J. DRUG EDUCATION, Vol.

41(2) 183-202, 2011

POLYSUBSTANCE USE PATTERNS IN UNDERGROUND

RAVE ATTENDERS: A CLUSTER ANALYSIS
FERMN FERNNDEZ-CALDERN
Fundacin Andaluza para la Atencin e Incorporacin Social
and Universidad de Huelva
SCAR M. LOZANO
Universidad de Huelva
CLAUDIO VIDAL
Asociacin Bienestar y Desarrollo
JOSEFA GUTIRREZ ORTEGA
ESPERANZA VERGARA
FRANCISCO GONZLEZ-SIZ
IZASKUN BILBAO
Fundacin Andaluza para la Atencin e Incorporacin Social
ENERGY CONTROL TEAM: Marta Caluente, Toms Cano,
Francisco Cid, Celia Dominguez, Emcarni Izquierdo, Maria I. Prez

ABSTRACT

Drug use in mainstream rave parties has been widely documented in a large
number of studies. However, not much is known about drug use in underground raves. The purpose of this study is to find out the polysubstance use
patterns at underground raves. Two hundred and fifty-two young people
between the ages of 18 and 30 who went to underground raves were

*This research is supported by the Consejera de Igualdad y Bienestar Social de la Junta de

Andaluca (Spain) and Fondos Europeos de Desarrollo Regional (FEDER).
183
2011, Baywood Publishing Co., Inc.
doi: 10.2190/DE.41.2.d
http://baywood.com

184 / FERNNDEZ-CALDERN ET AL.

interviewed. They were given a questionnaire to collect information on

drug use at raves. Ravers used a mean of 4.9 different drugs at the last rave
they had been to. Over 75% of them used tobacco, alcohol, cannabis, and
amphetamine, and over half also used powder ecstasy. Two differentiated
use patterns were found: one pattern concentrated more on the use of stimulants and the other on the use of hallucinogens. Underground ravers have
a standard sociodemographic profile. The use of drugs is much higher than
equivalent age group. Higher drug use prevalence than in mainstream rave
parties is also observed. Different patterns of use appear which will be
necessary to consider in designing preventions and risk reduction strategies.

INTRODUCTION
The rave concept is sometimes used ambiguously and finding a clear accepted
definition is problematic (Boeri, Sterk, & Elifson, 2004). In general terms, rave
is understood to be any kind of an event where electronic music is played
(e.g., Arria, Yacoubian, Fost, & Wish, 2002; Gross, Barrett, Shestowsky, & Pihl,
2002). However, to study these parties two types of rave must be distinguished:
underground or alternative and mainstream or conventional. Both revolve around
music and dancing, but there are basic differences in their purpose, organization,
and publicity. This may determine the profile of young people who go to them.
Underground raves are long-lasting and alternatives to the conventional recreational circuits (Boeri et al., 2004). They are self-organized with no commercial
or economic purpose and drug use is quite present (Gross et al., 2002; Hansen,
Maycock, & Lower, 2001). They are held in places difficult to get to such as
abandoned buildings, beaches, mountains, or forests (Anderson & Kavanaugh,
2007), and revolve around the music (Sanders, 2006) and dance (Roman &
Seplveda, 2005). In contrast, mainstream raves are commercial (economic and
promotional), and are advertised publically. Furthermore, they are usually held
in clubs, discotheques, or rented venues (Boeri et al., 2004).
Drug use and the profile of mainstream rave attenders have been widely
documented in Europe (Chinet, Stphan, Zobel, & Halfon, 2007; McCambridge,
Mitcheson, Winstock, & Hunt, 2005; Riley & Hayward, 2004), the United States
and Canada (Hunt, Evans, Moloney, & Bailey, 2009; Miller, Furr-Holden, Voas,
& Bright, 2005; Yacoubian & Peters, 2007), Australia (Banta-Green, Goldbaum,
Kingston, Golden, Harruff, & Logan 2005), and Asia (Laidler, 2005; Lua, Lin,
Tseng, Hu, & Yeh, 2003). However, we agree with Yacoubian, Boyle, Harding,
and Loftus (2003) that it is reasonable to suspect that more illicit drug use occurs
at underground raves than in legally established clubs. At underground raves,
drug use can be open and unconcealed, which could also favor there being more
of it than at mainstream parties. Nevertheless, to the best of our knowledge, no
studies have explored the prevalence of drug use or sociodemographic profile
in samples of underground ravers. This could be related to their hidden, alternative

