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Intervenciones preventivas en contextos recreativos nocturnos: revision.

INTRODUCCION

En las ultimas decadas la vida nocturna de los fines de semana ha sido una de las actividades de ocio mas importantes para los jovenes de numerosos paises occidentales. Muchos experimentan las noches de los fines de semana como su propio mundo, lo cual entra en conflicto con el resto de la semana, identificada con el mundo adulto (en el que la gente trabaja, estudia, esta con la familia, etc.) Dependiendo de las ciudades, los jovenes europeos dedican entre 4 y 7 horas cada noche del fin de semana a actividades de ocio de este tipo (Calafat, Bohrn, Juan, Kokkevi, Maalste, Mendes et al., 1999). <<Esos fines de semana de excesos combinan la liberacion simbolica, educativa (aprendemos a moderarnos experimentando excesos), funcional y catartica de la semana laboral y estan condicionados por nuestra posicion estructural en la sociedad>> (Measham, 2004). Las noches de los fines de semana son contextos de socializacion cada vez mas importantes en los que los jovenes adquieren capital social. Parker (2003) incluso afirma que este tipo de consumidores recreativos realizan mejor la transicion a la vida adulta que sus coetaneos abstemios. Shedler y Block (1990) sostienen un argumento igualmente provocador, segun el cual las personas que prueban las drogas son psicologicamente mas sanas que las que se abstienen, basandose en un estudio longitudinal sobre una muestra de 85 individuos. No obstante, dicho argumento no se corroboro en un estudio de replicacion longitudinal realizado sobre una muestra de 2071 adolescentes (Milich, Lynam, Zimmerman, Logan, Martin, Leukefeld et al., 2000), ni en otro estudio en el que los clasicos factores de riesgo mantienen su prevalencia entre los consumidores de ocio recreativo (Calafat, Fernandez, Juan y Becona, 2008). Afortunadamente, estas cosas no hay que entenderlas en blanco y negro. Por ejemplo, una misma ocasion en la que se consume alcohol puede tener consecuencias positivas y negativas, que a veces se entremezclan (Graham, 2001).

Participar en la vida nocturna es una importante actividad cultural para los jovenes. Los ayuntamientos ven con buenos ojos la <<floreciente industria de la diversion nocturna>> (Greater London Authority, 2002). Pero ese florecimiento y las personas relacionadas con los ambientes recreativos tambien plantean problemas. Este articulo se centrara en la forma de minimizar esos problemas, revisando la eficacia de diferentes tipos de supuestas intervenciones preventivas. Empezaremos identificando las principales areas que presentan problemas:

--Problemas de salud (heridas, deterioro auditivo, trastornos mentales, hipertermia, embriaguez, consumo de drogas, etc.). Existe una relacion solidamente documentada entre determinados ambientes recreativos nocturnos y el consumo de sustancias sinteticas, asi como pruebas claras de una elevada prevalencia de consumo de sustancias recreativas en relacion con la participacion en estos ambientes (Bellis, Hale, Bennet, Chaves y Kilfoyle, 2000; Calafat et al., 1999; Forsyth, Barnard y McKeganey,1997; Tossmann, Bold y Tensil,1999). <<Investigaciones centradas en jovenes europeos que frecuentan eventos musicales demuestran invariablemente una prevalencia mucho mas elevada del consumo de drogas que la registrada entre la poblacion general. Ocurre lo mismo en todos los paises en los que se han realizado investigaciones similares>> (EMCDDA, 2006).

--La violencia nocturna es cada vez mas preocupante. La investigacion demuestra que el momento culminante de delitos violentos se produce en las noches de los fines de semana y los lugares preferidos son los pubs y discotecas y sus alrededores (Allen, Nicholas, Salisbury y Wood, 2003). En el Reino Unido la quinta parte de los ataques violentos se producen en el interior o cerca de un pub o una discoteca, y casi la mitad de todos los incidentes de violencia y desordenes ocurren las noches de los fines de semana (Maguire y Nettleton, 2003). Un pequeno numero de establecimientos autorizados registran la mayor parte de alborotos y agresiones (Briscoe y Donnelly, 2001; Graham y Wells, 2001, Jochelson, 1997), pero es evidente que quienes participan en actividades violentas seleccionan los locales (Hughes, Bellis, Calafat, Juan, Schnittzer y Anderson, 2008).

--Sexo inseguro o 'no deseado'. Para muchos clientes de discotecas el consumo de sustancias forma parte integral de su estrategia de acceso al sexo. Incluso tienen cierta idea de los efectos que deben esperar de cada droga sobre la sexualidad. Las drogas recreativas y el consumo concentrado de alcohol alteran sus decisiones sexuales e incrementan las posibilidades de practicar sexo inseguro o del que posteriormente se arrepienten (Bellis, Hughes, Calafat, Juan, Ramon, Rodriguez et al., 2008; Calafat, Juan, Becona, y Mantecon, 2008).

--El transporte a y desde las zonas de ocio provoca importantes problemas, sobre todo porque el medio de transporte mas frecuente (37,5%) son los automoviles particulares, de acuerdo con una muestra de 1363 clientes habituales de establecimientos nocturnos de nueve ciudades europeas en 2006. En el ultimo mes, el 18% de la muestra habia conducido en estado de embriaguez, el 13% bajo el efecto de las drogas, y el 37% habia viajado en un coche conducido por alguien embriagado o bajo los efectos de las drogas (Calafat , Blay, Juan, Adrover, Bellis, Hughes et al., 2009).

--Consumo de alcohol entre menores de edad. La venta de bebidas alcoholicas a los menores de edad es un fenomeno relativamente corriente. A pesar de que la edad minima para consumir alcohol es de 21 anos en Estados Unidos, los estudios demuestran que entre el 30 y el 70% de los establecimientos de venta de bebidas atienden a compradores por debajo de dicha edad, dependiendo en parte de la ubicacion geografica (Paschall, Grube, Black y Ringwalt, 2007). En la isla de Ibiza el 80% de los estudiantes de 17 anos han entrado en una discoteca, aunque la ley lo prohibe, siendo la edad de prohibicion sensiblemente inferior (18) de la americana (Villar, 2008).

--Molestias sociales (ruido, consumo de alcohol en la calle, vandalismo, etc.). La presencia de locales recreativos incide de forma positiva y negativa a la vez en las zonas en las que se ubican. La expansion de la economia del ocio nocturno en el centro de la ciudad de Manchester ha crea do unos 12.000 puestos de trabajo de camareros de barra y sala, servicio de comidas y personal de seguridad. Pero todo ese desarrollo ha provocado problemas. Algunos tienen la sensacion de que las ciudades han sido tomadas o colonizadas por los jovenes y aluden al <<llamado fenomeno de los gamberros de la litrona>> (Worpole, 1992).

En las ultimas decadas el sector del ocio nocturno ha experimentado numerosos cambios cuantitativos y cualitativos. El crecimiento de la industria recreativa ha sido enorme, no solo en los lugares turisticos tradicionales, sino en la mayoria de las ciudades occidentales. En la actualidad la oferta no se limita a los tipicos bares. La musica y el baile tienen una fuerte presencia. La clientela tambien ha cambiado: es mucho mas joven, y los horarios son mas nocturnos. Iniciativas comerciales, como la nueva comercializacion de las bebidas alcoholicas y el rediseno y cambio de imagen de los locales autorizados por parte de la industria de bebidas alcoholicas, dieron lugar a la transformacion de la economia del ocio nocturno a finales de los anos 90 para atraer a una nueva generacion de jovenes bebedores, tanto hombres como mujeres (Measham, 2004). En consecuencia, una significativa proporcion del consumo total de alcohol y drogas ilegales entre la juventud europea se vincula a las actividades recreativas nocturnas (Fountain y Griffiths, 1997).

INTERVENCIONES PREVENTIVAS

La necesidad de intervenir para abordar problemas en los bares (embriaguez, violencia ...) no es un fenomeno nuevo. En muchos paises la venta de alcohol en bares es una actividad regulada. La regulacion de permisos de venta de alcohol era un sistema de intervencion muy habitual para controlar problemas en los bares. Sin embargo, hay pocos estudios que valoren las politicas de intervencion en los locales autorizados (Graham, 2000).

Es bien sabido que en las ultimas decadas el ocio no se centra exclusivamente en los adultos, los bares y el alcohol. Las variantes modernas de ocio dirigidas a los jovenes y basadas en musica, discotecas, baile y otras actividades nocturnas juegan un papel esencial, sobre todo en zonas turisticas como las Islas Baleares. En los anos 70 y especialmente en los 80 este modelo experimento una gran expansion en Europa, dando lugar al cambio de los habitos de diversion de los jovenes de forma muy visible (Collin M, 1997).

En cuanto actividad en la que participan amplios sectores de jovenes, con buenas habilidades sociales y excelentes niveles de integracion, la impresion es que no genera demasiados problemas. Y es cierto, en parte, pero no es menos cierto que un determinado porcentaje de jovenes consumen alcohol y e incluso los problemas afectan a la mayoria, puesto que aproximadamente el 75% de los que salen se emborrachan al menos una vez al mes (Calafat, Fernandez, Juan, Anttila, Arias, Bellis, Bohrn, et al., 2003), lo cual aumenta las probabilidades de que practiquen conductas de riesgo. Por ejemplo, es muy habitual beber y conducir en ambientes de ocio nocturno (Calafat, Blay, Juan, Adrover, Bellis, Hughes et al., 2009).

En un estudio (Calafat et al., 2003) realizado hace unos anos sobre una muestra de 40 programas de prevencion concernientes a ambientes y actividades recreativas nocturnas de diez paises europeos, no se encontro ninguna iniciativa basada en la evidencia. El principal objetivo del ochenta por cien de las intervenciones era proporcionar informacion sobre las drogas y reducir el dano asociado a su consumo. Solo dos programas se centraron de forma explicita en reducir el consumo de drogas. La mayoria se dirigieron independientemente tanto a consumidores como a no consumidores, y el 72% utilizaron folletos, opusculos, comunicaciones con franqueo pagado o carteles. La distribucion de la informacion fue casi siempre directa. En otros casos se coloco en locales publicos (puestos en discotecas, bares, tiendas de ropa y otros lugares frecuentados por jovenes). Nueve programas tenian pagina web propia. El asesoramiento de profesionales se incluyo en casi el 30% de los programas, y aproximadamente el 40% incluyeron propuestas alternativas (deportes, talleres ...) a los ambientes de ocio nocturno como factor de proteccion contra el consumo de drogas. El 24% de los programas recurrieron a iguales, sobre todo para distribuir la informacion.

En 2003 un estudio de la EMCDDA (2009) sobre respuestas selectivas en entornos recreativos demostro que de 78 proyectos ejecutados por 15 paises europeos, 52 tenian como principal objetivo minimizar el dano y 26 la prevencion y reduccion del consumo de drogas. Casi la mitad de los proyectos se centraban en proporcionar informacion.

TIPOS DE INTERVENCION

Las posibilidades de intervencion son numerosas y la mayoria se han llevado a la practica; sin embargo, casi nunca se valoran sus resultados. La clasificacion que se ofrece a continuacion es una de las posibles, y en cualquier caso siempre existe cierto grado de superposicion. Por ejemplo, la intervencion comunitaria puede referirse a locales, servicios de urgencias, iniciativas culturales, etc. Los programas tienen a veces diferentes componentes y en ciertos casos es aconsejable revisar la eficacia de cada componente.

1. Locales

a. Programas de formacion del personal de los locales, incluyendo la gerencia. Normas de la casa.

b. Codigos de practicas y otros acuerdos.

c. Horas de apertura. Capacidad de los locales.

d. Entorno fisico y contextual.

e. Analisis de pastillas.

2. Intervenciones en la comunidad y en multicomponentes.

3. Educativas (educacion de clientes, en la escuela, entre iguales, etc.)y campanas.

4. Servicios de urgencias, servicios medicos y de primeros auxilios.

5. Control de licencias, aplicacion de la ley y control de menores de edad.

6. Contexto, ambientes, vecindario (transporte, iluminacion.)

7. Programas contra la conduccion bajo efectos del alcohol.

8. Implementacion de politicas; colaboracion con la industria.

9. Programas alternativos.

10. Enfoques culturales.

11. Medidas de prevencion <<clasicas>>.

A continuacion, analizaremos las evidencias que existen sobre cada una de estas formas de intervencion.

1.a Programas de formacion del personal y de la gerencia. Servicio Responsable de Bebidas (SRB)

Existen problemas relacionados (SRB), entre ellos la baja proporcion personal/clientes (Homel y Clarck, 1994; Graham, Bernards, Osgood, Homel y Purcell, 2005), la dispensacion de bebidas a personas en estado de embriaguez (Homel y Clark, 1994), la actitud hostil y agresiva del personal (Homel, Tomsen y Thommeny, 1992; Wells, Graham, West, 1998), personal mal preparado y sin coordinacion (Homel et al., 1992), elevada proporcion de personal masculino, y la presencia de <<gorilas>> (Homel y Clark, 1994; Quigley, Leonard, Collins, 2003) . Casi un tercio de los incidentes violentos registrados en locales autorizados implican a el personal de puerta, muchas veces como supuestos provocadores (Maguire y Nettleton, 2003).

La formacion del personal es uno de los tipos de intervencion mas extendidos para reducir problemas en los locales. El estado de Oregon impuso la formacion a todos los expendedores de alcohol (y durante un ano a todos los duenos/gerentes) desde diciembre de 1986. Se observo una reduccion estadisticamente significativa en los accidentes de trafico nocturnos (vinculados a altas tasas de alcohol) a finales de 1989, tras la puesta en practica de la formacion obligatoria de los empleados (Holder y Wagenaar, 1994). Otros estudios subrayan los beneficios de la formacion del personal (Gliksman, McKenzie, Single et al., 1993), aunque los efectos disminuyen al cabo de 4 anos (Buka y Birdthistle, 1999). La capacidad del personal de puertas para rechazar a clientes afectados por el consumo de drogas se valoro utilizando dos actores, obteniendose una cifra de referencia de rechazo del 7,5%, frente al 27% despues de la intervencion (Gripenberg, Wallin y Andreasson, 2007).

Un estudio sistematico de Shults (2001), anterior al de Cochrane (vease mas adelante), examino la eficacia de la formacion del personal de los locales a la hora de reducir la conduccion bajo los efectos del alcohol. Se incluyeron cinco estudios controlados, tres de ellos no aleatorios. Se llego a la conclusion de que <<existen pruebas suficientes de que la formacion del personal cara a cara, si se acompana de un apoyo fuerte y activo de la direccion de los locales, es eficaz en la reduccion del nivel de embriaguez de los clientes>>.

Otros estudios, sin embargo, no son tan positivos. Segun Graham (2000) o Homel (2001) la formacion del personal no produce efectos o produce efectos muy limitados. Segun estos autores los resultados no demuestran que la formacion influya en la ingesta de alcohol. Las medidas de fuerza surtieron mayor efecto. Pero la formacion del personal mostro su eficacia en la reduccion de la violencia (Wallin y Andreasson, 2005).

Una revision de Cochrane (Ker y Chinnock, 2008) analizo todos los estudios previos que comparaban los locales en los que los empleados habian participado en intervenciones para facilitar un consumo sensato de alcohol y/o prevenir la violencia con los locales que no habian recibido dichas intervenciones. Encontraron 20 estudios validos y llegaron a la conclusion de que no hay evidencia fiable de que las intervenciones en los locales que sirven alcohol sean eficaces en la prevencion de la violencia. La eficacia de las intervenciones sobre el consumo de alcohol de los clientes no resulto concluyente. Hay indicios de un mejor comportamiento de los empleados, pero es dificil predecir su efecto sobre el riesgo real de violencia. Uno de los problemas fundamentales es que, con el tiempo, las intervenciones dejan de hacerse; de ahi que las intervenciones obligatorias o las que ofrecen incentivos surtan mayor efecto. Tengase en cuenta que, por lo general, el trabajo en los bares esta mal pagado y que hay una elevada rotacion del personal.

Segun Mosher (2002) los requisitos minimos del SRB son:

1. Facilitar la informacion basica a los empleados de los locales.

2. Utilizar tecnicas conductistas de cambio/comunicacion (informar unicamente disminuye las posibilidades de cambiar la conducta o de perfeccionar habilidades). Hay que ensenar habilidades concretas (negarse a servir alcohol a clientes embriagados) . Conviene utilizar tecnicas activas (como la representacion de papeles).

3. Atencion tanto a los empleados como a los gerentes. Hay que incluir a los gerentes porque son responsables de la supervision de los empleados y, por tanto, deben estar familiarizados con las tecnicas.

4. Contemplar el desarrollo de normas por parte de la gerencia. Los gerentes deben elaborar normas de la casa por escrito, porque aumentan las posibilidades de poner en practica la SRB en el establecimiento.

