Policy implications of the widespread practice of‘pre-drinking’ or ‘pre-gaming’ before going to publicdrinking establishments—are current preventionstrategies backfiring?

Samantha Wells1,2, Kathryn Graham1,2 & John Purcell1,3

Centre for Addiction and Mental Health, London, ON, Canada,1 University of Western Ontario, London, ON, Canada2 and University of Toronto, Toronto,ON, Canada3

ABSTRACT

Aim To describe the research, policy and prevention implications of pre-drinking or pre-gaming; that is, plannedheavy drinking prior to going to a public drinking establishment. Methods The authors describe the phenomenonof pre-drinking, motivations for pre-drinking and its associated risks using available research literature, media andpopular internet vehicles. Results Heavy drinking prior to going out has emerged as a common and celebratedpractice among young adults around the world. Apparent motivations are: (i) to avoid paying for high priced drinksat commercial drinking establishments; (ii) to achieve drunkenness and enhance and extend the night out; and (iii) tosocialize with friends, reduce social anxiety or enhance male group bonding before going out. Limited existing researchon pre-drinking suggests that it is associated with heavy drinking and harmful consequences. We argue that policiesfocused upon reducing drinking in licensed premises may have the unintended consequence of displacing drinkingto pre-drinking environments, possibly resulting in greater harms. Conclusions Effective policy and prevention fordrinking in licensed premises requires a comprehensive approach that takes into account the entire drinking occasion(not just drinking that occurs in the licensed environment), as well as the ‘determined drunkenness’ goal of someyoung people.

Keywords Drinking consequences, licensed premises, policy, pre-drinking, pre-gaming, prevention, young adults.

Correspondence to: Samantha Wells, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, London, ON, Canada N6G 4X8.E-mail: swells@uwo.caSubmitted 10 April 2008; initial review completed 23 June 2008; final version accepted 23 September 2008

INTRODUCTION

‘Pre-drinking’ (or ‘pre-gaming’, ‘pre-loading’, ‘front-loading’) involves planned heavy drinking, usually atsomeone’s home, prior to going to a social event, typicallya bar or nightclub. Although it sometimes occursin preparation for events where alcohol is not available,especially by underage drinkers [1], pre-drinking hasparticular relevance to policies influencing licensedpremises. Our present focus, therefore, is mainly ondrinking before going to commercial drinking establish-ments, such as bars and nightclubs. In the present paper,we describe the phenomenon of pre-drinking, its associ-ated risks and its implications for research, policy andprevention.

While drinking before going out may not be anentirely new phenomenon, it appears to have becomean increasingly common, intense and ritualized activityamong young adults in countries around the world[1–8]. Pre-drinking is depicted, celebrated and even glo-rified in numerous internet bulletins and blogs, YouTubevideos and Facebook entries of young adults (see, forexample, music video by Right Side of the Tree withthe lyrics ‘before we hit the town, we’re slammin’ beersdown, it’s time to get your head in the game, we’reready for the party before it starts, so grab a beer it’stime to pregame’ (http://www.youtube.com/watch?v=IbhEwC9TEIc [accessed 24 November 2008]). Pre-drinking also appears to be integral to the college/university drinking culture. For example, a Princeton

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student writes: ‘There’s nothing like taking a solid nose-dive into the sauce and then, after some sort of too-loudconsensus, finding oneself rolling 20 deep, a snuffling,lowing pack, herdin’ it on over to those well-appointedabattoirs all in a row’ [9].

Despite its ubiquitous presence on the internet and itscritical relevance to policy, surprisingly little research hasbeen conducted on pre-drinking and little considerationgiven to its policy implications. Recent research suggests,however, that a large proportion of young adults engagein pre-drinking and that it is linked to harmful con-sequences. In a study of young adults in North WestEngland [5], 55% of men and 60% of women reportedpre-drinking prior to going to a pub, bar or nightclub andpre-drinkers were significantly more likely than non-pre-drinkers to report extremely high levels of consumptionand to have experienced a fight at a bar or nightclub.Sixty-four per cent of students enrolled in an introduc-tory psychology course at a US college [1] engaged inpre-drinking prior to attending a party, bar or concert,with heavier drinking and more negative consequencesexperienced on days when pre-drinking occurred. Thirty-one per cent of students at a private liberal arts universityin Northeast US who had been referred for mandatoryintervention following an alcohol-related violation hadbeen pre-drinking on the night of their violation, andpre-drinkers reported higher consumption than didnon-pre-drinkers [6].

WHY DO YOUNG ADULTS PRE-DRINK?

