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Original Article
Journal of Drug Issues
2023, Vol. 0(0) 1–15
© The Author(s) 2023
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DOI: 10.1177/00220426231197826
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Spiking Versus Speculation?
Perceived Prevalence,
Probability, and Fear of Drink
and Needle Spiking
Antonia Bendau
1,2
, Twyla Michnevich
1
, Moritz B. Petzold
1,3
,
Andrea Piest
4,5
, Rüdiger Schmolke
4,6
, Daniel Jakobson
7
,
Katharin Ahrend
7,8
, Thale Reitz
7,8
, Lukas Roediger
1,
*, and
Felix Betzler
1,
*
Abstract
Contrasting widespread speculation in the media and public debate about spiking (administration
of a substance to a person without their knowledge/consent), empirical evidence on the subject is
lacking. This study aimed to investigate the assumed prevalence, perceived likelihood, and fear of
drink-versus needle-spiking, and associated mental strain. Data from a cross-sectional online-
survey (November 2022 –January 2023) of 1916 adults connected to Berlin’s nightlife-scene were
analyzed. Almost a quarter reported having experienced drink-spiking, but only a small fraction
sought medical or police attention; about 1% suspected needle-spiking. Presumptive victims of
drink-spiking rated the likelihood and fear of spiking significantly higher and exhibited more
symptoms of depression and anxiety. Considering toxicological and police findings, the reported
prevalence and perceived likelihood of spiking seem to be highly overestimated. This, in con-
junction with associated mental strain, highlights the importance of adequately addressing the
issue of spiking through psychoeducation, prevention, and interprofessional investigation.
1
Department of Psychiatry and Neurosciences, CCM, Charit´
e–Universit¨
atsmedizin Berlin, Corporate Member of Freie
Universit¨
at Berlin and Humboldt Universit¨
at zu Berlin, Berlin, Germany
2
Department of Psychology, HMU Health and Medical University Potsdam, Potsdam, Germany
3
Department of Psychology, MSB Medical School Berlin, Berlin, Germany
4
Notdienst Berlin e.V., Berlin, Germany
5
BISS - Bundesinitiative für Sexualisierten Substanzkonsum e.V., München, Germany
6
University of Applied Sciences Potsdam, Potsdam, Germany
7
Clubcommission e.V., Berlin, Germany
8
Awareness Akademie, Berlin, Germany
*These authors should be considered joint senior author
Corresponding Author:
Antonia Bendau, Department of Psychiatry and Neurosciences, Charit ´
e–Universit¨
atsmedizin Berlin, Corporate Member
of Freie Universit¨
at Berlin and Humboldt Universit¨
at zu Berlin, Charit´
eplatz 1, Berlin 10117, Germany.
Email: antonia.bendau@charite.de
Keywords
knockout drops, injection spiking, syringe attack, unintentional drug exposure, panic
Introduction
Concerns regarding “spiking attacks”, so-called “knockout drops”,“date-rape drugs”, and related
issues have been present for many years and periodically received pronounced attention
(Blandamer et al., 2023;Sheard, 2011;Taylor et al., 2004). The discussion of this topic in media
and society has intensified in 2021 and 2022 due to the (re-)emergence of the phenomenon “needle
spiking”(Blandamer et al., 2023;Campion-Vincent, 2022;Home Affairs Committee, 2022).
Spiking is an umbrella term for the intentional administration of a substance to a person without
their knowledge or consent; often with the goal of rendering the intended recipient unconscious or
incapacitated. Drink spiking qualifies as a possible modality and refers to the addition of alcohol,
illegal substances, or prescription drugs (e.g., tranquilizers, sedatives, opioids) to non-alcoholic or
alcoholic drinks. Needle spiking (injection spiking, syringe spiking) denotes the administering of a
substance by injecting a needle. Further methods of spiking are conceivable, including the in-
tentional mislabelling of optically indistinguishable substances (e.g., labelling ketamine as
amphetamine).
Whereas mainstream media pays great attention to spiking and cites vast numbers of spiking
incidents, even calling out a “spiking epidemic”(Weaver, 2022), the empirical evidence regarding
spiking is scarce. Of the few existing studies, most concern drink spiking in the context of drug-
facilitated sexual assault (DFSA) whereas other conceivable motives and outcomes of spiking,
such as robbery, are understudied (Sheard, 2011;Swan et al., 2017).