POLYSUBSTANCE USE PATTERNS /

185

nature (informal networks are used to spread the word and they are held in
places that are hard to get to, etc.). This makes them hermetic and inaccessible
events for people outside of the rave culture.
Some studies have included subjects who attended underground raves, or
have studied the use of some particular substance at this type of rave, but none
of them have studied drug prevalence and use patterns in a sample exclusively of
underground rave attenders. For example, Boys, Lenton, and Norcross (1997)
interviewed 83 people to describe the use patterns at the last rave they had been
to, reporting that there were both mainstream and underground raves. Adlaf and
Smart (1997) analyzed drug use in a sample of teenage students in different
contexts, finding that those who had gone to underground raves had used more
substances than those who had done so in any other context outside of the raves.
Riley, Morey, and Griffin (2008) carried out a qualitative study on the use and
understandings of ketamine by underground ravers.
Furthermore, single-drug use is rare at these parties, polysubstance being the
most common. Boys et al. (1997) found that 67.5% of mainstream ravers had
used at least two drugs, and Barrett, Gross, Garand, and Pihl (2005) found that
80% of mainstream ravers took at least two drugs. Recently, Hunt et al. (2009),
using a qualitative methodology in a sample of mainstream ravers, analyzed the
polysubstance use patterns and the reasons for choosing some combinations and
avoiding others. Their main results point to these people as active polysubstance
users for pleasure administration and risk avoidance.
With the exception of the studies mentioned above, little is known about the
pattern of polysubstance use among ravers, and even less about underground
ravers. However, analysis of how the substances are used can be of more interest
than analysis of each of the drugs separately. Polysubstance use patterns may
involve potential negative effects on personal health beyond the consumption of
their separate use. Interaction of the effects of each drug are pharmacologically
unforeseeable, since effects could be strengthened, interact, or other new ones
could emerge, complicating the approach to severe intoxication episodes and
the ability of healthcare services to locate the problem drug or effect (Ricaurte
& McCann, 2005).
In this sense, the purposes of this study are: a) analyze the sociodemographic
profile of young underground ravers; b) contribute drug use prevalences in
underground raves in Spain; c) analyze the polysubstance use patterns of ravers;
and d) establish rave attender clusters by use pattern.
METHOD
Population and Sample
The population is young people between the ages of 18 and 30 who go to
underground rave parties. To get to this population, we contacted Energy Control,

186 / FERNNDEZ-CALDERN ET AL.

an outreach risk reduction project of the NGO Asociacin Bienestar y Desarrollo.

This organization has been carrying out harm reduction intervention in underground rave parties for years, and is well known among ravers. Its members
therefore enjoy wide acceptance and prestige among those who attend them, and
are not perceived as foreign to or outside of the party itself. The disconnection
of this type of organization from any government agency confers them with
greater credibility and proximity to participants (Glover, 2003), thereby facilitating their cooperation. Furthermore, the interview team was made up of Energy
Control volunteers who had belonged or belong to the rave scene, and their
aesthetics, slang, and other symbolic codes are similar to those of the persons
interviewed. All this made it easier for them to tune into the participants and
get them to cooperate in the study.
The sample in the study is made up of 252 young people aged 18 to 30 who
went to 22 underground rave parties held in Andalusia (Spain) from May to
October 2008. These raves took place in the mountains (11), on the beach (5),
in a swamp (2), in the forest (1), in an abandoned industrial bay (1), in an abandoned tunnel (1), and in an empty lot in an urban area (1). Eighty-two percent
were previously organized by those who went to them, while 18% were spontaneous. The average number of people at them was 132. Specifically, there
were seven raves with 99 or fewer participants, nine raves with between 100
and 199 participants, and six with 200 to 500 ravers. Different styles of electronic music were played at these raves: minimal, trance, techno, drum & bass,
breakbeat, and electro.
The selection of the subjects interviewed was done by a double sampling
procedure. On one hand, 181 subjects were selected at random at the beginning of
the rave for six interviewers from Energy Control previously trained in administering the interview. They went to the main entrance of the rave party and, by a
systematic random procedure (determined by a number, k, picked at random from
0 to 9), selected the young person to be interviewed. In those cases when
participants came to the party in a group, the interviewers had instructions
not to select more than one person per group. This did not mean fewer people
interviewed since normally the groups were no more than four or five persons.
On the other hand, a qualified incidental sampling procedure was used. People
next to the target population acted as captors to attract the target population to the
study. Using this procedure, 71 interviews were done. These interviews were done
in cafes, the home of the person interviewed, and/or the home of the interviewer.
Finally, of the total of 252 questionnaires collected, four were disqualified
because fewer than 75% of the questions had been answered. No significant
differences were found in the questionnaires collected in the party itself
(N = 177) and those collected by qualified incidental sampling (N = 71) on any
of the variables studied, so it was decided to analyze the data from both procedures together.
The subjects received no material or economic compensation.

