Determinants of the willingness to reduce or quit cocaine use among nightlife attendees

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Bukman, Matthijs Blankers, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4901788/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Worldwide, cocaine use and availability is very high by historical standards. People who use cocaine are exposed to physical and mental health risks. Prevention activities for this group traditionally focus on harm reduction, but research suggests there are opportunities for the deployment of interventions aimed at the reduction or cessation of cocaine use. Objectives This study aims to improve our understanding of the characteristics of people who are willing to reduce or quit their cocaine use, as well as the determinants of motivation to reduce or quit cocaine use. Methods We did a secondary data analysis on data collected for a Dutch cross-sectional study of Night live attendees (N=4824). Specifically, we selected the n=317 participants who had used cocaine at least once per month in the previous year. Logistic regression analyses were performed to investigate associations between willingness to reduce or quit cocaine use, and variables including risk perception, social norms regarding cocaine use, and mental health. Results We found that Personal acceptance of your own use was associated with both willingness to reduce and to quit cocaine use. A higher frequency of cocaine use was associated with willingness to quit cocaine use. Associations were also found for Perceived harmfulness and several other determinants. Conclusions Identifying determinants of motivation to reduce or quit cocaine use is crucial for developing interventions aimed at reduction or cessation of cocaine use. Cocaine cessation quit reduce recreational drug use I-Change model social norms risk perception Introduction Cocaine use and availability are very high by historical standards (UNODC, 2023a). It is estimated that 0.5% of all adults worldwide (aged 18-64) and 2.3% of adolescents and young adults in the European Union (aged 15-34) have used cocaine in the past year (EMCDDA, 2023; UNODC, 2023b). For the past six years, EU member states have been reporting record amounts of cocaine seized and between 2022 and 2023, 42 out of 72 European cities showed a significant increase in cocaine residues found in wastewater (EMCDDA, 2024). The recreational use of drugs among nightlife attendees is much higher than among the general population (Sañudo et al., 2015), and cocaine is one of the most used substances in nightlife (Mohr et al., 2021; Palamar & Keyes, 2020). Health risks of cocaine use include: acute cardiotoxic effects (risk enhanced by concomitant alcohol use), suicidal thoughts and psychosis, increased risk of coronary artery disease, cardiomyopathy (deterioration in heart muscle function), stroke and dependence (Arenas et al., 2020; Feltmann et al., 2021; Kim & Park, 2019; Porrino et al., 2007; Rounsaville, 2004; Winhusen et al., 2020). In Europe, cocaine was the second most common problem drug among people entering specialised drug treatment for the first time in their lives (EMCDDA, 2023). Considering these risks for both physical and mental health, reducing and quitting cocaine use are important prevention goals. People who set limits on the quantity of cocaine they use have decreased odds of experiencing a bad mood after drug use, sexual difficulties, injuries or fractures while under the influence, and involvement in fights or being attacked while under the influence (Fernández-Calderón et al., 2019). Because of the high prevalence of cocaine use among nightlife attendees, they are an important target group for prevention. However, prevention activities for this group have traditionally been focused on minimizing the risk at adverse health effects (harm reduction) and not at reducing or quitting use (Fernández-Calderón et al., 2014; Morley et al., 2015). In a previous study, Monshouwer and Van Miltenburg (2021) researched the willingness to reduce or quit drug use among Dutch nightlife attendees. For cocaine, nearly half of all participants that used cocaine in the previous year expressed an interest to quit or cut down their use. The fact that such a large percentage of cocaine users was interested to change their cocaine use behaviour, but had not done so yet, suggests there are opportunities for the deployment of interventions aimed at preparing and supporting them during their reduction or cessation of cocaine use. Understanding the mechanisms behind the willingness to reduce or quit cocaine use is crucial for developing effective prevention strategies (see also: Bartholomew Eldredge et al., 2016; Kok et al., 2016). Yet, most research has focused on those diagnosed with substance use disorder, leaving a gap in research among recreational users in nightlife settings (Palamar, 2023; Ronsley et al., 2020). While motivations for cocaine use, such as physical, mental, and social reasons, have been extensively studied (Hartwell et al., 2012; Kettner et al., 2019; van der Poel et al., 2009), there is a notable lack of research on the motivations driving reduction or cessation of cocaine use. In the few studies on cessation of recreational drug use, risk perception and social norms have been most commonly studied. Risk perception and health concerns have been associated with a desire to decrease or quit using cocaine, ecstasy and cannabis (Bachman et al., 1990; Leung et al., 2010; McBride et al., 1994). Other studies showed that social influences or disapproval by others was associated with a decline in cocaine use (Dennhardt & Murphy, 2013; Kollath-Cattano et al., 2020; McBride et al., 1994). Among people who use frequently or have a cocaine use disorder, cessation attempts tend to stem from cocaine use interfering in social obligations, poor health resulting from use, or from being tired of use or of engaging in illegal or socially disapproved behaviours to continue obtaining the drug (Cheney et al., 2016a). Other factors associated with seeking help for cocaine use were number of negative consequences experienced, feeling dependent on cocaine, and the amount of cocaine used (Varney et al., 1995). One recent study among nightclub attendees who use partydrugs recreationally, also found that personally experienced adverse effects can deter willingness to use certain party drugs again (Palamar, 2023). In this study, we investigated variables that are expected to be associated with the willingness to reduce or quit cocaine use, including risk perception, social norms and mental health. We used the I-Change model to map and select these variables and their expected association with the outcome variables (de Vries, 2017). The I-Change model is an integrated health behaviour theory that incorporates several theories on behaviour change, such as the Theory of Planned Behaviour (Ajzen, 1991) and the Health Belief Model (Janz & Becker, 1984). The I-Change model describes three phases in the behavioural change process: 1) an awareness phase, including a person’s knowledge and risk perceptions regarding their behaviour, leads to 2) the motivation phase, including attitude regarding the behaviour, perceived social norms and self-efficacy expectations. And the following 3) action phase includes skills, action planning and skills. This process of phases is in turn influenced by preceding factors, such as biological factors (e.g. gender, age, health), psychological factors (e.g. mental health), behavioural factors (e.g. previous experiences, frequency of use) and environmental factors (e.g. availability of substances, education). In this study, we used determinants from each of the phases and predisposing factors in the I-Change model, and studied their association with the willingness to reduce or quit cocaine use in nightlife attendees who had used cocaine in the previous year. Based on previous studies, we expected risk perception, social norms and personally experienced adverse effects to be the most strongly associated with willingness to reduce or quit cocaine use. Based on the I-Change model, we also anticipated some preceding factors, such as gender, age, previous experiences with other drugs, education and attitude toward one’s own cocaine use, to be also associated with the willingness to reduce or quit cocaine. The insights gained from this study can aid in designing more effective interventions to help people reduce or quit their cocaine use and to target these interventions at the relevant groups. Methods Recruitment of participants This study is based on secondary data analysis on data collected for a Dutch cross-sectional study: The Large Nightlife Survey (Monshouwer et al., 2021). Data collection took place from April to May 2020, using an online questionnaire in Dutch. Participants were recruited through (paid) social media campaigns and various other online channels. Only participants who had indicated they had visited a party, festival, club or disco at least once in the previous year were included in the study. This resulted in a convenience sample with relatively high levels of drug use. This allowed for in depth analyses of drugs which is generally not