5. La duracion minima de una SRB eficaz es de 4 horas.

Hay que tener en cuenta que la cooperacion de la gerencia de los locales es dificil de conseguir, a menos que sea obligatoria o que exista una fuerte presion social. Segun Graham (2000), los duenos de los bares, los gerentes y el personal a ) no suelen cambiar voluntariamente; b ) casi nunca cooperan al cien por cien con las intervenciones; c) no cambian gran cosa tras la mayoria de las intervenciones; y d) no mantienen los cambios despues de las intervenciones debido a factores como la competencia y las exigencias de los clientes.

1.b Codigos de practica y otros acuerdos

Las asociaciones de bares de diferentes paises (Australia, Reino Unido, Suecia.) han adoptado normas, generalmente de forma voluntaria. Se trata de un primer paso importante, pues con el la industria reconoce que tiene un papel que jugar y una responsabilidad en la prevencion del dano. Es una practica muy extendida en Australia, donde se han efectuado muchos estudios. Por desgracia, evolucion de la puesta en marcha de los codigos de practica voluntaria no demuestra su eficacia (Graham, 2000; Wilkins y Sweetsur, 2009) . A pesar de la existencia de unos codigos de practica para la Publicidad Responsable de Licores en una ciudad australiana, un seguimiento de ocho semanas demostro que existian numerosos ejemplos de publicidad que quebrantaba tanto el espiritu como la letra de las normas. Del mismo modo, el sistema de control del cumplimiento de los codigos de practica es basicamente inadecuado (Jones y Lynch, 2007).

Pero algunas experiencias de colaboracion con la industria, en las que las normas son obligatorias, resultan prometedoras (Lang y Rumbold, 1997; Wallin, 2005). Un interesante documento de consulta, elaborado por el Ministerio del Interior britanico y la KPMG (2008) es el estudio <<Normas de responsabilidad social para la produccion y venta de bebidas alcoholicas>>, distribuido en 2005. Los cinco principios de una buena reglamentacion son: proporcionalidad, responsabilidad, coherencia, transparencia y focalizacion. Los modelos mas eficaces tienen estructuras propias, independientes de las instituciones de la industria. Pero un conjunto de normas administradas por una organizacion empresarial, si se estructura y ejecuta debidamente, es mejor que nada. Para que la autorregulacion sea obedecida ha de castigar el incumplimiento con sanciones adecuadas, importantes y significativas desde el punto de vista comercial .

1.c Horarios de apertura

La limitacion de las horas de la apertura es una forma tradicional de regulacion en algunos paises como Reino Unido. En las horas con mayor numero de delitos relacionados con el alcohol, el cierre tardio de los establecimientos se relaciona con tasas mas elevadas de alcohol en sangre entre los bebedores propensos a sufrir danos provocados por el alcohol (Chikritzhs y Stockwell, 2007). La prohibicion de la venta de alcohol a partir de las 11 p.m. produjo una reduccion de casi nueve muertes al mes en Diadema (Brasil). Las agresiones a mujeres tambien descendieron, pero no de forma significativa (Dualibi, Ponicki, Grube et al ,2007). En el Reino Unido las autorizaciones de venta de bebidas alcoholicas se liberalizaron en 2005 con el fin de prevenir la delincuencia y de reforzar la seguridad publica. Un estudio efectuado en un hospital, en el que se comparaban las urgencias antes y despues de la nueva legislacion sobre venta de bebidas alcoholicas, registro un incremento de las asistencias nocturnas relacionadas con el alcohol en urgencias. Asimismo, tras la introduccion de las nuevas leyes, los pacientes resultaron mas dificiles de tratar y exigieron mas recursos, como examenes mas amplios y detallados. El cambio legislativo dio lugar a un incremento de las agresiones y las heridas relacionadas con el alcohol y de los ingresos hospitalarios (Newton, Sharker, Pahal, van den Bergh y Young, 2007).

Sin embargo, otro estudio demuestra que reducir las horas de apertura no influye en el numero de visitas a las salas de urgencias por cuestiones relacionadas con el alcohol o por agresiones (Graham, McLeod y Steedman, 1998). En terminos generales, segun Graham (2000), no hay pruebas consistentes de que el ajuste de las horas de apertura de los locales sea una medida eficaz para reducir los problemas derivados de los bares. Pero una revision de este mismo ano (Stockwell y Chikritzhs, 2009) a partir de 49 estudios (14 de ellos cumpliendo todos los criterios) concluye que la ampliacion de horarios si lleva a un aumento del consumo y de los problemas relacionados.

En la isla de Ibiza --donde ciertas noches se reunen mas de 20.000 clientes de bares y discotecas--, algunas discotecas cerraban a las 6 a.m., y a esa hora abrian otras que permanecian abiertas todo el dia, lo cual permitia a los clientes continuar con sus actividades sin parar durante 24 horas. Esta situacion cambio hace unos anos; en la actualidad todas las discotecas estan cerradas unas horas por la manana. Aun no se han valorado los resultados de esta decision, pero seguramente es un paso en la direccion correcta.

1. d Entorno fisico y contextual

Ciertos aspectos ambientales de los locales generan problemas, sin duda porque irritan o frustran a los clientes. Por ejemplo, la masificacion y los tropezones (Macintyre y Homel, 1997), el humo del tabaco (Homel y Clark, 1994), la musica a todo volumen y de mala calidad (Forsyth, 2009; Gueguen, Jacob, Le Guellec, Morineau y Lourel, 2008; Home y Clark, 1994), actividades como bailar o el billar (Graham, LaRocque, Yetman, Ross y Guistra,1980; Quigley et al., 2003), conducta sexual desinhibida o ambiente permisivo (Homel, Carvolth, Hauritz, McIlwain y Teague, 2004; Graham et al., 2006).

Una forma de actuar sobre el ambiente de los locales es prohibir todo tipo de cristaleria. En febrero de 2006 el Ayuntamiento de Glasgow promulgo una ordenanza municipal que prohibia utilizar vasos y copas en todos los locales con licencia para espectaculos del centro de la ciudad. En los establecimientos que utilizaban plastico habia menor riesgo de lesiones que en los que seguian utilizando cristal. Los clientes reconocieron que se sentian mas seguros en esas discotecas (Forsyth, 2008). En los lugares que utilizaban vasos y copas, el cristal "templado" con menor resistencia a los golpes provoco mas lesiones, y por tanto habria que perfeccionar las tecnicas de templado (Warburton, Shepherd, 2000).

Los locales que sirven comida registran menos violencia (Homel y Clark, 1994); tal vez porque atraen a una clientela distinta o porque la concentracion de alcohol en sangre se altera.

El tipo de musica influye en los clientes de las discotecas y en su comportamiento; por ejemplo, da lugar a diferencias en los niveles de alcohol o en el consumo de drogas ilegales, en la actividad sexual o en la violencia registrada en los locales. Es aconsejable, por tanto, que la politica musical se incorpore a los cursos de formacion para el servicio responsable en los locales nocturnos (Forsyth, 2009).

El control del ruido es una cuestion de salud esencial. Una buena solucion consiste en instalar limitadores de sonido en los amplificadores para no sobrepasar el nivel adecuado, pero la ley debe cumplirse. La rotacion del personal contribuye a mitigar los danos causados por el ruido.

Las investigaciones sobre la densidad de los locales sostienen que las agresiones se relacionan estrechamente con la concentracion de los mismos; es decir, a mayor densidad, mayores niveles de agresion. Con respecto a los accidentes de trafico y la conduccion bajo los efectos del alcohol, la evidencia de una relacion lineal positiva es menos contundente (Chikritzhs, Catalano, Pascal y Henrickson, 2007). Asimismo, las agresiones en la calle guardan una estrecha relacion con el numero y capacidad de los locales (Warburton y Shepard, 2005).

1. e. Analisis de pastillas in situ

En el pasado el analisis de pastillas in situ era una medida habitual, aunque polemica, y se basaba en que la adulteracion de pastillas era el principal problema. En la actualidad, ha perdido popularidad en Europa, e incluso en lugares pioneros como los Paises Bajos ya no se utiliza este tipo de intervencion in situ. Los principales argumentos contra el analisis de pastillas son la limitada capacidad de los analisis in situ para detectar de forma adecuada las sustancias daninas, la desproporcion entre costes/beneficios, y que los analisis de pastillas in situ generan mensajes contradictorios sobre los riesgos derivados del consumo y posesion de las sustancias controladas (EMCDDA, 2006). Por otro lado, la investigacion no ha demostrado que la adulteracion de las pastillas sea mas danina que las propias pastillas. Casi siempre, ocurre lo contrario, pues los problemas surgen mas bien de la pureza de las sustancias.

2. COMUNITARIAS O INTERVENCIONES MULTICOMPONENTES

Son muchas las instancias interesadas en la regulacion de la vida nocturna, y la cooperacion entre ellas resulta fundamental. La prevencion integral o multicomponente combina algunas o todas las siguientes intervenciones:

--Conciencia y movilizacion de la comunidad (colaboracion y cooperacion con sectores importantes, como las autoridades municipales, los pubs y las discotecas, los organizadores de fiestas, los servicios de salud/adiccion y la policia).

--Formacion: SRB, prevencion de la violencia, personal de los locales (desde los porteros a los gerentes) y otros sectores interesados.

--Normas de la casa.

--Mejora de los niveles sanitarios y de seguridad de las zonas y locales nocturnos (entornos saludables).

--Educacion de los clientes para reducir los riesgos del consumo de drogas y alcohol.

--Cumplimiento de la ley.

Aunque solo unos cuantos programas incluyen evaluaciones rigurosas con resultados claros, en general han demostrado su eficacia en la limitacion del acceso de los jovenes al alcohol, la reduccion de pautas conflictivas de consumo de alcohol, los accidentes involuntarios con o sin vehiculos y la violencia (Treno, Lee, Freisthler, Remer and Gruenewald, 2005). Algunas de las intervenciones estudiadas son:

--Community Trials Project o (Salinas, California). La intervencion logro reducir la tasa de accidentes de trafico nocturnos y los ingresos hospitalarios derivados de los mismos (Roeper, Voas, Padilla-Sanchez et al., 2000).

--The Surfers Paradise Safety Action Project, en la Costa Dorada de Queensland, Australia. Se produjo una notable reduccion de la violencia y los delitos (dentro y fuera de los locales) y en las practicas que fomentaban el consumo irresponsable de alcohol (como los incentives al consumo concentrado), asi como mejoras en las medidas de seguridad, en los espectaculos, en el trato a los clientes y en las politicas de transporte (Homel, Hauritz, Wortly, McIlwain y Carvolth, 1997).

--STAD (Stockholm Prevents Alcohol and Drug Problems). El programa nacio en 1996 y continua funcionando con exito. La principal intervencion se baso en la movilizacion de la comunidad, la formacion de los empleados de los locales en SRB y un cumplimiento mas estricto de las leyes sobre el alcohol. Resultados: descenso de los problemas provocados por el alcohol en los establecimientos autorizados; aumento de los locales autorizados que se negaron a servir alcohol a clientes embriagados (del 5% en 1996 al 47% en 1999 y 70% en 2001); creciente rechazo a servir alcohol a menores (del 55% en 1996 al 59% en 1999 y 68% en 2001). Durante el periodo de evaluacion del proyecto el numero de agresiones descendio el 29 % en la zona de ejecucion del proyecto y experimento un leve descenso en la zona de control (Wallin y Andreasson, 2005).

--Geelong Local Industry Accord (Lang y Rumbold, 1997). La intervencion se baso en la colaboracion entre la policia y los locales para reducir la violencia interpersonal. Se desarrollo un codigo de conducta escrito para contribuir a la autorregulacion de los locales autorizados. Entre los resultados destaca la reduccion de la violencia en un periodo de tres anos.

La investigacion indica que el enfoque comunitario es mas eficaz que la ejecucion de intervenciones aisladas (Holder, Gruenewald, Ponicki, Treno, Grube, Saltz et al., 2000; Wagenaar, Murray y Toomey, 2000). El problema de los proyectos comunitarios es conseguir la continuidad tras la fase inicial. A medio plazo surgen inconvenientes como el liderazgo, la participacion de la comunidad o la financiacion.

3. EDUCATIVAS (EDUCACION DE CLIENTES, EN LA ESCUELA, ENTRE IGUALES, ETC.) Y CAMPANAS

La educacion de los clientes (mediante folletos o utilizando el sistema de iguales ...) es una intervencion para la reduccion de danos que se ha puesto en practica a menudo en los ambientes recreativos. En las zonas de ocio se han repartido miles de folletos con informacion sobre reduccion de danos (no conducir bajo los efectos del alcohol, beber agua cuando se consume MDMA --extasis--, etc.) Sin embargo, poco se sabe de su efecto para evitar el estado de intoxicacion de los clientes o en la reduccion de danos. Como medida aislada, su eficacia es muy reducida o inexistente si no se combina con la imposicion de las leyes o con otros tipos de intervencion (Graham, 2000).

Sin embargo, hay que tener en cuenta (Faggiano y Vigna-Taglianti, 2008) que las intervenciones de los medios de comunicacion (mensajes breves y repetidos para informar y estimular a los individuos a abstenerse o reducir el consumo de sustancias) son a veces muy eficaces, sobre todo cuando se conjugan con acciones comunitarias. Es lo que ha ocurrido con el tabaco (despertando la conciencia, mejorando actitudes, reduciendo la prevalencia ...), y en el caso del alcohol las campanas contra la conduccion en estado de embriaguez han reducido los accidentes en un 10% (Tay, 2005). Sin embargo, no existen estudios sobre las campanas contra las drogas ilegales.

Una idea que ofrece posibilidades interesantes es la que prevencion en las escuelas que incluyan la prevencion en ambientes recreativos nocturnos entre sus objetivos, puesto que es en dichos ambientes donde los jovenes suelen consumir alcohol y drogas. En este contexto se necesitan habilidades especiales para tomar las decisiones mas adecuadas.

La utilizacion de pares o iguales en intervenciones dentro de los ambientes recreativos ha gozado de gran popularidad, puesto que destaca la importancia de la edad del educador a la hora de ganarse la credibilidad de un determinado publico. Por el mismo motivo se recurre a veces a jovenes con experiencia en consumo de drogas. No obstante, no hay evaluaciones sobre el resultado de dichos programas. En los programas escolares, los pares o iguales resultan mas eficaces que los profesores (Faggiano, 2008). Sin embargo, los programas que estimulan el contacto social corren el peligro de aumentar la exposicion a influencias sociales negativas. No solo los lideres, sino tambien los grupos tienen capacidad de reforzar las normas tanto positivas como negativas; y por tanto, estas intervenciones deben ejecutarse con mucho cuidado (Philliber, 1999)

4 SERVICIOS DE URGENCIAS, Y DE PRIMEROS AUXILIOS

Durante las actividades recreativas surgen problemas medicos. En <<I love techno>> (edicion de 2001), una fiesta rave celebrada en un recinto cerrado a la que asistieron 37.000 personas, o <<De Nacht>>, una tradicional fiesta de Noche vieja, se recogieron datos sobre incidencias medicas (sobre todo, los problemas derivados de las drogas). La incidencia de problemas medicos en <<I love techno>> fue de 66,5/10.000 asistencias, y en el caso de <<De Nacht>> de 70,0/10.000 asistencias (Van Sassenbroeck, et al., 2003). La proporcion de pacientes atendidos en los servicios de urgencias de los hospitales britanicos por embriaguez fue del 4% entre adultos; el 70% de los pacientes eran hombres, con una edad media de 30 anos, y el 72% ingresaron en urgencias entre las 20.00 y las 08.00 horas. El motivo mas comun para recibir asistencia fueron los accidentes (34%), seguidos de cerca por las agresiones (30%). El 27% de los pacientes habian consumido gran parte del alcohol en casa, el 36% en un pub y el 16 % en una discoteca (Benger y Carter, 2008).

El marcado descenso de las agresiones registradas en los locales autorizados a raiz de una serie de medidas dirigidas se reforzo con la intervencion del servicio de urgencias y de especialistas maxilofaciales. Dos especialistas (uno de urgencias y un maxilofacial) visitaron los locales y mostraron detalles graficos de las heridas sufridas, el tratamiento y el numero de agresiones a los duenos de los locales. Asimismo, los informaron de que el servicio de urgencias llevaba un control sobre la violencia registrada en sus locales y que seis meses despues se publicaria un informe que se daria a conocer en los medios de comunicacion locales (Warburton y Shepard, 2005).