POLYSUBSTANCE USE PATTERNS /

187

Instrument
The research team developed a specific questionnaire to collect the data. This
includes items adapted from research done by other authors in previous similar
research (Barrett et al., 2005; Bogt & Engels, 2005; Boys et al., 1997). It also
included standard drug use indicators previously employed by the European
Drug Observatory and the Observatorio Espaol sobre Drogas (Spanish Drug
Observatory) (European Monitoring Centre for Drugs and Drug Addiction,
2010a; Plan Nacional sobre Drogas, 2007a). When the draft questionnaire was
ready, it was reviewed by experts in drug use and measurement for any contributions they could make to improve the validity of the information collected.
This instrument was subjected to a 2-month pilot stage in which it was given
(March and April 2008) to 53 persons at different rave parties in Andalusia.
During this period, the research team made several changesmodifying the
content of the questionnaire (to adjust it to the administration time in this
context) and the way it was applied (determining that some questions should
be self-administered).
The final questionnaire was comprised of two sections (an hetero-administered
one and another self-administered) with different modules. The hetero-administered
section included the following modules: sociodemographic (age, sex, education,
coexistence model, main source of income, employment, place of residence);
attendance at raves (frequency, time since the last rave); drugs taken at some time
in their lives and age started; drugs used in the last month and frequency;
drugs used at the last rave (before, during, and after, amount, frequency, positive
and negative effects); perception of risk; risk reduction behavior at the last
rave. The self-administered section included the following modules: risk behavior;
severity dependence scale (SDS); legal incidents related to drug use. The interview lasted around 10 to 15 minutes.
The reliability of the various scales given (risk behavior, severity of dependence
scale, perception of risk, risk reduction behavior) was compared by means of
the Cronbachs alpha coefficient for internal consistency, finding from 0.705
(perception of risk) to 0.832 (risk reduction behavior). The reliability of the
self-report on drug use is backed by other studies done on raves (e.g., Wijngaart,
Braam, De Bruin, Fris, Maalst, & Verbraeck, 1999). In our study, the reliability
of the self-report was demonstrated by analyzing the coherence of the question
response patterns (use in the last rave, last month, last year, some time) and no
incoherence was found.
Use prevalence and patterns were explored for the following substances:
tobacco, alcohol, cannabis, ecstasy pills, crystal ecstasy, amphetamines, LSD,
GHB, ketamine, cocaine, heroine, tranquilizers, and others. Subjects were to
indicate which of these substances they had never used, and the prevalence
of use in the last month (none, at least once a week, one to three times a week,
four or more times a week). Subjects were also asked to report on their use of

188 / FERNNDEZ-CALDERN ET AL.

substances associated with the last rave they went to, and to mark those they had
used before, during, and after the event. The amount of each drug used associated
with the last rave was also explored (coding them in grams, units, or both
measurements, depending on the type of substance).
Procedure
The interviewer first addressed a subject selected at random. He identified
himself as a member of Energy Control, and informed him that he was carrying
out a study. He also verified that the person selected did not have symptoms
of intoxication and was willing to answer the questionnaire. If the person
was not in condition to participate, the interview was concluded. If the person
was willing to participate, he was told that it was an anonymous questionnaire
and that the data were going to be used exclusively for statistical purposes. He
was also asked for verbal consent to his participation. The interview began with
the hetero-administrated section and continued with the self-reported section.
Finally, the interviewer thanked the interviewee for his participation.
The questionnaires collected were saved on a computer for statistical analysis
with SPSS software ver. 17.0. Descriptive analyses were applied for sociodemographic information; 95% intervals of confidence were calculated for the
estimation of drug use prevalence.
Clusters were created based on variables on drug use at the last rave. Since
there were no hypotheses about number of clusters, a two-step cluster analysis
procedure was used. Selection of the optimal number of clusters was based on
the Schwarz Bayesian Criterion. An internal cross validation procedure was
applied to test cluster stability. Two cluster analyses were done with the same
procedure, but with different sample sizes chosen at random from the original
sample: with 85% of the participants in the total sample and with 70% of the
sample. The results confirm the consistency of the two clusters, in terms of
grouping of subjects.
The two clusters were compared for the dependent variables of interest using
a Student t and contingency tables depending on the type of variable studied.
RESULTS
Sociodemographic Characteristics
The sample is made up of a similar percentage of men and women ravers
(see Table 1), with a mean age of 23.9 years (SD = 2.7). No significant age
differences were observed between the two groups.
Most of the attendees had a secondary school education and 24.3% had completed university studies; 33.1% were working and 20.4% were working and
studying at the same time; 60.7% said that their main source of income is their

POLYSUBSTANCE USE PATTERNS /

189

Table 1. Sociodemographic Characteristics

N
Age (mean, SD)

(%)

23.9 (2.7)

Gender
Female
Male

116 (47.2)
130 (52.8)

Education
Primary or less
Secondary
University

19 (7.7)
168 (68.0)
60 (24.3)

Employment
Working
Student
Working and student
Unemployed/disabled
Other

(%)

Coexistence
Family members
Partner
Roommates
Alone
Other

76 (30.8)
15 (6.1)
125 (50.6)
22 (8.9)
9 (3.6)

Source of income
Work
Social aid
Family
Drug trafficking

148 (60.7)
16 (6.2)
71 (29.1)
10 (4.1)