possible in general population studies because of the low prevalence of drug use. Data were collected anonymously. Prizes were randomly distributed among participants who completed the questionnaire and then opted to leave their email address in order to be included in a prize lottery. All research procedures were reviewed in advance and approved by the internal ethical review board of the Trimbos Institute. Sample The sample of The Large Nightlife Study consisted of a convenience sample of 4,824 participants aged 16-35. For the present study 317 participants were included who 1) had used cocaine at least once per month in the year preceding the completion of the questionnaire and who 2) had completed the questions concerning their willingness to quit or reduce the use of cocaine. Measures The variables in the online questionnaire covered a wide range of behaviours and believes concerning alcohol and drug use. In the current study, the I-Change model was used to map and select a subset of these variables, aiming to characterize the three phases of the I-Change model and the predisposing factors. Personal acceptance/disapproval of ones’ own cocaine use. Participants rated their personal acceptance of their own use of cocaine: “I approve of my own cocaine use” (1=agree, 3=disagree). Demographics. Participants were asked about gender, age, and highest education (enrolled or completed). Cessation and/or reducing cocaine use. Participants were asked two separate questions: “Would you like to quit your use of cocaine?” (Yes/No) and “Would you like to reduce your use of cocaine?” (Yes/No). Concurrent alcohol and cocaine use. Measure of how often in the past 12 months cocaine use was concurrent with alcohol use (1=always, 5=never). Frequency of cocaine use. Frequency of cocaine use in the past 12 months (At least once per week/ Several times per month/At least once per month). Other drugs. Number of other drugs used in the past year, including cannabis, spice, nitrous oxide, MDMA, 4-FA, amphetamines, GHB/GBL, ketamine, 2C-B, LSD, magic mushrooms, truffles, 3-MMC, 4-MMC, 4-MEC, MXE, methylone, benzo fury, phenibut, DMT, poppers, ayahuasca, benzodiazepines, fentanyl, heroin and methamphetamine (0-3/4-6/7+). General health. Perceived general health, rated on a scale of 1 (very good) to 5 (very bad). Mental health. Participants filled out the Mental Health Inventory (MHI-5), a short questionnaire measuring mental health (Berwick et al., 1991). The MHI-5 included the following five questions: “In the past four weeks: were you nervous? / were you so down nothing could cheer you up? / did you feel calm and quiet? / did you feel depressed and gloomy? / did you feel happy?” (1=never, 6=always). The MHI-5 results in a total score between 0-100, 80 meaning mentally very healthy). Risk perception. Participants rated the risk of regularly using cocaine (1=not harmful at all, 5=very harmful). During analysis, the ratings 1 and 2 (not harmful and a little harmful) were merged, because of the small numbers per category. Social acceptance among nightlife attendants/ friends/in the Netherlands. Participants rated the perceived social acceptance of cocaine use among nightlife attendants/ friends/in the Netherlands by the following question: “Do you feel that the use of cocaine is socially accepted among nightlife attendants/ friends/in the (general) Dutch society?” (1=completely disagree, 5=completely agree). Using too much cocaine. “I believe I use too much cocaine/use cocaine too often” (Yes/no). Data analyses The data were analysed using SPSS version 29. Descriptive statistics were used to determine the frequencies (%) or means and standard deviations (SD) of all variables. Regression analyses were performed for two dependent variables: willingness to reduce cocaine use and willingness to quit cocaine use. Univariate logistic regression analyses were performed to examine the association between the outcome variables (cessation or reduction of cocaine use) and the independent variables described under ‘measures’ (Table 3a) one by one. The alpha level was set at 5%. For the multiple logistic regression variables were tested for multi-collinearity using Pearson’s Chi-Square. Some of the variables were excluded: General health showed excessive multicollinearity with Mental health; Concurrent alcohol use was unevenly distributed, with a prevalence rate of 93,4%; Social acceptance of cocaine use among nightlife attendants/friends/in the Netherlands showed excessive multicollinearity, and because Social norms in the Netherlands was most evenly distributed, it was kept in favour over the other two variables. Lastly, Using too much cocaine showed multicollinearity with Personal acceptance of ones’ own cocaine use so the former was dropped.The remainingindependent variables were included in the multiple logistic regression (Table 3b). Results Sample characteristics A total of 317 individuals were included in the study (42.0% female, Mean age=23.9, SD =3.8). 49.3% Reported having or currently studying for a bachelors’ degree. All had frequently used cocaine in the previous month, of which 42.6% once per month, 41.3% more than once per month but not weekly and 16.1% at least once per week (Table 1). 39.8% Had used seven or more other types of drugs in the previous year. 44.8% Perceived regular cocaine use to be very harmful, 40.7% felt they were using too much cocaine and 49.8% reported accepting their own use of cocaine. A large majority (respectively 86.8% and 85.0%) perceived the social norm concerning cocaine use among friends and nightlife attendants to be accepting. A minority (38.9%) perceived the social norm of acceptance of cocaine use among the wider Dutch population to be accepting. Insert Table 1 - sample characteristics Of the 317 participants, 62.8% stated wanting to quit using cocaine, reduce their use, or both. Of the participants interested in quitting, 87.1% would also like to reduce their use of cocaine. Of the participants interested in reducing their use of cocaine however only 29.3% was also interested in quitting (Table 2). N=317 (100%) Would like to reduce Would not like to reduce Would like to quit 81 (26%) 12 (4%) Would not like to quit 106 (33%) 118 (37%) Table 2 – Participants wanting to quit or reduce their use of cocaine Univariate logistic regression analyses Tabel 3a presents the results of the univariate regression model. The univariate regression analyses shows that a higher Perceived harmfulness, Frequency of cocaine use and a lower Mental health score were associated with higher odds of both wanting to reduce and quit cocaine use. For example, participants who thought the use of cocaine could do a great deal of harm were more likely to want to reduce (OR 4.430, P<0.0001 ) and quit (OR 5.526, P<0.0007 ) their cocaine use than participants who thought using cocaine caused little to no harm. And participants with a Mental health score over 80 were less likely to want to reduce (OR 0.426, P<0.014 ) and quit (OR 0.421, P<0.016 ) their cocaine use compared to participants with a Mental Health score under 60. Participants with a low Personal acceptance of their own use or who felt like they were Using too much cocaine also had higher odds of both wanting to reduce (OR 9.149, P<0.000) and quit (OR 2.357, P<0.001) their cocaine use. Participants older than 25 years, with a bad General health, or who Used fewer than 3 types of other drugs were more likely to want to quit, whereas participants with a higher education or perceived Social acceptance of cocaine use among Friends were less likely to want to quit their cocaine use. Insert Table 3a Results of univariate logistic regression analyses. Multiple logistic regression analyses Tabel 3b presents the results of the multiple logistic regression model, showing that participants who approved of their own cocaine use, had much lower odds of wanting to reduce (OR 0.217, P<0.000 ) or quit (OR 0.118, P<0.000 ) their use. Participants who used cocaine less than weekly had lower odds of wanting to quit their cocaine use than participants who used cocaine weekly (OR 0.217, P<0.001 ) and those who used monthly had lower odds of wanting to reduce their use (OR 0.429, P<0.049 ). Those who perceived cocaine to be harmful had higher odds of wanting to quit than those who perceived little to no harm in cocaine use. The model for reducing cocaine use demonstrated a moderate goodness of fit, with Nagelkerke's R-squared value at 0.206. The model for quitting cocaine use demonstrated a moderate to strong goodness of fit, with Nagelkerke's R-squared value at 0.393. Insert Table 3b Results of multiple logistic regression analyses. Discussion This discussion first debates the results of the multiple regression analyses, which show associations between the determinants Frequency of use, Personal acceptance of one’s own cocaine use and Perceived harmfulness, and willingness to reduce or quit the use of cocaine. Subsequently, results from the univariate regression analysis are discussed, showing associations between various other determinants and willingness to reduce or quit the use of cocaine. Frequency and personal acceptance of one’s own cocaine use The most notable associations were observed