Ibiza Uncovered: Drug and sexual related behaviour amongst young people on holiday.

Mark Bellis

Liverpool John Moores University, School of Health and Human Sciences, Public Health Sector, 70 Great Crosshall Street, Liverpool, L3 2AB, UK. Phone no: +44 (0)151 231 4301 Fax no: +44 (0)151 231 4320 E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

What I want to talk about is the difference between people’s behaviour at home and abroad, and what that means in terms of health protection and promotion. In the UK 35% of 16 – 24 year olds drink 21 or more units of alcohol a week; the figure is slightly lower for females exceeding 14 units. In relation to tobacco use, we are not making much of a dent. In a recent British Crime Survey 27% of people had ever used substances and 8% used in the last month. The level of drug use has generally risen.

Of course, all of this information is based upon what people have done in their own country. When someone asks you what you do, you do not generally tell them about or even include what you have done on holiday. You tend to talk about what you do in your own country. You almost exclude from your normal behaviour your behaviour abroad. Apart from articles in tabloid newspapers, how do we know what people do when they are abroad? When we provide health prevention and promotion leaflets, or even when we look at the health consequences of taking a particular amount of tablets we usually look at the everyday behaviour in their own country. We decide what promotional materials are needed based on the toxicological risk involved in what people do in their own country what promotional materials are needed.

However, it may be appropriate to inform people for when they go abroad. We wanted to look at what people actually do when they go abroad. I do not need to tell you there is a link between drugs and clubs. There is a clear relationship between people liking a particular type of music and drug use. There are a number of recent surveys which present a high level of drug use among clubgoers and historical links which go back in many respects to links between ecstasy and the Balearic Islands, in particular with Ibiza.

There are not just drug risks but also sexual risks and we should not underestimate those at all. We seldom mention HIV and other far more prevalent problems in the UK like chlamydia and the relationship between chlamydia and infertility. We are not doing particularly well if you take the number of teenage pregnancies we have: nine thousand in under-16s each year, five times higher than the rate in Holland.

Even if people behaved exactly the same abroad, there are reasons why the risks they take out there may be manifested in a much greater way. The same type of behaviour might be much riskier because of unknown geography. People do not necessarily know where they are, which can be disorientating. There are language problems, so if you get into trouble you do not know how to ask for help. They may be familiar with the location of services at home, but they are not familiar with them abroad. There are reduced social constraints; when people go on holiday they tend to relax, act a bit more wild and, in some cases, there is a binge mentality. That applies not only to drugs, alcohol and tobacco but might also relate to sexual behaviour. If they buy drugs abroad they will generally come from unknown sources. You might trust someone at home, but abroad you do not know exactly who you are getting them off. They may have poor access to emergency services. Drink-driving regulations may be a bit more relaxed. There are elements which can complicate the way drugs may affect you. For instance, if you have been dehydrated through gastric infections you may have diahorrhea. You will also sweat more, not just in clubs, but also on the beach, and this could dehydrate you even more. Moreover, you may not have access to various health protection methods such as condoms.

Ibiza

Ibiza is a tiny little place which has an endemic population of 80,000 people, but then receives in excess of 1.5million people every summer. What happens to services in a place like that? How do they cope? Are they properly prepared for when people go out there and have particular expectations of the services? There will be literally hundreds of times more people trying to access a much smaller set of services.

44.2% of people who go to Ibiza travel from England. The majority of them are young (ie under thirty-five). The year 2000 will see even more people visiting this tiny little island. Some of the largest nightclubs in the world have up to ten thousand people apiece. That is a phenomenal number of people in a single place to be using substances. Even if they only use alcohol, they are divorced from their normal environment. Some of these places do not open until midnight and then they close at nine o’clock in the morning, so people have often been to bars and places like that beforehand. There are clubs this size all over Ibiza but most people stay in the resort of San Antonio. There are a huge number of buses that take people all over the island, so streams of people pour out of San Antonio each day and night.

We wanted to find out what these people are actually doing, rather than just relying on tabloid reports. So we targeted a sample of about a thousand people, looking at drugs such as alcohol, tobacco, amphetamine, ketamine, cannabis, LSD, ecstasy, cocaine and GHB. We compared what people were generally doing in the UK in the last sixth months with what they did in Ibiza over a very short period of time. We also examined whether they had seen drugs information abroad and asked why they visited Ibiza. We carried out the survey during the summer period of 1999. We captured this information through distributing questionnaires to people at the airport while they were waiting to board their return flight to the UK, so they had nothing better to do.

Results

Compliance was high. Nearly 94% of the questionnaires handed out were returned. That is about as good as you get in terms of representativeness. Just over half of respondents were male. The age range we wanted was up to 35, 15 being the youngest and the median around 20 years old. About half of the people stayed for one week and half stayed for two weeks. Most people were on their first visit but some had come back for more. Actually, it was obvious why people went over there: people who had returned to Ibiza a second or more times were more likely to say they had chosen Ibiza as a destination because of drugs. So that gives some indication of why people go to Ibiza. Why did other people go? Respondents could pick as many options as they liked for this question; there could be a number of reasons. However, 80% said they went for the music scene so there is a real link here with the club culture. A lot of people said they went because of the weather. Some people said they went for sex: unsurprisingly, more males than females.

Comparing the types of substances used over sixth months in England with use during a one or two week period in Ibiza, three substances were used by exactly the same number of people in both places: alcohol, tobacco and ecstasy. The "UK use only" group represents people who only used a given substance in the UK and did not use it in Ibiza, but there is hardly anybody in this group for these three substances. Therefore, almost everybody who used in the last six months has also used in Ibiza. About a third of people from the whole sample had used ecstasy while in Ibiza; almost everybody was using alcohol; and about half were using cigarettes.

