Illicit drug use at licensed premises and the potential for prevention: A qualitative interview study of stakeholders

Abstract

Background: The aim of this study was to explore how stakeholders perceive illicit drugs at licensed premises, existing and potential prevention interventions, and to identify facilitators and barriers to reduce illicit drugs at these locations. Methods: Semi-structured interviews with police officers, licensed premises owners, security staff and municipality officials (n = 28) in seven counties in middle Sweden were conducted and analysed using qualitative content analysis. Results: The informants reported frequent illicit drug use and dealing at licensed premises, causing a negative influence on the restaurant environment. Efforts to prevent illicit drugs varied with respect to type and intensity but included environmental and situational changes as well as education and training, policy implementation and law enforcement. Facilitators for the reduction of illicit drugs are confidence that sufficient resources are allocated, motivated and skilled stakeholders who see benefits of prevention and collaborate closely, along with visible results. General societal prevention was also seen as important. Identified barriers were perceived drug-positive norms and high availability and use in the society, perceived lack of prioritisation and resources, difficulties to collaborate due to e.g., secrecy between organisations, lack of action among stakeholders due to financial considerations, perceived confusion about roles and mandate, and owner's and staff's fear of threats and violence from criminals or own involvement in crime. Conclusion: To maximise the potential of successful prevention, authorities should support owners of licensed premises to act firmly against illicit drugs by providing training, ensure that they apply a strict policy, work for increased stakeholder collaboration and provide appropriate police resources. Authorities should also investigate criminal activities among owners and staff as well as combat organised crime and availability of illicit drugs in the society.

Keywords

drug crimes drug prevention illicit drugs licensed premises public health Sweden

According to the Swedish Alcohol Act (Ministry of Health and Social Affairs, 2010), individuals noticeably intoxicated by any substance should not be served alcohol. Furthermore, order and sobriety should prevail at a licensed premise. Therefore, the Public Health Agency of Sweden recommends owners and employees of licensed premises to expel guests showing signs of intoxication of alcohol or illicit drugs (The Public Health Agency of Sweden, 2014). Notwithstanding this, illicit drug use is frequent in the nightlife setting (Feltmann et al., 2022a; Strandberg et al., 2020), necessitating the implementation of more effective prevention and law enforcement (Gripenberg Abdon, 2012).

Previous studies on preventive interventions in nightlife have primarily focused on the reduction of alcohol consumption among restaurant guests and club goers (Bolier et al., 2011; Calafat et al., 2009; Wallin et al., 2005). There are also some studies about how to prevent illicit drug use among staff working in restaurants, bars and clubs (Belhassen and Shani, 2012; Cain et al., 2020; Giousmpasoglou et al., 2018; Hight and Park, 2018; Kaminski et al., 2018; Kitterlin et al., 2015; Pizam, 2012; Zhu et al., 2010). Apart from these studies, our research team found four studies about interventions to reduce illicit drug use among nightlife attendees, of which one was conducted in the Netherlands and three were conducted in Sweden.

The first study was carried out by Whittingham and colleagues (2009), assessing the effects of written health education messages on the personal acceptance of party drug use among club attendees in two experimental studies in Maastricht, the Netherlands. The messages provided information on minimising potential hazards associated with drug use. Among users and non-users, potential adverse effects were examined on measures of attitude, intention and outcome expectancy towards the use of party drugs. In the first experiment, a leaflet on ecstasy use was evaluated among attendees, showing neither health-promoting effects, nor counterproductive results on the outcome measures. In the second experiment, the effects of leaflet versus info-card about two different kinds of party drugs (ecstasy vs. GHB) were compared within a non-using population. Again, the results showed no positive changes on the outcome measures towards ecstasy use as a result of exposure to the ecstasy materials. However, exposure to the GHB materials resulted in a more negative attitude towards GHB use and lower estimates of the likelihood of positive outcomes of use.

The second and third studies were carried out in Stockholm, Sweden, and evaluated the short- and long-term effects of a multi-component community-based club drug-prevention programme, “Clubs Against Drugs” (CAD) (Gripenberg Abdon et al., 2011; Gripenberg et al., 2007). CAD includes community mobilisation, drug-training for doormen and other staff, policy work, increased enforcement, environmental changes, and media advocacy and public relations work. Five years after implementation, the results demonstrated a significant increase in doormen intervention towards noticeably intoxicated guests (65.5% of the attempts (n = 55) compared to 7.5% (n = 40) at baseline in 2003) (Gripenberg Abdon et al., 2011).

The fourth study, also carried out in Sweden, explored facilitators and barriers for CAD implementation in various Swedish municipalities (Norrgård et al., 2014). A survey was conducted among key stakeholders from the police, municipality officials and licensed premises owners, along with 12 interviews with representatives from the same professional groups in 21 municipalities (Norrgård et al., 2014). The survey highlighted several crucial factors for the successful implementation of CAD. These included key stakeholders’ ability to perceive needs for change (connecting to organisational readiness for change), formulate goals, and collaborate and access sufficient resources within stakeholder organisations. Stockholm was considered a successful example of implementation, partly because of its large size, which can amplify resource allocation, which is in line with previous implementation research (Aarons et al., 2012; Fixsen et al., 2005; Scaccia et al., 2015; Vanclay, 1996; Weiner, 2009; Wendel et al., 2009). Enthusiastic individuals were also emphasised as contributing to the successful implementation of CAD.