To date, it remains elusive to accurately estimate the prevalence of spiking (Blandamer et al.,
2023;Sheard, 2011). Many individuals seem reluctant to seek medical and/or police services to
investigate suspected spiking –probably due to stigma, shame, insecurity, and other barriers
associated with such incidents (Busard `
o et al., 2019;Taylor et al., 2004). Further, even among
those who do seek professional investigation, the suspicion of spiking is often not confirmed: In
the vast majority of cases, involuntarily consumed substances are not detected or their phar-
macological profiles do not align with spiking (Greene et al., 2007;Hughes et al., 2007;Quigley
et al., 2009). Contrary to the widespread populistic assumption that gamma-Hydroxybutyric acid
(GHB) / gamma-Butyrolactone (GBL) is frequently used in drink spiking, this substance is
seldomly detected in toxicological analyses. Instead, high levels of alcohol intoxications seem to
play a much more prominent role than often expected (Anderson et al., 2019;Bühler et al., 2019;
Fiorentin & Logan, 2019;Greene et al., 2007;Hughes et al., 2007;Quigley et al., 2009). In a
prospective observational case series, Greene et al. (2007) investigated urine and blood samples
from 78 adults (mean age = 24 years; 82% women, 18% men) who presented to an emergency
department in London within 12 hours of allegedly having consumed a spiked drink. Ethanol was
detected in 90% of participants. The mean serum ethanol concentration was 1.65 g/L (range: 0.04–
3.10 g/L) and 60% exhibited a concentration associated with significant intoxication (>1.5 g/L).
Whether these levels of intoxication were voluntary or (in part) due to spiking with alcohol
remains indistinguishable. Illicit drugs were detected in 12 (15%) participants, prescription drugs
in 13 (16.7%). Illicit or medicinal substances of unexplained origin (with denied intentional
exposure) were detected in eight participants (10%). Three of these cases exhibited methyl-
enedioxymethamphetamine (MDMA), three cannabis, and two (3%) unexplained sedative drug
exposure (one case GHB/GBL; one case benzodiazepine) (Greene et al., 2007). In a prospective
observational study of 97 individuals with suspected drink spiking within the previous 12 hours at
an emergency department in Australia, nine cases appeared to be clinically plausible and in four of
2Journal of Drug Issues 0(0)
those cases unexpected substances were detected (Quigley et al., 2009). In a descriptive toxi-
cological analysis of urine and blood samples of 264 females aged ≥12 years who sought
consultation at a Sexual Assault Center in Trondheim (Norway) between 2003 and 2010, Ethanol
was again the most prevalent substance, with high concentrations frequently observed (estimated
median serum ethanol concentration at the time of assault: 1.87 g/L) (Hagemann et al., 2013). A
total of 19% screened positive for drugs; 62% of these with benzodiazepines/benzodiazepine-like-
drugs, 28% central stimulants (MDMA, amphetamine, methamphetamine), 26% cannabinoids,
and 18% opioids; no one tested positive for GHB/GBL. A total of 57 females (22%) suspected
proactive DFSA, but only seven (12%) of these individuals tested positive for substances not
voluntarily ingested (benzodiazepines, opioids, cannabis, and amphetamines). Toxicological
results from a study in Wales (UK) (Hughes et al., 2007) as well as a Canadian study of 882 alleged
victims of DFSA (mean age = 26 years; 96.2% women, 3.8% males; Du Mont et al., 2010) aligned
with these findings. In 87 (10%) cases, unexpected drugs were found, and again, most of them
were not typically expected “spiking drugs”: 40% cannabinoids, 32% cocaine, 14% amphet-
amines, 9% MDMA, 2% ketamine, and 1% GHB/GBL (Du Mont et al., 2010).
The prevalence of spiking suspicions seems to mirror the topic’s media presence and awareness
campaigns (Sheard, 2011;Taylor et al., 2004). This trend was evident for decades for drink spiking
suspicions and skyrocketed in the past two years regarding needle spiking (Blandamer et al., 2023;
Campion-Vincent, 2022;Home Affairs Committee, 2022). For example, the UK National Police
Chiefs’Council recorded 1,032 suspected needle spiking incidents between September 2021 and
December 2022 (Home Affairs Committee, 2022). In France, the Netherlands, Germany, and
various other countries, this trend has persisted (Blandamer et al., 2023;Koppen et al., 2023). To
date, none of the suspected cases have been definitively verified, neither in police investigations
nor the very few medical/toxicological case reports concerning needle spiking (Koppen et al.,
2023). Further, no study so far has directly compared subjective experiences, risk perceptions, and
fears of drink versus needle spiking.
It can be assumed that the salience of the topic, biases in its perceived likelihood, and fear
processes are connected to the high rates of unconfirmed spiking suspicions (Campion-Vincent,
2022). Theoretical frameworks (Figure 1) and empirical findings on fear of crime suggest that
demographic variables, such as gender, may be directly and indirectly related to perceived risk and
fear of spiking (Gainey et al., 2011). Specifically, individuals who perceive themselves as more
vulnerable to spiking (e.g., females) regard spiking as likelier and experience more fear as a result
Figure 1. Adapted and expanded theoretical model of fear of crime hypothesizing factors associated with
the perceived risk and fear of spiking (modified from Gainey et al., 2011).