An important motive for pre-drinking prior to going to abar appears to be economic; that is, to avoid paying thehigh price of drinks [2,10,11]. For example, in a study ofyoung bar-goers in Glasgow [2] one respondent noted‘. . . if you bought something with your pals first andthen drink it first . . . it will save you money’ (p. 66). Inexploratory focus group interviews with students at col-leges and universities in Pennsylvania ([10], no pagenumbers in document), one participant reported thatpre-drinking is ‘just getting drunk before you go some-where else so you don’t have to purchase as muchalcohol’.

Intoxication is also a primary motive for pre-drinking[1,5,10]. For example, one participant in the Pennsylva-nia study [10] reported: ‘No matter what the quantity,if it gets the job done, the intent is to get wasted.’Pre-drinking may be symptomatic of a ‘new culture ofintoxication’ apparent in European and other countrieswhereby young people drink and use other drugs with thestrategic and hedonistic goal of achieving drunkennessand other altered states of consciousness [12,13]. Parker& Williams [14] noted that, among young adult bar-goersin the United Kingdom, regular heavy drinking is essen-

tially normative. It is no longer a marginal phenomenonto be found among subcultures of poor or troubled youth;rather, ‘determined drunkenness seems to be a main-stream phenomenon, occurring in all social classes, inlarger cities as well as in the countryside, among girls aswell as boys’ ([15], p. 164).

Pre-drinking also offers important social functions.Young people report that pre-drinking allows them tosocialize with their friends before going out, which isoften not possible in contemporary large, crowded barsand clubs [2,10]. For example, one observer in a studyof Toronto nightclubs described a typical nightclubsetting as: ‘Very high-energy, chaotic environment—lotsof bumping, yelling, hands in the air . . . Intense energyin bar due to crowdedness . . . Generally loud andextremely lively, boisterous and rowdy’ ([16], p. 148). Incontrast, pre-drinking typically occurs in quieter and lesscrowded settings and provides an opportunity for youngpeople to talk and socialize. An additional social functionof pre-drinking among young people is to ‘ease the dis-comfort or awkwardness they associate with meetingnew people at the intended destination’ ([1], p. 243). Inthe Pennsylvania study, young people reported engagingin pre-drinking to alleviate anxiety and stress associatedwith socializing with other people [10]. Similarly, partici-pants in the Glasgow study described getting drunkbefore going to a nightclub to increase their confidenceand reduce self-consciousness [2].

An extension of these social functions is that pre-drinking also may serve to enhance group bonding,especially among young males. Grazian [11] found, forexample, that young heterosexual college men used pre-drinking to engage in a collective ritual of confidencebuilding to prepare themselves for subsequent interac-tions with the opposite sex. Participants in this researchdescribed pre-drinking events in which they locked armsin a circle, jumped in unison and chanted: activitiesdescribed by Grazian [11] as fulfilling ‘the same functionas the last minute huddle (with all hands in the middle)does for an athletic team’ (p. 230).

WHY IS PRE-DRINKING PROBLEMATIC?

Pre-drinking has been found to be associated with agreater risk of negative consequences; but why is thisso? Hughes et al. [5] speculated that it is the way peopledrink during pre-drinking events that is problematic.Because pre-drinking occurs in locations without servingrestraints and other social controls, it allows for the rapidconsumption of large quantities of alcohol. For example,young adults in New South Wales reported drinkinghalf a bottle of vodka, a bottle of wine or six or sevenbeers before going out [3]. The rapid consumption oflarge amounts of alcohol in a short period of time

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increases the risk of blackouts, passing out, hangoversand even alcohol poisoning [1]. For example, in at leasttwo independent investigations, young people reporteddrinking so much while pre-drinking they passed outor were too intoxicated to go out [10,17].

While it is possible that pre-drinking simply replacesa portion of licensed drinking (i.e. young drinkersdrink the same amount with or without pre-drinking),some research suggests that pre-drinking may increasethe overall level of alcohol consumption among youngpeople. Participants in the Pennsylvania focus groupstudy [10] indicated that pre-drinking resulted in losingtrack of how much alcohol had been consumed anddrinking more alcohol than planned. Consistent withthis, Pedersen & LaBrie [1] found that pre-drinking led tofurther heavy drinking. Additionally, a study in whichlate-night pedestrians of downtown Blacksburg, Virginiawere administered breathalyzer tests, found that bloodalcohol concentration levels were higher among partici-pants who had been pre-drinking and then went to a barcompared with participants who went to a bar withoutpre-drinking [18]. In a recent event-level study, womenwere found to drink significantly more drinks and to havehigher blood alcohol concentrations on pre-drinkingdays compared with non-pre-drinking days [19].