Given the scarce research on interventions to reduce illicit drug use among nightlife attendees, the aim of the present study was to explore how stakeholders perceive illicit drugs at licensed premises, existing and potential prevention interventions, and to identify facilitators and barriers to reduce illicit drugs at these locations. The results can enable the development and implementation of prevention strategies to limit access to and use of illicit drugs and related problems in the nightlife setting.

Theoretical point of departure

This study starts from the perspective that illicit drug-related problems at licensed premises are attributable to several factors, such as social norms, availability, demand, control and sanctions, encompassing an environmental approach to the prevention of illegal drug use (Holder, 1998). Therefore, combating illicit drug use in the nightlife setting requires actions from several stakeholder organisations, primarily owners of licensed premises, municipality officials who handle licenses to serve alcohol, and the police, which enforces the penal law on narcotics (Ministry of Justice, 1968; Swedish parliament, 1988). In Sweden, efforts to enhance collaboration between stakeholders to more effectively implement prevention activities and law enforcement were previously made by developing CAD (Gripenberg Abdon, 2012). It was inspired by a similar programme, i.e., “Responsible Beverage Service” (Wallin et al., 2003), designed to prevent alcohol-related problems because of overserving guests at licensed premises and is based on the systems theory and a community-based environmental approach (Holder, 1998). The programme comprises several components, including community mobilisation and improved cooperation between authorities and the nightlife industry, drug-training of serving and security staff at licensed premises and the police, environmental changes at licensed premises to make them less appealing for drug use and dealing, policy work and improved law enforcement (Holder, 1998; Weiner, 2009). Studies conducted in Stockholm showed that implementing CAD resulted in improved doormen intervention towards drug-intoxicated guests and indicated decreased illicit drug use among nightlife attendees and staff (Gripenberg Abdon et al., 2011). Efforts to implement the programme outside Stockholm was studied with the assessment of facilitators and barriers for implementation in different municipalities (Norrgård et al., 2014).

Previous implementation research has identified several crucial factors for the effective implementation of interventions in organisations (Aarons et al., 2012; Chinman et al., 2004; Fixsen et al., 2005; Weiner, 2009; Wendel et al., 2009). First, organisations should have readiness to adopt an intervention with subsequent changes. Weiner (2009) treats organisational readiness as a shared psychological state in which organisational members feel committed to implementing an organisational change and are confident in their collective abilities to do so. Crucial for achieving commitment is a perceived need for change (Chinman et al., 2004), which in turn amplifies the motivation to implement an intervention. The motivation is consequently based not only on the perceived need to solve a problem but also on beliefs about the intervention's ability to improve the situation with relative benefits compared to regular routines (Aarons et al., 2012). Meanwhile, the collective ability to implement an intervention is closely connected to the organisational capacity, which, according to Wendel et al., includes knowledge, resources and collaboration (Wendel et al., 2009). The perception of an organisation's capacity is part of its organisational readiness (Scaccia et al., 2015; Weiner, 2009), which may be connected to the real capacity, as revealed later in the implementation process.

After an organisation decides to adopt an intervention and carries out the required activities by overcoming its initial hesitation, further barriers and facilitators may arise during the implementation process and influence the outcome. In a comprehensive synthesis of the implementation literature, Fixsen et al. (2005) argue that the success of implementing an intervention is influenced by the implementation process itself (e.g., the quality and extent of activities, such as training and coaching of staff), the organisation in which an intervention is implemented (e.g., sufficient prioritisation and attitudes and norms compatible with the innovation) and external circumstances (e.g., supportive societal norms, politics and economy). Since the implementation of interventions to reduce illicit drugs at licensed premises fundamentally entails engaging people in purposeful action, it is pertinent to the theory of planned behaviour. This theory posits that most human behaviour is largely driven by intentions (Ajzen, 1985), which stems from attitudes influenced by personal knowledge, abilities and social context (Ajzen, 2005; Ajzen and Fishbein, 1970; Bandura, 1978; Wallace et al., 2005).

We hypothesise that facilitators and barriers for reducing illicit drug use at licensed premises can be detected to a large extent in accordance with the various theoretical perspectives outlined above but with unique concrete manifestations.

Methods

Setting and recruitment

During the fall of 2021, our research group was contacted by representatives of seven Swedish county administrations because of increased concerns about illicit drug use in the nightlife setting. They wished to intensify illicit drug prevention efforts at licensed premises, starting with investigating the extent and nature of the problem and further exploring the potential for increased efforts. Our research team decided to undertake two studies for this purpose by using (1) a quantitative survey and (2) qualitative interview data. Here, we present the qualitative interview study. For the interview study, participants were selected using purposive sampling in cooperation with county administration representatives (Palinkas et al., 2015). The aim was to include stakeholders from all seven counties, representing different municipalities, police districts and licensed premises, as well as the following professionals: police officers; licensed premises owners; security staff; and municipality officials. These professions have central areas of responsibility regarding the prevention of illicit drug use at licensed premises. Moreover, they were likely to be able to provide rich information about perceived problems and recommendations for preventive strategies. The county administration representatives provided the research team with a list of suitable persons, i.e., based on an instruction from researchers that it would be stakeholders from their network that they assumed had a good insight into the illicit drug situation in the nightlife. Based on that list, the research team selected potential informants and contacted them via email. Apart from a participation request, the emails contained information about the study and ethical aspects connected to participation. If a potential informant declined to participate, the next person on the list was contacted until a sufficient number of informants had been attained (Weller et al., 2018). The final group of informants (n = 28; 24 men, 4 women) included 10 municipality officials, 7 licensed premises owners, 6 security staff (doormen) and 5 police officers, representing 7 counties and 25 municipalities. Information on ethnicity or country of origin was not collected, as it was irrelevant to our research objective. The informants’ background information is presented in Table 1.