Bendau et al. 3
(Brooks, 2014;Gainey et al., 2011). Evidence on the link between experiences as a victim and fear
of crime is sparse and inconsistent but it can be assumed that having been (allegedly) subjected to a
spiking incident in the past is associated with a higher perceived risk and fear of spiking (Gainey
et al., 2011). Further, indirect information about crime from media coverage and word of mouth
seemed to influence risk perception and fear in previous studies (Chiricos et al., 2000;Gainey
et al., 2011;Weiss & Colyer, 2010). These effects may also be applicable to spiking. However,
research that specifically examines the connections between sociodemographic characteristics,
previous alleged spiking incidents, subjective risk perception, and fear associated with drink
versus needle spiking is currently absent. The present study addresses this research gap. In
addition, the study aimed to investigate associations of depressive and anxiety symptoms with
spiking-related experiences, perceptions, and fears, as psychological distress could be a con-
sequence of alleged spiking incidents as well as a pre-existing vulnerability factor (Anderson et al.,
2017).
Methods
Study Design
The data were collected within the framework of a larger cross-sectional research project focusing
on the perception, consumption, and risk mitigation of GHB/GBL. The survey was conducted
online via the platform SoSci Survey from November 19, 2022 to January 16, 2023.
Participants were recruited via non-probability convenience sampling; primarily through social
media channels (Instagram, Facebook) of institutions, organizations, and associations within the
Berlin nightlife scene, as well as prevention and counselling services in Berlin. The inclusion
criteria were a minimum age of 18 years and sufficient language proficiency to complete the
questionnaire in German or English. Written informed consent was obtained from all participants
before participation. Monetary or material incentives were not offered in exchange for partici-
pation. The study was granted ethical approval by the Ethics Committee of Charit´
e–Uni-
versit¨
atsmedizin Berlin and pre-registered at Deutsches Register Klinischer Studien (https://drks.
de/search/de/trial/DRKS00030608).
The questionnaire was accessed 4155 times; 2668 individuals completed (at least distinct parts
of) the questionnaire and a final sample of 1916 participants completed the items regarding drink
and needle spiking.
Assessment
The online survey captured sociodemographic information (e.g., gender, age). Past suspicions of
drink or needle spiking occurrences among themselves or their social contacts were assessed with
two dichotomous items (yes/no). The perceived likelihood of becoming subjected to drink or
needle spiking, respectively, was rated on a 5-point Likert-scale from 1 (very unlikely) to 5 (very
likely). The fear of becoming a victim of drink or needle spiking, respectively, was also answered
on a 5-point Likert-scale from 1 (very low) to 5 (very high).
The two subscales of the well-established Patient Health Questionnaire-4 (PHQ-4, (L¨
owe
et al., 2010) were used to assess the dimensional presence of core symptoms of depression (PHQ-
2) and generalized anxiety (GAD-2). The PHQ-2 and GAD-2 subscales comprise two items each,
which rate the intensity of the symptoms on 4-point Likert-scales ranging from 0 (not at all) to 3
(nearly every day). A subscale sum score of ≥3, and a total score of ≥6, are indicative of high
symptom severity and are considered alarming.
4Journal of Drug Issues 0(0)
Analyses
Statistical analyses were performed with IBM SPSS Statistics Version 29. The significance level
was set at .05 (two-tailed). Descriptive statistics were utilized to examine the prevalence of spiking
occurrences and the levels of perceived likelihood and fear of spiking; Odds Ratios were cal-
culated to quantify gender-based differences in the rates of spiking incidents. ANOVAs were used
to analyze differences in perceived likelihood and fear based on spiking modalities (drink vs.
needle), gender, sexual orientation, and past suspicion of spiking. The association of perceived
likelihood and fear with age were tested with Pearson’s correlations. ANOVAs, controlling for age
and gender, were carried out to determine differences in mental strain based on past suspicion of
having been subjected to spiking. Partial Pearson’s correlations (controlling for age, gender, and
past suspicion of spiking) were used to explore the relationship of depressive and anxiety
symptoms with perceived likelihood and fear of spiking.
Results
Sample Characteristics
Of the final sample of N= 1916 individuals, 48.7% (n= 933) reported identifying as male, 43.5%
(n= 833) as female, 5.3% (n= 101) as diverse, and 1.8% (n= 34) as other (e.g., non-binary,
agender); 0.8% (n= 15) of participants did not indicate their gender. The mean age was
29.23 years (SD = 6.82; range: 18 –62). About half (51.3%, n= 983) of the sample was employed,
14.9% (n= 286) self-employed, 4.6% (n= 88) unemployed/work-seeking, 21.7% (n= 416)
enrolled at university, 5.2% (n= 99) in vocational training, and 1.3% (n= 24) in school. Sexual
orientation was heterosexual for 45.1% (n= 865), homosexual for 27.0% (n= 518), bisexual for
21.3% (n= 408), and other for 5.4% (n= 103) (e.g., pansexual, asexual).