It is not the same for cannabis, amphetamine and cocaine. Quite high percentages of people only used these in the UK and not in Ibiza. So for cannabis, amphetamine and cocaine there is a group of people who are not using in Ibiza. That might just be that they cannot get hold of these substances abroad. Nevertheless, there is a sizeable number of people using these substances in Ibiza: about 30% of people using cannabis, up to 13% using cocaine, and about 11% using amphetamines. So we are not talking about a small group number of people, but they are, however, using slightly less than in their own country.

A quarter of people said they used alcohol five or more days per week in the UK. Of the people who used alcohol when they are in Ibiza, nearly 90% were using alcohol every night. There is not that much difference in tobacco use, so the people who smoke, as might be expected, are still smoking every night more or less when they go out to Ibiza. Other drugs are like alcohol and show a huge increase in frequency.

Ecstasy users were at the same periphery as tobacco because there is no change in the numbers of the people using. In the UK only 2.9% of people were using it five or more days per week and the vast majority of people were using less than one day per week or one day per week. However, when people go to Ibiza (a lot of them for two weeks), nearly half (42%) of users were using more or less every night. That is a completely different pattern of substance use. Amphetamine showed a similar pattern abroad. 2% of people were using five or more nights in the UK, but in Ibiza nearly a quarter of users were using five or more nights a week - more or less every night. The frequency of drug use among people using substances in Ibiza also increases for every other drug: GHB, cannabis, LSD and ketamine.

It must be pointed out that more frequent UK users are more likely to use in Ibiza, but even if we single out people who used in both countries, there is the same rise. If we compare what one single person does in the UK to what they did in Ibiza, they are doing substantially more, following more or less the same pattern except they are using every night. We did notice that the number of tablets taken per day stayed the same. We need to ask questions about what people may think about risks because people are taking the same sort of dosage in Ibiza, but half of them are using this almost every single day. Although we do have information on people who do not use in England but do in Ibiza, this is a small group of people, and we cannot demonstrate that they are using in Ibiza for the first time.

What do people do sexually? 54% of individuals had at least one sexual partner on the island. Some of these partners will be their regular sexual partner who went with them on holiday. Nearly a quarter (23%) of people had more than one sexual partner on the island. Considering they are only there for one week or two, that is a fair number. A quarter of all the people who reported having sex with at least one person in Ibiza had done so without a condom, so effectively nearly half of all the people who had sex out there had unprotected sex at least once.

What should we do on the basis of information like this? The people trying to attract people out there should act. The mission statement for one Club 18-30, one of are biggest exporters of young British people to Ibiza, claims: "try sex in the surf; wake up in the wrong hotel; drink all your duty free in one day". They are certainly trying to appeal to a particular group but they are not just getting an age group but a group that are drug users who binge when they are in places like Ibiza.

What the tabloids say, although grossly exaggerated in some parts and very ill informed, and what the magazines are trying to encourage does actually happen. People use a lot of alcohol and there are dramatic increases in frequency of drug use (although fewer people are using some particular drugs). We do not know why. Maybe as the drug market develops people can get hold of more of certain drugs. 7.5% of the people in our survey had sought some kind of medical attention while in Ibiza. Although we have safer dancing guidelines in the UK and other countries, the question is whether they are needed in Ibiza, and whether the club industry, which promotes facilities like access to free water in the UK, are doing the same thing in places like Ibiza. They may be training staff up in the UK or in the Netherlands, but when set up abroad are the staff trained as well? One of the things we should be concentrating on is basic training, not just for club staff, but for people in the holiday industry. The people who are making the money should take responsibility for their clients’ well being and provide suitable training for hotel staff, holiday reps, tour-guides. If they are saying "Wake up in another hotel" are they making sure people know where they can access condoms? We need to just get the messages in the right place when people are abroad by micro-posting and putting information in hotels and clubs. There has been some work on it. With HIT, a local drugs information agency, we have been doing some work on developing materials that specifically target young people abroad. We should consider whether there could be more on poly-drug use. People are often taking many more amounts of substances than when they are at home. We should be telling people a bit more about the problems around higher dosages and what happens in terms of a build up of drugs if you are using them over prolonged periods, and reiterate complications of dehydration. Club magazines and radio stations could distribute sensible information on the kinds of behaviour that is actually happening. However, this sort of joint work requires collaboration across the EU because we have an incredibly mobile young population.

A lot of people find it difficult to actually pinpoint where to work with particular groups. It can be difficult in your own country to find the people who are using more drugs and having unsafe sex. One of the best places you could look for that in the UK population is in Ibiza. In terms of changing attitudes, it may be better to work with those groups out there. We should be thinking about how we can do this sort of work in other places. It is not a unique idea to go to where people are looking for a social outlet in order to carry out health promotion or protection work. There are other ways of doing it, but the point is that if you are going to do work which focuses on a particular group of people, who use substances or engage in certain sexual behaviours, then you need a very focused group of people who may be one of the highest risk sub-sets. Looking around for these people at home would be a more difficult way of reaching the population. We need to get away from the idea of just working with our own populations at home because there are particular places where work can be far more focused.

As to whether behaviour returns to what it was before a holiday, we do not know but I think the next step should be to look at this. What I suspect is if people go through a period of using drugs in a much higher frequency, it may drop back but there may be a certain confidence around then in using drugs at a much higher level and their perception of safe levels of use may be very different to their idea of what was safe before holidaying. This study cannot say whether people used drugs for the first time ever when they were abroad but what it can say is that they did not use the drugs in the last six months in the UK. There is a small percentage who used drugs in Ibiza, but not in the six months previous. This was also true of tobacco.