Excessive alcohol intake exposes male and female clubbers to different risks

Men are more likely to use illicit drugs when drunk, while women risk alcohol overdose and sexual abuse, research shows.

By Karina Toledo  |  Agência FAPESP – A survey of 2,422 young men and women who frequent night clubs in São Paulo City shows that the prevalence of alcohol abuse in this population is 43.4%, much higher than the rate for the Brazilian population as a whole, which is 18.4%.

On the day the clubbers were interviewed, 30% left the establishment with a blood alcohol level usually classified as the result of binge drinking (or heavy episodic drinking): four drinks or more for women, five or more for men, in a period of about two hours.

This high-risk pattern of alcohol use has been associated, in several studies, with higher rates of sexual abuse, suicide attempts, unprotected sex, unwanted pregnancy, heart attack, alcohol overdose, falls, and other health problems. 

The survey was coordinated by Zila Sanchez, a professor in the Department of Preventive Medicine at the Federal University of São Paulo’s Medical School (EPM-UNIFESP), and supported by FAPESP.

“The results show that men and women expose themselves to different risks when they leave a club intoxicated,” Sanchez said. “Men tend to use illicit drugs and engage in drunk driving, whereas women tend to continue drinking and run a greater risk of alcohol overdose.

“We also observed that excessive drinking in women triples the likelihood of their suffering sexual abuse in clubs.”

The interviewees, 60% men and 40% women, were aged 21-25 years and agreed to take part in the survey with a guarantee of anonymity. They were approached while in line to enter 31 clubs in a variety of neighborhoods of the city that are frequented by different social classes and play different styles of dance music.

“We set out to survey a representative sample of the city’s nightclubs,” Sanchez said. “We contacted the proprietors or managers and requested permission to collect data. Brothels and swinger clubs weren’t included because we wanted to focus on places people go to dance.”

Each venue was visited by a team of eight uniformed researchers – six dedicated to interviewing volunteers and two who observed environmental factors that might influence alcohol use, such as temperature, humidity, lighting, sound pressure, number of tables, number of dance floors, and drink promotions.

The club patrons were first interviewed while queuing to get in. The volunteers answered questions related to demographics (age, occupation, education, income), whether they drank to “warm up” on the way to a club (place, type of alcoholic beverage consumed, frequency, typical expenditure), their usual alcohol use pattern (lifelong or recent), and whether they had taken other drugs at any time in the past. Their breath alcohol concentration was measured with a breathalyzer at the time of the interview, and they were each given a numbered bracelet for identification upon leaving the club.

The breathalyzer test was repeated for the same participants on their way out. The participants also said how many drinks they had had and how much they had spent. The next day, they received an email with a link to a questionnaire asking about their activities after leaving the club.

Of the 1,222 volunteers who completed both interviews and the online questionnaire, 10% said they could not remember what they did after they left the club. “Many said they’d had sex but had no idea with whom, or they’d woken up in a strange place or couldn’t recall how they’d gotten home. All this is alarming,” Sanchez said. 

The use of the “open bar” system to sell alcohol (unlimited drinks for a set time at a fixed rate paid in advance) was the main environmental factor associated with intoxication. “It increased the alcohol intake, as expected, but also the use of illicit drugs,” Sanchez said. “At open-bar clubs or parties, the consumption of ecstasy [methylenedioxymethamphetamine], marijuana, cocaine and even ketamine, a horse anesthetic that causes hallucinations, is 12 times more probable.”

Sound pressure and style of music also influenced alcohol intake patterns. According to the survey results, the louder the ambient sound, the more likely the clubbers were to be drunk when leaving the venue. Alcohol use was more frequently associated with drug use in clubs that specialized in electronic music or hip-hop. Intoxication was far less frequent among clubbers who frequented venues specializing in forró or zouk, probably because they were genuinely interested in dancing. 

The researchers were struck by the higher prevalence of ketamine use and unprotected sex, even where free condoms were available, at LGBT (lesbian, gay, bisexual and transgender) clubs, especially among male patrons. 