Subjective Experiences With Spiking
Figure 2 depicts the percentage of respondents who suspected that they or others in their social
environment had been previously subjected to drink or needle spiking. About half (53.3%, n=
1021) of the participants reported that someone in their social environment had been subjected to
drink spiking, almost a fifth (18.2%, n= 348) indicated knowing someone who was affected by
Figure 2. Percentage of participants who expressed suspicion of having been a victim of spiking themselves
or knowing someone in their social environment who had experienced spiking.
Bendau et al. 5
needle spiking, but only a fraction subsequently underwent a medical or police examination.
Almost a quarter (22.2%, n= 425) of the sample reported that drink spiking happened to them, but
again only a negligible fraction sought medical examination (2.7%) or initiated police investi-
gation (0.9%) concerning this matter. Only a few individuals (1.3%, n= 25) suspected themselves
to have been victims of needle spiking and even fewer have had this inspected by medicals and/or
the police.
Participants identifying as females most frequently reported the suspicion of having experi-
enced drink spiking (26.5% of female participants), followed by diverse (25.7%), others (23.5%),
and males (18.1%). The Odds Ratio (OR) between females and males was 1.63 (95% confidence
interval (95%-CI): 1.3, 2.05; p< .001). Regarding needle spiking, again the percentage in females
was higher than in males (2.2% vs. .6%; OR = 3.41, 95%-CI: 1.35, 8.64); in the smaller sub-
samples of individuals identifying as diverse or other, no one reported a needle spiking suspicion.
Perceived Likelihood and Fear of Spiking
Figure 3 and Table 1 present the perceived likelihood and fear of becoming subjected to drink
spiking (for the total sample and, in Table 1, divided by gender, sexual orientation, and previous
presumptive experience with drink spiking). The likelihood of drink spiking was rated sub-
stantially higher than the likelihood of needle spiking (repeated measures ANOVA: F(1,1804) =
454.702, p< .001; η
2
= .201), whereas fear of drink over needle spiking was higher with a very
small effect size (F(1,1829) = 10.146, p< .001; η
2
= .006).
Higher age was associated with a lower perceived likelihood and fear of spiking (see Table 1).
Significant gender differences were observed in the perceived likelihood and fear of becoming
subjected to drink and needle spiking, respectively. On average, females reported the highest
perceived likelihood and fear, males the lowest.
The differences in the perceived likelihood and fear of spiking among individuals of different
sexual orientations (see Table 1) might partly be accounted for by unequal gender distributions.
For instance, the majority of homosexual participants indicated male gender (84.7% male, 6.9%
female, 7.5% diverse, 0.8% other), while the majority of bisexual participants was female
Figure 3. Perceived likelihood and fear of a spiking incident in the future.
6Journal of Drug Issues 0(0)
Table 1. Perceived Likelihood and Fear of Becoming Subjected to Spiking –As a Function of Age, Gender,
Sexual Orientation, Self-Reported Suspicion of Having Been a Victim of Drink Spiking in the Past, and Mental
Strain.