Cierto numero de grandes discotecas tienen salas <<medicas>> para atender a esos individuos, pero no hay datos sobre esas intervenciones. Dada la falta de orientacion concreta sobre la preparacion del personal que trabaja en dichas salas, en algunos casos los clientes no han sido atendidos correctamente. Se ha elaborado una intervencion para tratar este aspecto, consistente en un conjunto piloto de pautas y en una formacion adecuada ; a partir de entonces, el personal medico de las discotecas tiene capacidad para diagnosticar a los clientes que sufren intoxicaciones por drogas recreativas, para utilizar las pautas y para llamar a una ambulancia en caso necesario (Wood, Greene, Alldus et al., 2008).

5. CONTROL DE LICENCIAS, APLICACION DE LA LEY Y CONTROL DE MENORES DE EDAD

La mayoria de los estudios demuestran la eficacia de hacer cumplir las leyes y de la intervencion policial. El primer ejemplo con resultado positivo es la introduccion, en un centro turistico de la costa inglesa, de nuevas medidas de control y de supervision de establecimientos de venta de bebidas en la zona portuaria, donde se concentran gran parte de los bares y las discotecas. Agentes de policia uniformados visitaron los bares entre 2 y 3 veces por semana, y los resultados mostraron una reduccion del 20% de los delitos por alteracion del orden publico en la zona de intervencion, sin reduccion en la zona de control (Jeffs y Saunders, 1983).

Las nuevas tecnologias juegan un papel importante en la seguridad nocturna. El Proyecto de Seguridad del Centro de la Ciudad de Manchester es una agencia puesta en marcha por la Policia del Gran Manchester. Adopta un criterio holistico y a largo plazo para reducir los delitos relacionados con el alcohol en el centro de la ciudad. Abarca veinte iniciativas independientes que abordan diferentes aspectos del problema. Por ejemplo, colaboro en la introduccion del sistema de radio <<Nite Net>> que pone en comunicacion pubs, discotecas, un circuito cerrado de television y a los agentes de policia durante la noche. De ese modo pueden enviar informacion sobre clientes agresivos expulsados de los locales y dirigir a la policia hacia grupos concretos de alborotadores (Roberts, 2004). Las medidas de vigilancia en los pubs han florecido en tiempos recientes en el Reino Unido. La Ley de Permiso de Venta de Bebidas Alcoholicas de 2003 recomienda a todos los establecimientos contar con un proyecto de <<vigilancia>>. Mas de las tres cuartas partes de los participantes (77,5%) en la encuesta nacional expresaron la intencion de aplicar las medidas de vigilancia de los pubs a sus zonas estableciendo comunicacion directa con los centros de control por circuitos cerrados de TV (CCTV) de la policia. En conjunto, hay pruebas que indican que estas medidas ejercen un efecto positivo en la reduccion de los delitos, aunque dicha reduccion es bastante pequena si se considera el numero total de delitos. La evidencia demuestra que el CCTV es mas eficaz para reducir los delitos contra la propiedad que contra las personas (Brown, 1995).

Llama la atencion que, a pesar de que la coercion ha demostrado ser una intervencion eficaz, hay cierta resistencia a ejecutar medidas de ese tipo. Los motivos son numerosos: ignorancia de la ley o ideas equivocadas sobre la misma, desconocimiento de los efectos del alcohol, incapacidad para valorar el dano del alcohol, sobre todo si, como suele ocurrir, el propio agente de policia tambien bebe (Jeffs y Saunders, 83). Las discotecas son negocios, y a Homel (2004) le preocupan los tratos secretos tan propios de este tipo de industria: <<la policia y los funcionarios que expiden las autorizaciones para venta de bebidas no se ocupan de los locales si no hay problemas graves que atraigan la atencion de los medios de comunicacion o de los politicos>>.

La policia tiene capacidad para jugar un papel de liderazgo en la reduccion de los incidentes y los danos provocados por el alcohol. Es mas facil mantener un buen ambiente cuando se cuenta con apoyo politico y se centra el interes en actividades para reducir el dano derivado del alcohol. Sin embargo, hay que conseguir el compromiso de los representantes locales y la cooperacion de un centro local que coordine los recursos fisicos y humanos disponibles (Doherty y Roche, 2003).

El consumo de alcohol entre menores de edad es un problema importante, sobre todo en Europa, donde la edad legal para comprar alcohol baja en algunos casos de los 18 anos. Hay pocos estudios sobre los efectos hacer cumplir la ley, pero los que hay demuestran que dicha imposicion reduce la venta de bebidas a los jovenes. Por ejemplo, la relacion de controles evitan la venta de alcohol a menores, pero los efectos disminuyen con el tiempo, lo cual indica la necesidad de un programa sostenido para mantener la disuasion (Wagenaar, Toomey y Erickson, 2005). Los aparatos de verificacion electronica de la edad (VEE) son uno de los medios para reducir las ventas de tabaco y bebidas alcoholicas a menores, gracias a los cuales se evitan las multas y las suspensiones/revocaciones de los permisos en caso de incumplimiento. Los aparatos de VEE utilizan tecnologia similar a los escaneres de los cajeros automaticos, leen la fecha de nacimiento codificada en la banda magnetica o en el codigo de barras del carnet de conducir del cliente o en un documento de identidad similar y calculan si el posesor de la tarjeta tiene la edad reglamentaria para comprar tabaco o bebidas alcoholicas. Aunque los VEE contribuyen a una estimacion mas ajustada de la edad, no incrementaron la verificacion de la edad en un experimento en el que su utilizacion era voluntaria (Krevor, Capitman, Oblak et al., 2003).

6. CONTEXTOS, AMBIENTES, VECINDARIO (TRANSPORTE, ILUMINACION ...)

Los problemas no se reducen al interior de los locales. En realidad, gran parte de la violencia se produce fuera de los mismos y tiene que ver con cuestiones ambientales externas. Son varios los factores que pueden desencadenar problemas:

* Las colas en las paradas de taxis o autobuses provocan a veces discusiones y peleas (Allen y Goody, 2002).

* Falta de transporte publico (Homel et al., 2004; Marsh y Kibby, 1992).

* Gente que merodea fuera de los locales a la hora de cierre (Marsh y Kibby, 1992; Graham, Bernards, Osgood y Wells, 2006).

* Densidad de los establecimientos (Homel et al., 1997; Zhu, Gorman y Horel, 2004).

* Gran numero de personas embriagadas concentradas en un punto y compitiendo por comida y medios de transporte limitados (Marsh y Kibby, 1992)

La solucion a todas estas cuestiones es esencial para garantizar la seguridad y erradicar la violencia.

En Leeds, por ejemplo, las paradas de taxis y autobuses se han dispersado para evitar grandes concentraciones de gente. En Manchester la policia vigila estrechamente las colas en las paradas de taxis y buses (Robert, 2004).

En muchas ciudades se han introducido autobuses nocturnos y otros servicios de transporte. La existencia de aparcamientos tambien es muy util, aunque el uso de los coches particulares se asocia a la conduccion bajo los efectos del alcohol.

La iluminacion y los telefonos publicos tambien contribuyen a proporcionar un ambiente seguro.

El problema de controlar el ruido de los clientes que salen de los establecimientos autorizados una vez abandonan la zona inmediata a los locales no es facil de solucionar. Entre las sugerencias se cuentan las campanas educativas, las advertencias y avisos dentro de los locales por medio de carteles y de la intervencion directa del personal de puertas (MCM Research, 2003).

7. PROGRAMAS SOBRE LA CONDUCCION BAJO LOS EFECTOS DEL ALCOHOL

Conducir en estado de embriaguez o tras consumir drogas es una cuestion cada vez mas preocupante. Se ha observado que los clientes de discotecas y similares utilizan muy a menudo su propio coche (37,5%) para desplazarse hasta las zonas de ocio (Calafat et al., 2009). La Organizacion Mundial de la Salud calcula que, en los paises europeos, el alcohol es responsable del 45% de las incapacidades provocadas por los accidentes de trafico entre los hombres y del 18% entre las mujeres (Lopez, Mathers, Ezzati, Jamison y Murray, 2006).

Una de las intervenciones mas populares es la del conductor designado. Se trata de una medida que tiene todo el apoyo de la industria recreativa. En algunos casos la propia industria participa activamente, fomentando el programa de conductores designados con incentivos como consumiciones gratis. En Europa hay pocos estudios sobre los programas de conductores designados, pero la limitada informacion con que se cuenta acerca de la eficacia de dichos programas indica, lamentablemente, que son menos eficaces para prevenir la conduccion bajo los efectos del alcohol de lo que se penso en un principio. Hasta el momento la evidencia apenas avala la validez de los programas de conductores designados para reducir la conduccion bajo los efectos del alcohol (Aresi, Fornari, Repetto y Scolari, 2009; Eurocare, 2003). Hay que tener en cuenta, ademas, que las acciones peligrosas de los pasajeros embriagados estresan al conductor y fomentan a veces situaciones de conduccion de alto riesgo, imposibilitando la conduccion segura (Rothe y Carroll, 2009).

El estado de Oregon impuso la formacion obligatoria de todas las personas que sirven bebidas alcoholicas y de los propietarios/gerentes de los locales. Se registraron reducciones significativas de los accidentes de trafico nocturnos en vehiculos con un solo ocupante (vinculados a altos porcentajes de alcohol) (Holder y Wagenaar, 1994).

Intervenciones mas clasicas, como los controles de alcohol en sangre o el aumento de la edad minima para consumir alcohol, son herramientas de gran importancia para controlar este problema. Los programas obligatorios de control de alcoholemia han contribuido a una reduccion significativa del papel del alcohol en los accidentes de trafico mortales (Brady, Baker, Dimaggio, McCarthy, Rebok y Li, 2009). La legislacion que establece la edad minima para consumir alcohol en 21 anos en Estados Unidos es una de las medidas de salud publica mas eficaces que se han adoptado en epoca reciente, y entre sus efectos se incluye la prevencion de la conduccion bajo los efectos del alcohol de quienes no alcanzan la edad legal (Fell, Fisher, Voas, Blackman y Tippetts, 2007).

Tambien se ha estudiado la eficacia de los dispositivos antiarranque para evitar que un conductor embriagado conduzca. Este tipo de intervencion, utilizada con personas con antecedentes de conduccion bajo los efectos del alcohol, mostro buenos resultados durante el tiempo que se utilizo el dispositivo antiarranque, pero la eficacia desaparecio cuando se retiro dicho dispositivo (Willis, Lybrand y Bellany, 2004).

8. IMPLEMENTACION DE POLITICAS. COLABORACION CON LA INDUSTRIA

Como hemos mostrado anteriormente, las normas voluntarias de la industria son normalmente ineficaces, aunque se pueden considerar como un primer paso hacia un compromiso mas profundo por parte del sector. En varios paises europeos se ha ensayado la colaboracion entre la industria del ocio y las autoridades locales; es el caso del Reino Unido, Paises Bajos, Alemania, Belgica, Suecia, Republica Checa, Italia, Francia o Lituania, en muchos casos siguiendo el modelo britanico del <<saferdance>> (EMCDDA, 2009). Las posibilidades de colaboracion son numerosas: formacion del personal, colaboracion con la policia y con los servicios de urgencias, puesta en practica de campanas de conductores designados, etc.

Dicha colaboracion se facilita cuando es obligatoria o cuando la opinion publica exige soluciones a determinados problemas. Los profesionales de la prevencion consideran esencial un verdadero compromiso de la industria del ocio. A pesar del claro crecimiento de los problemas entre los asiduos de fiestas en los paises europeos, se han registrado menos respuestas en 2007 que en 2004 (EMCDDA, 2009).

La industria de bebidas alcoholicas de la UE ha puesto en practica algunas iniciativas voluntarias para reducir el dano provocado por el alcohol (ejemplos de dichas iniciativas se pueden ver en paginas web como www.europeanspirits. org, www.efrd.org, o www.drinkaware.co.uk). A la industria le preocupa mucho la posible imposicion de una legislacion mas restrictiva, por eso les interesa demostrar su disposicion a cooperar. Sin embargo, apoya medidas como los programas de conductores designados o las normas de cumplimiento voluntario que no tienen el aval de la investigacion, y en cambio no apoya otras medidas que han demostrado su eficacia, como el aumento de los impuestos. La realidad es que actualmente acceder a las bebidas alcoholicas es mas asequible en todos los paises de la UE (excepto Italia) desde 1996 (Rabinovich, Brutscher, de Vries, Tiessen, Clift y Reding, 2008).

Toda buena iniciativa para prevenir problemas en los ambientes recreativos exige que la policia, las autoridades locales y otros sectores interesados ofrezcan pruebas estadisticas para realizar una valoracion formal del efecto acumulativo de los problemas de delincuencia, alborotos y perturbaciones del orden publico. Asimismo, deberia consultarse a todas las partes interesadas (DCMS, 2004).

Las buenas politicas dentro de un distrito de ocio comienza con la planificacion del distrito y el diseno del entorno. Los principales problemas son la concentracion de discotecas y bares, y una disposicion inadecuada de calles, aceras y aparcamientos. Las medidas esenciales desde una perspectiva proactiva son: identificar a los posibles alborotadores, realizar inspecciones en los bares, evitar las concentraciones de gente, descongestionar los lugares recargados, garantizar la circulacion de los peatones y cortar de raiz las actividades de las bandas (Berkley y Thayer, 2000).

9. PROGRAMAS ALTERNATIVOS

Carmona y Stewart (1996) estudiaron la eficacia de las medidas alternativas para el Centro para la Prevencion del Abuso de Sustancias (CSAP). Definieron como actividades <<alternativas>> los programas y eventos que excluian el alcohol, el tabaco y las drogas y en los cuales la participacion era voluntaria. Hubo muchas variantes, y sus componentes incluian casi siempre la transmision de conocimientos y actitudes, la capacitacion de destrezas, actividades prosociales y sin estructurar, la relacion con iguales y el desarrollo de relaciones positivas con adultos o la supervision a cargo de adultos. Identificaron solo 10 estudios con una Metodologia que les permitio clasificarlos de relativamente concluyentes. Hay escasa evidencia de la eficacia de dichas medidas.

En Espana la mayoria de las ciudades organizan actividades alternativas las noches de los fines de semana (como talleres o la apertura de espacios publicos para practicar deporte), paralelas a las actividades nocturnas habituales con la pretension de ejercer un efecto preventivo. La valoracion de uno de estos programas alternativos no mostro ninguna influencia en el consumo de drogas o en el cambio de actitudes/conductas con relacion al grupo de control (Fernandez-Hermida y Secades, 2003). El problema de estos programas es que a veces incluso son contrarios a la prevencion, puesto que admiten a preadolescentes y no evitan que la gente acuda posteriormente a los locales de ocio nocturno habituales.

Hay mas estudios sobre este tipo de programas alternativos, pero debe tenerse en cuenta que la mayoria de ellos no se refieren a la prevencion de los problemas relacionados con el alcohol y las drogas entre los clientes de los locales de ocio nocturno. Segun un analisis de programas realizado por Norman (1997), no hay pruebas de que organizar actividades artisticas, deportivas y de ocio ... contribuya a reducir el consumo de drogas. En un estudio de 45 programas contrastados de diferentes tipos (Hansen 1992), casi todos arrojaron resultados positivos, con la excepcion de los programas que ofrecian experiencias alternativas (experiencias incompatibles con el consumo de sustancias).

10 . ENFOQUES CULTURALES

Salir de noche los fines de semana es un fenomeno muy complejo que ha crecido de forma incesante en las ultimas decadas. Muchos jovenes participan activamente en este contexto, controlado basicamente por la industria del ocio. Este nuevo modelo de diversion es hegemonico para muchos jovenes, es decir, excluye otras formas de ocio. Por otro lado, cumple muchas funciones: socializacion, la busqueda de amigos, opciones sexuales, etc. En este contexto, para quienes consumen drogas cada sustancia ocupa un lugar concreto dentro de las preferencias y objetivos de cada cual. El extasis se asocia con el baile, el alcohol con la desinhibicion y la sociabilidad, y asi sucesivamente. Es obvio que los mas asiduos de este tipo de diversion son mas propensos al consumo y el abuso del alcohol y las drogas (Calafat, 2004). Measham y Hadfield (2009) ofrecen mas informacion sobre esta cultura de discoteca dentro de los ambientes del ocio nocturno.

La prevencion de conductas de riesgo en estos contextos no es sencilla, puesto que existe un complejo marco cultural y economico que confiere significado a todo. Cuesta creer que se vayan a producir cambios significativos en la presente situacion sin introducir cambios reales en el simbolismo, alcance y expresion de esta cultura y de la economia que la sustenta. La verdad es que, en terminos generales, no se ha cuestionado seriamente la cultura recreativa; no lo ha hecho la sociedad en general ni las lineas politicas y los programas de prevencion actuales. En algunos casos ha ocurrido todo lo contrario. En concreto, las intervenciones basadas principalmente en ofrecer informacion a quienes asisten a las fiestas (muy comun en Europa) o en el analisis de pastillas parten de un respeto absoluto hacia la actual racionalidad del ocio y se conforman con transmitir a los consumidores de drogas la informacion y las habilidades necesarias para reducir los riesgos derivados de sus conductas recreativas.