among participants who used cocaine frequently (once per week or more) and those who disapproved of their own cocaine use. Multiple regression analyses indicated that these participants had significantly higher odds of both wanting to reduce and quit their cocaine use compared to those who used cocaine less frequently, and those who were neutral or accepting of their own use. To the best of the authors' knowledge, no previous studies have identified ‘acceptance of one’s own use’ as being directly associated with the willingness to reduce or quit cocaine use. However, these findings do possibly corroborate earlier findings suggesting that the amount of cocaine used and feeling dependent on cocaine were associated with seeking help for cocaine use, as well as the number of negative consequences experienced (Varney et al., 1995). The univariate analyses corroborated these findings: in these analyses, participants who felt they were ‘using too much cocaine’ also showed significantly higher odds of wanting to reduce or quit their cocaine use in the univariate analysis. It is also possible that these determinants are interconnected: a higher frequency of cocaine use suggests a higher amount used, which increases both the chance of ‘using too much cocaine’ and the chance of negative experiences and a feeling of dependency. Both factors could lead to disapproval of one’s own use. Interventions aiming to help people reduce or quit their cocaine use could target people who use cocaine frequently (once per week or more) and those who disapproved of their own cocaine use. Perceived harmfulness The multiple regression analyses showed that participants who perceived regular use of cocaine as (quite or very) harmful, had significantly higher odds of wanting to quit their use compared to those who perceived it as not or only slightly harmful. This finding aligns with findings in earlier studies stating that risk perception, negative consequences experienced and health concerns are associated with a desire to quit cocaine use (Bachman et al., 1990; Leung et al., 2010; McBride et al., 1994; Palamar, 2023; Varney et al., 1995). The univariate analysis also found that participants who perceived regular use of cocaine as (quite or very) harmful had significantly higher odds of wanting to reduce their use of cocaine. This association between perceived harmfulness and wanting to quit or reduce cocaine use can be interpreted in two ways. First, interventions could target individuals who already recognize the harmful effects of cocaine use. Second, interventions could focus on educating those who perceive regular cocaine use as not harmful, as suggested by previous studies (Morley et al., 2015). Age, education, health and social norms Several determinants showed an association with wanting to quit or reduce cocaine use in the univariate analyses but not in the multiple analyses. Nevertheless, they are interesting to discuss. To begin with, being older than 25 years increased the odds of wanting to quit cocaine use, whereas having a higher education reduced those odds. People who do not attend university tend to take on more responsibilities earlier in life (job, mortgage, family) than those who do. Therefore, these findings could be explained by increased responsibility, either as a result of higher age or a more practical education, being associated with higher odds of wanting to quit cocaine use. This corresponds with earlier findings that cessation attempts tend to stem from cocaine use interfering with social obligations (Cheney et al., 2016b). Subsequently, having a lower mental health index score was associated with higher odds of wanting to reduce and quit the use of cocaine. A (very) bad general health was also associated with higher odds of wanting to quit. This is consistent with earlier studies in which health concerns and poor health resulting from cocaine use were associated with a desire for reducing or quitting cocaine use (Bachman et al., 1990; Cheney et al., 2016b; Leung et al., 2010; McBride et al., 1994). These findings suggest that university students, people under 25 and people with general or mental health issues should be target groups for cocaine cessation interventions. Social acceptance Additionally, the perceived social acceptance of cocaine use among various groups (nightlife attendants, friends, in general in the Netherlands) was investigated. Considering the extensive body of literature on social norms theory, we anticipated that determinants concerning social acceptance of cocaine use among various groups would be strongly associated with willingness to reduce or quit cocaine use. We found that participants who perceived a high level of acceptance among other nightlife attendants had lower odds of wanting to reduce their cocaine use. Conversely, we also found that participants who perceived little or no acceptance of cocaine use from their friends, had higher odds of wanting to quit their cocaine use. These findings are in corroboration with the social norms theory as described in previous studies, which state that perceived social norms or disapproval by others are associated with a decline in drug use (Bachman et al., 1990; Martens et al., 2006; McBride et al., 1994). However, these associations did not hold up in the multiple analyses and social acceptance of cocaine use in the Netherlands was not associated with the willingness to quit or reduce the use of cocaine. One possible explanation is that the distribution of social acceptance among nightlife attendants and friends is skewed: more than 85% agrees that cocaine use is socially accepted among these groups, making it difficult to interpret the results. We found no association between perceived social acceptance of cocaine use in the Netherlands and willingness to reduce or quit cocaine use. When investing in social norms interventions, we should ensure that the focus is on the relevant social norm for the targeted group (Legros & Cislaghi, 2020). In this case, social norms interventions should concentrate on the norms among friends and other nightlife attendees, rather than those of the general public, and should always be monitored for effectiveness. Reducing in relation to quitting cocaine use Our study revealed that among participants interested in quitting, 87.1% also expressed a desire to reduce their use of cocaine. Conversely, only 29.3% of participants who were interested in reducing their cocaine use were also interested in quitting. This indicates the presence of a subset of cocaine users who are open to reducing their consumption but may not be receptive to interventions aimed at complete cessation. Therefore, interventions that focus on reducing cocaine use without the immediate goal of quitting could potentially be more effective in engaging this group. The I-Change model The I-Change model was used to map and select variables and their expected association with the outcome variables (de Vries, 2017). Determinants from the awareness phase, the motivation phase and preceding factors were, in the multiple analyses, found to be associated with willingness to quit or reduce cocaine use. Approval of one’s own use corresponds to the Motivation Phase of the I-Change model, Perceived harmfulness to the Awareness phase and Frequency of use corresponds to the Preceding Factors. Several other determinants corresponding to preceding factors from the I-Change model showed an association with wanting to quit or reduce cocaine use only in the univariate analyses: Age, Education, Health and Social norms. The questionnaire lacked variables corresponding to the Action phase of the I-Change model, such as skills and perceived barriers for quitting. Future research should include those variables, to better understand what is needed for participants to make the transition from willingness to reduce or quit, to the actual behaviour of quitting. LIMITATIONS This study used an unprecedently large sample of recreational users of cocaine, offering valuable information on their drug use behaviour. However, it is important to note that this study was cross-sectional and used a convenience sample recruited through social media. The sample also showed an overrepresentation of individuals with a bachelor’s or masters’ degree in relation to the general population, which may restrict the extent to which our findings can be applied to a broader population of people who use cocaine. Caution should be exercised when drawing conclusions. The questionnaire was developed in collaboration with experts in behavioural psychology, but not specifically to investigate the I-Change model. While variables were selected to corresponded with the phases and preceding factors of the I-Change model, these variables were not originally designed for the evaluation of cocaine use behaviour within this framework. Other factors that are central to the I-Change model, such as Perceived ques, Self-Efficacy and Barriers, could not be included in the model because they were not part of the questionnaire. This potential mismatch between variables and the model's intended purpose may introduce limitations in the precision and applicability of our results. Conclusion The aim of this paper was to identify