Perceived Likelihood of Perceived Fear of
Drink Spiking Needle Spiking Drink Spiking Needle Spiking
Total sample M±SD 2.68 ± 1.16 2.16 ± 1.12 2.70 ± 1.28 2.62 ± 1.39
Median 2.00 2.00 2.00 2.00
Gender
Female M±SD 3.13 ± 1.17 2.60 ± 1.17 3.18 ± 1.26 3.16 ± 1.37
Median 3.00 3.00 3.00 3.00
Male M±SD 2.27 ± 1.01 1.77 ± .91 2.24 ± 1.13 2.13 ± 1.24
Median 2.00 2.00 2.00 2.00
Diverse M±SD 2.64 ± 1.07 2.15 ± 1.10 2.77 ± 1.20 2.55 ± 1.29
Median 2.00 2.00 3.00 3.00
Other M±SD 2.79 ± .93 2.39 ± 1.03 2.94 ± 1.22 2.88 ± 1.36
Median 3.00 3.00 3.00 3.00
Between-subjects
ANOVA:
F(3,1804) =
54.885, p< .001;
η
2
= .084
F(3,1865) =
53.856, p< .001;
η
2
= .080
F(3,1830) =
49.953, p< .001;
η
2
= .076
F(3,1864) =
49.110, p< .001;
η
2
= .073
Sexual orientation
Heterosexual M±SD 2.72 ± 1.14 2.26 ± 1.13 2.78 ± 1.26 2.75 ± 1.41
Median 3.00 2.00 3.00 3.00
Homosexual M±SD 2.29 ± 1.07 1.77 ± .97 2.26 ± 1.19 2.11 ± 1.27
Median 2.00 1.00 2.00 2.00
Bisexual M±SD 3.04 ± 1.14 2.39 ± 1.13 3.04 ± 1.28 2.90 ± 1.38
Median 3.00 2.00 3.00 3.00
Other M±SD 2.88 ± 1.32 2.42 ± 1.17 2.87 ± 1.32 2.93 ± 1.30
Median 3.00 2.00 3.00 3.00
Between-subjects
ANOVA:
F(3,1778) = .664,
p= .574; η2=
.002
F(3,1839) =
1.235, p= .296;
η2 = .002
F(3,1805) =
1.328, p= .264;
η2 = .002
F(3,1838) = .912,
p= .435; η2=
.001
Past drink spiking
Suspected M±SD 3.34 ± 1.11 2.35 ± 1.11 3.33 ± 1.19 2.93 ± 1.34
Median 4.00 2.00 3.00 3.00
Not
suspected
M±SD 2.79 ± 1.10 2.11 ± 1.11 2.52 ± 1.24 2.53 ± 1.40
Median 2.00 2.00 3.00 2.00
Between-subjects
ANOVA:
F(1,1804) =
33.572, p< .001;
η2 = .018
F(1,1865) =
2.800, p= .094;
η2 = .001
F(1,1830) =
20.313, p< .001;
η2 = .011
F(1,1864) =
1.574, p= .210;
η2 = .001
Age
Pearson’s correlation: r=.238,
p< .001
r=.220,
p< .001
r=.202,
p< .001
r=.234,
p< .001
Mental strain
Depressive symptoms r= .063, p= .021 r= .040, p= .140 r= .075, p= .006 r= .073, p= .008
Anxiety symptoms r=.072, p= .009 r= .033, p= .226 r= .085, p= .002 r= .053, p= .053
Note. The perceived likelihood of becoming subjected to spiking was rated on a 5-point Likert-scale from 1 (very unlikely)
to 5 (very likely). The fear of becoming subjected to spiking was rated on a 5-point Likert-scale from 1 (very low) to 5 (very
high). For categorial data, between-subjects ANOVAs were conducted; for quantitative data, (partial) Pearson’s cor-
relations were calculated (controlling for age, gender, and past suspicion of spiking when analyzing correlations with mental
strain). Bold formatting to visually distinguish M & SD from the median.
Bendau et al. 7
(68.1% female, 20.6% male, 8.3% diverse, 2.9% other). Upon controlling for the effect of gender,
none of the mean differences between sexual orientations were significant.
Individuals with assumed past exposure to drink spiking rated the likelihood of drink spiking,
but not needle spiking, significantly higher than those unexposed (see Table 1). Participants’fear
of spiking followed a similar pattern.
Mental Strain and Spiking
Symptoms of depression were higher in individuals who reported alleged drink spiking in the past
(M= 1.99, SD = 1.68) compared to those who did not (M= 1.68, SD = 1.53) (between subjects
ANOVA controlled for age and gender: F(3,1391) = 8.412, p= .004; η
2
= .006). A similar finding
occurred with regard to symptoms of generalized anxiety: M= 2.00 (SD = 1.72) versus M= 1.56
(SD = 1.52), F(3,1391) = 17.534, p< .001; η
2
= .012.
Higher symptoms of depression were associated with a higher perceived likelihood of drink
(r= .063, p= .021) but not needle spiking (r= .040, p= .140) as well as a more pronounced fear of
becoming subjected to drink (r= .075, p= .006) and needle spiking (r= .073, p= .008). A
corresponding pattern of results was evident for anxiety symptoms (see Table 1).
Discussion
Summary and Interpretation of the Results
The study investigated alleged victimization, perceived likelihood, and fear of drink versus needle
spiking, and its associations with mental strain. Results indicate that a substantial percentage of the
sample suspected having been subjected to drink spiking themselves (22%) or knowing an alleged
victim (53%), but only a negligible fraction sought medical attention or initiated police inves-
tigation. This corresponds to the finding of Hughes et al. (2007) that only 14% of the patients
presenting to an emergency department in the UK with alleged drink spiking informed the police
about their drink spiking suspicion. Thus, the barriers to medical examination seem very high and
those to police investigation even higher. Reasons for reluctance to report alleged incidents may
include a perceived or actual difficulty in accessing appropriate services, feared harsh treatment in
emergency departments and police stations, stigmatization, shame, guilt, and blurred memories
(Busard`
o et al., 2019;Dinis-Oliveira & Magalhães, 2013). Therefore, efforts should be aspired to
reduce the barriers in a transdisciplinary manner. For example, by providing services specialized
in spiking suspicions and being particularly sensitive with potentially affected individuals
(Blandamer et al., 2023). Significantly fewer participants reported being subjected to needle
spiking compared to drink spiking. However, the percentage of 1% (and 18% reportedly knowing
an alleged victim of needle spiking) is still remarkably high, considering that not a single case of
needle spiking has been undoubtedly proven so far (and taking into account that the subcutaneous
or intramuscular injection of an effective dose of a sedative substance is unlikely to happen
completely unnoticed). That actual medical or police evidence is not always decisive with regard
to the conviction of having been spiked, was previously implied by findings of Hughes et al.