Table 1.

Background information of the informants.

Informant.nr/ ID	Profession	Gender	County	Municipality
I	Municipality official	Man	G	17
II	Municipality official	Woman	B	19
III	Municipality official	Woman	C	1, 4, 21, 20, 14, 6, 3
IV	Municipality official	Man	C	1, 4, 21, 20, 14, 6, 3
V	Municipality official	Man	E	11, 16, 13, 7
VI	Municipality official	Man	D	23
VII	Municipality official	Man	B	5
VIII	Municipality official	Man	E	24
IX	Municipality official	Man	F	15
X	Municipality official	Man	A	25
XI	Licensed premises owner	Man	A	22
XII	Licensed premises owner	Man	B	19
XIII	Licensed premises owner	Woman	A	2
XIV	Licensed premises owner	Man	C	6
XV	Licensed premises owner	Man	D	18
XVI	Licensed premises owner	Man	E	24
XVII	Licensed premises owner	Man	G	8
XVIII	Police officer	Man	F	18
XIX	Police officer	Man	B	5
XX	Police officer	Man	E	24
XXI	Police officer	Man	A	22
XXII	Police officer	Man	D	10
XXIII	Security staff	Man	A	22
XXIV	Security staff	Man	F	12
XXV	Security staff	Man	E	24
XXVI	Security staff	Man	C	1
XXVII	Security staff	Man	D	18
XXVIII	Security staff	Woman	G	9

Note. Roman letters represent each informant, and the letters A–G represent different counties. The numbers 1–25 in the rightmost column represent the municipalities. Municipality officials can represent more than one municipality, as some of them are employed by several municipalities.

Interviews

Based on previous research on implementing methods and routines in organisations (Aarons et al., 2012; Chuang et al., 2011; Fixsen et al., 2005; Holder, 1998; Norrgård et al., 2014; Scaccia et al., 2015; Vanclay, 1996), the research team developed a semi-structured interview guide by slightly adapting it to different professionals and creating four versions. These versions included questions on the informant's role, perception of illicit drug use at licensed premises, how and why various prevention interventions are conducted, and perceived facilitators and barriers for implementing these interventions. Examples of interview questions included: How do you perceive the illicit drug use situation at the licensed premises where you work? What are your perceptions of drug dealing and related problems at licensed premises? Do you think that drug prevention at licensed premises could be improved, and if so, in what way? Open-ended questions were followed by probing statements (Kvale, 1996). Interviews were carried out via a digital video telephone platform and recorded after receiving the informants’ permission. Before starting an interview, the informant was notified about the confidentiality arrangements and their right to withdraw their participation, after which their consent to participate was solicited. Consent was recorded and transcribed along with the interview content. Three of the authors conducted the interviews, which were, on average, 38 min in length (range 14–84 min). After 28 interviews had been conducted, the interviewers perceived that no or little new information could be obtained by additional interviews, and the interview process was terminated (Weller et al., 2018). Recorded audio and transcribed text files were saved under a code name and stored separately from a code key displaying the informants’ contact information, profession, municipality, county and gender.

Qualitative content analysis

Qualitative content analysis – a flexible family of methods covering impressionistic, intuitive, interpretive and strict textual analytical approaches, with possibilities to handle manifest and latent content – was used for data analysis (Hsieh and Shannon, 2005). Content analysis can be used in a more inductive form (conventional) if theories on the research topic are lacking, as well as in deductive form (directed) when a theoretical base exists. As previous research has detected many factors connected to implementing routines or methods in various organisations (Aarons et al., 2012; Chuang et al., 2011; Fixsen et al., 2005; Holder, 1998; Norrgård et al., 2014; Scaccia et al., 2015; Vanclay, 1996), the authors began with a deductive approach, based on the themes addressed in the interview guide. The interview statements were, to a large extent, taken at face value in the sense that they were assumed to represent the informant's honest experience, but not necessarily objective facts. Furthermore, to explore if statements were based on participants’ observations and experiences, as well as to discover nuances in the participants’ views and knowledge, follow-up questions were conducted, leading to in-depth interviews. A team-based approach (Graneheim and Lundman, 2004; Hsieh and Shannon, 2005; MacQueen et al., 1998) was employed to utilise the competence of the whole research team, and NVivo 12 software was used to structure the data and enhance credibility of the results (Golafshani, 2003). Initially, one of the researchers read the interview transcripts repeatedly to outline an overview of the material. To receive guidance for the initial coding of the content, this researcher then met the other two researchers who had conducted the interviews to discuss their impressions of the interviews during the data collection process. During the first coder's reading and initial coding of the interviews, the interview questions and previous research guided the coding. However, any unexpected content that was observed was soon factored in. The coding process is exemplified in Table 2.

Table 2.

Example of analysis.

