Pre-Loading with Drugs before Entering the Nighttime Entertainment District: A Scoping Review

Figures & data

Figure 1. This model provides an updated visual representation of a ‘session’ at the event-level.

Note. The colored dotted line represents the trajectory a person makes as they transition through the phases of pre-loading, target-event, side-loading⁵, and back-loading⁶. It is to be noted that people may not participate in all phases of the session (e.g., a person may avoid ‘loading’ practices altogether and choose only to enter the target-event). The squares labeled ‘A’ and ‘B’ inside the target-event denote venues inside the NED. The doubled arrow connecting these venues reflects a persons’ movements around the NED.

Table 1. Inclusion and exclusion criteria across all studies.

Criteria	Inclusion	Exclusion
General	Information published in English. Empirical (i.e., represented a peer-reviewed article with overt data collection) and non-empirical research (i.e., grey literature).	Information published in languages other than English.
Contextual	People transitioning from a pre-loading event. Information focuses on people transitioning from a pre-loading event and into a target-event within an NED.	Information focused on environments and/or target-events occurring outside of NEDs.
Conceptual	Any information that operationally defines pre-loading (or another term synonymous with the act itself). Any information that provides prevalence rate estimates of drug and/or polysubstance use. Any information that provides insight into the behavioral and contextual nuances of pre-loading and drug use.	No identifiable theme relating to pre-loading type behaviors.
Methodological	Information must be / report on field-based research. The methodology of this field-based research describes recruiting participants a point in time (e.g., entry / exit or pre / post event) so to discern pre-loading from other practices. This must be clearly specified.	Non-field-based research. Methodologies that rely heavily on retrospective / cross-sectional reports (i.e., participants report on past event-level sessions and/or no specific time point is referenced as to when the data was collected).

Table 2. A summary table demonstrating the key features of the nine studies included.