the determinants associated with the willingness to reduce or quit cocaine use among nightlife attendees. Information on these determinants is valuable, because they can be used to design more effective interventions to help people reduce or quit their use of cocaine and to target the relevant groups with these interventions. This paper showed that people who used cocaine weekly had higher odds of wanting to reduce or quit their use than participants who used less often, as did participants who disapproved of their own use. Participants who perceived cocaine to be harmful also had higher odds of wanting to quit their cocaine use. When developing or implementing interventions, it is imperative to understand the characteristics of the target groups and the determinants of the health behaviour being targeted. Abbreviations EMCDDA – European Monitoring Centre for Drugs and Drug Addiction (now: EUDA: European Union Drug Agency) UNODC – United Nations Office on Drugs and Crime Declarations Ethical Approval All research procedures were reviewed in advance and approved by the internal ethical review board of the Trimbos Institute. Competing interests The authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Authors' contributions MJ, AB, SO and MK set the scope and designed the study. MJ and AB performed the data analyses, under guidance of MB and MK. MJ wrote the main manuscript text. All authors contributed to the manuscripts stucture and revised the manuscript for important intellectual content. 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Het Grote Uitgaansonderzoek 2020: Uitgaanspatronen, middelengebruik, gezondheid en intentie tot stoppen of minderen onder uitgaande jongeren en jongvolwassenen . Trimbos-instituut. Morley, K. I., Lynskey, M. T., Moran, P., Borschmann, R., & Winstock, A. R. (2015). Polysubstance use, mental health and high‐risk behaviours: Results from the 2012 Global Drug Survey. Drug and Alcohol Review , 34 (4), 427–437. https://doi.org/10.1111/dar.12263 Palamar, J. J. (2023). Adverse drug effects as a deterrent against willingness to use in the future among nightclub/festival attendees. Drug and Alcohol Review , December 2022 , 1–6. https://doi.org/10.1111/dar.13673 Palamar, J. J., & Keyes, K. M. (2020). Trends in drug use among electronic dance music party attendees in New York City, 2016–2019. Drug and Alcohol Dependence , 209 (February), 107889. https://doi.org/10.1016/j.drugalcdep.2020.107889 Porrino, L. J., Smith, H. R., Nader, M. A., & Beveridge, T. J. R. (2007). The effects of cocaine: A shifting target over the course of addiction. Progress in Neuro-Psychopharmacology and Biological Psychiatry , 31 (8), 1593–1600. https://doi.org/10.1016/j.pnpbp.2007.08.040 Rounsaville, B. J. (2004). Treatment of cocaine dependence and depression. Biological Psychiatry , 56 (10), 803–809. https://doi.org/10.1016/j.biopsych.2004.05.009 Sañudo, A., Andreoni, S., & Sanchez, Z. M. (2015). Polydrug use among nightclub patrons in a megacity: A latent class analysis. International Journal of Drug Policy , 26 (12), 1207–1214. http://10.0.3.248/j.drugpo.2015.07.012 UNODC. (2023a). Global Report on Cocaine 2023. Global Report on Cocaine 2023 . https://doi.org/10.18356/9789213626788 UNODC. (2023b). World Drug Report 2023 . Varney, S. M., Rohsenow, D. J., Dey, A. N., Myers, M. G., Zwick, W. R., & Monti, P. M. (1995). Factors Associated with Help Seeking and Perceived Dependence among Cocaine Users. The American Journal of Drug and Alcohol Abuse , 20 (1), 81–91. Winhusen, T., Theobald, J., Kaelber, D. C., & Lewis, D. (2020). The association between regular cocaine use, with and without tobacco co-use, and adverse cardiovascular and respiratory outcomes. Drug and Alcohol Dependence , 214 (April). https://doi.org/10.1016/j.drugalcdep.2020.108136 Tables Tables 1 and 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tabel1samplecharacteristics170724.docx Tabel3bmultivariableanalyses160724.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Bukman","email":"","orcid":"","institution":"Trimbos Institute","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"J.","lastName":"Bukman","suffix":""},{"id":343067287,"identity":"2c3984f6-966a-4929-89b3-a0064e233623","order_by":2,"name":"Matthijs Blankers","email":"","orcid":"","institution":"Trimbos Institute","correspondingAuthor":false,"prefix":"","firstName":"Matthijs","middleName":"","lastName":"Blankers","suffix":""},{"id":343067289,"identity":"64404695-f8fd-4f66-86e2-1ff4463f2cd8","order_by":3,"name":"Simone A. Onrust","email":"","orcid":"","institution":"Trimbos Institute","correspondingAuthor":false,"prefix":"","firstName":"Simone","middleName":"A.","lastName":"Onrust","suffix":""},{"id":343067291,"identity":"56c9931a-135f-478c-9d8e-6b4ddcbcd839","order_by":4,"name":"Desirée B. Spronk","email":"","orcid":"","institution":"Trimbos Institute","correspondingAuthor":false,"prefix":"","firstName":"Desirée","middleName":"B.","lastName":"Spronk","suffix":""},{"id":343067293,"identity":"d07dd588-5bac-4b10-b7cf-54f8bde8f827","order_by":5,"name":"Margriet van Laar","email":"","orcid":"","institution":"Trimbos Institute","correspondingAuthor":false,"prefix":"","firstName":"Margriet","middleName":"van","lastName":"Laar","suffix":""},{"id":343067294,"identity":"368f5916-3068-4d6b-92fe-792a0f5ea1b0","order_by":6,"name":"Marloes Kleinjan","email":"","orcid":"","institution":"Trimbos Institute","correspondingAuthor":false,"prefix":"","firstName":"Marloes","middleName":"","lastName":"Kleinjan","suffix":""}],"badges":[],"createdAt":"2024-08-12 15:55:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4901788/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4901788/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77824215,"identity":"938409b1-89d4-4d92-b520-bbf759feea36","added_by":"auto","created_at":"2025-03-05 22:31:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":571876,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4901788/v1/53b92dd7-8d80-4218-818d-b467475be039.pdf"},{"id":64233210,"identity":"557998e4-a4bd-4dea-8282-5fd5261a3e60","added_by":"auto","created_at":"2024-09-10 15:39:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":27036,"visible":true,"origin":"","legend":"","description":"","filename":"Tabel1samplecharacteristics170724.docx","url":"https://assets-eu.researchsquare.com/files/rs-4901788/v1/d4b43099a4294a50b0a09a23.docx"},{"id":64233211,"identity":"85de3a05-0376-4055-9beb-6fed97fabfc1","added_by":"auto","created_at":"2024-09-10 15:39:47","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29491,"visible":true,"origin":"","legend":"","description":"","filename":"Tabel3bmultivariableanalyses160724.docx","url":"https://assets-eu.researchsquare.com/files/rs-4901788/v1/e307deba2783bb3741494599.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of the willingness to reduce or quit cocaine use among nightlife attendees","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCocaine use and availability are very high by historical standards (UNODC, 2023a). It is estimated that 0.5% of all adults worldwide (aged 18-64) and 2.3% of adolescents and young adults in the European Union (aged 15-34) have used cocaine in the past year (EMCDDA, 2023; UNODC, 2023b). For the past six years, EU member states have been reporting record amounts of cocaine seized and between 2022 and 2023, 42 out of 72 European cities showed a significant increase in cocaine residues found in wastewater (EMCDDA, 2024). The recreational use of drugs among nightlife attendees is much higher than among the general population (Sa\u0026ntilde;udo et al., 2015), and cocaine is one of the most used substances in nightlife (Mohr et al., 2021; Palamar \u0026amp; Keyes, 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHealth risks of cocaine use include: acute cardiotoxic effects (risk enhanced by concomitant alcohol use), suicidal thoughts and psychosis, increased risk of coronary artery disease, cardiomyopathy (deterioration in heart muscle function), stroke and dependence (Arenas et al., 2020; Feltmann et al., 2021; Kim \u0026amp; Park, 2019; Porrino et al., 2007; Rounsaville, 2004; Winhusen et al., 2020). In Europe, cocaine was the second most common problem drug among people entering specialised drug treatment for the first time in their lives (EMCDDA, 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsidering these risks for both physical and mental health, reducing and quitting cocaine use are important prevention goals. People who set limits on the quantity of cocaine they use have decreased odds of experiencing a bad mood after drug use, sexual difficulties, injuries or fractures while under the influence, and involvement in fights or being attacked while under the influence\u0026nbsp;(Fern\u0026aacute;ndez-Calder\u0026oacute;n et al., 2019). Because of the high prevalence of cocaine use among nightlife attendees, they are an important target group for prevention. However, prevention activities for this group have traditionally been focused on minimizing the risk at adverse health effects (harm reduction) and not at reducing or quitting use\u0026nbsp;(Fern\u0026aacute;ndez-Calder\u0026oacute;n et al., 2014; Morley et al., 2015).