Pero es dificil mantener esta <<neutralidad>>. La propaganda de las discotecas y la forma en que se anima o disuade a los posibles clientes son claros ejemplos del efecto de esos procesos informales en la seleccion de elites; grandes proporciones de jovenes son excluidos de dichos espacios, bien directamente, prohibiendoseles la entrada, o indirectamente, haciendo que se sientan incomodos o fuera de lugar (Measham, 2009). Las relaciones sociales son un aspecto esencial para muchos jovenes profesionales. Un estudio sobre profesionales britanicos entre 25 y 34 anos demostro que las relaciones sociales eran el aspecto mas importante de sus vidas. Casi la mitad consideraban el trabajo importante, pero no fundamental, y solo el 16% daban prioridad absoluta a sus carreras profesionales. La tendencia era mas pronunciada entre las mujeres: el 40% desmintieron el estereotipo de la mujer volcada en su carrera y afirmaron que la principal funcion del trabajo era tener una gran vida social (Goswami, 2004).

La cultura del ocio nocturno influye mucho en las categorias que los jovenes elaboran sobre el placer, la diversion, las relaciones sociales, el consumo de alcohol y drogas, etc. Los programas y las politicas tradicionales de prevencion poco influyen en esta cultura. Pero los enfoques ambientales son medidas de prevencion que funcionan a la altura de esas normas sociales y culturales. En ese sentido, cobran importancia las reglas, la normalidad y los valores sobre el consumo de sustancias. Pero no sabemos gran cosa sobre el funcionamiento de dichos factores y, en consecuencia, no hay muchas intervenciones basadas en ellos. En un estudio para observar si la intervencion por retroalimentacion o feedback de normas sociales reduce el consumo excesivo de alcohol entre estudiantes universitarios, se obtuvieron resultados positivos con el feedback por ordenador/web (WF) y con el feedback cara a cara (IFF). Este tipo de intervenciones pueden ser eficaces para reducir el consumo excesivo de alcohol. No se hicieron comparaciones directas entre el WF y el IFF, pero el WF ofrecio un conjunto mas amplio de resultados y es menos costoso; por tanto, resulta preferible. Los efectos significativos se notaron mas a corto plazo (hasta tres meses). En el caso del feedback por correo o en grupo y de las campanas de promocion de normas sociales, los resultados no son significativos, y por tanto dichas alternativas no se recomiendan (Moreira, Smith y Foxcroft, 2009).

En resumen, el aspecto cultural es esencial. Sin embargo, hacen falta estudios bien orientados que describan y analicen los elementos culturales dentro de su realidad social para saber que tipo de intervencion conviene poner en practica. Una cuestion basica de este punto es la gran importancia de la ideologia. Las intervenciones dirigidas a los principios culturales y recreativos no dependeran solo de la voluntad o las habilidades de los profesionales, sino mas bien de cambios de la sociedad en conjunto.

11. MEDIDAS DE PREVENCION <<CLASICAS>>

La base del presente estudio no contempla el analisis de la eficacia de las medidas clasicas, aunque se ha aludido a ellas al analizar otras intervenciones relacionadas de forma mas directa con los ambientes de ocio nocturno. Las intervenciones clasicas se centran fundamentalmente en la reduccion del dano provocado por el alcohol, pero entendemos que este tipo de intervencion tambien influye en los problemas derivados del ocio nocturno.

Se ofrece a continuacion una breve lista de dichas intervenciones (Giesbrecht, 2008) :

--Aumento del precio real de las bebidas alcoholicas e interrupcion de los descuentos y las rebajas.

--Establecimiento de un techo y un limite para otros factores: horarios y dias de venta, densidad de establecimientos en cuyo interior se consume y aquellos que venden para consumir fuera.

--Renovacion de la funcion de control de las juntas y comisiones de licores, incluyendo una reduccion de la publicidad y promocion del alcohol.

--Provision de los recursos necesarios para la ejecucion eficaz de estas medidas y para otras intervenciones eficaces ya ensayadas ...

CONCLUSIONES

El ocio nocturno es un fenomeno en expansion (y no solo en las sociedades occidentales), con resultados positivos para el progreso de la comunidad y el desarrollo de los individuos. No obstante, esta actividad presenta problemas especificos (accidentes de trafico, consumo de drogas, violencia, etc.). Se ha probado una amplia gama de intervenciones, pero aun no contamos con la evaluacion de los resultados. Es necesario investigar mas a fondo los problemas derivados del ocio nocturno y los factores de riesgo y proteccion, sobre todo los vinculados al contexto y a las relaciones ambientales y socioculturales. Asimismo, se necesitan mas estudios antes de hacer recomendaciones y redactar pautas. De especial interes es la eficacia de las intervenciones despues de realizar el proceso de evaluacion.

En estos ambientes las intervenciones no son sencillas ni faciles de sistematizar, pues se trata de un sector muy dinamico. Pero la dificultad de lanzar intervenciones surge tambien por otros motivos muy diversos. Aun hay poca conciencia sobre los problemas de este sector. En general, la gente considera el ocio nocturno como algo positivo y no le gusta admitir los problemas. Senalar los problemas que se presentan en estos ambientes se ve en ocasiones como una critica al derecho de los jovenes a ser felices o, mas aun, una critica a los jovenes por ser jovenes.

En el ocio nocturno hay muchos sectores con intereses. En el caso de los profesionales de la prevencion, su formacion no suele tener que ver con estos ambientes. Tambien hemos de tener en cuenta los debates ideologicos (muy intensos puesto que se trata de una situacion totalmente nueva, con numerosas implicaciones culturales) sobre el fomento de determinadas iniciativas en detrimento de otras. Los enfoques iniciales de reduccion de danos potenciaban las intervenciones que se limitaban a informar a los clientes sobre las consecuencias de su conducta por medio de folletos, analisis de pastillas, etc., pero sin cuestionar conductas individuales ni la estrategia de la industria. <<Comprender la relacion entre consecuencias positivas y negativas contribuye a redefinir las politicas que sean mas eficaces a la hora de reducir las consecuencias negativas>> (Graham, 2001).

Ya se han ido presentado conclusiones y comentarios sobre la eficacia de las intervenciones analizadas dentro de cada unos de los apartados correspondientes. Corresponde aqui hacer observaciones mas generales:

1. Los esfuerzos de prevencion se concentran casi siempre en las drogas ilegales. Sin embargo, la mayoria de los problemas surgen del consumo de alcohol o de la combinacion del alcohol con otras drogas. Por tanto, la intervencion deberia concentrarse en el consumo de alcohol.

2. La cooperacion es esencial. Como hemos dicho, a veces la industria del ocio nocturno no coopera, aunque en algunos paises la colaboracion es cada vez mayor. Los ayuntamientos y la policia tambien se retraen a la hora de cumplir con su deber. La burocracia municipal y los conflictos de intereses llevan muchas veces a la pasividad de estas instituciones. En el caso de la policia, aunque la investigacion demuestra su eficacia, a menudo se resiste a intervenir. Los profesionales de la prevencion y los investigadores deben buscar intervenciones innovadoras y realizar estudios practicos para los responsables en tomar decisiones.

3. Intervenciones mas populares en Europa y en todas partes se han basado durante muchos anos en ofrecer informacion sobre la reduccion de danos a los jovenes clientes de los locales de ocio nocturno. En fechas mas recientes, las intervenciones mas populares han incluido servicios sobre la ingestion responsable de bebidas, la formacion del personal de puertas (parte del SRB) y los programas de conductores designados, ademas de las conocidas intervenciones basadas en la informacion que recomiendan responsabilidad a la hora de beber o que explican estrategias individuales de reduccion del dano.

Estas intervenciones tan populares, en su mayoria respaldadas por la industria, no son precisamente las mas eficaces, sobre todo existe una obligatoriedad. Los gerentes y empleados de los locales no aceptan voluntariamente u olvidan la intervencion al cabo de un breve tiempo. Deberia haber, como en otros sectores de la prevencion, un claro compromiso con una intervencion eficaz. Sin embargo, el uso frecuente de intervenciones tan populares como ineficaces contribuye a agravar el problema y a empanar la reputacion de las medidas preventivas.

4. Mayor responsabilidad en la aplicacion de la ley. Se trata claramente de una de las medidas mas eficaces en si (basta con que la policia visite los locales) o para reforzar un determinado conjunto de medidas, garantizando su ejecucion. Pero la aplicacion de la ley:

--necesita apoyo politico y social.

--Es mas facil de llevar a la practica cuando existe una conciencia social de los problemas (vandalismo, accidentes de trafico con victimas jovenes que regresan de los centros de ocio, etc.).

5. Las intervenciones deben intentar cubrir areas amplias para evitar que los clientes se desplacen de las zonas mas exigentes normativamente a las que lo son menos. Es importante establecer criterios de calidad internacionales, puesto que muchos jovenes van de vacaciones a centros internacionales de ocio nocturno. El establecimiento de criterios de calidad internacionales depende de la creacion de una red exhaustiva y duradera a nivel local, nacional e internacional, en la que participen los paises de origen de los turistas y los de destino.

6. La mayoria de las intervenciones son multicomponentes. En el caso de las intervenciones en los locales en los que se consume alcohol, se consigue mayor efecto combinando la formacion de los empleados con la educacion de los clientes, el desarrollo de politicas de reduccion de riesgos y asegurar el cumplimiento de las normativas que disminuyan los riesgos derivados del alcohol (Graham, 2000). La mejor estrategia es la combinacion de formacion, cooperacion y aplicacion de la ley.

7. Los enfoques comunitarios son siempre intervenciones multicomponentes y producen los efectos mas duraderos y significativos. Sin embargo, hay que tener en cuenta una serie de detalles:

--son caros.

--Necesitan apoyo politico y social.

--A medio plazo hay problemas de cumplimiento y sostenibilidad.

8. Las medidas <<clasicas>> (subida de impuestos, restriccion de las horas y dias de venta, restriccion de la densidad de los puntos de venta, controles de alcoholemia, reduccion de los limites de alcohol en sangre, edad minima para comprar alcohol, suspension de la licencia administrativa y otras similares) se basan en la evidencia y son eficaces.

9. Urge hacer una valoracion. Los recursos humanos y economicos no son ilimitados. El uso de intervenciones o estrategias ineficaces no solo es un derroche de dinero, sino que ademas tiene un efecto perverso. Las perso nas que participan en ellas tienen la sensacion de que hacen algo util y de que, por tanto, no es necesario buscar alternativas. Hay muchas razones para que sigan en marcha programas ineficaces (la autopercepcion de que el programa es bueno debido a una determinada ideologia, al temor a descubrir que lo que se ha hecho no sirve de nada, etc). Por otro lado, hay muchos intereses economicos en este contexto recreativo, lo cual subraya la importancia de las evaluaciones. Pero la evaluacion requiere inversiones y estrategias experimentales correctas. Por ejemplo, despues de dos decadas de SRB, aun no conocemos el contenido, formato y duracion optima de dicha formacion (Graham, 2000).

10. Las nuevas tecnologias ofrecen muchas posibilidades de intervencion, como la vigilancia por video, la verificacion electronica de la edad, o los dispositivos antiarranque de los coches para evitar que los conductores embriagados conduzcan. Pero Internet tambien ofrece posibilidades de establecer contactos, transmitir informacion sobre riesgos, etc., lo cual resulta util.

11. Por ultimo, pero no por ello menos importante, conviene centrarse en los aspectos culturales. Las drogas cumplen otras funciones simbolicas diferentes a las que tenian en la antiguedad. Tienden mas bien a facilitar el vivir el momento, el presente, la inmediatez, el hedonismo. que son valores dominantes de la sociedad postmoderna. La vida de noche resume de forma paradigmatica esta situacion. Actualmente el individuo en nuestras sociedades esta presionado tanto para trabajar como para divertirse, otorgando la significacion necesaria para que ambas actividades se complementen coherentemente. La diversion es una gran industria y, por tanto, divertirse <<es bueno>> para el capitalismo. De hecho Jeremy Rifkin (2000) calculaba que para el ano 2015 el sector del entretenimiento supondra el 50% del PIB norteamericano. Conviene estudiar con mayor profundidad las siguientes facetas: 1) la faceta economica--tendencias del mercado de trabajo, socioeconomicas y comerciales, flujos de simbolos, mercancias y consumidores; 2) la faceta constitucional--alcance y distribucion de los poderes y las jurisdicciones; y 3) la faceta cultural--<<redes complejas de intercambios comunicativos>>, que incluyen normas, tradiciones, relaciones y roles familiares y de genero, y divisiones y cohesiones (Hadfield, 2009).

Muchas cuestiones pues estan en liza y no solo de tipo economico, sino tambien de orden social, ideologicas. Por poner un ejemplo, segun unos <<siempre que haya gente dispuesta a montar una fiesta, otros se opondran, y la policia y los legisladores tendran mucho trabajo. Es uno de los inconvenientes de la convivencia., la vida nocturna es otro aspecto de la rueda disciplinaria cotidiana a la que los ciudadanos adultos deben someterse; con lo cual, parte de la inocencia y la magia del ocio nocturno se pierden>> (Hadfield, 2009 ). Para otros, mas pesimistas, <<la diversion es la prolongacion del trabajo bajo el capitalismo tardio. Es buscada por quien quiere sustraerse al proceso de trabajo mecanizado para poder estar de nuevo a su altura, en condiciones de afrontarlo. Del proceso de trabajo en la fabrica y en la oficina soloes posible escapar adaptandose a el en el ocio. La industria cultural ofrece como paraiso la misma vida cotidiana de la que se queria escapar. Huida y evasion estan destinadas por principio a reconducir al punto de partida. La diversion promueve la resignacion que se quisiera olvida precisamente en ella>> (Horkheimer y Adorno, 1944).

Se escapa obviamente de las posibilidades de esta revision seguir profundizando sobre estas cuestiones culturales y sobre las estrategias de actuacion mas adecuadas a la cultura recreativa nocturna. Pero seguramente en una primera fase lo que convendra hacer es aumentar la informacion y la concienciacion sobre esta realidad. Paralelamente hay que intentar conseguir una buena base cientifica para basar las politicas y las intervenciones.

AGRADECIMIENTOS

Esta investigacion forma parte del proyecto Club Health (Diversion nocturna mas saludable y segura; proyectoHP-101123-2008 12 11). Este proyecto es parcialmente financiado por la Comision Europea (EAHC).

INTRODUCTION

Weekend nightlife has been for the last few decades one of the most important leisure activities of young people in many Western countries. Many of them truly experience weekend nights as their own world , which conflicts with the rest of the week, identified with the adult world (where people work, study, stay with the family, etc.). Depending on the city, young Europeans are devoting between 4 and 7 hours every weekend night to leisure pursuits of this kind (Calafat, Bohrn, Juan, Kokkevi, Maalste, Mendes et al., 1999). 'These weekends of excess combine the symbolic, educational (we learn moderation through experiencing excess), and the functional cathartic release from the working week, and are bounded by our structural position in society' (Measham, 2004). Weekend nights are becoming important socialization contexts in which young people acquire social capital. Parker (2003) is even of the opinion that this kind of recreational user may make a better transition to adult life than his/her abstemious peers. Shedler and Block (1990) make the similarly provocative proposal that people who experiment with drugs are psychologically healthier than abstainers, on the basis of a longitudinal study with a sample of 85 individuals. Nevertheless, this proposal could not be corroborated in a longitudinal replication study made with a sample of 2071 adolescents (Milich, Lynam, Zimmerman, Logan, Martin, Leukefeld et al., 2000), or in another study in which classic risk factors still maintain their importance among recreational users (Calafat, Fernandez, Juan and Becona, 2008). Fortunately, the issue is not black and white. For example, in the case of drinking alcohol, a single drinking occasion may have positive and negative consequences, and these consequences may be interrelated (Graham, 2001).

Participating in nightlife it is a meaningful cultural activity for young people. Councils welcome a 'flourishing l ate-n ig ht enterta inm ent in du str y' ( G reater Lon d on Authority, 2002). But there also problems related to the flourishing of this industry and to the people involved in such recreational contexts. This paper will focus precisely on how to minimise these problems, through a review of the effectiveness of different proposals for preventive intervention. We begin by identifying the principal areas in which problems arise:

--Health problems (injuri es, h earing dama ge, mental disorders, heat stroke, drunkenness, drug use, etc.). There is a well-documented relationship between specific n ig htli fe recrea tion al en viron m ents an d syn th etic substance use, as well as evidence of a high prevalence of recreational substance use (Bellis, Hale, Bennet,Chaves and Kilfoyle, 2000; Calafat et al., 1999; Forsyth, Barnard, & McKeganey, 1997; Tossmann, Bold, & Tensil, 1999). "Research studies targeted at young people in the EU who attend dance music events consistently report much higher prevalence of drug use than that found in surveys of the general population. This appears to be the case in all of the countries where such surveys have been conducted" (Annual report 2006, EMCDDA).

