Recent trends identify a global rise in the use of drugs such as ecstasy as part of nightlife behaviour. In order to protect young people's health, a variety of harm reduction interventions have been implemented, often focusing on the direct effects of substance use. However, the risk to health posed by substances is also related to the nightlife environmental in which they are used. A healthy settings approach to nightclubs allows environmental issues and substance use to be tackled together. Consequently, a wider range of individuals and organisations feel capable of participating in the risk reduction process. Some countries have already developed integrated approaches to nightlife health. However, growth in international travel associated with nightlife and the additional risks posed by nightclubbing in an unfamiliar country mean that both interventions and basic health and safety measures are now required on an international basis.