interviews supported these

® ndings.

the thing that struck me was the very accepting nature towards it,

which was quite unusual compared to previous drug compaigns.

(Male, regular clubber, 18 ± 24)

Full of information, the facts and ® gures of it, rather than the actual

government hype.


The in-depth interviews also showed that the target audience was impressed

by the quality and the nature of the information presented. They appreciated the

approach of presenting simply `the facts’ , and the safety guidelines for clubbing.

It’ s a really good idea and it reminds me a lot of the kind of campaigns

that they’ve got for condoms. It’s a really similar approach to not being

judgmental in addressing an audience which might be likely to practise

in this case drug use, and indicate a safer way to do it.

(Female, occasional clubber, 24 1 )

I think it’ s the kind of thing which everyone who ever has anything to

do with drugs, or is thinking about doing drugs, or knows people who

do drugs should have and read, `cause if you know about drugs then

Dru

gs E

du P

rev

Pol D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Bat

h on

11/

02/1

4Fo

r pe

rson

al u

se o

nly.


you can actually make a decision based on proper evidence and

understanding of drugs.


Generally , the opinions expressed about the campaign philosophy were posi-

tive. This seemed to be attributable to the realistic tone and honest, non-judge-

mental style of the campaign.

I think it’ s a brilliant idea. I think it’ s the ® rst time that any drug

campaign has the right thrust. Rather than telling people not to take

drugs, it’ s accepting that they do, tells them how to do it properly and

tells them how to help their mates out, and not be stupid about it and

not die.

(Female, regular clubber, 18 ± 24)

I think it’ s an excellent idea, because it’ s approaching it in a new way.

It’ s almost expecting that people are going to take drugs and telling

them how they should take them safely, which I think is good, because

I don’t think you’re ever going to stop people taking drugs.

(Male, occasional clubber, 24 1 )

Some concerns were raised during the in-depth interviews about the possible

adverse effects of a drugs campaign of this nature involving broad spectrum

mass media approaches on public transport. This was due to a belief that people

outside the target audience who came into contact with the material might ® nd

it potentially offensive.

It’ s gotta be something that’ s targeted at a much more speci® c audi-

ence, which either is going to come into contact with it [drugs] or has

come into contact with it [drugs], rather than a mass audience where

people aren’ t informed and might be shocked by it [poster].

(Female, London clubber, 24 1 )

The non-target group

Response from the general public. A major hurdle to be overcome by harm

reduction campaigns is the potential for adverse reaction on the part of the

general public. Public acceptance of the harm reduction approach requires at the

very least that non-use of drugs be included as one of several viable goals. Thus,

there was particular concern about the possible unintended outcomes of this

campaign, speci® cally with the impact of such broad spectrum techniques as

posters on the underground, whose message was not `Just say no’, but harm

minimization.

In the event, fears of public outrage against the harm minimization message

and the techniques of the campaign proved unfounded. The `backlash’ consisted

of one formal letter of disapproval about the posters, and not a single complaint

made to London Underground or TDI Advertising (the company which owns

the rights to advertizing sites on the underground). Some of this success may be

attributed to the formative process of developing the posters with both target

and non-target focus groups (parents of clubbers, tube travellers, young non-

Dru

gs E

du P

rev

Pol D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Bat

h on

11/

02/1

4Fo

r pe

rson

al u

se o

nly.


club goers) whose input helped to shape the format and language used in the

® nal versions and highlight possible unintended outcomes at the developmental

stages .

Another possible channel for negative feedback was the campaign helpline.

Out of 448 calls received during the campaign there was not one logged

complaint (although two complaints were made against speci® c London clubs).

The mean age of callers to the helpline was over 30 years . Given the target

audience of the campaign, this was a surprising result and analysis by logged

comments re¯ ected a large number of calls from the non-target group. A proxy

measure for further evidence of the acceptability of this harm reduction material

was found in the high demand for the booklets from non-target groups mani-

fested in requests for VIPs taken on the campaign helpline. Just under 80% of

these calls were requests for booklets and campaign information (Figure 1). This

demand suggested an unmet need for access to this type of information among

parents and in some cases drugs agencies based outside of London, who had

seen the poster advertisements or read articles referring to the campaign in

newspapers. The view taken seemed to be that it is impossible to have an honest

debate about drugs, without having up-to-date, accurate facts.

Older age groups were also found to be highly reliant upon the media for

information about drugs. This was found also by Coggans et al. (1991) in the

national evaluation of drug education in Scotland where the main source of

information about drugs was the media (Figure 2).

Response from the media. The relationship between the media and drugs is not a

simple one. Messages about drugs are often contradictory and strong editorial

positions are taken (Coomber, 1996) . An important aim of the evaluation, as

stated above, was to assess any unintended outcomes of the intervention, in

particular those relating to public reaction. A valuable measure of such reaction

was the extent and tone of media coverage of the campaign. This was monitored

before and during the campaign by analys ing press cuttings collected by a

public relations company (Carol Hayes Associates) and by monitoring recorded

television and radio features during the 3-month period. Local press activity was

monitored by a DAT representative.