Meaning unit	Condensed meaning unit	Code	Category
There are also examples of licensed premises owners themselves getting actively involved in drug dealing. Therefore, we are not talking about looking between the fingers but rather a substantial problem. Some staff facilitate or even sell drugs. It is, of course, a big problem.	Owners are reluctant to take action against illicit drug use because of their own involvement in the handling of illicit drugs at their premises.	Individual reasons behind the lack of preventive action	Barriers for reducing illicit drug use at licensed premises

In the early stages of the analysis, approximately 40 codes were applied to capture the richness of the material. These were later merged into 15 codes, divided into 4 categories. The categories and codes were compiled in a coding scheme along with the definitions of each code (i.e., a codebook) (MacQueen et al., 1998), which was tested by one of the authors, who independently coded three randomly selected interviews. After this, the three aforementioned authors met to discuss the coding scheme again, resolving some disagreements concerning definitions through discussions, which resulted in a new scheme with the same categories but with 23 codes. These 23 codes were generated from the initial 15 by adding 4 codes and splitting 2 of them into three subparts each (thereby generating 6 codes). After the coding scheme and codebook were revised, two authors independently coded three randomly selected interviews, using NVivo 12. The agreement between the coders was high (98% agreement, kappa coefficient = 0.63), indicating substantial interrater reliability, with an average for all codes and sources unweighted (McHugh, 2012). The final coding scheme is outlined in Table 3.

Table 3.

Coding scheme.

Categories	Stakeholders’ perception of illicit drug use at licensed premises	Preventive interventions	Facilitators for reducing illicit drug use at licensed premises	Barriers for reducing illicit drug use at licensed premises
Codes	Illicit drug use among guests Illicit drug use among staff Drug dealing Negative influence on working environment Negative influence on guests’ experience Uncomfortable atmosphere	Environmental or situational changes at premises Policy implementation and law enforcement Policy-related development Formal and informal education and training	Proper resource allocation Motivated stakeholders Knowledge and skill Visible results Benefits of prevention Collaboration and cooperation General societal prevention	Drug-positive norms High availability and use in the society Lack of prioritisation and resources Lack of collaboration Individual reasons behind lack of prevention action Contextual aspects

Results

In the following subsections, the content analysis results are presented in accordance with the four identified categories. Quotes from the informants are in italics.

Stakeholders’ perceptions of illicit drug use at licensed premises

Informants from all professions reported that illicit drug use and dealing are common among guests at licensed premises, especially at nightclubs. The detection is, according to the informants, done using “cocaine wipes” at restrooms and through observation of guests’ behaviour.

You can see when the guests are under the influence of drugs. I have worked in the security industry for many years, so I have the knowledge. Besides, drugs are openly used. I would say that drugs are bought, sold and used openly, both at the tables where guests sit and in the restrooms. (Security staff)

Several informants underscored that illicit drug use has increased after the COVID-19 pandemic, as guests behave in ways that were common at home parties during the period when people stayed at home because of restrictions regarding the number of guests allowed at nightclubs. Some informants also reported about staff using illicit drugs and one of the police officers meant that staff sometimes supply guests with drugs. The informants perceived that illicit drug use negatively influenced the staff's working environment as well as the guests’ experience and created an uncomfortable atmosphere. Unpredictable, externalising or dominant behaviour and threats from criminals selling illicit drugs to guests were reported as problems.

The work environment is not great for those who work at licensed premises and have to deal with people who are affected in various ways by drugs. This is partly [due] to violence, but I mean, it differs a little. They [illicit drugs] can make people [behave] more unpredictably than what you are used to with alcohol. (Police officer)

Preventive interventions

The efforts to prevent illicit drug use vary between municipalities, police districts and licensed premises with regard to type of intervention and intensity, according to the informants. Some licensed premises owners have physically changed premises and instruct staff to observe what is happening, as per the informants.

Many [licensed premises], I would say, have started to place staff outside the restroom area, partly to check that glasses and drinks are not brought into the restrooms and partly to keep an eye on the restrooms. (Municipality official)

Other efforts carried out to prevent drug use at premises include attracting other target groups by abolishing cash handling, using a dress code to make premises less suitable for criminals and avoiding the sale of whole bottles of spirits for self-service.

According to municipality officials and licensed premises owners, policies to prevent drug use vary across licensed premises. Some owners have implemented a drug policy, incorporating routines on how to act if guests or staff appear to be under the influence of illicit drugs or are handling drugs; they clearly communicate their zero tolerance for illicit drugs to their guests. Other owners are less engaged, and some are suspected of handling drugs themselves, according to one of the police officers. Municipality officials enforce and control the nightlife setting to prevent illicit drug use at licensed premises by making control visits and having a dialogue with owners and staff of licensed premises, according to the municipality officials. Some municipality officials reported lack of time to carry out this task properly, while others expressed higher frequency in this respect.

We do quite a lot of supervision when we meet the staff. [Municipality X] has approximately [X number of] alcohol licenses, and we make approximately 400 visits. […] That is quite a lot of visits. The clubs get approximately 10 visits per year. (Municipality official)

According to the informants, municipality officials’ supervision addresses alcohol and other substances; penalties can be imposed if owners do not comply with the law. The service staff at premises are expected to require drug-intoxicated guests to leave, and security guards can and should physically remove people from premises, if needed. Furthermore, staff frequently contact the police, which according to security staff is often made by them, to come and perform body searches for drugs, conduct drug testing and gather evidence for later prosecution. The police in many districts also visit licensed premises to check with the staff and owners and prevent drug use and dealing through their visible presence, according to municipality officials who also described common official visits together with the police. Visits by police officers or municipality officials in plain clothes also occur to varying extents, according to the police officers and municipality officials.