Study Information	Sample^7	Methodology	Key Findings
Authors (Date) Miller, Furr-Holden, Voas, and Bright (2005). Research Objective To assess the prevalence of drug and alcohol use and related risks by attendees at electronic music dance events in nightclub settings.	Sample Size n = 240. Personal Characteristics Age: x̅ = 24.10 years old (σ = 5.57; range = 18 – 45; n = 238). Gender: male = 61% and female = 39% (n = 235). Education / Vocation: most participants were not students (54%), and a small percent were in the military (4%). Ethnicity: the sample was ethnically diverse. Location: North America (east and west coasts).	Design Portal design. Measures Interviewer and self-administered surveys. BrAC tests for alcohol intoxication. Oral assays for drug use. Recruitment Participants were selected randomly (groups were approached over individuals to improve participation rates). Response rates ranged from 82% − 90% across events. Financial incentive: $5 for entry participation and $10 for exit participation. Inclusion criteria: at least one member of the group was between the ages of 18 – 25; all participants had to be over the age of 18; and all participants were attending the venue. Participation At entry, interviewers questioned participants use of drugs within four hours of the event. The results of the oral assay and BrAC tests were not available on-site. Bracelets with a unique identifier was used to link entry and exit data.	Alcohol was the most used substance detected at entry (59%) and exit (60%). The use of drugs at entry (45%) and exit (38%) was less prevalent. Cannabis was the most used drug with a third of participants testing positive for use at entry and 15% at exit. Fewer people (18%) tested positive for a stimulant drug upon entering the event, with more (23%) testing positive at exit. Cocaine (entry = 6.4%; exit = 8.1%) and MDMA (entry = 4.7%; exit = 7.5%) use increased during the event. Opioids, sedatives, and hallucinogen use was far less prevalent at rates < 5% at entry and exit. A small percent of people (5.4%) converted from no use to drug use on premise. Most people who intended to use drugs did so while at the event. A smaller proportion of people who did not intend to use drugs did so at the event. No significant difference in drug or alcohol use at entry and no difference in drug use at exit by gender, ethnicity, or student status.
Authors (Date) Miller, Furr-Holden, Johnson, Holder, Voas, and Keagy (2009). Research Objective To determine the prevalence of drug and alcohol use of patrons attending nightclubs using biological assays.	Sample Size n = 277. Personal Characteristics Age: ≤ 25 years old = 54%; 26 – 35 years old = 37.3%; and 36 – 55 years old = 8.7% Gender: male = 58.7% and female = 41.3%. Relationship status: in a relationship = 51.8% (married = 13.1%) and not in a relationship = 48.2%. Education / Vocation: most participants were employed (86.5%) and not students (64.1%). Ethnicity: the sample was ethnically diverse. Location: North America (east and west coasts).	Design Portal design Measures Interviewer and self-administered surveys. Oral assays for drug and alcohol use. Recruitment Participants were selected randomly (groups were approached over individuals to improve participation rates). Most groups (56%) approached agreed to participate. Financial incentive: $5 for entry participation and $10 for exit participation. Participation The results of the oral assay tests were not available on-site. Bracelets with a unique identifier was used to link entry and exit data.	Alcohol was the most used substance detected at entry (43%) and exit (62.3%). The use of drugs at entry (20.9%) and exit (26%) was less prevalent. At entrance 9% of the sample arrived with both alcohol and drugs present. Of this, 2.9% arrived intoxicated with a BrAC ≥ .080. Cannabis (entry = 11.9% and exit = 11.6%); cocaine (entry = 8.3% and exit = 11.2%); and MDMA (entry = 5.1% and exit = 9.0%) were the most used drugs. No personal characteristics were related to drug use, except for those who are employed full-time (74.8%). This group was 2.15 times more likely to use drugs than those who were working part-time or were unemployed. 18.4% arrived too the club alone.
Authors (Date) Miller, Byrnes, Branner, Voas, and Johnson (2013). Research Objective - To examine the personal characteristics and prevalence of alcohol and drug use among nightclub attendees.	Sample Size N = 2,028 Personal Characteristics Age: 18 - 21 years old = 18.5%; 22 – 25 years old = 29.8%; 26 – 35 years old = 37.9%; and ≥ 36 years old = (13.8%). Gender: male = 52.4%; female = 47.1%; and transgender = 0.5%. Sexual Orientation: participants displayed a diverse range of sexual orientations. Relationship status: less than half (40.1%) were in a relationship. Education / Vocation: most participants were employed (54.7%) and not students (59.4%). Ethnicity: the sample was ethnically diverse. Location: North America (east and west coasts).	Design Portal design. Measures Interviewer and self-administered surveys. BrAC tests for alcohol intoxication. Oral assays for drug use. Recruitment Participants were recruited as they approached nightclubs. Random selection occurred where possible. Members of groups participated out of convenience. A subset of street-based sample (39.5%) refused to participate. Most people declined due to being in a rush to enter the nightclub (29.9%), hesitancy around providing data (8.5%), and weather related (5%). Median participation rate was 57.9%. Financial incentive: $10 for entry participation and $20 for exit participation. Participation The results of the oral assay and BrAC tests were not available on-site. Bracelets with a unique identifier was used to link entry and exit data.	Alcohol was the most used substance detected at entry (54.9%) and exit (71.6%). The use of drugs at entry (22.3%) and exit (25.3%) was less prevalent. Of drug users, most were polysubstance users at entry (13.8%) with a smaller number (8.5%) using drugs only. Rates of drug use only declined at exit (5.5%), whereas polysubstance use increased (19.1%) at exit. Only 6% of non-drug users converted to using drugs on premises. On average, only one type of drug was detected. From both entry and exit data, cannabis (18.2%) use was more prevalent than cocaine (6.5%), and amphetamines / MDMA (5.4%). The use of other drugs was far less prevalent at rates < 2% collectively. Personal indicators related to drug use did signify a difference between gender and sexual orientation (i.e., being male and heterosexual) was related to use of cannabis. As was living in the area, driving, or riding to the club, being African American, and reporting problems with alcohol. Higher levels of cocaine were predicted by having driven to the nightclub and higher levels of alcohol consumed over the past 30 days.