Dru

gs E

du P

rev

Pol D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Bat

h on

11/

02/1

4Fo

r pe

rson

al u

se o

nly.


Figure 2. Where callers ® rst saw the helpline number.

The expectation was that the intervention would cause some media contro-

versy. Back in 1987, Manchester drug agency `Lifeline’ issued the ® rst edition of

the heroin user’ s drug awareness comic `Smack in the eye’ which employed the

humour and street language of the user to get across its message. Then, the

result was two interviews with the Director of Public Prosecutions and several

attempts by other drugs agencies to in¯ uence the Department of Health to stop

Lifeline’s funding (Collin, 1997) . Interestingly, all the criticism of Lifeline’ s

message of harm reduction came from the professionals, not the media.

It has been suggested (Goode & Ben-Yehuda, 1994) that the media is manipu-

lated into playing up drug issues at the expense of other sensitive topics, such

as unemployment and poverty. Just before the launch of the campaign, two

popular musical role models, Noel Gallagher and Brian Harvey, decided to voice

their opinions about recreational drug taking. Both of their comments sparked a

media outrage that resulted in the latter’ s dismissal from his band East 17 and

the tabloids screaming for `an honest debate on drugs’ . So, with the prevailing

social climate and the run up to the election there was a realistic potential at

least, for a large-scale negative reaction generated by the appearance of a

campaign of this nature.

It seemed that the pre-campaign outbursts by the popstars ultimately proved

useful in stimulating debate, as careful monitoring of the media and timely

educational releases about campaign aims and philosophy by the press agency,

led to overall positive and continuous press coverage (Figure 3). The Financial

Times (1997) ran a full page article discussing the posters as part of new liberal

attitudes expressed by tube travellers and Londoners in general. The VIP was

welcomed as contributing to an honest debate on drugs and the press coverage

helped to establish London Dance Safety as the authoritative voice in dance/

drug culture at that time.

Awareness of the Cam paign

The signi® cance of high acceptability levels would be limited if few people had

actually seen or been exposed to the material. However, there was evidence to

show that campaign awareness levels were high among the target and non-

Dru

gs E

du P

rev

Pol D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Bat

h on

11/

02/1

4Fo

r pe

rson

al u

se o

nly.


Figure 3. Positive press response to the campaign.

(Reproduced from Health Education Journal (1998) 57, 232± 240 )

target audience. Table 2 shows that unprompted awareness to drugs information

posters was low in the pre-test survey, fewer than one in to clubbers reporting

having seen one. Subsequently, it rose during the course of the campaign, such

that more than half the sample reported having seen a campaign drugs infor-

mation poster. The only on-going drug prevention poster campaign being

promoted in London during this period (December 1996 to March 1997) was the

London Dance Safety campaign.

The press agency maintained a consistently high level of media interest for the

duration of the campaign. This resulted in a large number of positive articles in

newspapers and magazines about the campaign and its materials.

Discussion

Traditional anti-drugs programmes have tended to attempt to prevent drug use

by emphasizing the negative aspects (Dupont & Voth, 1995) . Non-use is pre-

sented as the normative behaviour pattern and use is equated with abuse/mis-

use. The effectiveness of such programmes has not been yet demonstrated

convincingly (Dorn & Murji, 1992; Ennett et al., 1994) . The recent increase in

adolescent drug use (Miller et al., 1996; Wright & Pearl, 1995) is further evidence

of a failure of proscriptive policies.

Some have argued that prevention programmes aimed at young persons

cannot be effective because their messages are inconsistent with the messages

Table 2. Unprompted awareness to drugs information: information about drugs

seen or heard by clubbers in the last month

Pre-test (n 5 90) (%) Post-test 1 (n 5 88) (%) Post-test 2 (n 5 90) (%)

Lea¯ et 8 4 10

Magazine 13 14 27

Newspaper 31 12 25

Postcard 0 4 3

Poster 9 45 56

Rad io 33 27 32

Television 37 20 25

Dru

gs E

du P

rev

Pol D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Bat

h on

11/

02/1

4Fo

r pe

rson

al u

se o

nly.


that young people receive from the larger social environment. In most drug

prevention programmes the value and meaning of drug use for users is misun-

derstood and the bene ® ts underestimated (O’Connor & Saunders, 1992) . The

strength with which such views are held varies. Some have concluded that it is

unrealistic to expect such programmes to prevent or change adolescent drug use

and have proposed more realistic goals, such as promoting safer use, delaying

use, preventing increasing use and encouraging users to take responsibility for

themselves and others. Other critics of drug prevention aimed solely at absti-

nence/proscribing drug use have suggested that it may actually be harmful

(Cohen, 1996; Saunders, 1995) . They argue that an emphasis on abstinence as the

norm may isolate and stigmatize young people who are using drugs and may

reinforce other forms of deviance. In addition, those who are experiencing

problems may be deterred from seeking help.