Several informants from all professional groups expressed a wish to improve illicit drug preventive efforts. This could, according to informants' suggestions, be implemented through stricter policies at licensed premises, such as staff drug testing, stricter rules for approving alcohol licenses by mandating staff training to equip them to take proper action under the law, and withdrawing licenses based on misbehaviour. Training of owners and staff at licensed premises, including security staff, was also emphasised as central to illicit drug prevention. Municipalities can, according to municipality officials, arrange staff training at licensed premises, often in cooperation with the police who provide knowledge about the signs of the influence of illicit drugs on behaviour. However, the scope for implementing such measures varies across municipalities. According to some municipality officials, the county administration provides updated information on regulations and illicit drugs to them. However, access to such trainings varies across municipalities, according to the municipality officials.

Facilitators for reducing illicit drug use at licensed premises

Several licensed premises owners and municipality officials highlighted the importance of proper allocation of resources for successful prevention of drug use, directly or indirectly by pointing to lack of resources. Some indicated a need to obtain greater resources from the national level, such as updated material for training, to use at the local level. Some informants also perceived that additional resources for control visits would improve the quality of prevention. To deal with illicit drug use, the informants emphasised the importance of resources for police tasks, with regard to both the number of officers and constant presence of drug-specialised officers.

I would like the police to be present [at the clubs] every weekend. I mean those who work against drugs to counteract mischief. It is the police who need to pull a heavy load and be out more often. (Municipality official)

In general, the informants expressed motivation to combat illicit drug use at licensed premises; however, reasons for this motivation differed across professional groups. For example, municipality officials emphasised public health promotion, while owners wanted to create a safe environment at licensed premises and build a flourishing business.

We want to have a pleasant environment where you can drink and eat and hang out and be social. […] I think that both the owners and I [a municipality official] have a common goal, which is to create a pleasant environment at licensed premises in [Municipality X]. Although my goal is from a public health perspective and theirs is from a business perspective, we have the same objective. If you remove drug-intoxicated guests from premises and keep the level of [alcohol] intoxication low, you will get this pleasant atmosphere. (Municipality official)

In this context, the informants provided suggestions, such as having specialised police officers focusing mainly on illicit drug use, police and municipality officials working undercover, and more training and environmental changes at licensed premises.

According to the informants, the knowledge and skill to implement interventions to prevent illicit drug use at licensed premises vary between individuals in professional groups, depending on whether they have received proper training. However, several informants said that stakeholders, such as restaurant owners, have sufficient knowledge about drug prevention – at least those who have worked for many years – which facilitates prevention.

I think they [licensed premises owners] have a relatively high level of competence […] Many are old-timers who have been around for a long time. They have had a lot of contact with us [municipality officials] over the years, so I think they probably know what is really going on. You notice when you talk to them that they understand the rules of the Alcohol Act and have a relatively good picture of what is going on in the city. So, it feels pretty good. (Municipality official)

Delivering concrete results of preventive efforts, for example, by identifying and prosecuting dealers further appears to amplify the motivation to act. In some areas, a method called “fast prosecution process” has been introduced, which is a collaborative effort between several authorities in the judicial chain aiming to significantly reduce the duration between the occurrence of a crime and the delivery of judgement. Especially police officers perceive this method as effective from a law enforcement perspective.

We have been working with that [fast prosecution process] for a year and a half. It is starting to settle more and more, and I think that is a success factor. If we find something wrong, we use the fast prosecution process. Previously, we used to write down a report, and then it was cumulated into these big piles; but then nothing happened, and it was written-off because too much time had passed. (Police officer)

Moreover, almost all informants expressed aspects related to the beneficial effects of illicit drug prevention and the negative effects of the absence of illicit drug prevention and law enforcement.

Public order problems will increase [without illicit drug prevention]. The licensed premises will take less responsibility for serving alcohol, and it will potentially result in more violent crimes and disturbances. (Police officer)

Collaboration and cooperation between stakeholders were further highlighted as a facilitator for the success of illicit drug use prevention at licensed premises. This view of collaboration applies to municipality officials, as well as police and owners, including serving and security staff. As security staff have a limited mandate to act against guests whom they suspect of using illicit drugs, they are, according to the informants, dependent on a quick response from the police when they deal with such guests and contact them. Moreover, municipality officials underlined the importance of collaboration with the police on aspects such as common control. Other authorities were also mentioned as important partners for collaboration, such as the tax authority, as the detection of tax fraud can promote the prosecution of owners who may also engage in other criminal activities, such as drug dealing. Such collaboration occurs in several forms (e.g., common education, meetings, dialogue and routines) when guests appear to be under the influence of illicit drugs. Personal relationships appear to facilitate cooperation between stakeholders.

When you have worked for a long time, you have personal ties. So, you also have shortcuts to the police authority. […] We know local police officers that we can call if there is anything special. They have been to restaurateur meetings and talked about the drug situation in the nightlife scene and about what they want the restaurateurs to do, and so on. (Municipality official)

Despite efficient cooperation within many municipalities and police districts, several informants wished for further cooperation between stakeholders to better combat illicit drug use.

You will not get rid of it [illicit drugs], but you can counteract it by working together, by being there as much as possible. Perhaps, you can increase it [the collaboration] a little more than what we actually do today. After that, I would like to get the municipality officers more involved. (Licensed premises owner)

Apart from prevention efforts carried out at licensed premises, interest and support from politicians and general prevention in the society are perceived as important to reduce illicit drug use at licensed premises. Although the informants reported some actions in this regard, many of them expressed a wish for a more intensive focus on general drug prevention.

