Preferences for simultaneous polydrug use. A comparative study of young adults in England and Denmark (2016)

Cross-national surveys of young adults’ simultaneous polydrug use (SPU) are rare, as measuring polydrug use requires multiple questions capturing the timing, sequence, and dosage of mixing drugs. This study proposes a new way of measuring SPU by examining how preferences for simultaneous polydrug use (PSPU) vary among club/bar-goers in two European countries, Denmark and England, typically cited as exemplars of the normalization of illegal drug use. The study considers the utility of the normalization thesis for understanding preferences for polydrug use in the European nighttime economy. An in situ survey of 1,298 young adults (18-35 years) conducted in 50 bars, pubs, and nightclubs in England and Denmark assessed sociodemographics, substance use patterns, and personal preference(s) for mixing alcohol and drug use. Multinomial regression analyses examined the relative risk of PSPU categories among those reporting drug use, according to sociodemographics, alcohol intake, frequency of intoxication, and smoking. Illicit drug use was more prevalent among young adults in England than Denmark. The difference was smallest for cannabis use: Lifetime cannabis use is 66% in England and 58% in Denmark. Lifetime cocaine use was 38% in England and 17% in Denmark. In England, young adults with drug experience preferred to mix alcohol with cocaine (65%). In Denmark, young adults with drug experience preferred to mix alcohol with cannabis (78%). In multinominal regression, Danish young adults' educational level was associated with PSPU, whereas in England legal substance use was associated with PSPU. This study calls for a more differentiated understanding of normalization. Preferences for mixing alcohol and drug use varied significantly cross nationally (alcohol/cocaine, England; alcohol/cannabis, Denmark). Different factors are associated with PSPU in each country. In England, not Denmark, drinking behaviors appear to shape preferences for mixing alcohol with cocaine, suggesting caution should be taken when replicating harm reduction interventions.