It is questionable whether traditional anti-drug programmes (e.g. `Just say no’ )

can equip young people for life in the real world. Even if young people choose

not to use drugs themselves they may need to assist and understand those who

do (Erickson, 1997) . The wide availability of illicit drugs is a now a fact of

modern life that has not been altered by the `war on drugs’ . The task ahead may

be to best prepare young people by equipping them for the realistic challenges

of a world in which legal and illegal drugs are very accessible.

The evolving harm reduction model can provide a pragmatic and ¯ exible

response to the problem of young people and drug usage in club environments

(Adlaf & Smart, 1997; Branigan et al., 1997). However, new alternative drug

strategies must also address fundamental problems of the environment, be it

harsh inner city life (violence, poverty, low education, unemployment) or the

club environment and culture (culture of hedonism, music, escapism, few

credible reasons not to take drugs, price, availability). The evidence presented

here suggests that the attitudes of clubbers, parents, the media and drug

agencies were more positive to the harm minimization approach of this cam-

paign than might have been expected. Public health strategies promoting a harm

reduction policy have clear advantages, and the public may be beginning to

acknowledge this.

References

ADL AF , E .M. & SM A RT , R.G. (1997) . Party subculture or dens of doom? An epidemiological study of

rave attendance and drug use patterns among adolescent students. Journal o f Psychoactive D rugs,

29, pp. 193 ± 98.

BRAN IGAN , P.M., W E LL IN G S, K. & KU PER H. (1997). Poste rspotting: the evaluation of the London D ance

Safety cam paign . Report for Kensington, Chelsea & Westminster Health Authority.

COG GA N S, N . et al. (1991). N ational Evaluation of Drug Education in Scotland . London: Institute for the

Study of Drug Dependence .

COH E N , J. (1993) . Achieving a reduction in drug-related harm through education. In N. Heather, A.

Wodak, E. Nadelmann & P. O’Hare (Eds), Psychoactive Drugs and H arm Reduction: from faith to

science . London: W hurr Publishers.

COH E N , J. (1996) . Drug education, politics, propaganda and censorship. Inte rnational Journal o f D rug

Policy , 7, pp. 153 ± 57 .

COL LIN , M . (1997). A ltered State. The story of ecstasy culture and acid house . London: Serpent’s Tail.

COO M BE R, R. (1996) . Drugs and the media. In ISD D Student Reader: D rugs Ð your questions answered

(pp. 116 ± 27). London: Institute for the Study of Drug Dependence .

D ES JARL AIS, D .C. (1995) . Harm reduction: a framework for incorporating science into drug policy.

A merican Journal o f Public Health , 85 , pp. 10 ± 12.

Dru

gs E

du P

rev

Pol D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Bat

h on

11/

02/1

4Fo

r pe

rson

al u

se o

nly.


D OR N , N . & M UR JI, K. (1992). D rug Prevention: a rev iew of the Eng lish language literature. London:

Institute for the Study of Drug Dependence .

D UPON T , R.L. & VOT H , E .A. (1995) . Drug legalisation, harm reduction, and drug policy. A nnals of

Inte rnal Med icine , 123 , pp. 461 ± 65.

EN N ET , S .T., TOB LE R, N .S., R IN G W AL T , C .L. & FLE W EL LIN G , R. (1994) . How effective is Drug Abuse

Resistance Education? A meta-analysis of project DARE outcome evaluations. A merican Journal of

Public Health , 84 , pp. 1394 ± 401.

ERIC KSO N , P.G. (1997) . Reducing the harm of adolescent substance use. Canad ian Medica l A ssociation

Journal, 156 , pp. 1397 ± 99.

FO RSY TH , A .J. (1996) . Places and patterns of drug use in the Scottish dance scene. A ddiction , 91, pp.

511± 21.

GOO DE , E . & BEN -YEH U DA , N . (1994). M oral Panics: the construction of dev iance . Cambridge, MA:

Blackwell.

HMSO (1995) . Tackling D rugs Togethe r. London: HMSO.

M AR LA TT , G.A. (1996) . Harm reduction: come as you are. A dd iction Behaviour, 21, pp. 779 ± 88.

M ILL ER , P., M C , M.C. & PL AN T , M . (1996) . Drinking, smoking and illicit drug use among 15 and 16

year olds in the United Kingdom. British Med ical Journal 313 , pp. 394 ± 99 .

O ’CON N O R, J. & SAU N DE RS, B. (1992) . Drug education: an appraisal of a popular preventive. Inter-

national Journal o f A ddiction , 27 , pp. 165 ± 85 .

REL EA SE (1997). Release drugs and dance surve y : an insigh t into the culture . London: Release .

SA UN D ER S, B . (1995) . Illicit drugs and harm reduction education. A dd iction Research 2, pp. i± iii.

i± iii.

The Financia l Times (1997) . Tolerance on the tube, 16 March.

W RIGH T, J.D . & PE AR L, L . (1995) . Knowledge and experience of young people regarding drug misuse,

1969± 94. British Med ical Journal, 310 , pp. 20 ± 24.

Dru

gs E

du P

rev

Pol D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Bat

h on

11/

02/1

4Fo

r pe

rson

al u

se o

nly.

Documents

Acceptance of the Harm Minimization Message in London Clubs and Underground System