We must have more active interwoven preventive work in municipalities. Right now, there are a lot of small “islands” that no one knows about; for example, where social services might have a working group that works on drug prevention, the police have one, and the crime prevention council has one. But nobody talks to each other, and therefore nothing happens. We need to start [prevention] before they [the kids] enter the licensed premises, and we need to actually talk to them. (Municipality official)

Several informants also emphasised the importance of combating criminals and seizing drugs to reduce the influence of gangs and curtail the supply of illicit drugs in the society.

The sale of narcotics is a cornerstone of many criminal individuals’ and gangs’ activities. […] We have to raise the risk of detection for such elements. It does not really matter if you have policies and laws if the risk of detection is low. (Police officer)

Barriers for reducing illicit drug use at licensed premises

According to informants from various professions, illicit drug use at licensed premises mirrors the societal situation. They expressed concerns about increasingly liberal drug norms, claiming that illicit drug use at licensed premises is a result of the high availability and supply of drugs nationally and internationally.

Drugs are so widespread today. They are available across all societal levels, at all ages. Around 15–20 years ago, we had addicts on park benches. They [the addicts] were so easy to spot. […] Today, 19-year-olds go in and sniff cocaine or takes some amphetamine and…it is so widespread. (Security staff)

Many informants further indicated the lack of prioritisation and resources as a barrier to illicit drug use prevention, which they claimed is attributable to both sparse national support and local circumstances. Such issues manifest in ways such as municipality officials being responsible for a large number of premises spread over several municipalities, impeding the possibility of their conducting frequent control and supervision activities. The most prominent barrier in the prevention of illicit drugs at licensed premises is insufficient allocation of police resources, according to one of the police officers.

I would say that the biggest barrier to effective work against drugs at licensed premises is primarily the lack of the police's own resources. (Police officer)

This expressed experience is underlined by statements from licensed premises owners about long waiting times for licensed premises staff when they call for police assistance and about different police officers showing up at different times at the same premises, impeding continuity and mutual collaboration. Other reasons for perceived lack of collaboration between stakeholders are different views on how the law should be interpreted and secrecy between stakeholders, thereby impeding professional learning.

[The security staff] do not receive any feedback on whether their assessment was correct. Was a certain person under the influence of illicit drugs or not? In those cases, the police reply that we cannot give you feedback because it is confidential. (Municipality official)

According to a municipality official, secrecy rules also prevent stakeholders from informing each other about individuals that they suspect of using or dealing in illicit drugs.

Furthermore, a common reason underlying the lack of preventive action appears to be a confusion about the role distribution and mandate. Security staff may hesitate to act against guests because they are unsure about the legal grounds on which they can deny a guest access to the premises and also out of fear of threats or violence from guests and organised criminals, according to one of the police officers.

Then, there is this difficulty with those who stand at the door and…well, who is the owner and who is the door man, and what is the basis for turning someone away at the door? And, if they stop a wrong person from entering, they might receive a threat, perhaps from an organisation.

(Police officer)

Threats against a licensed premises owner were also reported, and an informant even referred to an incident where a doorman was shot. In the context of confusion about roles and mandate, some municipality officials hesitate to carry out control activities because of the risk of interfering with police work.

Based on the fact that the Alcohol Act regulates alcohol sales and the person who serves alcohol, you may end up somewhere in a border zone. If you check and maybe start commenting on things that are not directly connected to the regulations of the Alcohol Act… it is difficult to establish overserving or whether someone has served alcohol to someone who is under the influence of something else, if you understand? You are within and maybe playing on a field that might be more of the police's area, really. (Municipality official)

According to the informants, there is a duality in the role of security staff. On the one hand, they have to be loyal towards the licensed premises owners who pay their salaries. On the other hand, they are responsible for handling and reporting violations of the penal law on narcotics, which sometimes contribute to a lack of action, as some owners fear a bad reputation and lower footfall and revenues if illicit drugs are discovered at their premises.

The vast majority [of licensed premises owners] want to run a business; they want to make money. They will make less money if they scare away customers. Moreover, a high police presence is not something that makes for great public relations either. (Municipality official)

The problem with dual roles depends upon the context. For example, in small municipalities, security staff may be extremely loyal towards licensed premises owners. Informants reported that some owners and security staff were involved in the handling of illicit drugs, which further decreased their incentives to act against illicit drug use.

There are examples of licensed premises owners getting actively involved in drug dealing. And now we are not talking about looking the other way but a more substantial problem. Some staff members facilitate or even sell drugs. It is, of course, a big problem. (Police officer)

Licensed premises owners may also lack the resources and opportunities to send their staff for training, which makes the staff less equipped to take action against illicit drug use.

It is up to each licensed premise to achieve this [training of staff]. There is a cost linked to it as well, which many people think is not worth paying. If you are a big nightclub, you might have… say 60, 70 employees, and you cannot send them all for training. (Licensed premises owner)

Factors such as high staff turnover and many seasonal employees in the nightlife business further amplify this problem.

Discussion

This study examined how stakeholders perceive illicit drugs at licensed premises, existing and potential prevention interventions, and facilitators and barriers to reduce illicit drugs at these locations.