\u003c/p\u003e\n\u003cp\u003eIn a previous study, Monshouwer and Van Miltenburg (2021) researched the willingness to reduce or quit drug use among Dutch nightlife attendees. For cocaine, nearly half of all participants that used cocaine in the previous year expressed an interest to quit or cut down their use. The fact that such a large percentage of cocaine users was interested to change their cocaine use behaviour, but had not done so yet, suggests there are opportunities for the deployment of interventions aimed at preparing and supporting them during their reduction or cessation of cocaine use. Understanding the mechanisms behind the willingness to reduce or quit cocaine use is crucial for developing effective prevention strategies (see also: Bartholomew Eldredge et al., 2016; Kok et al., 2016). Yet, most research has focused on those diagnosed with substance use disorder, leaving a gap in research among recreational users in nightlife settings (Palamar, 2023; Ronsley et al., 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile motivations for cocaine use, such as physical, mental, and social reasons, have been extensively studied (Hartwell et al., 2012; Kettner et al., 2019; van der Poel et al., 2009), there is a notable lack of research on the motivations driving reduction or cessation of cocaine use. In the few studies on cessation of recreational drug use, risk perception and social norms have been most commonly studied. Risk perception and health concerns have been associated with a desire to decrease or quit using cocaine, ecstasy and cannabis (Bachman et al., 1990; Leung et al., 2010; McBride et al., 1994). Other studies showed that social influences or disapproval by others was associated with a decline in cocaine use (Dennhardt \u0026amp; Murphy, 2013; Kollath-Cattano et al., 2020; McBride et al., 1994). Among people who use frequently or have a cocaine use disorder, cessation attempts tend to stem from cocaine use interfering in social obligations, poor health resulting from use, or from being tired of use or of engaging in illegal or socially disapproved behaviours to continue obtaining the drug (Cheney et al., 2016a). Other factors associated with seeking help for cocaine use were number of negative consequences experienced, feeling dependent on cocaine, and the amount of cocaine used (Varney et al., 1995). One recent study among nightclub attendees who use partydrugs recreationally, also found that personally experienced adverse effects can deter willingness to use certain party drugs again (Palamar, 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, we investigated variables that are expected to be associated with the willingness to reduce or quit cocaine use, including risk perception, social norms and mental health. We used the I-Change model to map and select these variables and their expected association with the outcome variables (de Vries, 2017). The I-Change model is an integrated health behaviour theory that incorporates several theories on behaviour change, such as the Theory of Planned Behaviour (Ajzen, 1991) and the Health Belief Model (Janz \u0026amp; Becker, 1984). The I-Change model describes three phases in the behavioural change process: 1) an awareness phase, including a person\u0026rsquo;s knowledge and risk perceptions regarding their behaviour, leads to 2) the motivation phase, including attitude regarding the behaviour, perceived social norms and self-efficacy expectations. And the following 3) action phase includes skills, action planning and skills. This process of phases is in turn influenced by preceding factors, such as biological factors (e.g. gender, age, health), psychological factors (e.g. mental health), behavioural factors (e.g. previous experiences, frequency of use) and environmental factors (e.g. availability of substances, education).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, we used determinants from each of the phases and predisposing factors in the I-Change model, and studied their association with the willingness to reduce or quit cocaine use in nightlife attendees who had used cocaine in the previous year. Based on previous studies, we expected risk perception, social norms and personally experienced adverse effects to be the most strongly associated with willingness to reduce or quit cocaine use. Based on the I-Change model, we also anticipated some preceding factors, such as gender, age, previous experiences with other drugs, education and attitude toward one\u0026rsquo;s own cocaine use, to be also associated with the willingness to reduce or quit cocaine. The insights gained from this study can aid in designing more effective interventions to help people reduce or quit their cocaine use and to target these interventions at the relevant groups.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eRecruitment of participants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study is based on secondary data analysis on data collected for a Dutch cross-sectional study: The Large Nightlife Survey\u0026nbsp;(Monshouwer et al., 2021). Data collection took place from April to May 2020, using an online questionnaire in Dutch. Participants were recruited through (paid) social media campaigns and various other online channels. Only participants who had indicated they had visited a party, festival, club or disco at least once in the previous year were included in the study. This resulted in a convenience sample with relatively high levels of drug use. This allowed for in depth analyses of drugs which is generally not possible in general population studies because of the low prevalence of drug use. Data were collected anonymously. Prizes were randomly distributed among participants who completed the questionnaire and then opted to leave their email address in order to be included in a prize lottery. All research procedures were reviewed in advance and approved by the internal ethical review board of the Trimbos Institute.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe sample of The Large Nightlife Study consisted of a convenience sample of 4,824 participants aged 16-35. For the present study 317 participants were included who 1) had used cocaine at least once per month in the year preceding the completion of the questionnaire and who 2) had completed the questions concerning their willingness to quit or reduce the use of cocaine.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMeasures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe variables in the online questionnaire covered a wide range of behaviours and believes concerning alcohol and drug use. In the current study, the I-Change model was used to map and select a subset of these variables, aiming to characterize the three phases of the I-Change model and the predisposing factors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePersonal acceptance/disapproval of ones’ own cocaine use.\u003c/strong\u003e Participants rated their personal acceptance of their own use of cocaine: “I approve of my own cocaine use” (1=agree, 3=disagree).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographics.\u003c/strong\u003e Participants were asked about gender, age, and highest education (enrolled or completed).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCessation and/or reducing cocaine use.\u0026nbsp;\u003c/strong\u003eParticipants were asked two separate questions: “Would you like to quit your use of cocaine?” (Yes/No) and “Would you like to reduce your use of cocaine?” (Yes/No).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcurrent alcohol and cocaine use.\u003c/strong\u003e Measure of how often in the past 12 months cocaine use was concurrent with alcohol use (1=always, 5=never).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency of cocaine use.\u0026nbsp;\u003c/strong\u003eFrequency of cocaine use in the past 12 months (At least once per week/ Several times per month/At least once per month).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOther drugs.\u0026nbsp;\u003c/strong\u003eNumber of other drugs used in the past year, including cannabis, spice, nitrous oxide, MDMA, 4-FA, amphetamines, GHB/GBL, ketamine, 2C-B, LSD, magic mushrooms, truffles, 3-MMC, 4-MMC, 4-MEC, MXE, methylone, benzo fury, phenibut, DMT, poppers, ayahuasca, benzodiazepines, fentanyl, heroin and methamphetamine (0-3/4-6/7+).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral health.\u0026nbsp;\u003c/strong\u003ePerceived general health, rated on a scale of 1 (very good) to 5 (very bad).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMental health.\u003c/strong\u003e Participants filled out the Mental Health Inventory (MHI-5), a short questionnaire measuring mental health\u0026nbsp;(Berwick et al., 1991). The MHI-5 included the following five questions: “In the past four weeks: were you nervous? / were you so down nothing could cheer you up? / did you feel calm and quiet? / did you feel depressed and gloomy? / did you feel happy?” (1=never, 6=always). The MHI-5 results in a total score between 0-100, \u0026lt;60 meaning mentally not healthy and \u0026gt;80 meaning mentally very healthy).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk perception.