Another potential problem with pre-drinking is thatit may facilitate use of recreational drugs (e.g. cannabisand powder cocaine). As found by Parker & Williams[14], many young adult bar-goers purposely mix sub-stances to enhance and extend their nights out. Similarly,Brain et al. [20] found that young heavy drinkers oftenused both alcohol and illicit drugs as part of a ‘psychoac-tive “time-out” ’. Because pre-drinking occurs in anunsupervised environment, it allows for the use of illicitsubstances that might risk detection in public settings.Although most students in the Pennsylvania study [10]did not report illicit substance use while pre-drinking, onestudent noted that: ‘Weed is a big factor in pre-gaming forsome people.’ The combined effects of alcohol and illicitdrugs could increase impairment as well as risk-takingbehaviors that may, in turn, increase the likelihood ofsubsequent injury, violence or victimization.

An additional concern is that, if pre-drinking pro-motes group bonding among young males, as suggestedby Grazian [11], it may make them more likely to engagein conflicts with other groups of males at public drinkingestablishments or perhaps even prepare them for aggres-sive encounters. Bar-room research has linked the pres-ence of groups of young males with increased risk ofviolence [21]. As well, in an interview study on malebar-room aggression ([22], p. 551) one participantreported pre-drinking with friends as a kind of prepara-tion before going to a bar where they planned to beat upanother man with whom they had a grudge: ‘It’s got to be

done. So even if it takes getting a little drunk to do it,then we’ll do it.’ Given evidence that pre-drinkers were2.5 times more likely than non-pre-drinkers to reportinvolvement in a fight [5], the potential link betweenpre-drinking and aggression requires further study.

Finally, pre-drinking means that young adults requiretransportation both on their way to and from licensedpremises. While considerable prevention and policy plan-ning pertains to promoting safer ways of getting youngpeople home from licensed premises, little considerationhas been given to the fact that young people are navigat-ing public places and using various modes of transporta-tion with impaired judgement and reduced perceptionof risk on their way to licensed premises. They may drink-and-drive [10] or may experience other problems, suchas violence or victimization. Unlike downtown areas inwhich licensed premises are located, these problems mayoccur in out-of-the-way locations where there is littlepolice surveillance [5]. Overall, the implications of thispractice for personal and public health are substantial,considering the sheer numbers of young adults migrat-ing to bars and ‘club lands’ on weekends to consume evenmore alcohol [23].

IMPLICATIONS FOR RESEARCH, POLICYAND PREVENTION: ARE CURRENTPREVENTION STRATEGIES BACKFIRING?

Because many young people arrive at bars and nightclubsalready intoxicated [24], pre-drinking has particularrelevance to policy relating to licensed premises. Thewidespread phenomenon of pre-drinking begs the ques-tion: to what extent have current policies contributed topre-drinking among young adults? While factors influ-encing pre-drinking probably vary by jurisdiction anddepend on cultural drinking norms and local alcoholpolicy and licensing, one mainstay policy for licensedpremises in many jurisdictions has been the banning ofdrink promotions or specials such as ‘happy hour’ pricing[25–28]. For example, in a review of licensing authorityand court responses to applications for license extensionsin London, England, most included the requirement thatdiscount drinks not be permitted [29]. The banning ofdrink promotions is based on evidence that they contrib-ute to high levels of intoxication and problem behavior(e.g. troubles associated with 11-cent drinks at a Sydneyhotel, Austrialia, Box 2.5 [30]). However, in some juris-dictions, this policy may be having the unintended con-sequence of encouraging young people to drink cheaperalcohol in private settings before going out, especiallywhen heavily discounted prices are offered at off-premisealcohol outlets [5]. Consistent with this argument, onenightclub patron interviewed as part of a newspaperarticle on a proposed ban on drink specials following a

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bar-related brawl in Halifax, Canada [31] noted: ‘Even ifthey blame it on dollar drinks, kids are just going to spendmore at the liquor store before they go to the bar and getmore hammered that way.’ Similarly, when asked abouthow pre-drinking might be prevented, one focus groupparticipant in the Pennsylvania [10] study replied: ‘Thereused to be specials at the bars, and now there are not, somore people pre-game.’

Similarly, later closing times have been justified insome jurisdictions [e.g. [32]] as a way of reducing pro-blems associated with large numbers of young peoplebeing on the streets after drinking establishments close.However, while early closing times may result in drink-ing events occurring in private settings after bars close(i.e. ‘after-parties’ or ‘chill-out’ parties), late closing timesmay encourage private drinking to precede rather than tofollow public drinking, producing different social dynam-ics (i.e. ‘getting in the party mood’ rather than ‘keepingthe party going’; see [2]) and possibly increasing thepotential for violence and other alcohol-related problems.A number of studies have shown that longer openinghours may increase alcohol-related crime and disorder[33–35], although not all studies have found this effect[36].