(2007): Irrespective of the negative toxicology results, 35% of the individuals still believed that
they had been subjected to drink spiking. Commonly expressed reasons are the limited de-
tectability of certain substances due to rapid metabolization and the presumed involvement of
unknown/untested substances (Busard`
o et al., 2019;Morgillo et al., 2023). These arguments
cannot be entirely dismissed. However, it can be assumed that toxicological studies with a narrow
time window (e.g., max. 12 hours) between alleged substance intake and sample extraction, and a
8Journal of Drug Issues 0(0)
comprehensive composition of toxicological tests, have very high detection rates (Bühler et al.,
2019;Greene et al., 2007;Quigley et al., 2009).
Females reported the suspicion of having experienced drink and needle spiking significantly
more frequently than males. This is congruent with findings from previous studies (Anderson
et al., 2019;Busard`
o et al., 2019;Fiorentin & Logan, 2019). For example, in an observational
study of 6064 university students in the US, 10% of females and 4% of males reported having been
drink spiked (Swan et al., 2017). Outcomes after (alleged) drink spiking also differed with female
victims experiencing more negative outcomes such as sexual assault and blacking out, while male
victims were more likely to have been physically hurt by others (Swan et al., 2017). In our study,
females reported the highest levels of perceived likelihood and fear of drink and needle spiking,
compared to other genders. This is in line with the assumption that (subjective) vulnerability is
associated with higher risk perception and fear (Figure 1). Age also appears to play a part, with
younger individuals rating risk and fear of spiking higher. Beyond actual differences in the risk of
becoming subjected to spiking, this might be attributed to a tendency of younger individuals to
consume more media coverage on this topic, leading to a stronger salience of this subjective threat.
It should be noted, nonetheless, that the magnitude of the differences and correlations, albeit
statistically significant, was relatively small.
The fear of drink versus needle spiking was similar, whereas the perceived likelihood of drink
spiking was rated higher than needle spiking. About a third of the sample thought it likely or very
likely they would become subject to drink spiking (33.8%), and more than a quarter thought the
same for needle spiking (27.9%). Considering the very small percentage of actually confirmed
drink spiking cases (Greene et al., 2007;Hughes et al., 2007;Quigley et al., 2009) and no
confirmed case of needle spiking (Koppen et al., 2023), this subjectively perceived likelihood of
spiking, particularly of needle spiking, seems to be highly overestimated (Campion-Vincent,
2022;Colyer & Weiss, 2018;Weiss & Colyer, 2010). This may be attributable to the extensive
media coverage and public debate, particularly with a focus on needle spiking, resulting in
increased salience of the perceived threat (Figure 1) and the emergence of processes of social panic
(Campion-Vincent, 2022;Sheard, 2011). High or very high fear of drink (29.5%) and needle
spiking (29.6%) was very prevalent in the study sample, which emphasizes the need to address
these concerns with appropriate measures (e.g., taking this aspect of distorted risk perception into
account in information campaigns by counselling services, feeding this information on social
media channels that relate to nightlife etc.).
Individuals who reported to have putatively been victims of drink spiking rated the likelihood
and fear of drink and needle spiking, respectively, significantly higher than those who did not
suspect they had been previously affected. Further, allegedly affected individuals reported higher
symptoms of depression and generalized anxiety. In addition, a higher perceived likelihood and
fear of becoming subjected to drink and needle spiking was associated with more symptoms of
depression and anxiety. This underscores the importance of taking mental health into consid-
eration in the context of (alleged) spiking incidents. Psychological distress may arise as a
consequence of such incidents, which could be regarded as traumatic or distressing events. At the
same time, higher state anxiety, rumination, and riskier substance use may be linked to a higher
(perceived) probability and fear of spiking. In a study by Anderson et al. (2019), alleged victims of
spiking (in the context of DFSA) exhibited a four times higher prevalence of self-reported
premorbid depression (12-month prevalence: 21%) and a two times higher prevalence of drug and
alcohol abuse (10%) than the general population (Anderson et al., 2019).