\u0026nbsp;\u003c/strong\u003eParticipants rated the risk of regularly using cocaine (1=not harmful at all, 5=very harmful). During analysis, the ratings 1 and 2 (not harmful and a little harmful) were merged, because of the small numbers per category.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial acceptance among nightlife attendants/ friends/in the Netherlands.\u0026nbsp;\u003c/strong\u003eParticipants rated the perceived social acceptance of cocaine use among nightlife attendants/ friends/in the Netherlands by the following question: “Do you feel that the use of cocaine is socially accepted among nightlife attendants/ friends/in the (general) Dutch society?” (1=completely disagree, 5=completely agree).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUsing too much cocaine.\u003c/strong\u003e “I believe I use too much cocaine/use cocaine too often” (Yes/no).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData analyses\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analysed using SPSS version 29. Descriptive statistics were used to determine the frequencies (%) or means and standard deviations (SD) of all variables. Regression analyses were performed for two dependent variables: willingness to reduce cocaine use and willingness to quit cocaine use. Univariate logistic regression analyses were performed to examine the association between the outcome variables (cessation or reduction of cocaine use) and the independent variables described under ‘measures’ (Table 3a) one by one. The alpha level was set at 5%. For the multiple logistic regression variables were tested for multi-collinearity using Pearson’s Chi-Square. Some of the variables were excluded: General health showed excessive multicollinearity with Mental health; Concurrent alcohol use was unevenly distributed, with a prevalence rate of 93,4%; Social acceptance of cocaine use among nightlife attendants/friends/in the Netherlands showed excessive multicollinearity, and because Social norms in the Netherlands was most evenly distributed, it was kept in favour over the other two variables. Lastly, Using too much cocaine showed multicollinearity with Personal acceptance of ones’ own cocaine use so the former was dropped.The remainingindependent variables were included in the multiple logistic regression (Table 3b).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eSample characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 317 individuals were included in the study (42.0% female, Mean age=23.9, SD =3.8). 49.3% Reported having or currently studying for a bachelors\u0026rsquo; degree. All had frequently used cocaine in the previous month, of which 42.6% once per month, 41.3% more than once per month but not weekly and 16.1% at least once per week (Table 1). 39.8% Had used seven or more other types of drugs in the previous year. 44.8% Perceived regular cocaine use to be very harmful, 40.7% felt they were using too much cocaine and 49.8% reported accepting their own use of cocaine. A large majority (respectively 86.8% and 85.0%) perceived the social norm concerning cocaine use among friends and nightlife attendants to be accepting. A minority (38.9%) perceived the social norm of acceptance of cocaine use among the wider Dutch population to be accepting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Table 1 - sample characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOf the 317 participants, 62.8% stated wanting to quit using cocaine, reduce their use, or both. Of the participants interested in quitting, 87.1% would also like to reduce their use of cocaine. Of the participants interested in reducing their use of cocaine however only 29.3% was also interested in quitting (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=317 (100%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.346578366445915%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWould like to reduce\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.32008830022075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWould not like to reduce\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eWould like to quit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.346578366445915%\" valign=\"top\"\u003e\n \u003cp\u003e81 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.32008830022075%\" valign=\"top\"\u003e\n \u003cp\u003e12 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eWould not like to quit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.346578366445915%\" valign=\"top\"\u003e\n \u003cp\u003e106 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.32008830022075%\" valign=\"top\"\u003e\n \u003cp\u003e118 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eTable 2 \u0026ndash; Participants wanting to quit or reduce their use of cocaine\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUnivariate logistic regression analyses\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTabel 3a presents the results of the univariate regression model. The univariate regression analyses shows that a higher Perceived harmfulness, Frequency of cocaine use and a lower Mental health score were associated with higher odds of both wanting to reduce and quit cocaine use. For example, participants who thought the use of cocaine could do a great deal of harm were more likely to want to reduce (OR 4.430, \u003cem\u003eP\u0026lt;0.0001\u003c/em\u003e) and quit (OR 5.526, \u003cem\u003eP\u0026lt;0.0007\u003c/em\u003e) their cocaine use than participants who thought using cocaine caused little to no harm. And participants with a Mental health score over 80 were less likely to want to reduce (OR 0.426, \u003cem\u003eP\u0026lt;0.014\u003c/em\u003e) and quit (OR 0.421, \u003cem\u003eP\u0026lt;0.016\u003c/em\u003e) their cocaine use compared to participants with a Mental Health score under 60. Participants with a low Personal acceptance of their own use or who felt like they were Using too much cocaine also had higher odds of both wanting to reduce (OR 9.149, \u003cem\u003eP\u0026lt;0.000)\u003c/em\u003e and quit (OR 2.357, \u003cem\u003eP\u0026lt;0.001)\u0026nbsp;\u003c/em\u003etheir cocaine use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants older than 25 years, with a bad General health, or who Used fewer than 3 types of other drugs were more likely to want to quit, whereas participants with a higher education or perceived Social acceptance of cocaine use among Friends were less likely to want to quit their cocaine use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Table 3a Results of univariate logistic regression analyses.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMultiple logistic regression analyses\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTabel 3b presents the results of the multiple logistic regression model, showing that participants who approved of their own cocaine use, had much lower odds of wanting to reduce (OR 0.217, \u003cem\u003eP\u0026lt;0.000\u003c/em\u003e) or quit (OR 0.118, \u003cem\u003eP\u0026lt;0.000\u003c/em\u003e) their use. Participants who used cocaine less than weekly had lower odds of wanting to quit their cocaine use than participants who used cocaine weekly (OR 0.217, \u003cem\u003eP\u0026lt;0.001\u003c/em\u003e) and those who used monthly had lower odds of wanting to reduce their use (OR 0.429, \u003cem\u003eP\u0026lt;0.049\u003c/em\u003e). Those who perceived cocaine to be harmful had higher odds of wanting to quit than those who perceived little to no harm in cocaine use. The model for reducing cocaine use demonstrated a moderate goodness of fit, with Nagelkerke\u0026apos;s R-squared value at 0.206. The model for quitting cocaine use demonstrated a moderate to strong goodness of fit, with Nagelkerke\u0026apos;s R-squared value at 0.393.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Table 3b Results of multiple logistic regression analyses.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis discussion first debates the results of the multiple regression analyses, which show associations between the determinants Frequency of use, Personal acceptance of one’s own cocaine use and Perceived harmfulness, and willingness to reduce or quit the use of cocaine. Subsequently, results from the univariate regression analysis are discussed, showing associations between various other determinants and willingness to reduce or quit the use of cocaine.