One approach to discourage pre-drinking would befor licensed premises to enforce refusal of entry for into-xicated people consistently, as required by law in manyjurisdictions. While most staff training has focused uponpreventing service to intoxicated people [37–41], trainingdoor staff how to recognize the signs of intoxication andrefuse entry is also important. A potential problem withthis approach, however, is that evidence of intoxicationmay not be fully apparent when people first arrive, par-ticularly when they drink rapidly just before going out.Although breathalyzer-testing could be implemented atthe door, this has a number of logistical problems. To beeffective, breathalyzer-testing would need to be imple-mented community-wide so that pre-drinking patronsdo not simply choose venues without breathalyzers.Additionally, as argued by Hughes et al. [5], systemati-cally refusing entry to intoxicated people could result ingreater numbers of drunken people in the streets andother public places. Hobbs et al. ([42], p. 104) noted thatmuch of the current nightlife, at least in the UnitedKingdom, is not controlled by police but by a ‘privatearmy’ of security staff overseeing problems withinlicensed premises. Thus, moving the problems onto thestreet could have serious immediate consequences interms of violence and disorder that would requireadditional public resources.

An alternative approach to reduce pre-drinking mightbe to attract young people of legal drinking age back to thebar for early drinking. Although the supervisory role ofbar staff sometimes falls short of what it should be [43]

and staff have been shown to be less than perfect in imp-lementing responsible beverage service [37–41,44,45],alcohol consumption in the bar-room setting is moni-tored by serving staff, at least to some extent, and drinksare served in standard sizes. While bars and clubs arelocations for many alcohol-related problems such asaggression, prevention strategies exist and have shownsome success in making bars safer places (e.g. Canada’sSafer Bars Program [46], Responsible Beverage ServicePrograms [37–40]). In contrast, when drinking at home,young people can and do drink large amounts in a shortperiod of time, especially when pre-drinking, puttingthemselves at risk of alcohol-related harms such as black-outs, alcohol poisoning and injury. Moreover, there arefew options available to prevent harm when people aredrinking in unsupervised locations.

To reduce pre-drinking, approaches might be devel-oped that address young people’s motivations for pre-drinking, including being able to socialize with friendsand saving money. For example, drinking establishmentsmight expand their social function and create an attrac-tive atmosphere for more intimate socializing and not justbe ‘high-energy, chaotic environments’ that elicit rowdybehavior. They might also set more affordable prices forearly evening drinking, although drink promotions thatclearly encourage intoxication should be prohibited [47].In addition, as suggested by Hughes et al. [5], on- andoff-premise pricing of alcoholic beverages needs to be bal-anced in favor of reducing overall consumption in bothprivate and public settings. A shift to earlier closing timesmay also reduce pre-drinking. However, given the goalamong many young people to enhance and extend theirnights out [12], this licensing change may result inincreased post-drinking (i.e. drinking after the bars close).Overall, a careful analysis of pricing (both on and off-premises) and closing times is required to attain theright balance in terms of achieving the ultimate goal ofreducing alcohol-related harms among young people.

Perhaps the most important lesson for policy and pre-vention planning is the recognition that getting drunkappears to be an underlying motivation for drinking (andpre-drinking) among many young people, highlightingthe need for effective strategies to reduce planned intoxi-cation. For example, policy and programming aimed tochange drinking norms and promote moderation requirefurther development, implementation and evaluation.Approaches that encourage young people to make saferchoices when they are drinking require further deve-lopment and should address pre-drinking specifically[18]. For example, Lakehead University in Thunder Bay,Ontario, Canada, runs a prevention program entitled‘Pre-Thinking While You’re Predrinking’ that focuseson staying safe by arranging transportation both to andfrom the public drinking establishment.

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Pre-drinking also has implications for future research.Studies estimating the quantity of alcohol consumed byyoung people or assessing the links between alcohol useand related harms need to take into account the entiredrinking occasion, including pre-drinking. Studies areneeded examining the nature, extent and consequen-ces of pre-drinking as well as the contribution of pre-drinking to overall consumption and gender differencesin effects. To guide new prevention initiatives, furtherassessments of motives for pre-drinking are needed.Finally, research comparing jurisdictions and examiningpatterns over time is needed to assess the extent to whichpre-drinking is influenced by policies affecting licensedpremises, such as drink promotions and on- and off-premise alcohol pricing.

In sum, existing alcohol policies may not apply to thecontemporary public drinking culture of young peopleand may exacerbate rather than reduce alcohol-relatedproblems in this population. To make young people’sdrinking occasions safer, comprehensive policy andprevention planning needs to be guided by intense andthorough investigations of young people’s drinking expe-riences and the impact of alcohol policy on their drinkingbehavior.

Declarations of interest

None.

Acknowledgements

The research that inspired this paper was funded bythe Canadian Institutes of Health Research (CIHR),Operating Grant (MOP 82872). We also extend ourthanks to Peter Miller for providing valuable editorialsuggestions.

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