It seems to be relevant to consider voluntary substance use as a vulnerability factor for actual
spiking incidents as well as unconfirmed suspicions. The vast majority of alleged victims vol-
untarily consumed psychoactive substances; alcohol emerged as the most commonly consumed
substance, whereas concomitant use of alcohol, prescription drugs, and illicit drugs was also
Bendau et al. 9
frequently reported (Anderson et al., 2017,2019;Greene et al., 2007;Hagemann et al., 2013;
Hughes et al., 2007;Quigley et al., 2009). In addition, there appears to be a tendency among
potential victims to underreport drug use (Juhascik et al., 2007), possibly due to memory errors,
response biases (such as social desirability), and concerns about stigmatization. In fact, victim-
blaming occurs more frequently in DFSA-cases with intentional substance use (Clough, 2019;
Girard & Senn, 2008;Thompson, 2021). This emphasizes the importance of reducing stigma and
provide adequate care for potential victims. Further, preventive efforts often solely focus on the
behavior of potentially affected individuals (e.g., watching drinks, using protective devices),
which is problematic because it places the responsibility on the potential victims and, additionally,
self-administered devices to detect spiked drinks often fail in providing valid and reliable results
(Quest & Horsley, 2007). As a side effect of prevention messages and devices it should be noted
that their amplified presence in specific environments (e.g., clubs) may engender a perception of
spiking as a ubiquitous or selectively prevalent phenomenon (Sheard, 2011;Taylor et al., 2004). In
addition, extensive campaigns concerning spiking may potentially deflect attention and resources
from other (more prevalent) risks, such as harmful excessive alcohol consumption.
Preventive efforts should also educate about the effects of alcohol and other substances, as well
as various physiological and psychological processes. For example, hypoglycemia, dehydration,
or sleep deprivation can trigger physiological sensations similar to those of being spiked with a
sedative substance (Zucker et al., 2022). Additionally, even if individuals are familiar with specific
substances, they do not always have the same effect and can sometimes trigger unexpected
symptoms. Moreover, unclear somatic sensations can exacerbate into severe panic symptoms
(which again correspond to possible spiking symptoms), especially when combined with anxiety
processes - for example, due to high salience and social panic regarding spiking. Notably, the
surge in suspected needle spiking incidents coincided with the reopening of nightlife venues in
different countries (Blandamer et al., 2023); a prolonged hiatus and pandemic-related strains may
have fostered a sense of unfamiliarity or estrangement within the party context, leading indi-
viduals to be more susceptible to misperceptions.
While previous awareness campaigns focused mainly on spiking in public spaces (e.g., bars and
clubs) and anonymous perpetrators, it is important not to lose sight of private settings. In an Australian
study, half of the examined alleged DFSA-cases occurred in private residences, and in half of the
incidents, the perpetrators were known to the complainant (Anderson et al., 2019). This is not only
pertinent in the context of DFSA, but also spiking incidents with other motives, such as enhancing
social enjoyment among friends during a home-based gathering (Swan et al., 2017). Even though
participants in our study were primarily recruited from nightlife-associated settings, it is plausible that
some of the suspected spiking incidents have occurred in private settings or the context of intimate
encounters (as the questionnaire was not specifically about spiking in nightlife-related situations).
Future research should endeavor to differentiate more clearly between different contexts.
In the future, preventive attention should also be extended to (potential) perpetrators and their
motives (Costello & Blyth, 2004). Yet, no empirical data on needle spiking addresses this and only
scattered findings exist regarding drink spiking. In a survey by Swan et al. (2017), 1.4% (83
students; 1.2% of female students and 1.8% of male students) indicated that they or someone they
know had purposefully drink-spiked someone. Participants’views on motives for drink spiking
varied by gender, with women being more likely to assume sex or sexual assault as a motive, while
men were more likely to mention having fun (Swan et al., 2017). Other motives reported or
assumed by participants included getting others more intoxicated or relaxed.
10 Journal of Drug Issues 0(0)
Limitations
Our sample was recruited through convenience sampling, which may limit its representativeness. For
instance, individuals with an interest in the topic and those more proficient with online media may have
been more likely to participate. All outcome measures were obtained through self-report, which can be
susceptible to deliberate as well as unaware biases such as retrospective memory and response biases.
So as not to overwhelm participants and minimize dropout rates, we used primarily brief instruments in
our investigation. This may have reduced the overall conclusiveness and reliability of our results
compared to more extensive instruments, and the complex topic of spiking may not have been
encompassed in all relevant dimensions. Future research should strive to comprehensively assess
spiking in more detail, potentially incorporating alternative modalities of spiking, such as intentional
mislabelling of substances, and investigate a broader range of related variables. Whenever possible,
subjective self-report information should be complemented with objective data (e.g., toxicological
findings). Due to the cross-sectional observational study design, the effects of unconsidered third
variables cannot be ruled out and no causal conclusions can be drawn. Thus, future longitudinal studies
as well as randomized-controlled trials, if feasible, are desirable.
