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
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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.
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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
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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.
(Male, regular clubber, 18 ± 24)
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
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Acceptance of the H arm Minim ization Message 393
you can actually make a decision based on proper evidence and
understanding of drugs.
(Male, regular clubber, 18 ± 24)
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-
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394 P. Branigan & K. Wellings
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.
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Acceptance of the H arm Minim ization Message 395
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-
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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
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Acceptance of the H arm Minim ization Message 397
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.
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