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFrequency and personal acceptance of one’s own cocaine use\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe most notable associations were observed among participants who used cocaine frequently (once per week or more) and those who disapproved of their own cocaine use. Multiple regression analyses indicated that these participants had significantly higher odds of both wanting to reduce and quit their cocaine use compared to those who used cocaine less frequently, and those who were neutral or accepting of their own use. To the best of the authors' knowledge, no previous studies have identified ‘acceptance of one’s own use’ as being directly associated with the willingness to reduce or quit cocaine use. However, these findings do possibly corroborate earlier findings suggesting that the amount of cocaine used and feeling dependent on cocaine were associated with seeking help for cocaine use, as well as the number of negative consequences experienced\u0026nbsp;(Varney et al., 1995). The univariate analyses corroborated these findings: in these analyses, participants who felt they were ‘using too much cocaine’ also showed significantly higher odds of wanting to reduce or quit their cocaine use in the univariate analysis. It is also possible that these determinants are interconnected: a higher frequency of cocaine use suggests a higher amount used, which increases both the chance of ‘using too much cocaine’ and the chance of negative experiences and a feeling of dependency. Both factors could lead to disapproval of one’s own use. Interventions aiming to help people reduce or quit their cocaine use could target people who use cocaine frequently (once per week or more) and those who disapproved of their own cocaine use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePerceived harmfulness\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe multiple regression analyses showed that participants who perceived regular use of cocaine as (quite or very) harmful, had significantly higher odds of wanting to quit their use compared to those who perceived it as not or only slightly harmful. This finding aligns with findings in earlier studies stating that risk perception, negative consequences experienced and health concerns are associated with a desire to quit cocaine use\u0026nbsp;(Bachman et al., 1990; Leung et al., 2010; McBride et al., 1994; Palamar, 2023; Varney et al., 1995). The univariate analysis also found that participants who perceived regular use of cocaine as (quite or very) harmful had significantly higher odds of wanting to reduce their use of cocaine. This association between perceived harmfulness and wanting to quit or reduce cocaine use can be interpreted in two ways. First, interventions could target individuals who already recognize the harmful effects of cocaine use. Second, interventions could focus on educating those who perceive regular cocaine use as not harmful, as suggested by previous studies\u0026nbsp;(Morley et al., 2015).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAge, education, health and social norms\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSeveral determinants showed an association with wanting to quit or reduce cocaine use in the univariate analyses but not in the multiple analyses. Nevertheless, they are interesting to discuss. To begin with, being older than 25 years increased the odds of wanting to quit cocaine use, whereas having a higher education reduced those odds. People who do not attend university tend to take on more responsibilities earlier in life (job, mortgage, family) than those who do. Therefore, these findings could be explained by increased responsibility, either as a result of higher age or a more practical education, being associated with higher odds of wanting to quit cocaine use. This corresponds with earlier findings that cessation attempts tend to stem from cocaine use interfering with social obligations\u0026nbsp;(Cheney et al., 2016b). Subsequently, having a lower mental health index score was associated with higher odds of wanting to reduce and quit the use of cocaine. A (very) bad general health was also associated with higher odds of wanting to quit. This is consistent with earlier studies in which health concerns and poor health resulting from cocaine use were associated with a desire for reducing or quitting cocaine use\u0026nbsp;(Bachman et al., 1990; Cheney et al., 2016b; Leung et al., 2010; McBride et al., 1994). These findings suggest that university students, people under 25 and people with general or mental health issues should be target groups for cocaine cessation interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSocial acceptance\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAdditionally, the perceived social acceptance of cocaine use among various groups (nightlife attendants, friends, in general in the Netherlands) was investigated. Considering the extensive body of literature on social norms theory, we anticipated that determinants concerning social acceptance of cocaine use among various groups would be strongly associated with willingness to reduce or quit cocaine use. We found that participants who perceived a high level of acceptance among other nightlife attendants had lower odds of wanting to reduce their cocaine use. Conversely, we also found that participants who perceived little or no acceptance of cocaine use from their friends, had higher odds of wanting to quit their cocaine use. These findings are in corroboration with the social norms theory as described in previous studies, which state that perceived social norms or disapproval by others are associated with a decline in drug use\u0026nbsp;(Bachman et al., 1990; Martens et al., 2006; McBride et al., 1994). However, these associations did not hold up in the multiple analyses and social acceptance of cocaine use in the Netherlands was not associated with the willingness to quit or reduce the use of cocaine. One possible explanation is that the distribution of social acceptance among nightlife attendants and friends is skewed: more than 85% agrees that cocaine use is socially accepted among these groups, making it difficult to interpret the results. We found no association between perceived social acceptance of cocaine use in the Netherlands and willingness to reduce or quit cocaine use. When investing in social norms interventions, we should ensure that the focus is on the relevant social norm for the targeted group\u0026nbsp;(Legros \u0026amp; Cislaghi, 2020). In this case, social norms interventions should concentrate on the norms among friends and other nightlife attendees, rather than those of the general public, and should always be monitored for effectiveness.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eReducing in relation to quitting cocaine use\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOur study revealed that among participants interested in quitting, 87.1% also expressed a desire to reduce their use of cocaine. Conversely, only 29.3% of participants who were interested in reducing their cocaine use were also interested in quitting. This indicates the presence of a subset of cocaine users who are open to reducing their consumption but may not be receptive to interventions aimed at complete cessation. Therefore, interventions that focus on reducing cocaine use without the immediate goal of quitting could potentially be more effective in engaging this group.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe I-Change model\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe I-Change model was used to map and select variables and their expected association with the outcome variables\u0026nbsp;(de Vries, 2017). Determinants from the awareness phase, the motivation phase and preceding factors were, in the multiple analyses, found to be associated with willingness to quit or reduce cocaine use. Approval of one’s own use corresponds to the Motivation Phase of the I-Change model, Perceived harmfulness to the Awareness phase and Frequency of use corresponds to the Preceding Factors. Several other determinants corresponding to preceding factors from the I-Change model showed an association with wanting to quit or reduce cocaine use only in the univariate analyses: Age, Education, Health and Social norms. The questionnaire lacked variables corresponding to the Action phase of the I-Change model, such as skills and perceived barriers for quitting. Future research should include those variables, to better understand what is needed for participants to make the transition from willingness to reduce or quit, to the actual behaviour of quitting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLIMITATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used an unprecedently large sample of recreational users of cocaine, offering valuable information on their drug use behaviour. However, it is important to note that this study was cross-sectional and used a convenience sample recruited through social media. The sample also showed an overrepresentation of individuals with a bachelor’s or masters’ degree in relation to the general population, which may restrict the extent to which our findings can be applied to a broader population of people who use cocaine. Caution should be exercised when drawing conclusions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe questionnaire was developed in collaboration with experts in behavioural psychology, but not specifically to investigate the I-Change model. While variables were selected to corresponded with the phases and preceding factors of the I-Change model, these variables were not originally designed for the evaluation of cocaine use behaviour within this framework. Other factors that are central to the I-Change model, such as Perceived ques, Self-Efficacy and Barriers, could not be included in the model because they were not part of the questionnaire. This potential mismatch between variables and the model's intended purpose may introduce limitations in the precision and applicability of our results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe aim of this paper was to identify the determinants associated with the willingness to reduce or quit cocaine use among nightlife attendees. Information on these determinants is valuable, because they can be used to design more effective interventions to help people reduce or quit their use of cocaine and to target the relevant groups with these interventions. This paper showed that people who used cocaine weekly had higher odds of wanting to reduce or quit their use than participants who used less often, as did participants who disapproved of their own use. Participants who perceived cocaine to be harmful also had higher odds of wanting to quit their cocaine use. When developing or implementing interventions, it is imperative to understand the characteristics of the target groups and the determinants of the health behaviour being targeted.