Observational study on the consumption of recreational drugs and alcohol by Swiss travelers

Recreational substance use among international travellers

BACKGROUND

Drug tourism reflects the expanding illicit drug market, posing health risks in unfamiliar travel settings. Existing knowledge specifically addressing substance use among international travellers is sparse and has not been reviewed to date. This review aimed to describe the recreational substance abuse in international travellers.

METHODS

A literature search was conducted on PubMed, Google Scholar and Scopus using keywords related to recreational substances and international travellers. A total of 11 021 articles were reviewed, charted and summarized for the evidence on prevalence, patterns and characteristics of substance abuse and their health- and non-health-related problems on international travellers.

RESULTS

A total of 58 articles were included. Most were cross-sectional studies and review articles. In total, 20 articles addressed the prevalence of substance abuse in travellers, 33 looked at characteristics and patterns of substance abuse in travellers and 39 investigated the health- and non-health-related problems from substance abuse. Estimated prevalence of recreational substances abuse varied from 0.7% to 55.0%. Rates of substances abuse were 9.45-34.5% for cannabis, 20.4-35.9% for alcohol intoxication, 2.82-40.5% for MDMA, 2-22.2% for cocaine, 2-15% for psychedelic agents and 2% for methamphetamine. The prevalence varied according to travellers' characteristics and travel destinations. Direct health problems included neuropsychiatric problems. Indirect problems included accident and unintentional injuries, crime and violence, risky sexual behaviours and sexual violence and blood-borne infections. Non-health-related problems included air rage, deportation and violation of local laws.

CONCLUSION

Substance abuse among international travellers is an underestimated problem that requires intervention. These findings emphasize the importance of addressing this issue to mitigate both health and well-being problems among travellers whilst promoting safer and more responsible travel experiences. In the context of travel health practices, practitioners should counsel travellers whose itineraries may include substance abuse, informing them about associated risks and consequences.

Addiction as a BAD, a Behavioral Allocation Disorder

Addiction is continued drug use despite its harm. As one always has alternatives, addiction can be construed as a decision to allocate behavior to drug use. While decision making is commonly discussed and studied as if it resulted from deliberative, evaluative processes, such processes are actually only rarely involved in behavior allocation. These deliberative processes are too slow, effortful and inefficient to guide behavior other than when necessary. Rather, most actions are guided by faster, more automatic processes, often labeled habits. Habits are mostly adaptive, and result from repeated reinforcement leading to over-learned behavior. Habitual behavior occurs rapidly in response to particular contexts, and the behavior occurring first is that which occurs, i.e., the behavior that is decided upon. Thus, as drug use becomes habitual, drug use is likely to be chosen over other available activities in that particular context. However, while drug use becoming habitual is necessary for addiction to develop, it is not sufficient. Typically, constraints limit even habitual drug use to safer levels. These constraints might include limiting occasions for use; and, almost always, constraints on amount consumed. However, in a minority of individuals, drug use is not sufficiently constrained and addiction develops. This review discusses the nature of these constraints, and how they might fail. These failures do not result from abnormal learning processes, but rather unfortunate interactions between a person and their environment over time. These accumulate in the maladaptive allocation of behavior to drug use. This Behavior Allocation Disorder (BAD) can be reversed; occasionally easily when the environment significantly changes, but more often by the arduous application of deliberative processes generally absent from decision making. These deliberative processes must continue until new more adaptive habits become the most probable behavior in the contexts encountered. As alternatives to drug use become the most probable behavior, relapse risk diminishes.

Captain Haddock's health issues in the adventures of Tintin. Comparison with Tintin's health issues

BACKGROUND

We currently lack a comprehensive and systematic description of the challenges and health impairments (HI) faced by Captain Haddock over the course of the 15 Tintin adventures in which he appears. Their respective HIs have yet to be compared.

METHODS

We evaluated the spectrum of HIs that Haddock sustains in these 15 adventures as well as their causes, consequences, and their relationship to alcohol or travel beyond Belgium. We diagnosed Haddock's HIs according to descriptive terms in the text. We then classified HIs as traumatic and non-traumatic, and distinguished between intentional and unintentional events. We compared the depiction of HIs involving Haddock and Tintin.

RESULTS

We found 225 events leading to 249 HIs, two hospitalisations, and three medical consultations. There was a median of 19 HIs/adventure (range 4-27/adventure) with 193 cases of trauma (77.5%) and 56 non-traumatic problems (22.5%). There were 109 cases of concussion (43% of all HI, 56% of all trauma). We encountered 12 burns including ten relating to Haddock's tobacco habit. The most common forms of non-traumatic problems were linked to alcoholism (57%), and specifically drunkenness (37%). Haddock is diagnosed with cirrhosis early in Tintin's adventures. He significantly decreases his consumption of alcohol after he meets Tintin (58.3% of HI before vs 10.7% of HI after; P<0.001; OR 5.4) but not his use of tobacco. He is also susceptible to certain travel-related illnesses such as mosquito bites, ear discomfort, exposure to exotic animals, and perhaps jet lag. Overall, Haddock presents as many HIs (249 vs 244) and trauma (190 vs 193) as Tintin, but suffers significantly more HIs/adventure than Tintin (median 19 vs 8, P=0.03), and the traumas are significantly less severe, LoCs accounting for 23% of Tintin's traumatic HIs vs 2.5% for Haddock (P<0.001; OR: 5.1).

CONCLUSION

Traumatic HIs and concussion are the leading cause of HIs for Tintin and Haddock but are clearly less severe for Haddock. Haddock evolves from alcoholic sea Captain to a country gent who is less addicted to alcohol than he is to tobacco.