Relative contributions of holiday location and nationality to changes in recreational drug taking behaviour: a natural experiment in the Balearic Islands.

AIM To examine the contributions of international holiday resorts and visitors' nationality to recruitment, relapse into, and escalation in frequency of recreational drug use. METHODS Retrospective design surveying British, German and Spanish (n = 3,003) holidaymakers aged 16-35 visiting Ibiza or Majorca (Spain). RESULTS Individuals' drug use in international resorts was related to use at home, holiday destination and nationality. While visiting Ibiza, 7.2% of British tourists tried ecstasy for the first time with similar recruitment amongst Spanish (8.6%) but not Germans (1.8%) or those visiting Majorca (0.8, 1.5 and 1.2%, respectively). Recruitment into cocaine use was associated with being Spanish, male, visiting Ibiza and drunkenness. One in 5 British holidaymakers visiting Ibiza tried at least one new drug. British and Spanish were most likely to relapse into using a drug after at least 12 months' abstinence; 6.8% of British (1.3% German, 2.9% Spanish) relapsed into using at least one drug. Across nationalities, substance use frequency increased on holiday. CONCLUSIONS International nightlife resorts are major sources of recruitment, relapse and escalation in drug use. Such resorts contribute to the international spread of drug cultures but have been largely ignored as settings for interventions to tackle drugs.