81 (33.1)
71 (28.9)
50 (20.4)
32 (13.1)
11 (4.5)

job; and 29.1% receive money from family. Most of the participants live with
friends or flat mates (50.6%) or with family members (30.8%).
Drug Use Prevalence
The results show that over 90% of the sample had used tobacco, alcohol,
cannabis, crystal ecstasy, amphetamine, cocaine, or hallucinogenic mushrooms
some time in their lives. Ecstasy pills and LSD are used less by ravers, and around
50% said they had used ketamine and opium. The least used drugs were GHB,
tranquilizers (without prescription), cocaine base, and heroine.
Over 65% of the sample used tobacco, alcohol, cannabis, powder ecstasy,
amphetamine, and cocaine in the last month. Magic mushrooms, ecstasy pills,
LSD, and ketamine were used by 30-50% of the sample. It should be emphasized
that nearly 30% of raver attendees used opium and around 10% had used GHB,
tranquilizers, cocaine base, and heroine (see Table 2).
Pattern of Use at the Last Rave
Drug use during the last rave was very high. Alcohol was used by practically
all rave attendees (94.4%), and amphetamine, tobacco, and cannabis were used
by over 75%. Over 50% stated they had also used powder ecstasy. More than 20%

49
67
2.1
76.1
2.1
3.2
0.4
0.4
0.8
2.1
1.3
0.4

0.4
0.4

37.7
7.3
8.2
4.2
10.4
21.9
0.8
2.1
4.2
7.5
2.1
0.4
0.8

11.7
12.5
66.3
8.1
53.1
50.7
44.4
42.7
38.8
27.0
23.8
9.6
9.6
7.5
6.7

98.4 (96.2100)
86.8 (82.790.9)
76.6 (69.683.6)
88.3 (84.392.3)
65.6 (57.673.6)
75.8 (68.383.3)
45.6 (38.153.1)
45.2 (37.852.6)
43.8 (36.151.5)
36.6 (29.543.7)
27.2 (20.731.7)
10.4 (6.314.5)
10.4 (6.314.5)
7.9 (4.311.5)
7.1 (3.710.5)

98.8 (94.7100)
98.7 (97.4100)
94.8 (91.997.6)
93.9 (90.996.9)
93.9 (90.996.9)
93.5 (90.496.6)
90.7 (87.194.4)
83.1 (78.487.8)
72.9 (67.478.5)
54.1 (47.860.2)
43.5 (37.349.8)
16.1 (11.520.7)
16.1 (11.520.7)
12.1 (8.016.1)
8.9 (5.312.4)

Alcohol

Cannabis

Powder ecstasy

Tobacco

Cocaine

Amphetamine

Mushrooms

Ecstasy pills

LSD

Ketamine

Opium

GHB

Tranquilizers

Cocaine Base

Heroine

4 or more

1-3 times

< Once

Percentage

Frequencies

Last month prevalences

Percentage

Life-time prevalences

Table 2. Drug Use Prevalences

190 / FERNNDEZ-CALDERN ET AL.

POLYSUBSTANCE USE PATTERNS /

191

took cocaine, ketamine, and LSD and 17.7% referred the use of ecstasy pills. As
observed in Table 3, prevalence of the rest of the substances is less than 10%.
Drug use may be differentiated by whether they are taken before, during, or at
the end of the rave. Prevalence at these three times differ significantly in all of the
drugs analyzed (GHB, tranquilizers, cocaine base, and heroine were excluded
from this analysis due the low prevalence observed) (see Table 3). However,
tobacco, alcohol, and cannabis are present at all three times. Cocaine is used by
about double the attendees during the rave compared to before and after the party.
Powder ecstasy, ecstasy pills, amphetamine, and LSD are used mainly during the
rave, with noticeable differences from before and after it. Finally, the use of opium
and tranquilizers is more usual after the rave.
The amounts used show that the mean number of cigarettes smoked was
27.3, although this was highly variable (SD = 17). They also took an average
5.04 grams of cannabis. The average amount of the rest of the substances used
varied from 0.51 grams of powder ecstasies to 0.96 grams of hallucinogenic

Table 3. Drug Use Before, During, and After the Rave

Prevalences

Before

During

After

Amount
(in grams)
(SD)

Alcohol

94.4 (91.597.2)

81.9a

91.9b

65.5

Cannabis

76.6 (71.381.9)

66.1a

73.0b

64.5

5.04 (5.1)

Powder ecstasy 57.3 (51.163.5)

16.9a

53.2b

12.5

0.51 (0.4)

78.2 (73.183.4)

73.0a

77.4b

69.8

27.3 (17.0)

Cocaine

28.2 (22.633.9)

10.5a

21.8b

11.7

0.73 (0.7)

Amphetamine

74.7 (70.481.2)

35.1a

69.8b

23.0

0.81 (0.6)

9.7 (6.013.4)

2.0a

6.0b

2.8

0.96 (0.7)

17.7 (12.922.5)

3.2a

16.5b

3.3

1.7 (1.6)

LSD

22.9 (17.728.3)

2.4a

22.2b

2.4

0.43 (0.4)

Ketamine

23.8 (18.529.1)

3.2a

16.9b

17.3

0.51 (0.5)

Opium

7.9 (3.710.1)

0.4a

6.9

0.86 (1.2)

GHB

0.04 (0.00.1)

0.4

Tranquilizers

2.0 (0.23.8)

0.4

Cocaine Base

2.0 (0.23.8)

0.8

1.2

Heroine

1.2 (0.12.6)

0.4

0.4

0.8

Tobacco

Mushrooms
Ecstasy pills

ap < 0.01 in the McNemar test comparing before-during.

bp < 0.01 in the McNemar test comparing during-after.