“Warm-up” drinking was more frequent among men, who had higher blood alcohol levels upon arrival at the clubs. Women had similar levels when leaving, however, which suggests that they consumed more alcohol on the premises.

“We began with the hypothesis that the point of warm-up drinking was to save money on drinks at the club, but actually, the people who arrived at the club with higher blood alcohol levels ended up drinking more than the rest. The conclusion must be that these individuals are accustomed to drinking more heavily, so they spend more,” Sanchez said. 

Profit prioritized

In parallel with the epidemiological survey, the group from UNIFESP conducted a qualitative study with approximately 30 proprietors or managers of the establishments visited by the survey participants. The findings were presented by Claudia Carlini in her PhD research, which was supported by a scholarship from FAPESP.

According to Sanchez, many interviewees admitted to selling adulterated liquor as a strategy for increasing their profit, especially in clubs that use the open-bar model. Some said they deliberately kept the air conditioning low to raise the ambient temperature and stimulate alcohol consumption by patrons. However, the results of the epidemiological survey did not point to temperature as a factor influencing liquor consumption.

Although a majority said they did not approve of illicit drug sales or consumption on their premises, they acknowledged that they did nothing to stop the clandestine practice for fear of scaring away customers and lowering profits. 

“When we began the research, we thought of using the data to design intervention strategies that could be used in these clubs to curtail alcohol abuse,” Sanchez said. “However, the qualitative study showed this type of measure wouldn’t work. The proprietors aren’t open to interventions that could negatively affect their monthly revenue.”

In Sanchez’s view, only public policy can tackle the problem. One proposal would be to combat the open-bar model and other promotions that make liquor cheaper. “Another interesting measure would be to ban selling to people who already display signs of being drunk, such as slurred speech and bloodshot eyes. This is done in some countries. The idea isn’t outright prohibition but an attempt to make sure people leave the premises in safer conditions,” Sanchez said.

Intervention model

The 1,222 clubbers who completed all three stages of the survey were invited to take part in an online intervention inspired by a model developed in Australia to reduce binge drinking among undergraduates. Most (1,057) agreed: 465 stuck with the intervention to the end and were monitored for 12 months.

The participants were divided at random into two groups: a control group that only answered a few questions regarding alcohol use habits, and a second group that answered the same questions and were then shown a screen with information such as the individual’s annual spend on alcohol, what else could be bought with the same money, and a stratification of risk (light, moderate or heavy use, and dependence).

“This intervention screen was designed to show people whether their alcohol intake was in line with the normal curve for their age and could be considered safe,” Sanchez said.

The results of this specific study were inconclusive, according to Sanchez. Among young people classified as heavy drinkers, both the control group and the group that received the intervention were observed to reduce their intake during the 12-month period, but light drinkers in both groups increased their intake.

“These results can be explained in various ways. One hypothesis is that there was a statistical bias. From the public health standpoint, however, the findings reinforce the idea that this type of intervention should be confined to people who really do drink too much. Otherwise, it could actually be counterproductive,” Sanchez said.

The research began in 2012 and involved the participation of master’s student Mariana Guedes Ribeiro Santos and scientific initiation scholarship awardees Raissa Reis dos Santos, Karen Jennings Ribeiro, Miguel Rodolpho Benjamin and Yago Carvalho Baldin.

More information on the project and its results can be found at: baladacomciencia.com.br.

Articles: 

PLoS One: journals.plos.org/plosone/article?id=10.1371/journal.pone.0133646

International Journal of Drug Policy: sciencedirect.com/science/article/pii/S0955395915002133 

Alcohol and Alcoholism: academic.oup.com/alcalc/article-lookup/doi/10.1093/alcalc/agu055

Alcoholism: Clinical & Experimental Research: goo.gl/NNcUUT

The American Journal of Drug and Alcohol Abuse: tandfonline.com/doi/abs/10.3109/00952990.2015.1050497?journalCode=iada20

Sexual Health: publish.csiro.au/SH/SH14207

Drug and Alcohol Review: goo.gl/axZWJ0

Revista de Saúde Pública: scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102016000100801