--Nightlife violence is a topic of increasin g concern . Research consistently shows the peak time for violent offence is weekend nights and the peak location is in and around pubs and clubs (Allen, Nicholas, Salisbury and Wood, 2003). In the United Kingdom one fifth of all violent assaults take place in or around a pub or club, and almost half of all incidents of violence and disorder occur on weekend nights (Maguire and Nettleton, 2003) . A small number of licensed premises account for most disorder and assault (Briscoe & Donnelly, 2001; Graham & Wells, 2001, Jochelson, 1997), but is true that those involved in violence tend to select the venues they attend (Hughes, Bellis, Calafat, Juan, Schnittzer and Anderson, 2008).

--Unsafe and involuntary sex. For many clubbers substance use has become an integral part of their strategic approach to sex. They even have a certain idea of how each drug functions within sexuality. Recreational drug use and binge drinking alter their sexual decisions and increase their chances of unsafe and regretted sex (Bellis, Hughes, Calafat, Juan, Ramon, Rodriguez et al., 2008; Calafat, Juan, Becona, and Mantecon, 2008).

--Transport to and from recreational areas is related to substantial problems, mainly because the most frequent (37.5%) form of transport used when going out are private cars, according to the results from a sample of 1363 regular nightlife users from nine European cities in 2006. During the last month, the 18% of the sample had driven while drunk, 13% had driven under the influence of drugs, and 37% had taken a lift from someone drunk or under the influence of drugs (Calafat , Blay, Juan, Adrover, Bellis, Hughes et al., 2009).

--Underage drinking. The sale of drink to those legally underage is a relatively common phenomenon. Despite a national minimum drinking age of 21, US research indicates that 30 to 70 percent of alcohol outlets may sell to underage buyers, depending in part on their geographical location (Paschall, Grube, Black and Ringwalt, 2007). On the island of Ibiza, 80% of 17-year-old students have been to a disco, even though this is against the law (Villar, 2008).

--Social nuisance (noise, street drinking, vandalism, etc.). Neighbourhoods are strongly affected both positively and negatively by the presence of recreational venues. The expansion of the night-time economy in Manchester city centre has created an estimated 12,000 jobs for bar, waiting, catering and securit y staf f. But of cour se all this development has given rise to problems. Some people have the feeling that cities are being hijacked or colonised by the young, and refer to the 'so-called lager lout phenomenon' (Worpole, 1992).

During recent decades the nightlife sector has seen a good deal of quantitative and qualitative changes. The growth experienced by the recreational industry is enormous, and not only in traditional tourist places, but indeed in most cities in the West. Furthermore, what is now on offer goes beyond traditional bars. Music now has a strong presence, as well as dancing. The type of clientele has changed, insofar as it is much younger, and the hours are more nocturnal. Commercial developments, such as the recommodification of alcoholic drinks and the redesign and rebranding of licensed leisure venues by the alcoholic beverage industry, resulted in the transformation of the night-time economy in the late 1990s to appeal to a new generation of young drinkers both male and female (Measham, 2004). In consequence, a substantial proportion of the total use of alcohol and illegal drugs among youth in Europe occurs in relation to night-time recreational activity (Fountain and Griffiths, 1997).

PREVENTIVE INTERVENTIONS

The need to intervene to deal with problems in bars (drunkenness, violence ...) is far from being a new phenomenon. The fact is that in many countries the sale of alcohol in bars is a regulated activity. The regulation of licences to sell alcohol has been a very common system of intervention for controlling bar-related problems. Nevertheless, there has been relatively little assessment of research on intervention policy as it applies to licensed premises (Graham, 2000).

However, and as is well known, entertainment over recent decades is no longer focused exclusively on adults, bars and alcohol. Modern forms of entertainment aimed at young people and involving music, discos, dancing and other nightlife activities play a central role, and especially so in summer tourist areas such as the Balearic Islands. During the 1970s and particularly the 1980s in Europe this model saw enormous expansion, eventually changing young people's entertainment habits in a highly visible way (Collin M, 1997).

As an activity involving broad sectors of young people, with good social skills, and good levels of integration, the impression is that there are few problems around. This is largely true, but no less true is the fact of a certain percentage of young people using alcohol and drugs in an abusive and uncontrolled manner. But also, even among the majority problems can emerge, since about 75% of people go out to get drunk at least once a month (Calafat, Fernandez, Juan, Anttila, Arias, Bellis, Bohrn, et al., 2003), making it more likely for them to engage in risky behaviours. For example, drinking and driving in relation to nightlife is a common behaviour (Calafat, Blay, Juan, Adrover, Bellis, Hughes et al., 2009).

In a review (Calafat et al., 2003) carried out a few years ago on a sample of 40 prevention programs addressing the recreational context and activities in 10 different European countries, none of the initiatives were evidence-based. Eighty percent had as their main objective to provide information on drugs and to reduce harm associated with their use. There were only two programmes with an explicit focus on cutting down the use of drugs. Most of them targeted users and non-users independently and 72% used pamphlets, flyers, freepost or posters. Distribution was generally direct, with information handed out to the target population. In other cases it was placed in public venues (stands in discos, bars, clothes outlets and other places frequented by the young) . Nine of the programmes in this survey had their own websites. Counselling by professionals was included in nearly 30% of the programmes, and around 40% included some proposal encouraging an alternative (sports, workshops.) to the nightlife leisure environment as a protection factor against drug use. Twenty-four percent of the programmes used peers, mainly for distributing the information.

In 2003 an EMCDDA (2009) survey on selective responses in recreational settings showed that of 78 projects reported by 15 European countries, 52 reported harm minimisation as their main objective and 26 prevention and reduction of the use of drugs. In over half of the projects the main activity was the provision of information.

TYPES OF INTERVENTION

The intervention possibilities are numerous, and most have been implemented; however, assessment of their outcomes is less common. The classification shown below is a possible one among others, and in any case there is naturally some degree of overlap. Community intervention can b e related to venues, emergency rooms, cultural approaches, and so on. Programmes can also sometimes be multi-component, and in such cases it may be useful to review what we know about the effectiveness of each component.

1. Venues

a. Bar staff and management training programmes. House policies

b. Code of practice and other agreements

c. Opening hours. Venue density.

d. Physical and contextual

e. Pill-testing

2. Community and multi-component interventions

3. Education (patron education, in-school education, peer education, etc.) and campaigns.

4. Emergency rooms, medical and first-aid services.

5. Licensing, Law enforcement and Underage control.

6. Context, environments, neighbourhood ( transp ort, lighting.)

7. Drink-Driving programmes

8. Policing; collaboration with the industry.

9. Alternative programmes.

10. Cultural approaches

11. 'Classical' prevention measures.

We shall continue by reviewing the existing evidence in relation to each of these forms of intervention.

1.a Bar staff and management training programmes. Responsible Beverage Service (RBS)

Several issues related to bar staff have been linked to problems, including low staff/patron ratio (Homel and Clarck, 1994; Graham, Bernards, Osgood, Homel and Purcell, 2005), staff serving to intoxicated people (Homel and Clark, 1994) , hostile and aggressive staff (Homel, Tomsen and Thommeny, 1992; Wells, Graham, West, 1998), staff who are poorly trained and poorly coordinated (Homel et al., 1992), a high proportion of male staff, and the presence of 'bouncers' (Homel and Clark, 1994; Quigley, Leonard, Collins, 2003). Over one third of violent incidents inside licensed premises involve door staff, often as alleged perpetrators (Maguire and Nettleton, 2003).

Training of staff has b een one of the most widely implemented types of intervention for reducing problems in the venues. The state of Oregon introduced training for all alcohol servers (and for one year all owners/managers) from December 1986. They found statistically significant reductions in single-vehicle night-time traffic accidents (those with high percentage of alcohol involvement) by the end of 1989, following the implementation of the compulsory server-training policy (Holder and Wagenaar, 1994) . Other studies also support the benefits of staff training (Gliksman, McKenzie, Single et al., 1993), even if the effects are diminished after 4 years (Buka and Birdthistle, 1999). When training of door staff to reject drug-useimpaired patrons was assessed using two actors, the baseline figure for rejection was 7.5%, compared to 27% at post-test (Gripenberg, Wallin and Andreasson, 2007).

A systematic review by Shults (2001), prior to the Cochrane review (see below), examined the effectiveness of server training in reducing drink-driving. Five controlled studies were included, three of which were non-randomised. The review concluded that 'there is sufficient evidence that face to face server training, when accompanied by strong and active management support, is effective in reducing the level of intoxication in patrons'.

However, other findings are not so positive. According to Graham (2000) or Homel (2001), server training has no effect, or the effects are quite limited. The results, according to these authors, do not show that RBS training alone has produced effects on alcohol intake. Clearly, enforcement was better. However, server training was probably effective in the reduction of violence (Wallin and Andreasson, 2005).

A Cochrane review (Ker and Chinnock, 2008) examined all studies which compared server settings receiving an intervention aimed at facilitatin g sensible alcohol con sump tion an d /or preventing injuri es, wi th ser ver settings not receiving such an intervention. The authors found 20 studies, and concluded that there is no reliable evidence that interventions in the alcohol server setting are effective in preventing injuries. The effectiveness of the interventions on patron alcohol consumption was found to be inconclusive. There is some indication of improved server behaviour, but it is difficult to predict what effect this might have on actual injury risk. Lack of compliance with interventions appears to be a particular problem; hence, mandated interventions or those with associated incentives for compliance may be more likely to show an effect. It should be considered that bar work is generally low-paid, and that staff turnover is high.

Minimum requirements for RBS would be, according to Mosher (2002):

1. Cover all basic information with servers

2. Use behavioural change/communication techniques (by simply providing information the chances of promoting behaviour change or increasing skills is limited). Specific skills (refusing alcohol to an intoxicated patron) should be taught. Active techniques (e.g., role playing) should be used.

3. Focus on both managers and servers. Managers should be targeted because they are responsible for supervising the servers, so that they should be familiarised with the techniques.

4. Include policy development for managers. Managers should develop written house policies. This increases the chances of implementing RBS at the establishment.

5. The minimum length for effective RBS is four hours.

It must also be taken into account that cooperation from venue managers is often difficult to obtain, unless the scheme is mandatory or there is strong social pressure. According to Graham (2000), bar owners, managers and staff a) do not usually volunteer to change, b) often do not cooperate fully with interventions; c) typically do not change very much as a result of most interventions; and d) often do not sustain changes beyond interventions because of factors such as competition and patron demand.

The bar associations of different countries (Australia, UK, Sweden.) have adopted codes of practices, normally on a voluntary basis. This may be an important first step, implying that the industry accepts it has a role and a responsibility in the prevention of harm. This is quite a common practice in Australia, where much of the research has also been carried out. Unfortunately, however, assessment of the voluntary code of practice does not support its effectiveness (Graham, 2000; Wilkins and Sweetsur, 2009). Despite the existence of a Code of Practice for Responsible Promotion of Liquor Products in an Australian town, an 8-week follow-up clearly showed that there are numerous examples of promotions which breach both the spirit and the letter of the Code. It is equally evident that the system for monitoring compliance with the Code is fundamentally inadequate (Jones and Lynch, 2007).

But some experiences, in collaboration with the industry, and where the code of practice is mandatory, are promising (Lang and Rumbold, 1997; Wallin, 2005). An interesting document for consultation, produced by the British Home Office and the KPMG (2008), is the review of the 'Social Responsibility Standards for the Production and Sale of Alcoholic Drinks', launched in 2005. The five principles of good regulation would be: proportionality, accountability, consistency, transparency and targeting. The most effective schemes have their own specific structures, separate from the industry's institutions. But a code administered by a trade organisation, if properly structured and implemented, can be better than none at all. To be taken seriously, selfregulation demands adequate, meaningful and commercially significant sanctions for non-compliance.

1.c Opening hours

Restricting opening hours has been a traditional form of regulation in some countries, such as the UK. At peak times for alcohol-related offences, late trading is associated with higher BALs among those drinkers most at risk of alcoholrelated harm (Chikritzhs and Stockwell, 2007). Prohibition of alcohol sales after 11pm led to a reduction of almost 9 murders a month in Diadema (Brazil) . Assaults against women also fell, but this effect was not significant. (Dualibi, Ponicki, Grube et al. (2007). The licensing laws in the United Kingdom were liberalised in 2005 with a view to preventing crime and enhancing public safety. An assessment carried out in a hosp ital comp aring em ergencies before and after the new licensing legislation found an increase in overnight alcohol-related ED attendances. Also, following the introduction of the new laws, the patients were more difficult to manage and required more resources, including more extensive and longer assessments. The legislative change has also been associated with an increase in alcohol-related assaults and injuries and alcohol-related hospital admissions (Newton, Sharker, Pahal, van den Bergh & Young, 2007).

However, other research finds that restricting opening hours does not have an effect on the numbers of alcohol--or assault-related visits to emergency rooms (Graham, McLeod and Steedman, 1998). In general terms, according to Graham (2000), there is no strong evidence that adjusting hours of operation is an effective policy intervention for reducing bar-related problems. But, a more recent review (Stockwell y Chikritzhs, 2009) of 49 studies (14 included baseline and control measures) suggests that extended late-night trading hours lead to increased consumption and related harms.

On the relatively small island of Ibiza -where some nights there may be more than 20,000 clubbers around-, when some discos closed at 6 a.m., others were just opening, and remained open the whole day. This allowed clubbers to continue their activity non-stop, 24 hours a day. This situation changed a few years ago, so that there are now some hours in the morning during which all discos are closed. The outcomes of this decision have not yet been assessed, but this may be a step in the right direction.

1.d Physical and contextenvironment

There are environmental aspects of the venues that have proven to be related to different problems, possibly because they can cause frustration or irritation in patrons. Some examples are overcrowding and bumping (Macintyre and Homel, 1997), smokiness (Homel and Clark, 1994), bad and loud music (Forsyth, 2009; Gueguen, Jacob, Le Guellec, Morineau and Lourel, 2008; Home and Clark, 1994), activities such as dancing or pool ( Graham, LaRocque, Yetman, Ross and Guistra,1980; Quigley et al., 2003), overt sexual activity or a permissive atmosphere (Homel, Carvolth, Hauritz, McIlwain and Teague, 2004; Graham et al., 2006).

One example of addressing the venue's environment involves banning glassware. In February 2006, a Glasgow City Council bye-law was introduced banning glassware from all venues holding an Entertainment Licence within the city centre. Disorder in all-plastic venues was observed to incur less injury risk than others still using glass. Patrons also reported feeling safer in these nightclubs than in others (Forsyth, 2008). In cases where bars used glass, it seemed that "toughened" glass with lower impact resistance caused more injuries, so that standards for toughening need to be developed (Warburton, Shepherd, 2000).

Serving food is associated with less violence (Homel and Clark, 1994) . This could be because such places attract a different clientele, or BAC is delayed.

Music policy was found to influence nightclubs' clientele and their behaviours, in relation, for example, to differences in levels of alcohol or illegal drug use, sexual activity and violence between venues. It is recommended that music policy be incorporated into responsible bar server training packages (Forsyth, 2009).

Noise control is an essential health issue. The installation of soun d limiters linked to any soun d am pli fica ti on equipment at appropriate levels is a good solution, but the law must be enforced. Rotation of staff can also be very helpful for mitigating noise burden.

Outlet density research literature supports that assaults are highly correlated with outlet density; that is, as density increases so do levels of assault. In relation to studies on road accidents and drink-driving, the evidence for a positive linear relationship is less consistent (Chikritzhs, Catalano, Pascal and Henrickson, 2007). Also, street assault correlates significantl y with numb ers and cap a city of p remises (Warburton and Shepard, 2005).

1. e. On-site pill-testing

On-site pill-testing has in the past been quite a common but controversial measure, and was essentially based on the assumption that pill adulteration was the main problem. However, it is now becoming less popular in Europe, and even in pioneering countries such as the Netherlands this type of on-site intervention is no longer used. The main arguments against pill-testing are the limited capacity of on-site tests to accurately detect harmful substances, the poor costbenefit ratio, and the fact that allowing on-site pill-testing sends out contradictory messages about the risks related to both the use and possession of controlled substances (EMCDDA, 2006). Moreover, there is no research suggesting that adulteration of these pills is more harmful than the drug itself. Indeed, very often the contrary is true, with problems being related to the purity of the content.