192 / FERNNDEZ-CALDERN ET AL.

mushrooms. The subjects estimated that they had taken 1.7 ecstasy pills at the
last rave they went to.
Such high prevalences found clearly show how polysubstance use is very
common among rave attendees. The mean number of drugs used at the last
rave was 4.9 (SD = 1.8); 38.7% stated they had used from one to four different
drugs, 42.8% used five or six different drugs, and the remaining percentage used
more than six drugs.
Table 4 shows the combinations of drugs used. As observed, alcohol, tobacco,
amphetamine, and cannabis were the most commonly co-administered drugs by
most of the users. Except for alcohol, tobacco, and cannabis, the most frequently
co-administered by those who took amphetamine were powder ecstasy (56.4%),
ketamine (30.9%), and LSD (27.1%). Users of powder ecstasy also used
amphetamine (74.6%), cocaine (31%), and ketamine (26.8%), while users of
cocaine show a very stimulant pattern with a high percentage of powder ecstasy
(64.3%) and amphetamine (62.9%). Practically 100% of those who used ketamine
at the last rave also used amphetamine.
Hallucinogenic substances are mostly co-administered with amphetamine
(see column) (ketamine: 98.3%, LSD: 89.5%, ecstasy pills: 86.4%, hallucinogenic
mushrooms: 83.3%). The average number of substances used shows that users
of opium and magic mushrooms have the highest rate of polysubstance use,
while rates are lower for those who used tobacco, alcohol and cannabis.
Polysubstance Use Clusters
Clustering of subjects by substances showed two different clusters with 189
and 59 subjects respectively. The first cluster shows a higher prevalence of
cocaine than the second cluster. On the contrary, the second cluster has more
use of cannabis, amphetamine, LSD, ketamine, and opium (see Table 5). In spite
of these differences, no statistically significant differences in amounts used are
observed except, obviously, in those which were not used by Cluster 1.
Statistically significant differences between the two groups do appear in the
number of drugs used (t = 8.471; g.l. = 246; p < 0.01). Subjects in Cluster 1 used a
mean of 4.51 (SD = 1.5) drugs at the last rave, while the mean number of drugs
used by subjects in Cluster 2 was 6.45 (SD = 1.7). There are also statistically
significant differences in the frequency during the last year (c2 = 27.272; g.l. = 3;
p < 0.01). In Cluster 1, 60.2% said they had gone to at least one rave a month
on average, and in Cluster 2 the percentage is 23.7%. On the contrary, 28.7% of the
subjects in Cluster 1 went to one or two raves per month, while this percentage
increased to 62.7% in Cluster 2.
The sociodemographic profile analysis of the two clusters shows that there
are no statistically significant differences in gender (54.5% and 47.5% men in
Cluster 1 and 2, respectively), age, education, or in main source of income. On
the other hand, there are statistically significant differences in the coexistence

5.3 (1.6)
5.6 (1.7)
5.3 (1.6)
5.5 (1.8)
5.4 (1.6)
6.8 (2.2)
6.6 (1.9)
6.4 (1.7)
6.6 (1.6)
7.2 (2.2)

7.9
9.2
5.7
1.4
7.4
8.3
9.1
24.6
13.6
XXX

25.8
26.8
25.8
21.4
30.9
25.0
38.6
49.1
XXX
47.1

27.4
23.2
21.1
10.0
27.1
37.5
31.8
XXX
47.5
82.4

18.4
19.0
20.1
21.4
20.2
33.3
XXX
24.6
28.8
23.5

11.1
12.7
9.8
14.3
10.6
XXX
18.2
15.8
10.2
11.8

78.9
74.6
78.4
64.3
XXX
83.3
86.4
89.5
98.3
82.4

24.2
31.0
32.5
XXX
23.9
41.7
34.1
12.3
25.4
5.9

80.0
76.8
XXX
90.0
80.9
79.2
88.6
71.9
85.7
64.7

57.9
XXX
56.2
62.9
56.4
75.0
61.4
57.9
64.4
76.5

XXX
77.5
78.4
65.7
79.8
87.5
79.5
91.2
83.1
88.2

95.3
96.5
97.4
92.9
96.8
91.7
97.7
96.5
94.9
100

76.6
57.3
78.2
28.2
75.8
9.7
17.7
22.9
23.8
6.9

Cannabis

Powder ecstasy

Tobacco

Cocaine

Amphetamine

Mushrooms

Ecstasy pills

LSD

Ketamine

Opium

5.1 (1.6)
7.3

23.9

23.5

18.4

9.4

77.8

27.8

80.8

Means
Ketamine Opium substances

58.5

LSD

77.4

Mush- Ecstasy
rooms
pills

XXX

Amphetamine

94.4

Tobacco Cocaine

Alcohol

PrevalPowder
ences Alcohol Cannabis ecstasy

Table 4. Simultaneous Substance Use Patterns

POLYSUBSTANCE USE PATTERNS

/ 193

194 / FERNNDEZ-CALDERN ET AL.