Conclusions
In summary, our findings suggest that the subjective threat of drink and needle spiking is high.
Considering toxicological findings and police investigations, the reported prevalence and per-
ceived likelihood of spiking seem highly overestimated –nevertheless, every allegedly affected
individual must be taken seriously and treated sensitively and adaptively. The high perceived
prevalence and subjective likelihood in combination with associated fear, anxiety, and depressive
symptoms emphasizes the importance of adequately addressing the issue of spiking and associated
fears in the society, explaining reasons for unconfirmed spiking-like symptoms, and improving
awareness, prevention, and medical-toxicological as well as police-related investigation efforts.
Ethical Statement
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the
ethical standards of the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Acknowledgments
We would like to thank Clubcommission e.V. Berlin,SONAR –Safer Nightlife Berlin, and Notdienst e.V.
Berlin for the support in conceptualization and data collection. Further, we thank Lucie Schr¨
oder, Grace
Viljoen, and Dr Helene Naegele for their support in designing and preparing the survey.
Author Contributions
Antonia Bendau: Project Administration, Conceptualization, Methodology, Investigation, Data Curation,
Formal analysis, Visualization, Writing –Original Draft. Twyla Michnevich: Conceptualization, Writing -
Review & Editing. Moritz Bruno Petzold: Conceptualization, Writing - Review & Editing. Andrea Piest:
Bendau et al. 11
Conceptualization, Writing - Review & Editing. Rüdiger Schmolke: Conceptualization, Writing - Review &
Editing. Daniel Jakobson: Conceptualization, Writing - Review & Editing. Katharin Ahrend: Concep-
tualization, Writing - Review & Editing. Thale Reitz: Conceptualization, Writing - Review & Editing.
Lukas Roediger: Project Administration, Conceptualization, Investigation, Data Curation, Writing - Review
& Editing. Felix Betzler: Conceptualization, Supervision, Writing - Review & Editing.
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship,
and/or publication of this article: Felix Betzler received honoraria (consulting, lectures) from Takeda
Pharmaceutical. All remaining authors declare that they have no conflict of interest.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Research Transparency Statement
The authors are willing to share their data, analytics methods, and study materials with other researchers. The
material will be available upon request.
Design and Analysis Transparency
The STROBE checklist for observational studies served as reporting guideline for the study.
Preregistration Statement
The authors have pre-registered this research at Deutsches Register Klinischer Studien (https://drks.de/
search/de/trial/DRKS00030608) without an analysis plan.
ORCID iD
Antonia Bendau https://orcid.org/0000-0002-3789-6205
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Author Biographies
Antonia Bendau is a psychologist and researcher at Charit ´
e–Universit¨
atsmedizin Berlin. Her
research interests include intentional and involuntary substance intake, anxiety disorders, and
sports psychiatry.
Twyla Michnevich is a psychiatry resident and clinical researcher at Charit´
e–Uni-
versit¨
atsmedizin Berlin. Her research interests focus on expectation effects, e-mental health, and
substance abuse.
Moritz B. Petzold is a professor at Medical School Berlin. He conducts research in psychiatry,
clinical trials, substance use, and associations of physical activity with mental health.
Andrea Piest is engaged in social work and drug counseling. In her practical work as well as in
research, she primarily focuses on prevention and harm reduction, risk competence, drug in-
formation, and health promotion strategies.
Rüdiger Schmolke is involved in the field of drug prevention and counseling. He holds expertise
in drug trends, risk competence, drug information, and health promotion strategies.
Daniel Jakobson works in the field of political, media, and cultural communication. He has
expertise in communication strategies, prevention, and harm reduction.
14 Journal of Drug Issues 0(0)
Katharin Ahrend is head of the Awareness Akademie Berlin, leads the work in the field of Awareness
& Diversity at Clubcommission Berlin, and holds expertise in awareness, anti-discrimination, and
harm reduction.
Thale Reitz works in the field of awareness and diversity at Clubcommission Berlin and
Awareness Akademie Berlin and holds expertise in harm reduction, diversity, and awareness.
Lukas Roediger is a psychiatry resident and clinical researcher at Charit´
e–Universit¨
atsmedizin
Berlin. His research primarily focuses on (recreational) substance use.
Felix Betzler is a medical specialist in psychiatry and psychotherapy and head of the research
group Recreational Drugs at Charit´
e–Universit¨
atsmedizin Berlin. His research interests include
psychiatry, substance use, prevention and harm reduction, and therapeutic aspects of recreational
drugs.
Bendau et al. 15