2. COMMUNITY OR MULTICOMPONENT INTERVENTIONS

M any stakeholders are involved in the regulation of nightlife, and co-operation among them app ears to be essential. An integral or multicomponent prevention approach combines some or all of the following interventions:

--Community awareness and community mobilisation (involvement of and cooperation with important stakeholders, such as municipal authorities, pubs and clubs, party organisers, health/addiction services, and police)

--Training: RBS, violence prevention, bar staff (from doormen to managers) and other stakeholders.

--House policies.

--Improving the health and safety levels of nightlife areas and venues (healthy settings).

--Education for nightlife clients about reducing the risks of drug and alcohol use.

--Law enforcement.

While only a few such programs have included rigorous evaluations with well defined outcomes, these programs have generally proven to be effective in reducing young persons' access to alcohol, problematic drinking patterns, unintentional vehicular and non-vehicular injuries, and assaultive violence ( Treno, Lee, Freisthler, Remer and Gruenewald, 2005). Some of the interventions evaluated are:

--Community Trials Project (Salinas, California). The intervention was successful in reducing the rate of nighttime traffic injuries and the number of admissions to hospitals due to traffic accidents (Roeper, Voas, PadillaSanchez et al., 2000).

--The Surfers Paradise Safety Action Project, in Queensland AUS's Gold Coast. Findings showed marked reductions in violence and crime (inside and outside venues) and in practices th at p rom ote the irresp on sible use of alcohol (such as binge drinking incentives) , as well as improvements in security p ractices, entertainment, handling of patrons, an d transport policies ( Homel, Hauritz, Wortly, McIlwain and Carvolth, 1997).

--STAD (Stockholm Prevents Alcohol and Drug Problems). The program began in 1996 and still is implemented successfully. The main intervention included community mobilization, training of servers in RB S and stricter enforcement of existing alcohol laws. Results: a decrease in alcohol-related problems at licensed premises; an increase in licensed premises that refused alcohol to intoxicated patrons (from 5% in 1996 to 47% in 1999 and 70% in 2001); increased refusal to serve minors (from 55% in 1996 to 59% in 1999 and 68% in 2001). During the project evaluation period the number of assaults fell by 29% in the project area and slight increased in the control area (Wallin and Andreasson, 2005).

--Geelong Local Industry Accord (Lang and Rumbold, 1997). The intervention is based on collaboration between police and venues to reduce interpersonal violence. A written code of conduct was co-developed to assist self-regulation of licensed venues. Outcomes included a reduction of violence over a three-year period.

Scientific research indicates that a community approach will probably be more effective than the implementation of separate interventions (Holder, Gruenewald, Ponicki, Treno, Grube, Saltz et al., 2000; Wagenaar, Murray and Toomey, 2000) . The problem with community projects is how to achieve their continuity after the initial phase. Leadership, community involvement or funding can be problems in the medium term.

3. EDUCATION (PATRON EDUCATION, IN-SCHOOL EDUCATION, PEER-EDUCATION, ETC.) AND CAMPAIGNS)

Patron education (through pamphlets, peer-to-peer approach.) has been a frequently-implemented form of harm-reduction intervention in recreational contexts. Thousands of pamphlets have been distributed in recreational areas with harm-reduction information ( not to dri ve drunk, to drink water when using MDMA, etc.) . However, there has been little assessment of their effect on patron's intoxication or on harm reduction. Their effectiveness as an isolated measure will probably be greatly reduced or nonexistent unless combined with enforcement or other types of intervention (Graham, 2000).

Nevertheless, we should consider (Faggiano and VignaTaglianti, 2008) that mass media interventions (brief and recurrent messages to inform and motivate individuals to abstain or reduce substance use) are sometimes a very effective measure, especially when they are implemented together with community actions. This has been seen in the case of tobacco (raising awareness, improving attitudes, reducing prevalence.), while in that of alcohol, drink-driving mass media campaigns have proven to reduce accidents by 10% (Tay, 2005). However, there are no assessments of campaigns against illegal drugs.

An idea with interesting possibilities would be for school prevention targeting adolescents to include recreational nightlife prevention among its objectives, since we know that this recreational context is where young people normally use alcohol and drugs. Special skills are needed to take the appropriate decisions in this context.

The use of peers in interventions in recreational settings has been quite popular, since it places the emphasis on the importance of the educator's age in establishing credibility with an audience. For the same reason, young people with experience of drug misuse are sometimes viewed as credible sources. Nevertheless, there are no outcome evaluations of such programs. In school programs, peers seem to be more effective than teachers (Faggiano, 2008). However, it should be borne in mind that programs which encourage social contact clearly run some risk of increasing the exposure to negative social influences. Not only the leaders, but also the groups have the potential for reinforcing both positive and negative norms, so that such interventions must be implemented with great care (Philliber, 1999)

4 EMERGENCY ROOMS, MEDICAL AND FIRST AID SERVICES

Medical problems related to recreational activities do occur. During 'I love techno' (2001 edition), an indoor rave party attended by 37,000 people, or 'De Nacht', a traditional New Year's Eve dance party, data on medical problems (especially drug-related problems) were collected. The incidence of medical problems during 'I love techno' was 66.5/10,000 attendees, and in the case of 'De Nacht', 70.0/10,000 attendees (Van Sassenbroeck et al., 2003). The proportion of patients attending the Emergency Department in British hospitals as a result of alcohol intoxication was 4% in adults; 70% of patients were male, with a mean age of 30 years, and 72% attended the department between 20.00 and 08.00 h. The most common reason for ED attendance was accidents (34%), followed closely by assault (30%). Twentyseven percent of patients had done most of their drinking at home, 36% in a pub and 16% in a nightclub (Benger and Carter, 2008).

Marked reductions in licensed premises assaults resulting from targeted policing were enhanced by the intervention of Emergency Department and maxillofacial consultants. Two consultants (ED and maxillofacial) visited these premises and presented in graphic detail the injuries sustained, treatment, and numbers of assaults to premises managers. They also informed the managers that the ED was auditing violence in their premises and that a report would be published six months later and disclosed to the local media (Warburton and Shepard, 2005)

A certain proportion of big clubs have 'club medic' rooms for managing these individuals, but there have been no evaluations of such interventions. Due to the lack of specific guidance on the training of staff working in these rooms, there have been instances where clubbers have been inappropriately managed within the club environment. One intervention has addressed this issue by developing a pilot set of guidelines and implementing appropriate training; after this, all the club medic staff were confident in their ability to assess unwell clubbers with recreational drug toxicity, to use the guidelines and to know when to call an ambulance (Wood, Greene, Alldus et al., 2008).

5. LICENSING, LAW ENFORCEMENT AND UNDERAGE CONTROL

Most of the research supports the efficacy of law enforcement and police intervention. A first successful example has been the introduction, in an English seaside resort, of new policing practice with regard to the supervision of licensed premises in the harbourside area, where there is the greatest concentration of public houses and licensed clubs. Uniformed police officers visit pubs 2 to 3 times a week, and the results showed a 20% of reduction in recorded public disorders offences in the intervention area, with no reduction in the control area (Jeffs and Saunders, 1983).

New technologies play an important role in night-time safety. Manchester City Centre Safe Project is an agency run by Greater Manchester Police. It adopts a holistic and long-term approach to reducing alcohol-related crime in the city centre. It comprises twenty separate initiatives that tackle different parts of the problem. For example, it was involved in introducing the 'Nite Net' radio system that links pub, clubs, CCTV and police officers together in the night-time hours. They can then warn each other of aggressive customers who have been ejected from venues and can target police activity towards particular groups of troublemakers (Roberts, 2004). Pub watch and club watch schemes have flourished in recent years in the UK. The Licensing Act 2003 recommends that all premises subscribe to a 'watch' scheme. Over three-quarters of the respondents (77.5%) in the national survey expressed an intention to extend the pubwatch schemes in their areas with direct links to police CCTV control centres. On the whole there is evidence to suggest that these schemes have a significant desirable effect on crime reduction, though such reduction may be rather small across all crimes. Evidence suggests that CCTV is more effective in reducing crimes against property than crimes against the person (Brown, 1995).

What is striking is that despite the fact that enforcement has proved to be an effective type of intervention, there is some reluctance to implement such kinds of policies. Many reasons can be suggested: ignorance of, or mistaken beliefs about the law, a lack of knowledge about the effects of drink, and a failure to see much harm in drinking, especially if, as is often the case, the police officer is a drinker him/ herself (Jeffs and Saunders, 83). Nightclubs are businesses, and Homel (2004) is worried about the hidden deals that are so characteristic of this industry: "venues will be left alone by police and licensing officials if there is no trouble serious enough to attract media or political attention".

It has been shown that police have the ability to play a leadership role in reducing alcohol-related incidents and harm. Sustained success is more likely when there is political support for and focus on alcohol-related harmreduction activities. However, responses must engage local representatives and involve a local focus sensitive to available physical and human resources (Doherty and Roche, 2003).

Underage drinking is a substantial problem, especially in Europe, where the legal age for buying alcohol may be even lower than 18. Studies of enforcement effects are few, but results show that enforcement can reduce sales to youth. For example, enforcement checks prevent alcohol sales to minors, but effects can diminish over time, suggesting that a regular schedule of enforcement is necessary for maintaining deterrence (Wagenaar, Toomey and Erickson, 2005). Electronic Age Verification (EAV) devices are one means of reducing underage sales of tobacco and alcoholic beverages, and thus avoiding the fines and license suspensions / revocations which can result from non-compliance. E AV devices -using similar technology to credit and ATM card scanners--read the date of birth encoded on the magnetic strip and/or bar code on the back of the customer's driver's license or similar ID and then calculate and display whether the card-holder is old enough to purchase tobacco or alcohol products. Although EAVs may have improved the accuracy of age verification, they did not increase the frequency of age verification in an experiment in which their use was on a voluntary basis (Krevor, Capitman, Oblak et al., 2003).

6. ENVIRONMENTS, NEIGHBOURHOOD (TRANSPORT, LIGHTING ...)

Problems are not only related to inside venues. In fact, a good deal of violence takes place outside venues, and is related to external environmental factors. Problems can be triggered by various factors:

* queuing for taxis or buses can trigger arguments and fights (Allen and Goody, 2002)

* lack of availability of public transport (Homel et al., 2004; Marsh and Kibby, 1992).

* people hanging around outside the bar at closing time (Marsh and Kibby, 1992; Graham, Bernards. Osgood and Wells, 2006).

* outlet density (Homel et al., 1997; Zhu, Gorman and Horel, 2004).

* large numbers of intoxicated people congregating and competing for limited food and transport facilities (Marsh and Kibby, 1992)

The solution to all these questions is essential to ensure safety and avoid violence.

In Leeds, for example, taxi ranks and bus stops have been dispersed to avoid large concentrations of people. In Manchester the queues for taxi ranks and buses are especially closely policed (Robert, 2004).

Late-night buses and other transport facilities have been introduced in many towns. The provision of parking areas is also very useful, but the use of private cars is associated with drinking and driving.

Lighting and telephone facilities are also useful for providing a safe atmosphere

The problem of controlling noise from customers leaving licensed premises once they have left the immediate vicinity of the venue itself is not easily solved. Suggestions include educational campaigns, and advice and reminders within the premises by means of posters and the direct intervention of door staff (MCM Research, 2003).

7. DRINK-DRIVING PROGRAMMES

Driving while drunk or after using drugs is of widespread concern. It has been found that clubbers use their private car quite often (37.5%) to get to recreational areas (Calafat et al., 2009). The World Health Organization estimates that in European countries, alcohol is responsible for 45 percent of the burden of disability arising from motor vehicle accidents for men and for 18 percent of the burden for women (Lopez, Mathers, Ezzati, Jamison and Murray, 2006).

One of the most popular interventions is that of the designated driver. This is a measure strongly supported by the recreational industry. In some cases the industry participates actively, backing the designated driver program by offering free drinks or other incentives. In Europe, there has been little assessment of designated driver programs, but the limited information that is available on the effectiveness of such programs suggests, unfortunately, that these programs are less effective in preventing alcohol-impaired driving than originally envisaged. There is little evidence to date that designated driver programs lead to a reduction in drinking and driving (Aresi, Fornari, Repetto and Scolari, 2009; Eurocare, 2003). It should also be taken into account that the unsafe actions of drunken passengers in the vehicle creates stress for the driver that can lead to high-risk driving situations and the disruption of safe driving (Rothe and Carroll, 2009).

The state of Oregon introduced compulsory training for all alcohol servers and owners/managers. Statistically significant reductions were found in single-vehicle nighttime traffic accidents (those with high percentages of alcohol involvement) (Holder and Wagenaar, 1994).

More classical types of intervention, such as blood alcohol controls or increasing the minimum legal age for drinking, are highly important tools for controlling this problem. Mandatory alcohol testing programs may have contributed to a significant reduction in alcohol involvement in fatal motor carrier crashes ( Brad y, Baker, Dimaggio, McCarthy, Rebok and Li, 2009). The legislation setting the minimum legal drinking age at 21 in the United States has been documented as one of the most effective public health measures adopted in recent times, its effects including the prevention of alcohol-impaired driving by those under the legal age (Fell, Fisher, Voas, Blackman and Tippetts, 2007).

The effectiveness of placing interlocks on the ignition to prevent an alcohol-impaired driver from operating the car has also been assessed. Assessment of this type of intervention, used with drink-driving offenders, showed good results during the period of time they were using the interlock, but the effects disappeared when the interlock was removed (Willis, Lybrand and Bellany, 2004).

8. POLICING; COLLABORATION WITH THE INDUSTRY

We have already mentioned that voluntary industry codes of practiques are generaly ineffective, even though they can be considered as a first step towards more effective commitment from the industry. Collaboration between the leisure industry and local authorities has been set up various European countries, such as the UK, the Netherlands, Germany, Belgium, Sweden, the Czech Republic, Italy, Germany, France or Lithuania, sometimes based on the UK's 'safer dance' guidelines (EMCDDA, 2009). There are many possibilities for collaboration: staff training, cooperation with p olice or em ergency d epartments, implementing designated driver campaigns, and so on.

Such collaboration is facilitated when it is mandatory or when there is strong public opinion demanding solutions as a consequence of some problems. Prevention professionals believe that the real involvement of the leisure industry is essential. In spite of an admitted growth in the incidence of partygoer problems in European countries, there were fewer assessed responses in 2007 than in 2004 (EMCDDA, 2009).

There are some voluntary initiatives by the EU spirits ind ustr y to h elp red uce al cohol-related ha rm ( some examples of these initiatives can be seen on web pages such as www.europeanspirits.org, www.efrd.org, or www.drinkaware.co.uk). There is strong concern in the alcohol industry over the possibility of more restrictive legislation, and that is why they are interested in demonstrating that they are cooperating. However, they support measures such as designated driver programmes or volunteer codes of practice that are not supported by research, and fail to support measures that have shown their efficacy, such as increasing taxation. The fact is that the affordability of alcohol has increased in all EU countries (apart from Italy) since 1996 (Rabinovich, Brutscher, de Vries, Tiessen, Clift and Reding, 2008).

A good policy approach to the prevention of problems in the recreational context requires the police, local authority and other interested parties to provide statistical evidence in order to make a formal assessment of the cumulative effect of problems of crime, disorder and public nuisance within a specified boundary. It should also be informed by consultation with the relevant stakeholders (DCMS, 2004).

Effective entertainment-district p olicing begins at the district planning and design stage. Concentrations of nightclubs and bars, and inadequate street,parking, and sidewalk capacities are the main problems. Identifying potential troublemakers, making proactive bar checks, preventing congregations, cooling hot spots, assuring pedestrian flow, and stopping gang activity are the main forms of proactive policing (Berkley and Thayer, 2000).

9. ALTERNATIVE PROGRAMS

Carmona and Stewart (1996) reviewed the effectiveness of alternative approaches for the Centre for Substance Abuse Prevention (CSAP) . They defined as 'alternative' activities, programmes and events at which alcohol, tobacco and drugs were excluded and in which participation was voluntary. These took many different forms, and their components frequently included the transmission of knowledge and attitudes as well as skills training, use of free and otherwise unstructured time, pro-social activities, interaction with pro-social peers and development of positive relationships with adults or supervision by adults. They could identify only 10 studies with a methodology allowing them to be classed as relatively conclusive. There is little evidence for the effectiveness of these measures.

In Spain, many towns organise alternative activities on weekend evenings (such as workshops, or opening up public places for sport), in parallel to the usual nightlife activities, aimed at having a preventive effect. An assessment of one of these alternative programs showed no effects on use of drugs or change of attitudes/behaviors in relation to the control group (Fernandez-Hermida and Secades, 2003) . The problem with such programs is that they can even be counter-preventive, since they are open to preadolescents and do not prevent people attending the usual nightlife venues later.