Table 5. Polysubstance Use Clusters

Cluster 1
(n = 189)

Cluster 2
(n = 59)

Significance

Alcohol

93.7

96.6

NS

Cannabis

72.0

91.5

p < 0.01

Powder ecstasy

56.6

59.3

NS

Tobacco

79.9

72.9

NS

Cocaine

33.3

11.9

p < 0.01

Amphetamine

71.4

89.8

p < 0.01

Mushrooms

7.9

15.3

NS

Ecstasy pills

15.9

23.7

NS

96.6

p < 0.01

LSD

15.9

49.2

p < 0.01

Opium

0.5

25.1

p < 0.01

GHB

1.7

NS

Tranquilizers

1.1

5.1

NS

Cocaine Base

2.1

1.7

NS

Heroine

0.5

3.4

NS

Ketamine

model (in Cluster 1 there are higher percentages living with family members
and partner, and in Cluster 2 more subjects live with friends or alone) and in
employment (in Cluster 1 there is a higher percentage of students and workers,
while in Cluster 2 the percentages of unemployed are higher).
DISCUSSION
This article offered an epidemiological analysis of young people attending
underground rave parties. It is the first epidemiological study published on drug
use in rave parties in Spain and as far as we know, also the first to exhaustively
analyze the use pattern in a sample exclusively recruited at underground raves, a
concealed population difficult to gain access to. Proof of it is that the field work
was done in raves held in out-of-the-way places, organized by the users themselves and not for commercial purposes or advertised by agencies or businesses.
The results have shown that drug use in this type of rave is higher than found
in mainstream raves or in other recreational contexts (Adlaf & Smart, 1997).
This is true in two ways, on one hand with regard to the prevalence of use of the
different drugs, and on the other with regard to polysubstance use or the number of

POLYSUBSTANCE USE PATTERNS /

195

substances used at a single rave. Furthermore, two differentiated user profiles

were identified, one more stimulating and moderate with significant use of
cocaine, and the other more hallucinogenic and severe with more use of
LSD and ketamine among other drugs.
The sociodemographic profile of this sample does not differ from those found
in previous studies carried out at mainstream raves (e.g., Bogt & Engels, 2005;
Hunt et al., 2009; Tossmann, Boldt, & Tensil, 2001; Winstock, Griffiths, &
Stewart, 2001). This is consistent with what some authors have shown (e.g.,
Goulding, Shankar, & Elliott, 2002) with regard to ravers as socially integrated
persons who have activities and life styles that could fit in standard or
conventional values of the societies they live in, but break up their reality by
joining subculture raves in their leisure time. This integration is also
demonstrated compared to the profile of this sample with sociodemographic data
contributed by the Spanish National Institute of Youth (Instituto de la Juventud,
2010), where differences are observed in the percentage of young people who live
with their original family (58.8% vs. 30.8% in this study) but not in education or
employment, variables which usually determine integration of young people in
their original society. However, one characteristic in which underground ravers
differ from mainstream is their commitment to their culture. This group has a
differentiated ideology and ways of spending their leisure which are manifested in
aesthetic elements (clothing, accessories, etc.) and in the search for their own
spaces far from the mainstream for their night-time entertainment. The dynamics
of these parties (self-organization, hidden) involves participants being committed
to and identified with the rave culture and the values it represents.
Nonetheless, the absence of marginal characteristics should not obviate that
this group of young people is exposed to an obvious risk to their health compared to their reference group. Their use pattern in raves can lead to acute
imminent physical health problems (Schwartz & Miller, 1997; Van Sassenbroeck,
Calle, Rousseau, Verstraete, Belpaire, Monsieurs, et al., 2003). As other studies
also show, the use of drugs typically taken at these parties can cause neuropsychological (Verdejo-Garca, Snchez-Fernndez, Alonso-Maroto, FernndezCaldern, Perales, Lozano, et al., 2010) and dependence problems (Leung &
Cottler, 2008; Parsons, Grov, & Kelly, 2009).
Excluding alcohol, tobacco, and cannabis, powder ecstasy is the substance most
used during their lifetime and during the last month. This contrasts with the data
on the general young population in Spain (Plan Nacional sobre Drogas, 2007b),
where cocaine is used more. Furthermore, at the last rave they went to, use of
amphetamine surpassed powder ecstasy, and prevalence of ketamine was also
relatively high. These results demonstrate the high use of this type of drug
among ravers compared to their reference populations. On the other hand, this
study supports the hypothesis that cocaine is a not very highly regarded in rave
contexts (Kavanaugh & Anderson, 2008), which is reflected in its high prevalence
of use during their lifetime and in the last month, but dropping sharply at the