Stakeholders’ experience of illicit drug use at licensed premises

The informants perceived that illicit drug use and dealing frequently occurs at licensed premises, consistent with previous studies’ findings (Feltmann et al., 2021a, 2022a; Nordfjærn et al., 2016; Strandberg et al., 2020). Moreover, the perception was that drug use at licensed premises has increased in the wake of the COVID-19 pandemic, which may be connected to a general increase in illicit drug use, which was shown in previous studies (Feltmann et al., 2022b; Roberts et al., 2021). Informants in the present study believed the increased and fairly open illicit drug use to be connected to new habits developed at home parties during the period when COVID-19–related restrictions prevented many people from enjoying nightlife. Another explanation for a possible rise in drug use during the last few years could be the increasing liberal norms and less restrictive attitudes to drug use, manifested in decriminalisation and even legalisation of production and sales, mainly of cannabis, in some countries (Carliner et al., 2017; Englund, 2019; European Monitoring Centre for Drugs and Drug Addiction, 2019; Public Health Agency of Sweden, 2021; Schmidt et al., 2016). The informants' general perception of guests under the influence of illicit drugs and guests who sell these substances is that they negatively influence the atmosphere and may create an unsafe environment through threatening behaviours, which has been observed in previous studies (Calafat et al., 2011; Zhong et al., 2020). Criminals who dominate licensed premises, using them as a base for illicit drug handling, were also mentioned by informants in another recent qualitative Swedish study (Feltmann et al., 2021b). Moreover, crime and violence connected to licensed premises and similar venues is a well-known phenomenon worldwide (Schneider, 2013). The stakeholders, i.e., the informants, clearly viewed illicit drug use at licensed premises as problematic. This may imply a perceived need for change, which according to previous research is a prerequisite for implementing prevention interventions through organisational or community readiness (Aarons et al., 2012; Norrgård et al., 2014; Weiner, 2009).

Preventive interventions

Efforts to prevent illicit drug use vary across municipalities, police districts and licensed premises regarding their interventions and intensity, according to the informants. In line with previous research and the components included in the CAD programme, reported prevention interventions include environmental changes at licensed premises as well as training, policy implementation and law enforcement (Gripenberg Abdon, 2012; Holder, 1998). The informants also made several recommendations on developing preventive efforts and law enforcement. One of the suggestions concerned drug testing among staff, which was highlighted in previous research (Kaminski et al., 2018). Previous studies have also suggested clear policies and procedures, increased accountability and comradery among the workforce, and communication of the long-term negative outcomes of illicit drug use to decrease illicit drug use among staff (Kaminski et al., 2018; Kitterlin et al., 2015; Pizam, 2012). None of the informants mentioned that a more systematic community mobilisation had occurred, which is also an important part of the CAD programme (Gripenberg Abdon, 2012). However, some informants underscored that politicians should pay more attention to problems connected to substance abuse, allocating resources for actions to prevent crime and violence.

Facilitators for reducing illicit drug use in licensed premises

The reduction of illicit drug use at licensed premises appears to be facilitated by proper resource allocation and motivated and skilled stakeholders who collaborate closely, thereby creating evident results and perceived benefits. This corresponds to the previous implementation research, which emphasises the importance of motivation for implementing an innovation in an organisation, along with sufficient capacity (e.g., skilled staff) (Scaccia et al., 2015). Norrgård et al. (2014) also stressed the importance of sufficient resources for successfully preventing illicit drug use at licensed premises. Moreover, Aarons et al. (2012) argued that an organisation's employees must perceive the efforts to be beneficial for themselves and should expect them to generate the intended results. Our study's informants expressed several benefits of preventing illicit drug use, although some licensed premises owners were reluctant to take action because of the fear of reduced income. As effective illicit drug prevention at licensed premises should involve several stakeholders, this study indicates that several organisations should collaborate in this regard rather than working in isolation, which is in line with previous research (Freeth, 2001; Gripenberg Abdon et al., 2011; Holder, 1998; Vanclay, 1996). The informants further highlighted general societal prevention as important for reducing illicit drug use at licensed premises, e.g., corresponding to community mobilisation (Holder, 1998) or prevention in other settings (Stockings et al., 2016).