Authors (Date) Miller, Byrnes, Branner, Johnson, and Voas (2013). Research Objective To examine the effects of the social group on individual alcohol and drug use upon entering and exiting a nightclub.	Sample Size N = 986 (368 groups). Most people provided both entry and exit data (89.3%). Personal Characteristics Age: ≤ 24 years old = 25.2% and 25 – 29 years old = 32.8%. Gender: male = 48.2%; female = 50.7%; and transgender / no gender = < 2%. Sexual Orientation: participants displayed a diverse range of sexual orientations. Education / Vocation: most were employed (68.1%); fewer were unemployed (19.7%); and roughly a third were students (33.2%). Ethnicity: the sample was ethnically diverse. Location: North America.	Design Portal design. Measures Interviewer and self-administered surveys. BrAC tests for alcohol intoxication. Oral assays for drug use. Recruitment Participants were selected at random. Approximately 40% of all people asked did not participate (desire to get into the club quickly was the main reason for refusal). Most people (63%) that met inclusion criteria participated. Inclusion criteria: the person was entering the club; was a patron; and arrived with a group. Financial incentive: $10 for entry participation and $20 for exit participation. Participation The results of the oral assay and BrAC tests were not available on-site. Bracelets with a unique identifier was used to link entry and exit data.	Alcohol was the most used substance detected at entry (53.8%) and exit (77.2%). The use of drugs at entry (21.6%) and exit (25%) was less prevalent. From exit data, cannabis was the most used drug (17.2%) detected. This was followed by cocaine (7.0%); amphetamines / MDMA (5.1%). The use of other drugs was far less prevalent at rates < 2% collectively. At entry, 23.6% of groups had at least one member test positive for marijuana. Predicting pre-loading of marijuana: belonging in a group in which members expected more drug use was resulted in higher levels of entry use. Less discrepancy about drunkenness expectations resulted in higher levels of entry use. At entry 8.4% of groups had at least one member test positive for cocaine. Predicting pre-loading of cocaine: belonging to older groups in which members had greater expectations for drug use highs and less discrepancy in expectations of drug use were related to higher level of cocaine at entry. Greater average drinking intentions were also related to cocaine use at entry. Belonging to a dyad rather than a larger group was related to lower cocaine levels.
Authors (Date) Voas, Johnson, and Miller (2013). Research Objective To determine whether drivers were using less alcohol and fewer drugs at exit than their passengers and whether a driver for the group ever changed after consuming to much during the session.	Sample Size N = 1,148. Most people provided both entry and exit data (93%). Personal Characteristics Age: Median age was 31-years old. Gender: male = 50.1% and female = 49.9%. Sexual Orientation: A small minority (19.7%) described themselves as gay, lesbian, or bisexual. Education / Vocation: most were employed (57.7%) and/or college graduates (55.7%). Fewer were students (19.6%). Ethnicity: the sample was ethnically diverse. Location: North America.	Design Portal design. Measures Interviewer and self-administered surveys. BrAC tests for alcohol intoxication. Oral assays for drug use. Recruitment Groups of people were randomly selected to participate. Financial incentive: $10 for entry participation and $20 for exit participation. Approximately 40% of all people asked did not participate Participation The results of the oral assay and BrAC tests were not available on-site. Bracelets with a unique identifier was used to link entry and exit data.	Approximately 20% of sample used drugs with most of this drug use occurring before arriving to the target-event.
Authors (Date) Byrnes, Miller, Johnson, and Voas (2014). Research Objective To examine the relationship between club management practices and biological measures of patrons’ alcohol and drug use.	Sample Size N = 738. Most people provided both entry and exit data (89%). Personal Characteristics Age: Median age was 26-years old (x̅ = 27.47; σ = 7.88). Gender: male = 58.2% and female = 42.8%. Education / Vocation: most participants were not students (56.3%) or had graduated from university / college (51%). Ethnicity: the sample was ethnically diverse. Location: North America.	Design Portal design. Measures Interviewer and self-administered surveys. BrAC tests for alcohol intoxication. Oral assays for drug use. Recruitment Participants were selected at random where possible. Inclusion criteria: the person was entering the club; was a patron; and arrived with a group. Median participation rate was 57.9%. Financial incentive: $10 for entry participation and $20 for exit participation. Participation The results of the oral assay and BrAC tests were not available on-site. Bracelets with a unique identifier was used to link entry and exit data.	Alcohol was the most used substance detected at entry (52.4%) and exit (67.2%). The use of drugs at entry (21.6%) and exit (25%) was less prevalent. Cannabis was the most used drug at entry (16.9%) and exit (18.6%). This was followed by Amphetamines/MDMA at entry (4.9%) and (7.2%) at exit; and cocaine at entry (4.9%) and (6.9%) at exit. The use of other drugs was far less prevalent at rates < 2% collectively.