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eEMCDDA \u0026ndash; European Monitoring Centre for Drugs and Drug Addiction (now: EUDA: European Union Drug Agency)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUNODC \u0026ndash; United Nations Office on Drugs and Crime\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthical Approval\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll research procedures were reviewed in advance and approved by the internal ethical review board of the Trimbos Institute.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMJ, AB, SO and MK set the scope and designed the study. MJ and AB performed the data analyses, under guidance of MB and MK. MJ wrote the main manuscript text. All authors contributed to the manuscripts stucture and revised the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study were collected by the Trimbos Institute under licence specifically for this research and are not publicly available to protect participant privacy. However, anonymised data can be obtained from the authors upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAjzen, I. (1991). 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Differences between actual and perceived student norms: An examination of alcohol use, drug use, and sexual behavior. \u003cem\u003eJournal of American College Health\u003c/em\u003e, \u003cem\u003e54\u003c/em\u003e(5), 295\u0026ndash;300. https://doi.org/10.3200/JACH.54.5.295-300\u003c/li\u003e\n\u003cli\u003eMcBride, C. M., Curry, S. J., Stephens, R. S., Wells, E. A., \u0026amp; et al. (1994). Intrinsic and extrinsic motivation for change in cigarette smokers, marijuana smokers, and cocaine users. \u003cem\u003ePsychology of Addictive Behaviors\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(4), 243\u0026ndash;250. https://doi.org/10.1037//0893-164x.8.4.243\u003c/li\u003e\n\u003cli\u003eMohr, A. L. A., Fogarty, M. F., Krotulski, A. J., \u0026amp; Logan, B. K. (2021). Evaluating Trends in Novel Psychoactive Substances Using a Sentinel Population of Electronic Dance Music Festival Attendees. \u003cem\u003eJournal of Analytical Toxicology\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e(5), 490\u0026ndash;497. https://doi.org/10.1093/jat/bkaa104\u003c/li\u003e\n\u003cli\u003eMonshouwer, K., Van Miltenburg, C. J. A., Van Beek, R. J. J., Den Hollander, W., Schouten, F., Blankers, M., \u0026amp; Van Laar, M. W. (2021). \u003cem\u003eHet Grote Uitgaansonderzoek 2020: Uitgaanspatronen, middelengebruik, gezondheid en intentie tot stoppen of minderen onder uitgaande jongeren en jongvolwassenen\u003c/em\u003e. Trimbos-instituut.\u003c/li\u003e\n\u003cli\u003eMorley, K. I., Lynskey, M. T., Moran, P., Borschmann, R., \u0026amp; Winstock, A. R. (2015). Polysubstance use, mental health and high‐risk behaviours: Results from the 2012 Global Drug Survey. \u003cem\u003eDrug and Alcohol Review\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(4), 427\u0026ndash;437. https://doi.org/10.1111/dar.12263\u003c/li\u003e\n\u003cli\u003ePalamar, J. J. (2023). Adverse drug effects as a deterrent against willingness to use in the future among nightclub/festival attendees. \u003cem\u003eDrug and Alcohol Review\u003c/em\u003e, \u003cem\u003eDecember 2022\u003c/em\u003e, 1\u0026ndash;6. https://doi.org/10.1111/dar.13673\u003c/li\u003e\n\u003cli\u003ePalamar, J. J., \u0026amp; Keyes, K. M. (2020). Trends in drug use among electronic dance music party attendees in New York City, 2016\u0026ndash;2019. \u003cem\u003eDrug and Alcohol Dependence\u003c/em\u003e, \u003cem\u003e209\u003c/em\u003e(February), 107889. https://doi.org/10.1016/j.drugalcdep.2020.107889\u003c/li\u003e\n\u003cli\u003ePorrino, L. J., Smith, H. R., Nader, M. A., \u0026amp; Beveridge, T. J. R. (2007). The effects of cocaine: A shifting target over the course of addiction. \u003cem\u003eProgress in Neuro-Psychopharmacology and Biological Psychiatry\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(8), 1593\u0026ndash;1600. https://doi.org/10.1016/j.pnpbp.2007.08.040\u003c/li\u003e\n\u003cli\u003eRounsaville, B. J. (2004). Treatment of cocaine dependence and depression. \u003cem\u003eBiological Psychiatry\u003c/em\u003e, \u003cem\u003e56\u003c/em\u003e(10), 803\u0026ndash;809. https://doi.org/10.1016/j.biopsych.2004.05.009\u003c/li\u003e\n\u003cli\u003eSa\u0026ntilde;udo, A., Andreoni, S., \u0026amp; Sanchez, Z. M. (2015). Polydrug use among nightclub patrons in a megacity: A latent class analysis. \u003cem\u003eInternational Journal of Drug Policy\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(12), 1207\u0026ndash;1214. http://10.0.3.248/j.drugpo.2015.07.012\u003c/li\u003e\n\u003cli\u003eUNODC. (2023a). Global Report on Cocaine 2023. \u003cem\u003eGlobal Report on Cocaine 2023\u003c/em\u003e. https://doi.org/10.18356/9789213626788\u003c/li\u003e\n\u003cli\u003eUNODC. (2023b). \u003cem\u003eWorld Drug Report 2023\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eVarney, S. M., Rohsenow, D. J., Dey, A. N., Myers, M. G., Zwick, W. R., \u0026amp; Monti, P. M. (1995). Factors Associated with Help Seeking and Perceived Dependence among Cocaine Users. \u003cem\u003eThe American Journal of Drug and Alcohol Abuse\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(1), 81\u0026ndash;91.\u003c/li\u003e\n\u003cli\u003eWinhusen, T., Theobald, J., Kaelber, D. C., \u0026amp; Lewis, D. (2020). The association between regular cocaine use, with and without tobacco co-use, and adverse cardiovascular and respiratory outcomes. \u003cem\u003eDrug and Alcohol Dependence\u003c/em\u003e, \u003cem\u003e214\u003c/em\u003e(April). https://doi.org/10.1016/j.drugalcdep.2020.108136\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cocaine, cessation, quit, reduce, recreational drug use, I-Change model, social norms, risk perception","lastPublishedDoi":"10.21203/rs.3.rs-4901788/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4901788/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e Worldwide, cocaine use and availability is very high by historical standards. People who use cocaine are exposed to physical and mental health risks. Prevention activities for this group traditionally focus on harm reduction, but research suggests there are opportunities for the deployment of interventions aimed at the reduction or cessation of cocaine use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives \u003c/strong\u003eThis study aims to improve our understanding of the characteristics of people who are willing to reduce or quit their cocaine use, as well as the determinants of motivation to reduce or quit cocaine use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e We did a secondary data analysis on data collected for a Dutch cross-sectional study of Night live attendees (N=4824). Specifically, we selected the n=317 participants who had used cocaine at least once per month in the previous year. Logistic regression analyses were performed to investigate associations between willingness to reduce or quit cocaine use, and variables including risk perception, social norms regarding cocaine use, and mental health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e We found that Personal acceptance of your own use was associated with both willingness to reduce and to quit cocaine use. A higher frequency of cocaine use was associated with willingness to quit cocaine use. Associations were also found for Perceived harmfulness and several other determinants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e Identifying determinants of motivation to reduce or quit cocaine use is crucial for developing interventions aimed at reduction or cessation of cocaine use.\u003c/p\u003e","manuscriptTitle":"Determinants of the willingness to reduce or quit cocaine use among nightlife attendees","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-10 15:39:43","doi":"10.21203/rs.3.rs-4901788/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ae518411-26c8-4974-92da-212cc03b7362","owner":[],"postedDate":"September 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-05T22:23:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-10 15:39:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4901788","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4901788","identity":"rs-4901788","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}