196 / FERNNDEZ-CALDERN ET AL.

last rave. Our results are also consistent with other authors (Smith, Moore, &
Measham, 2009) regarding the change that has been occurring in recent years
from ecstasy pills to powder. This change in Spain began to tip the balance in
2005 and seems to have occurred, among other reasons, due to the perception by
users of low quality pills (Energy Control, 2009). In our study, this change is
reflected in the high prevalence of the use of both presentations at some time
during their lives and the sharp drop in use of pills during the last month and at
the last rave.
Another of the strengths of the study lies in the methodological focus followed.
On one hand, there are few epidemiological studies on ravers, and none of them
used a sample taken exclusively in underground raves. The studies done by Boys
et al. (1997) and Barrett et al. (2005) demonstrated the high prevalence of drug
use among young ravers. However, these studies were not done only in underground raves, but also included mainstream ravers and other contexts. By contrast,
the design of this study enabled analysis of use exclusively at underground
raves, where results empirically supported the hypothesis that use and polysubstance use of drugs is higher. When prevalences found in previous studies
done in mainstream raves are compared (see Table 6), higher use of all the
substances analyzed may be clearly seen, both at the last party and at some time
during their life. At the last rave, heavy use of alcohol, amphetamines, and
ketamine may be observed compared to the other two raves (Barrett et al., 2005;
Boys et al., 1997). On the contrary, the use of GHB (a drug that is hard to find
in Southern Spain) is practically anecdotal. The results also show high prevalence
of use some time during the lives of underground ravers compared to mainstream
rave samples (Gross et al., 2002; Lenton, Boys, & Norcross, 1997; Wijngaart
et al., 1999; Yacoubian & Peters, 2007). This seems to show that those attending
alternative parties may have more contact with different drugs. In this sense, the
use of cocaine in our sample is especially notable, which might reflect in its
high prevalence in Spain (European Monitoring Centre for Drugs and Drug
Addiction, 2010a). However, this comparison should be taken with caution since
cultural differences could also explain the differences observed.
Polysubstance use in this study is also higher than found in others carried out
in mainstream raves. For example, Barrett et al. (2005) found that approximately
80% of the sample had used at least two substances at the last rave they went to and
almost 50% had used three or more (excluding tobacco). In our underground
sample, 96.8% had used at least two substances, 85.5% three or more, and
40.7% had taken five or more drugs.
Ravers have been identified as active subjects in administration of pleasure
and risk avoidance (Hunt et al., 2009; Jacinto, Duterte, Sales, & Murphy, 2008).
This could be reflected in the use they make of drugs depending on when they
take them. Most of the substances are used more during the party itself, except for
some Central Nervous System depressant drugs (ketamine, opium, tranquilizers,
and heroine), use of which is more common after the rave and which the subjects

16.1
12.1
8.9

6.0

2.0
2.0
1.2

Tranquilizers

Cocaine base

Heroine

7.2

2.4

12.0

90.4

68.7

19.3

26

37

63

40

78

81

75

91

Wijngaart
et al.

Lifetime

71

40

18

64.3
34.8
73.3
70.0

56.2
13.8

18.6

3.8

Yacoubian
et al.

65.2

91.4

89.5

Gross
et al.

aDue to current study differentiates ecstasy pills and ecstasy powder, comparisons are done with powder ecstasy. Nonetheless, ecstasy use
prevalences (pill or powder) for last rave and lifetime are 64.1% and 97.2% respectively.

16.1

7.0

0.04

GHB

Ketamine
43.5

72.9

22.9

LSD
54.1

83.1

17.7

Ecstasy pills
8.6

90.7

9.7

Mushrooms

93.5

47.8

34.9

75.8

Amphetamine

93.9

9.1

28.2

Cocaine

93.9

78.2

Tobacco

6.9

94.8a

50.0

27.7

57.3a

Powder ecstasy

23.8

96.4

98.7

64.9

51.8

76.6

Cannabis

Opium

98.8

98.8

52.2

18.1

94.4

Alcohol
75.9

Lenton
et al.

Current
study

Barrett et al.
(n = 186)

Boys et al.
(n = 83)

Current
study
(n = 248)

Last rave attended

Table 6. Comparison with Use Prevalences from Other Studies

POLYSUBSTANCE USE PATTERNS

/ 197

198 / FERNNDEZ-CALDERN ET AL.