Authors (Date) Santos, Paes, Sanudo, and Sanchez (2015). Research Objective To describe the phenomenon of pre-drinking and to identify factors associated with pre-drinking practices among patrons.	Sample Size n = 2, 422. Personal Characteristics Age: Median age was 26-years old (x̅ = 27.47; σ = 7.88). Gender: male = 60.7% and female = 39.3%. Relationship status: most participants were not in a relationship (90.2%). Education / Vocation: most participants were employed (79.9%) or students (11.9%). Ethnicity: the sample was ethnically diverse. - Location: Brazil, South America.	Design Portal design. Measures Interviewer and self-administered surveys. BrAC tests for alcohol intoxication. Recruitment Participants were selected systematically selected from entrance lines of the nightclubs. People were excluded from participating if they showed signs of severe intoxication, including staggering gait on its own, glazed eyes and slurred speech, or combination of staggering gait with either of these other two signs. Patrons that reported no pre-drinking but showed a positive BrAC (3% of the sample) were excluded from the analysis. Estimated refusal rate at entry was 20% and at exit was 25%.	Alcohol was the most used substance detected at entry (44.3%). Cannabis was the most used drug at entry among pre-drinkers (11.4%) and non-pre-drinkers (5.2%). In pre-drinkers, this was followed by cocaine (2.7%). All other drugs use (irrespective of pre-drinking status) occurred at rates > 1%. Amphetamines/MDMA at entry (4.9%) and (7.2%) at exit; and cocaine at entry (4.9%) and (6.9%) at exit. The use of other drugs was far less prevalent at rates < 2% collectively. Pre-drinkers were 2.10 times more likely to use drugs than non-pre-drinkers.
Authors (Date) Devilly, Hides, and Kavanagh (2019). Research Objective To evaluate general levels of intoxication, crowd numbers, fear of violence, and illicit drug use as people enter and exit NEDs, both before and after legislative reform.	Sample Size n = 1, 267. Personal Characteristics Age: x̅ = 21.43 years old (σ = 0.54). Gender: gender: male = 52.09% and female = 47.91%. Location: Queensland, Australia.	Design Point-of-entry design Measures Interviewer and self-administered surveys. BrAC tests for alcohol intoxication. Recruitment Data was collected from people as they entered the NED. Participants were selected at random. People were excluded from participating if they had already been using substances inside nightclubs and pubs comprised within the NED. Refusal rates approximately 14.67%. Participation The results of BrAC tests were provided to participants on-site. Police were present during the early stages of data collection and absent in the later stages.	Findings from people who admittedly pre-loaded with drugs suggest there has been increased engagement in this practice over time: 2015 = 2.72%; 2016 = 8.21%, and 2017 = 9.57%. These results coincided with the introduction of legislative reforms designed to alleviate alcohol fueled violence in NEDs. Strategies to achieve this included restricting the sale and service of alcohol toward the end of the night, ceasing off-sale trading licenses at 10:00 pm, and, later, introduced ID Scanning.
Authors (Date) Fung, Santos, Sanchez, and Surkan (2021). Research Objective To determine personal and environmental risk factors for physical and sexual aggression in nightclubs.	Sample Size n = 2, 422. Personal Characteristics Age: 18 – 25 years old = 55.2%; 26 – 33 years old = 28.4%; and ≥ 34 years old = (16.4%) Gender: male = 60.8% and female = 39.2%. Relationship status: most participants were not in a relationship (87.5%). Sexual Orientation: roughly a third identified as LGBT (30.3%). Ethnicity: the sample was ethnically diverse. - Location: Brazil, South America.	Design Portal design. Measures Interviewer and self-administered surveys. BrAC tests for alcohol intoxication. Recruitment Participants were selected systematically selected from entrance lines of the nightclubs. People were excluded from participating if they showed signs of severe intoxication, including staggering gait on its own, glazed eyes and slurred speech, or combination of staggering gait with either of these other two signs. Patrons that reported no pre-drinking but showed a positive BrAC (3% of the sample) were excluded from the analysis. Estimated refusal rate at entry was 20% and at exit was 25%.	Alcohol was the most used substance detected at entry (37.6%). The use of drugs at entry (11.4%) and in the club (15.3%) was less prevalent. Inside the venue, drug users were found to be 2.06 times more likely to engage in acts of physical aggression than non-drug users.

Figure 2. A visual representation of the portal design applied to the broader event-level session.

Note. Portal-in (1) reflects the best point in time for the accurate collection of pre-loading data. However, any reference to the act of pre-loading should be discerned from portal-in (2).

Figure 3. A visual representation the point-of-entry design as applied to the broader event-level session.

Note. This approach captures pre-loading estimates as people transition from the pre-loading event and into the target-event. We have also specified various points-of-intermission and the point-of-exit as a methodological note for future reference.

Figure 4. A visual representation the point/s-of-intervention design as comprised within our model of an event-level session.

Note. In this figure we have labeled specific reference points where ‘loading’ and ‘event’ specific estimates of intoxication are most reliably captured. Additionally, we have also mapped on to this model points/s-of-intervention for future researchers to consider implementing into their designs to alleviate the burden of harm people experience in this context.

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