Barriers for reducing illicit drug use in licensed premises

The study highlighted several barriers for reducing illicit drug use at licensed premises. Factors such as positive norms about illicit drug use and high availability and use of such drugs in the society were emphasised by several informants as challenging. Previous studies have detected national and international trends in this respect (Carliner et al., 2017; Englund, 2019; European Monitoring Centre for Drugs and Drug Addiction, 2019; Public Health Agency of Sweden, 2021; Schmidt et al., 2016). As societal norms influence implementation processes in organisations (Fixsen et al., 2005; Scaccia et al., 2015), it is likely that such a trend negatively influences the possibility of reducing illicit drug use at licensed premises. Furthermore, a perception of lack of prioritisation and resources, especially insufficient allocation of police officers for combating illicit drug use, was highlighted by the informants. Another barrier that was emphasised is secrecy between organisations, which, according to the informants, prevents stakeholders from sharing important information for detecting and prosecuting individuals who use or sell narcotics. Secrecy and other reasons to abstain from sharing information between collaborating organisations when attempting to implement common interventions has been detected as problematic in previous research (Cairns, 2015; Haugstvedt and Tuastad, 2021). Whether the informants are interpreting the secrecy law correctly or whether there are ways to facilitate information exchange without breaking the law cannot be concluded based on the current study; however, it could be explored in future research. Finally, notwithstanding the many motivated stakeholders and professionals, some may have reasons or incentives not to act, either in certain situations or in general. Several reasons for inaction were proposed by the informants, including a perceived confusion about roles and mandate. Unclear perceptions about the allocation of responsibilities may lead to difficulties in collaboration between different professions (Vanclay, 1996). This study showed that both security staff and municipality officials were uncertain about their responsibilities according to the law or in relation to police tasks; they were also afraid to act beyond their mandate. This is greatly problematic, as a lack of action in this case enables illicit drug use at licensed premises and may exacerbate the problem over time. However, this problem can be solved by strengthening training in this aspect. While this study does not explore the reasons for this perception, future research could investigate the legal conditions surrounding different professions to clarify the boundaries within which professionals act. Another reason for the lack of motivation to take action against drug users and dealers is the fear of threats and violence from criminal guests and dealers. This is an important finding, as this problem cannot be solved through more training or extended police presence at licensed premises; such threats can be carried out outside of working hours as well. Moreover, some owners and staff are reported to deal in illicit drugs themselves, which may imply that they have an interest in criminal activities or are under pressure from other criminals, thereby leading to inaction. The risk of threats and violence to owners or staff may require combating criminal activity and the illicit drug market in the society as a whole. With regard to own use among staff, several previous studies have concluded that illicit drug use among staff in the hospitality and food service industry is more common than in the general population (Belhassen and Shani, 2012; Buvik et al., 2018; Cain et al., 2020; Giousmpasoglou et al., 2018; Hight and Park, 2018; Kaminski et al., 2018; Kitterlin et al., 2015; Pizam, 2012; Strandberg et al., 2020; Zhu et al., 2010), which may contribute to staff's lack of action towards drug dealing at their premises. Finally, financial considerations constitute a barrier for prevention, as some licensed premises owners perceive that combating illicit drug use may lead to less income, whereas others find it difficult to pay for their staff's training. The reluctance to take action because of the perceived risk of negative effects is in line with existing implementation research findings; this is an important barrier to prevention, as an intervention must be perceived as beneficial for those implementing it (Aarons et al., 2012). The problems with paying for staff's training and education, including providing them with information about negative consequences of illicit drug use, is problematic, as previous research show that illicit drug-users perceive the consequences of drug-use to be less of a problem than non-users, and therefore need to be informed about the risks with illicit drug use and abuse (Kaminski et al., 2018; Strandberg et al., 2020). Otherwise, illicit drug-using staff may lack motivation to take action towards illicit drug use and dealing among guests. Thus, it is important to educate all employees on the potential consequences of illicit drug-use and abuse. This information is provided in CAD, along with training in management of intoxicated guests (Gripenberg Abdon, 2012).

Strengths and limitations

This study has the following strengths. First, the inclusion of informants from four professional categories of stakeholders revealed different experiences and perspectives in the preventive efforts to decrease illicit drug use at licensed premises, thereby deepening the understanding of the implementation process. Second, the trustworthiness and credibility of the study's results were ensured by promising anonymity to the informants and employing a team-based analytical approach. However, the study also has some limitations. Recruiting informants on a voluntary basis entails a risk of selection bias, which may lead to collecting material that is not adequately representative of all professionals involved in the counteracting efforts. Since the recruitment of informants were carried out by county administrative boards, in the sense that they provided researchers with lists of potential informants, the research team did not control the whole process. This might be a study limitation in case county administrative boards systematically selected informants they expected would provide a similar view as themselves. Moreover, although the informants were anonymous in relation to their organisations, they may have given answers that they believed to be socially acceptable (Edwards, 1957) or influenced through their professional role. However, we have interviewed persons from various professions, including authorities and the hospitality industry, which unlikely have the same biases and motivations. Furthermore, we have conducted in-depth interviews using a semi-structured guide, meaning that through follow-up questions the informants’ views, statements and knowledge were investigated in depth to discover nuances. We assume that it is more difficult to defend views that one does not believe in for a length of an interview compared to a survey and have therefore chosen this method. Finally, this study did not assess the effects of the interventions used, thereby limiting the understanding of the potential of the interventions that were implemented.

Conclusion

Notwithstanding efforts to eliminate the problem of illicit drug use in licensed premises, there is potential for intensifying preventive measures and law enforcement. This study found several facilitators and barriers for reducing illicit drug use in licensed premises. To exploit the potential of successful prevention, authorities should (1) support owners of licensed premises and their staff in acting firmly against illicit drug use by providing them training, (2) ensure that owners apply a strict policy against illicit drug use and (3) provide appropriate police resources. Authorities should also extend the efforts to investigate criminal activities among owners and staff as well as combat organised crime and the availability of illicit drugs in the nightlife setting and the society in general. Future research should focus on aspects of secrecy and professional mandates to enhance effective prevention and on long-term quantitative data on both interventions and outcomes to provide a deeper understanding of effective prevention of illicit drug use in licensed premises.

Footnotes

Acknowledgments

We would like to thank all informants for making this study possible and for being generous enough to describe their experiences. We also thank all individuals who helped locate and provide contact information for the informants. This study was supported by grants from the seven County administrative boards and grants from Region Stockholm. The research was conducted independently by researchers and the funding bodies had no influence over decisions regarding study design, analysis, data interpretation or writing the manuscript.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Region Stockholm, County administrative boards.

Ethical approval and consent to participate

The study was performed in accordance with the Declaration of Helsinki, and the informants provided written consent to participate. The Swedish Ethical Review Authority was contacted for approval (dnr. Dnr 2007/504-31, 2019-03887, 2021-06483-02). However, the authority considered the approval unnecessary because the study was not covered by the Ethics Review Act (2003:460).

ORCID iDs

Tobias H Elgán

Pia Kvillemo

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