could be using to diminish the stimulant effects and be able to sleep. These results
are consistent with those found by Boys et al. (1997), who found more use of
benzodiazepines after the rave. In this sense, the results found on the pattern
of simultaneous use must be kept in mind (Table 4). For example, if considering
everyone who used ketamine or LSD at the last rave, 98.3% and 89.5%,
respectively, are observed to have also used amphetamine. These data could show
strong use of stimulants to counteract the hallucinogenic or depressant effects
of other substances.
An analysis of the drugs most used before, during, and after the rave (see
Table 3) shows that the order of preference is the same at all three times for 4 of
the 15 substances recorded: alcohol, tobacco, cannabis, and amphetamine. This
could be indicating a pattern of stable use based on which other drugs are added
depending on the effects sought or desired.
But as other authors have shown, ravers are not a completely homogeneous
group. For example, Schwartz and Miller (1997) differentiated three types of
ravers depending on the leisure time devoted to attending raves: the committed,
who go to raves every weekend, the occasional, who go about once a month, and
the curious, who only want to find out what goes on at these parties. McCaughan,
Carlson, Falck, and Siegal (2005) identified five types of ravers by their use
pattern and other variables, among them the Candy Kids whose use of ecstasy
is more prevalent, or the Junglists who tend to use more ketamine and
methamphetamines.
In our study, even though all of the subjects showed high use of substances, the
cluster analysis differentiated two groups. In the first cluster, the most numerous
(n = 189), a more stimulant use pattern is identified, with statistically significant
differences in the use of cocaine. The second cluster (n = 59) shows a use pattern
which is also stimulant, but more hallucinogenic, since practically all of the
subjects used LSD at their last rave (in contrast to 0% in Cluster 1) and half
of them used ketamine (in contrast to 15.9% in Cluster 1). Furthermore, this
second group has a more severe use profile. On one hand, the prevalence of
use compared to the first group is higher for all of the drugs except cocaine
(in powder or base) and tobacco. On the other, polysubstance use at the last
rave is significantly higher (6.45 vs. 4.51, p < 0.01). Another differentiating
characteristic of the subjects with the hallucinogenic profile is that they
go to raves more often, which following the typology suggested by Schwartz
and Miller (1997) could identify them as a group more committed to the
rave subculture.
Concerning the limitations of the study, the authors call attention to data
collection in the underground rave itself. Doing so in this context before the party
started was motivated by the studys main interest in collecting information
from people who go to this type of party, avoiding confusion with the mainstream. The researchers were aware that this could affect the quality of the data
collected. Therefore, it was especially emphasized during the pilot test that

POLYSUBSTANCE USE PATTERNS /

199

answering the questionnaire should be convenient and quick. Much attention

was also given to the interviewers being well trained in their administration, and
they were very strict about not administering the instrument to anyone who was
the slightest bit intoxicated. Proof of it is that when checking the statistical quality
of data, no atypical values appeared in the variables studied. That is, the responses
to the questionnaires were coherent within each questionnaire and with respect
to the rest of the persons interviewed.
The limitation of not interviewing anyone who seemed to be drunk may be
affecting the results related to drug use before the last rave. It is possible that
people who frequently use drugs before raves tend to repeat this pattern and they
would be expected to show signs of being drunk at the party the questionnaire
was given at. Therefore, these persons would be disqualified and the use of drugs
before raves may be underestimated in this study.
Another of the limitations of this study is that the sample was not selected
probabilistically, which leads us to think about how representative it is.
However, this is a common limitation in all epidemiological studies on drug
use that are not done in a healthcare context, since there is no frame of reference
for the probabilistic selection of the sample. To resolve this limitation, the
research team opted to diversify the parties where sampling was done (22
different underground parties), in addition to using a random procedure for the
selection of the persons interviewed, eliminating any possible subjectivity by
the interviewers.
In spite of the limitations, the data supplied in this study show the importance
of the context with regard to drug use and reflect a reality not well studied up
to now, the underground raves as high-risk spaces for those attending, where
use and polysubstance use are high. The fact that these parties are held in
out-of-the-way places that have no appropriate sanitary or emergency conditions
could lead to severe consequences to the health of ravers if they should have an
acute health problem. This, along with the identification of the different use
patterns among the ravers must be the basis of realistic approaches to designing
prevention strategies and interventions aimed at reducing risks in this population. Harm reduction has been suggested as an appropriate approach for minimizing the health problems associated with raves (European Monitoring Centre
for Drugs and Drug Addiction, 2010b; Glover, 2003; Weir, 2000). Along this
line, different strategies could be proposed. On one hand, those addressing the
organizers (providing unlimited drinking water, first aid training, availability
of chill out zones, etc.), and on the other, those directed at the users (reducing
the number of substances used, avoiding the added effects on the CNS of taking
several stimulants or various inhibitive substances, education on crisis identification patterns, and so forth).
Future studies must include new variables related to motivation, administration of pleasures and risks, dependence, etc., which contribute to minimizing
the risks associated with this type of party.

200 / FERNNDEZ-CALDERN ET AL.

ACKNOWLEDGMENTS
The researchers wish to thank the participants in the study for their cooperation
and good will. Without them this study would not have been possible. We also
wish to thank the Asociacin Bienestar y Desarrollo, especially the Energy
Control Project. The field work could not have been carried out without their help.

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41020, Sevilla
e-mail: fermin.fernandez@juntadeandalucia.es