There are some other reviews of this type of alternative program, but it should be borne in mind that most of these reviews do not actually refer to the prevention of alcoholor drug-related problems in people attending nightlife venues. According to a review of programmes by Norman (1997), there is no evidence that organising artistic, sports or other types of alternative leisure activities will be, in itself, successful in reducing the use of drugs. In a review of 45 assessed programs of different types (Hansen 1992), nearly all of them yielded positive results, with the exception of the programs that provided alternative experiences (experiences incompatible with the use of substances).

10. CULTURAL APPROACHES

Going out on weekend nights is a highly complex phenomenon that has been growing steadily over recent decades. Many young people participate actively in this event, which is basically managed by the recreational industry. This new model of fun tends to become hegemonic for many young people, i.e., excluding other forms of entertainment. On the other hand , it performs many functions: socialization release, seeking a mate, sexual choices, and so on. Within this context, and for those who use drugs, each specific substance has its place within the preferences and objectives of each person. Ecstasy is associated with better dancing, alcohol with disinhibition and sociability, and so on. Obviously, those most strongly involved in this model of fun are more likely to use and abuse alcohol and drugs (Calafat, 2004). More information about these club cultures in the night-life scene can be found in Measham and Hadfield (2009).

Thus, preventing risk behaviors in these contexts cannot be a simple matter, as there is a complex cultural and economic framework that gives meaning to everything. It seems difficult to imagine that there can be significant changes in the present situation without introducing real changes in the symbolism, extent and expression of this culture and its supporting economy. The truth, however, is that in general terms there has been no genuine questioning of this recreational culture, either by society in general or in current policies and prevention programmes. Indeed, quite the opposite is true in some cases. In particular, interventions based mainly on giving information to the partygoers (very common in Europe) or on pill-testing are based on a strict respect for the actual recreational rationality, and only attempt to convey to drug users the information and abilities necessary to reduce the risk associated with their recreational behaviour.

But this 'neutrality' is difficult to sustain. The promotion of club nights and the ways in which potential customers are encouraged or discouraged from entering are clear examples of how these informal processes have an effect on the selection of clubbing elites; thus, large proportions of young people are excluded from such spaces, either directly, through being denied entry, or indirectly, by being made to feel uncomfortable or unworthy (Measham, 2009). Socialising has become a central aspect for many young professionals. Research carried out on 25 to 34-year-old British professionals found that socialising was the most important aspect of their lives. Almost half saw work as significant but not dominant, with only 16% putting careers as their top priority. The report found that the trend was most pronounced among women, with 40 % defying the career-girl stereotype and saying the main function of work was to fund a busy social life (Goswami, 2004).

Nightlife culture has a strong influence on the way young people categorize pleasure, entertainment, social relations, alcohol and drug use, and so on. Obviously, traditional prevention p rograms or policies are highly unlikely to influence this culture. However, environmental approaches are prevention measures that operate at the level of these social and cultural norms. In this sense, norms, normality and values regarding substance abuse are an important issue. But we do not know much about how such factors operate, and, consequently there are not many interventions addressing them. In a review of the research to determine whether social norms feedback intervention reduces alcohol misuse in university or college students, there were positive outcomes for Web /computer feedback (WF) and individual face-toface feedback (IFF). These sorts of intervention are probably effective in reducing alcohol misuse. No direct comparisons of WF with IFF were found, but WF impacted across a broader set of outcomes and is less costly, so that it could be preferable. Significant effects were more apparent for short-term outcomes (up to three months). For mailed and group feedback, and for social norms marketing campaigns, the results are on the whole not significant, so that these alternatives cannot be recommended (Moreira, Smith and Foxcroft, 2009).

In summary, we should consider the cultural aspect as key. However, there is a need for well-directed research that describes and analyses cultural elements within their social reality in order to understand what sorts of intervention could be envisaged. A relevant question here is that ideology is of central significance. Interventions that will affect the recreational cultural background depend not only on the will or the skills of professionals, and indeed possibly depend more on societal changes.

11. 'CLASSICAL' PREVENTION MEASURES

The focus of the present review does not involve analysis of the effectiveness of classical measures, even though some reference has been made to them on analysing other interventions more directly related to nightlife recreational settings. Such classical interventions refer basically to the reduction of alcohol-related harm, but we are convinced that this type of intervention also has an effect on problems related to nightlife.

A short list of these interventions (Giesbrecht, 2008) would include:

--An increase in the real price of alcoholic beverages and a discontinuation of discount pricing and sale pricing.

--A ceiling and status quo on other types of availability hours and days of sale, density of on-premise and off-premise outlets.

--A rejuvenation of the control function of liquor boards and commissions that would include a reduction in alcohol marketing and promotion.

--Provision of the resources required for effective implementation of these measures and for other effective interventions already in place ...

CONCLUSIONS

Nightlife is an expanding phenomenon -and not only in Western societies--with positive outcomes for the welfare of the community and for individual development. Nevertheless we can identify specific problems related to this activity (traffic accidents, abuse of drugs, violence, etc.) . A wide range of interventions have been attempted, but there is still a lack of outcome evaluations. There is a need for more research on recreational nightlife-related problems and on risk and protective factors -especially in relation to context and environment and sociocultural relationships. Furthermore, more assessment is required before making recommendations and drawing up guidelines. Of particular cause for concern is the effectiveness of interventions after completion of the evaluation process.

Interventions in these settings are not simple or easy to systematize, since it is a highly dynamic sector. But the difficulties of launching interventions derive also from other and diverse sources. There is still little awareness about the problems related to this context. People in general tend to think very positively about nightlife, and don't like to see the problems. Pointing out the problems that emerge in these contexts is sometimes seen as questioning young people's right to hap piness, or even questioning young people themselves.

Many stakeholders are involved in nightlife. In the case of prevention professionals, their training is not normally related to these settings. We must also take into account the ideological debates -all the more intense considering that this is quite a new situation, with many cultural implications--over the fostering of certain approaches over others. Some early harm-reduction approaches fostered interventions that merely informed p atrons about the consequences of their behaviour through leaflets, pilltesting, etc., but without questioning either individual behaviour or industry strategy. "Understanding how positive and negative social consequences are linked may be helpful in fine-tuning policies to be maximally effective in reducing negative consequences" (Graham, 2001).

Conclusions and discussion about the efficacy and effectiveness of the interventions analysed and the problems related to them have been presented on addressing each one. Therefore, we shall make some more general comments:

1. Prevention efforts often concentrate on illegal drugs. However, most problems derive from the use of alcohol or the combination of alcohol with other drugs. Therefore, intervention should concentrate more on risky alcohol use.

2. Cooperation is essential. As we have already mentioned, there is sometimes a lack of cooperation from the nightlife industr y, even if in some countries such collaboration is increasing. However, local councils and police are also often reluctant to go carry out their duties. Council bureaucracy and conflicts of interests frequently lead to passivity in these institutions. In the case of the police, even though research demonstrates their effectiveness, they can be reluctant to intervene. Prevention professionals and researchers should strive for innovative interventions and assessments that could be advantageous and practical for policy-makers.

3. The most popular types of interventions in Europe and elsewhere have for many years involved providing information on harm reduction to young people attending nightlife venues. More recently, the most popular interventions have included responsible beverage services, training of door staff (a part of the RBS) and designated driver programmes, apart from the wellknown information-based interventions recommending resp onsible drinking or explaining individual harmreduction strategies. Such popular interventions, most of them backed by the industry, are not exactly the most effective, especially if they are not enforced. Managers and staff often fail to volunteer or forget about the intervention after a short time. There should be, as in other sectors of prevention, a clear commitment to effective intervention. However, the highly frequent use of popular but ineffective interventions contributes more to the problem than to its solution, and only contributes to giving preventive efforts a bad reputation.

4. Greater accountability for law enforcement. This is clearly one of the most efficient measures in itself (police simply visiting recreational venues or reinforcing an agreed set of measures and ensuring their implementation). But law enforcement:

--needs political and social support

--is easiest to implement when there is local awareness of problems (vandalism, traffic accidents involving young people returning from nightlife venues, etc.).

5. Interventions should attempt to cover extensive areas, with a view to avoiding a situation in which clients move from more strictly regulated areas to others without so many rules. It is important to draw up international quality standards, since many young people like to go to international nightlife resorts for holidays. The setting-up of international quality standards would depend on the establishment of an in-depth and long-lasting network, at local, national and international levels, involving tourist providers as well as recipient countries.

6. Most interventions tend to be multi-component. In the case of on-premise interventions it seems likely that the main effects will be achieved by combining bar staff training, education of patrons, development of lowerrisk policies and enforcement of regulations aimed at decreasing risks related to drinking alcohol (Graham, 20 00 ) . What em erges as th e b est strateg y is th e combination of training, cooperation and enforcement.

7. Community approaches are typical multi-component interventions. They tend to produce the largest and most significant effects. However, there are some issues to take into account:

--they can be expensive

--they need political and society support

--in the medium term there are often problems with compliance and sustainability

8. 'Classical' measures (basically taxation, restriction of hours or days of sale, outlet density restrictions, sobriety checkpoints, reduced BAC limits, minimum legal purchasing age, administrative licence suspension and the like) are evidence based and effective.

9. Assessment is an urgent need. Human and economic resources are n ot limitless. The use of inefficient interventions or strategies is not only a waste of money, but can also have a perverse effect. The persons involved have the feeling that they are busy doing something, so that there is no need to look for alternatives. There are many reasons why ineffective programs are still in use (self-perception that the program is good because of an ideology, fear of discovering that what has been done is ineffective, and so on). Moreover, there are many economic interests in this recreational context, making assessment even more important. However, assessment needs investment and correct experimental strategies. Despite two decades of RBS training, for example, we still do not know the optimal content, format and length of training (Graham, 2000).

10. New technologies open up many possibilities for interventions, such as video vigilance, 'pub watching', electronic age verification, or interlocks to prevent car driving by drunk drivers. But the Internet also offers possibilities for networking, information about risks, etc., that can be useful.

11. Last but not least, it is important to focus particularly on cultural aspects. Drugs fulfil symbolic functions different from those of previous eras. They tend more to facilitate "living the moment", experiencing the present, immediacy, hedonism., which are the dominant values of p ost-modern society. The nightlife phenomenon summarizes this in paradigmatic fashion. The individual in today's society is pressurized not only to work but also to have fun, and both are given the necessary significance to complement one another in a coherent way. Entertainment is big business, so that having fun is "good" for capitalism. Indeed, Jeremy Rifkin (2000) calculated that by 2015 the entertainment sector will account for 50% of the United States' GDP. It may be that we need to explore in more depth the following three spheres: 1) the economic sphere--labour-market, socio-economic, and commercial trends, flows of symbols, commodities and consumers; 2) the constitutional sphere--the extent and distribution of powers and jurisdictions; and 3) the cultural sphere--'complex networks of communicative exchange' --including normative codes, traditions, family and gender relations and roles, and cultural divisions and cohesions (Hadfield, 2009).

Many questions, then, are on the table, and not only economic questions, but also those of a social and ideological nature, among others. By way of example, for some 'as long as some people want to party, then others will want to object and police and regulators will be kept busy. This appears to be one of the perennial challenges of living together., nightlife becomes just another part of the daily disciplinary grind to which adult citizens must submit; thus, some of nightlife's innocence and magic is lost' (Hadfield, 2009). For others, more pesimist: 'Entertainment is the prolongation of work under late capitalism. It is sought by those who wish to extricate themselves from the process of mechanized work in order to be ready to confront it again. [ ...] Escape from the process of work in the factory or in the office is only possible by adapting oneself to it in leisure time [ ...] The culture industry offers as a paradise the same everyday life from which one wishes to escape. Flight and evasion are by their very nature destined to lead us back to where we started. Entertainment brings about the resignation from which we are actually trying to escape through it' (Horkheimer and Adorno, 1944).

It is clearly b eyond the brief of this review to go any deeper into the culture of fun and entertainment or into strategies of intervention on this type of culture. Undoubtedly, however, what is required in an initial phase is to increase information and awareness in relation to this reality. In parallel to this, we need a sound scientific basis for informing policy and intervention strategies.

ACKNOWLEDGEMENTS

This research is part of the project Club Health (Healthy and safer nightlife of youth; project-HP-101123-2008 12 11). This project is been financed by the European Commission (EAHC).

recibido: enero 2009

aceptado: septiembre 2009

REFERENCIAS / REFERENCES

Allen, C. y Goody, H. (LGA) (2002). All day and all of the night: an LGA discussion paper. London: LGA Publications, the Local Government Association.

Allen, J., Nicholas, S. Salisbury, H. y Wood, M. (2003). Nature of burglary, vehicle and violent crime. In Crime in England and Wales 2001/2002: Supplementary Volume, Edition (C. FloodPage and J. Taylor ed.). Home Office Statistical Bulletin 01/03. London: Home Office.

Aresi, G., Fornari, L., Repetto, C. y Scolari, M. (2009). Evaluation of a designated driver intervention to prevent alcohol-related road accidents in the clubs of Milan, Italy. Adicciones, 21, 279-288

Berkley, B. J. y Thayer, J. R. (2000). Policing entertainment districts. Policing: An International Journal of Police Strategies & Management, 23, 466-491.

Bellis, M., Hale, G., Bennett, A., Chaudry, M. y Kilfoyle, M. (2000). Ibiza uncovered: changes in substance use and sexual behaviour amongst young people visiting an international night-life resort. International Journal on Drug Policy 11, 235-244.

Bellis, M., Hughes, K., Calafat, A., Juan, M., Ramon, A., Rodriguez, J.A. et al. (2008). Sexual uses of alcohol and drugs and the associated health risks: a cross sectional study of young people in nine European cities. BMC Public Health, 8:155 doi:10.1186/1471 2458-8-155.

Benger, J. y Carter, R. (2008). Could inter-agency working reduce emergency department attendances due to alcohol consumption? Emergency Medicine Journal, 25, 331-334.

Brady, J.E., Baker, S.P., Dimaggio, C., McCarthy, M.L., Rebok, G.W. y Li, G. (2009). Effectiveness of mandatory alcohol testing programs in reducing alcohol involvement in fatal motor carrier crashes. American Journal of Epidemiology 170, 775-82

Briscoe S., Donnelly N. (2001). Assaults on Licensed Premises in InnerUrban Areas. Alcohol Studies Bulletin 2. Perth: Curtin University of Technology Western Australia National Drug Research Institute.

Brown, B. (1995). CCTV in Town Centres: Three Case Studies Police Research Group-Crime Disorder and Prevention Series Paper 68. London: The Home Office.

Buka, S. L. y Birdthistle, I. J. (1999). Long-term effects of a communitywide alcohol server training intervention. Journal of Studies on Alcohol, 60, 27-36.

Calafat, A., Bohrn, K., Juan, M., Kokkevi, A., Maal.ste, N., Mendes, F. et al. (1999). Night life in Europe and recreative drug use. Palma de Mallorca: Irefrea.

Calafat, A., Fernandez, C., Juan, M., Anttila, A., Arias, R., Bellis, M. A. et al. (2003). Enjoying nightlife in Europe. The role of moderation. Palma de Mallorca: Irefrea.

Calafat, A., Fernandez, C., Juan, M. y Becona, E. (2008). Recreational nightlife: Risk and protective factors for drug misuse among young Europeans in recreational environments. Drugs: education, prevention and policy, 15, 189-200.

Calafat, A., Blay, N., Juan, M., Adrover, D., Bellis, M.A., Hughes, K., Stocco, P., Siamou, I., Mendes, F. y Bohrn K (2009). Traffic risk behaviours at nightlife: drinking, taking drugs, driving and use of public transport by young people. Traffic injury prevention, 10, 162-169.

Calafat, A., Juan, M., Becona, E. y Mantecon A. (2008). Que drogas se prefieren para las relaciones sexuales en contextos recreativos. Adicciones, 20, 37-48.

Carmona, M. y Stewart, K. (1996). A Review of Alternative Activities and Alternative Programs in Youth-Oriented Prevention. CSAP Technical Report 13;DHHS Pub. No. SMA 96-3117. Rockville, MD: Center for Substance Abuse Prevention.

Chikritzhs, T., Catalano, P., Pascal, R. y Henrickson, N. (2007). Predicting alcohol-related harms from licensed outlet density: A feasibility study. Tasmania: National Drug Law Enforcement Research Fund.

Chikritzhs. T y Stockwell. T (2007). The impact of later trading hours for hotels (public houses) on breath alcohol levels of apprehended impaired drivers. Addiction, 102, 1609-17.

Collin, M. (1997). Altered State:The Story of Ecstasy Culture y Acid House. London: Serpent's Tail.

Department of Culture, Media y Sport. (DCMS) (2004). Draft Guidance issued under Section 182 of the Licensing Act 2003. Tabled Before Parliament on 23 March 2004. London: DCMS. Downloadable from: www.dcms.gov.uk

Doherty, S.J. y Roche, A.M. (2003). Alcohol and Licensed Premises: Best Practice in Policing. A Monograph for Police and Policy Makers. Payneham: Australasian Centre for Policing Research.

Dualibi, S., Ponicki, W., Grube, J. et al. (2007). The Effect of restricting opening hours on alcohol-related violence. American Journal. of Public Health, 97, 2276-2280.

EMCDDA (2006). Annual report 2006. Lisbon: EMCDDA. EMCDDA (2006). Developments in drug use within recreational settings. Lisbon: EMCDDA.

EMCDDA (2009). Trends and availability of responses to drug use in recreational settings in Europe. Poster downloadable in http://www.emcdda.europa.eu/attachements.cfm/att_78666_EN_RES%2020.pdf

Eurocare (2003). Drinking and Driving in Europe: A Eurocare Report to the European Union. Eurocare: Saint Ives, Cambridgeshire.

Faggiano, F. y Vigna-Taglianti, F. (2008). Drugs, Illicit --Primary Prevention Strategies. In: Kris Heggenhougen and Stella Quah (editors). International Encyclopedia of Public Health, Vol 2. San Diego: Academic Press.

Fell, J.C., Fisher, D.A., Voas, R.B., Blackman, K. y Tippetts, A.S. (2007). The relationship of 16 underage drinking laws to reductions in underage drinking drivers in fatal crashes in the United States. Annual Proceedings Association for the Advance of the Automotive Medicine, 51, 537-57.

Fernandez-Hermida, J R, y Secades, R. (2003). Guia de referencia para la evaluacion de programas de prevencion de ocio alternativo. Gijon: Colegio Oficial de Psicologos.

Forsyth. A.J.M. (2008). Banning glassware from nightclubs in Glasgow (Scotland): observed impacts, compliance and patrons views. Alcohol and Alcoholism, 43,111-117.

Forsyth, A.J.M. (2009). Lager, lager shouting': The role of music and DJs in nightclub disorder control. Adicciones, 21, 327-345.

Forsyth, A.J.M., Barnard, M. y McKeganey, N.P. (1997). Musical preference as an indicator of adolescent drug use. Addiction, 92, 1317-25.

Fountain, J. y Griffiths, P. (1997). Inventory, bibliography and synthesis of qualitative research in the European Union (Rep. No. 1). London: National Addiction Center.

Giesbrecht, N. (2008). Recent Developments in Overall Alcohol Consumption and High Risk Drinking: A Case for Effective Population Level Interventions in Canada. Adicciones, 20, 207-220.

Gliksman, L., McKenzie, D., Single. E., et al. (1993). The role of alcohol providers in prevention: an evaluation of a sever intervention programme. Addiction, 88, 1195-1203.

Goswami, N. (2004). Work ethic? They'll settle for a social life, thanks. The Sunday Times October 3, 2004. Retrieved in: http://www.timesonline.co.uk/article/0,2087-1291215,00.html

Graham, K. (2000). Preventive interventions for on-premise drinking: a promisi n g bu t under researched area of prevention. Contemporary drug problems, 27, 593-668.

Graham, K. (2001). The ying and yang of alcohol intoxication: implications for research on the social consequences of drinking. Addiction, 98, 1021-1023.

Graham K., Bernards, S., Osgood, D. W., Homel, R. y Purcell, J. (2005).

Guardians and handlers: the role of bar staff in preventing and managing aggression. Addiction, 100, 755-66.

Graham, K., Bernards, S., Osgood, D.W. y Wells, S. (2006). Bad nights or bad bars? Multi-level analysis of environmental predictors of aggression in late-night large-capacity bars and clubs. Addiction, 101 , 1569-1580.

Graham K., LaRocque L., Yetman R., Ross T. J., Guistra E. (1980). Aggression and bar-room environments. Journal of Studies on Alcohol, 41, 468-85.

Graham, C.A., McLeod, L.S. y Steedman, D.J. (1998). Restricting extensions to permitted licensing hours does not influence the numbers of alcohol or assault related attendances at an inner city accident and emergency department. Journal of accident and emergency medicine, 15, 23-25.

Graham, K. y Wells, S. (2001). Aggression among young adults in the social context of the bar. Addiction Research, 9, 193-219.

Greater London Authority. (2002). Late night London: planning and managing the late night economy. London: Greater London Authority.

Gripenberg, J., Wallin, E. y Andreasson. S. (2007). Effects of a Community-Based Drug Use Prevention Program Targeting Licensed Premises. Substance use and misuse, 42,1183-1898.

Gueguen, N., Jacob, C., Le Guellec, H., Morineau, T. y Lourel, M. (2008). Sound level of environmental music and drinking behavior: a field experiment with beer drinkers. Alcoholism: clinical and experimental research, 32, 1-4.

Hadfield, P. (2009). Nightlife and Crime: Social. Order and Governance in International Perspective. Oxford: Oxford University Press.

Holder. H.D. y Wagenaar. A.C. (1994). Mandated server training and reduced alcohol-involved traffic crashes: a time series analysis of the Oregon experience. Accident analysis and prevention, 26, 89-97.

Holder, H.D., Gruenewald, P.J., Ponicki, W.R., Treno, A.J., Grube, J.B., Saltz, R.F. et al. (2000). Effect of community-based interventions on High Risk drinking and alcohol-related injuries. JAMA 284, 2341-47.

Home Office/KPMG LLP (2008). Review of the Social Responsibility Standards for the production and sale of alcoholic drinks. Birmingham: KPMG LLP. Retrieved from: http ://d rugs. homeoffice.gov.uk/publication-search/alcohol/ alcohol-industryresponsibility/alcohol-industry-vol-3?view=Binary.

Homel, R., Carvolth, R., Hauritz, M. y McIlwain G. (2004). Teague R. Making licensed venues safer for patrons: what environmental factors should be the focus of interventions?Drug and Alcohol Review, 23, 19-29.

Homel, R. y Clark, J. (1994). The prediction and prevention of violence in pubs and clubs. Crime Prevention Studies, 3, 1-46.

Homel, R., Hauritz, M., Wortly, R., McIlwain, G. y Carvolth, R. (1997). Preventing alcohol-related crime though community action: the surfers paradise safety action project. In Homel, R. (Ed.) Policing for prevention: reducing crime, public intoxication and injury. Monsey, NY: Criminal Justice Press.

Homel, R., McIlwain, G. y Carvolth, R. (2001). Creating safer drinking environments. In: Heather N, Peters TJ, Stockwell T, eds. International handbook of alcohol dependence and problems. Chichester: John Wiley & Sons, 721-40

Homel, R., Tomsen, S. y Thommeny, J. (1992). Public drinking and violence: not just an alcohol problem. Journal of Drug Issues, 22, 679-97.

Horkheimer, M. y Adorno, T.H. (1944). Dialektik der Aufklarung. Philosophische Fragmente. (Ed. en castellano (1998). Dialectica de la Ilustracion. Fragmentos filosoficos. Madrid: Trotta.

Hugues, K., Bellis, M., Calafat, A., Juan, M., Schnittzer, S. y Anderson, Z. (2008). Predictors of violence in young tourists: a comparative of British, German and Spanish holidaymakers. European Journal of Public Health, 18, 569-74.

Jeffs, B.W., Saunders, W.M. (1983). Minimizing Alcohol Related Offences by Enforcement of the Existing Licensing Legislation. British Journal of Addiction, 78, 67-77.

Jochelson, R. (1997). Crime and Place: An anysis of assaults and robberies in inner Sydney. Sydney: NSW Bureau of Crime Statistics and Research.

Jones, S.C. y Lynch, M. (2007). Non-advertising alcohol promotions in licensed premises: does the Code of Practice ensure responsible promotion of alcohol? Drug and Alcohol Review, 26, 477-85.

Ker, K. y Chinnock, P. (2008). Interventions in the alcohol server setting for preventing injuries, Cochrane Database Systematic Review, 16, 3, CD005244.

Krevor, B., Capitman, J.A., Oblak. L. et al. (2003). Preventing illegal tobacco and alcohol sales to minors through electronic ageverification devices: a field effectiveness study. Journal of Public Health Policy, 24, 251-268.

Lang, E. y Rumbold, G. (1997). The effectiveness of community based interventions to reduce violence in and around licensed premises: a comparison of three Australian models. Contemporary drug problems, 24, 805-826.

Lopez, A.D., Mathers, M.D., Ezzati, M., Jamison, D.T. y Murray, C. (2006). Measuring the Global Burden of Disease and Risk Factors, 19902001: The Global Burden of Disease and Risk Factors. New York: Oxford University Press.

Marsh, P. y Kibby, K. (1992). Drinking and Public Disorder. London: Portman Group.

MCM Research (2003). Implications for noise disturbance arising from the liberalisation of licensing laws: Report of research and consultation conducted by MCM Research Ltd for the Department for Environment, Food and Rural Affairs (Defra). London: MCM Research Ltd.

Maguire, M. y Nettleton, H. (2003). Reducing alcohol-related violence and disorder: an evaluation of the 'TASCproject. Home Office Research Study 265. London: Home Office.

Measham, F. (2004). The decline of ecstasy, the rise of 'binge' drinking and the persistence of pleasure. Probation Journal, 51, 309-326.

Measham, F. y Hadfield, P. (2009). Everything Starts with an 'E': Exclusion, ethnicity and elite formation in contemporary English clubland. Adicciones, 21, 363-386.

Milich, R., Lynam, D.R., Zimmerman, R., Logan, T.K., Martin, C., Leukefeld, C.G., Portis, C., Miller, J. y Clayton, R. (2000). Differences in young adult psychopathology among drug abstainers, experimen ters, an d freq u ent users. Journal Substance Abuse, 11, 69-88.

Moreira, M.T., Smith, L.A. y Foxcroft, D. (2009). Cochrane Social norms interventions to reduce alcohol misuse in university or college students. Database Systematic Review, Jul 8, 3, CD006748.

Mosher, J.F., Toomey, T.L., Good, C., Harwood, E. y Wagenaar, A.C. (2002). State laws mandating or promoting training programs for alcohol servers and establishment managers: an assessment of statutory and administrative procedures. Journal of Public Health Policy, 23, 90-113.

Norman, E., Turner, S., Zunz, S. y Stillson, K. (1997). Prevention programmes reviewed: What works? In: E. Norman (Ed.), Drug free youth: A compendium for prevention specialists. New York: Garland.

Newton, A., Sharker, S.J., Pahal, G.S., van den Bergh, E. y Young, C. (2007) . Impact of the new licensing law on emergency hospital attendances: a cohort study. Emergency Medicine Journal, 24, 532-534.

Parker, H. (2003). Pathology or modernity? Rethinking risk Factor analyses of young drug users. Addiction Research and Theory, 11, 141-144.

Paschall MJ, Grube J W, Black C y Ringwalt C L. (2007). Is Commercial Alcohol Availability Related to Adolescent Alcohol Sources and Alcohol Use? Findings from a Multi-Level Study. Journal of Adolescent Health, 41 , 168-174.

Philliber, S. (1999). Search of Peer Power: A Review of Research on Peer-Based Interventions for Teens. In Peer Potential: Making the Most of How Teens Influence Each Other. Washington, DC: National Campaign to Prevent Teen Pregnancy.

Quigley, B. M., Leonard K. E. y Collins R. L. (2003). Characteristics of violent bars and bar patrons. Journal of Studies on Alcohol, 64, 765-72.

Rabinovich, L., Brutscher, P., de Vries, H., Tiessen, J., Clift, J. y Reding, A. (2008) . The affordability of alcoholic beverages in the European Union. Understanding the link between alcohol affordability, consumption and harms. Cambridge: Rand.

Rifkin, J. (2000). The Age of Access: The New Culture of Hypercapitalism. N. Y.: Penguin Group (USA).

Roberts, M. (2004). Good Practice in Managing the Evening and Late Night Economy: A Literature Review from an Environmental Perspective. London: Office of the Deputy Prime Minister. Retrieved from: http://www.communities.gov.uk/documents/ communities/pdf/131197.pdf

Roeper, Voas, R.B., Padilla-Sanchez. L. et al. (2000). A long-term community-wide intervention to reduce alcohol-related traffic injuries: Salinas, California, Drugs: education, prevention and policy, 7, 51-60.

Rothe, P.J. y Carroll, L.J. (2009). Hazards faced by young designated drivers: in-car risks of driving drunken passengers. International Journal of Environmental. Research Public Health, 6, 1760-77.

Shedler, J. y Block, J. (1990). Adolescent drug use and psychological health: A longitudinal inquiry. American Psychology, 45, 612630.

Schults, R., Elder, R.W., Sleet, D.A., Nichols, J.L., Alao, M.O., CarandeKulis, V.G. et al. (2001). Reviews of Evidence Regarding Interventions to Reduce Alcohol-Impaired Driving. American Journal of Preventive Medicine, 21, 4S.

Stockwell, T. and Chikritzhs, T. (2009). Do relaxed trading hours for bars and clubs mean more relaxed drinking? A review of international research on the impacts of changes to permitted hours of drinking. Crime Prevention and Community Safety, 11, 153-70.

Tay, R. (2005). Mass media campaigns reduce the incidence of drinking and driving. Evidence-based Healthcare Public Health, 9, 26-29.

Tossmann, P., Boldt, S. y Tensil, M. D. (2001), 'The use of drugs within the techno party scene in European metropolitan cities', European Addiction Research, 7, 2-23.

Treno, A.J., Lee, J.P., Freisthler, B., Remer, L.G. y Gruenewald, P.J. (2005). Application of evidence-based approaches to community interventios. In Stockwell, T., Gruenewald, P.J., Toumbourou, J.W., Loxley, W. (Eds), Preventing Harmful Substance Use: the Evidence Base for Policy and Practice. West Sussex: John Wiley & Sons

Van Sassenbroeck, D.K., Calle, P.A., Rousseau, F.M., Verstraete, A.G., Belpaire, F.M., Monsieurs, K.G. et al. (2003). Medical problems related to recreationaldrug use at nocturnal dance parties. European Journal of Emergency Medicine, 10, 302-8.

Villar, J.A. (2008). Ibiza: beauty of the day, queen of the night: the influence of clubbing on the Ibizan population. Proceedings from Club Health Conference Ibiza.

Wagenaar. A.C, Murray. D.M y Toomey. T.L (2000). Communities mobilizing for change on alcohol (CMCA): effects of a randomized trial on arrests and traffic crashes. Addiction, 95, 209-217.

Wagenaar, A.C., Toomey, T.L. y Erickson. D.J. (2005). Preventing youth access to alcohol: outcomes from a multi-community timeseries trial. Society for the study of Addiction, 100, 335-345

Wallin, E. y Andreasson, S. (2005). Effects of a community action program on problems related to alcohol consumption at licensed premises. In Stockwell, T., Gruenewald, P.J., Toumbourou, J.W., Loxley, W. (Eds), Preventing Harmful Substance Use: the Evidence Base for Policy and Practice. West Sussex: John Wiley & Sons.

Warburton, A. L. y Shepherd, J. P. (2000). Effectiveness of toughened glassware in terms of reducing injury in bars: a randomised controlled trial. Injury Prevention, 6, 36-40.

Warburton. A.L. y Shepard, J.P. (2005). Tackling alcohol related violence in city centres: effect of emergency medicine and police intervention. Emergency Medical Journal, 23,12-17.

Wells, S., Graham, K. y West, P. (1998). 'The good, the bad and the ugly': responses by security staff to aggressive incidents in public drinking settings. Journal of Drug Issues, 28, 817-36.

Willis, C., Lybrand, S. y Bellamy, N. (2004). Alcohol ignition interlock programmes for reducing drink driving recidivism. Cochrane Database of Systematic Reviews, 4, CD004168

Wilkins, C. y Sweetsur, P. (2009). Differences in harm from legal BZP/ TFMPP party pills between North Island and South Island users in New Zealand: A case of effective industry self-regulation? International Journal of Drug Policy (in press).

Wood. D.W, Greene. S.L, Alldus. G., Huggett, D., Nicolaou, M., Chapman, K. et al. (2008). Improvement in the pre-hospital care of recreational drug users through the development of club specific ambulance referral guidelines. Substance abuse treatment, prevention and policy, 3: 14. doi: 10.1186/1747597X-3-14.

Worpole, K. (1992). Towns For People: Transforming Urban Life. Buckingham: Open University Press.

Zhu, L., Gorman, D.M., y Horel, S. (2004). Alcohol outlet density and violence: A geospatial analysis. Alcohol and Alcohology 39, 369-375.

Enviar correspondencia a:

Amador Calafat. Irefrea. Rambla, 15, 2, 3a 07003 Palma de Mallorca. irefrea@irefrea.org

Amador Calafat; Montse Juan; Maria Angels Ducc Irefrea (European Institute of Studies on Prevention
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