The 2024 European School Survey Project on Alcohol and Other Drugs (ESPAD) has recently released comprehensive findings that illuminate the complex landscape of European youth substance use across 37 countries. Furthermore, surveying 113,882 students aged 15-16, this landmark study provides the most extensive dataset on adolescent substance behaviours, ultimately marking 30 years of continuous monitoring across Europe.

The Scale and Scope of European Youth Substance Use

The ESPAD 2024 survey represents the largest collection of data on teenage substance abuse in Europe, spanning from Iceland to Cyprus and covering diverse cultural, economic, and social contexts. Moreover, the findings reveal significant variations between countries whilst simultaneously highlighting concerning patterns that transcend national boundaries.

Across the surveyed population, substance use remains widespread, with 73% of students reporting lifetime alcohol consumption, 32% having tried cigarettes, and 12% having used cannabis at least once. Nevertheless, these figures, whilst showing long-term declining trends in some areas, mask emerging challenges that require urgent attention from education and health professionals.

Alcohol Consumption: Persistent Patterns and Regional Variations

Lifetime and Current Use Statistics

Alcohol consumption remains the most prevalent form of substance use among European adolescents. Specifically, the ESPAD 2024 data reveals that 73% of students report lifetime alcohol consumption, with significant variations between countries. Hungary leads with 91% lifetime prevalence, followed closely by Denmark at 90%, whilst Kosovo shows the lowest rate at 29% and Iceland at 41%.

Similarly, current alcohol use, defined as consumption within the past 30 days, affects 42% of students across ESPAD countries. Denmark reports the highest rate at 68%, followed by Germany at 62%, whilst Iceland (12%) and Kosovo (14%) show the lowest prevalence rates.

Early Initiation and Heavy Drinking Patterns

The data reveals concerning patterns of early alcohol initiation, with 33% of ESPAD students reporting their first alcoholic drink at age 13 or younger. Notably, Georgia shows the highest rate of early drinking at 64%, followed by Moldova at 49%, whilst Iceland (12%), Kosovo (14%), and Norway (14%) report the lowest rates.

Even more alarming is the prevalence of early drunkenness, with 8% of students reporting experiencing intoxication at age 13 or younger. Once again, Georgia leads this concerning statistic at 25%, followed by Bulgaria at 14%, whilst Kosovo (3%), France and Portugal (both 3.6%), and the Faroe Islands (3.9%) show the lowest rates.

Binge Drinking and Heavy Episodic Consumption

Binge drinking, defined as consuming five or more drinks on a single occasion within the past 30 days, affects 31% of European students on average. Consequently, Denmark reports the highest rate at 55%, followed by Germany (49%) and Austria (48%), whilst Iceland shows the lowest prevalence at 8.9%.

Additionally, recent alcohol intoxication (within the past 30 days) is reported by 13% of all ESPAD students, with Denmark leading at 36%, followed by Austria (24%) and Hungary (22%). In contrast, Kosovo reports the lowest rate at 4.9%.

Gender Differences in Alcohol Consumption

The data reveals evolving gender patterns in alcohol use. Specifically, lifetime alcohol consumption shows slightly higher prevalence among girls (74%) than boys (72%), a trend observed in more than half of the participating countries. Furthermore, the most pronounced gender differences are found in Iceland (48% versus 34%), Latvia (84% versus 73%), and Lithuania, Malta, and Monaco, each showing a 10-percentage-point gap favouring girls.

Historical Trends in Alcohol Use

Long-term trend analysis reveals that lifetime alcohol consumption has declined from 88% in 1995 to 74% in 2024, though with some fluctuations over the period. Particularly, the most dramatic decreases occurred in Iceland (from 79% to 41%) and Sweden (from 89% to 56%).

Similarly, current alcohol use (past 30 days) has also declined significantly, dropping from 55% in 1995 to 43% in 2024. Moreover, the greatest reductions are observed in Iceland (from 56% to 12%), Ireland (from 66% to 35%), and Finland (from 57% to 27%).

Tobacco and E-Cigarette Use: Shifting Patterns of Nicotine Consumption

Traditional Cigarette Use Statistics

Cigarette smoking has undergone dramatic changes over the past three decades. Currently, lifetime cigarette use affects 32% of ESPAD students on average, with Hungary (51%) and Slovakia (46%) showing the highest prevalence, whilst Iceland (13%) and Malta (16%) report the lowest rates.

Furthermore, current cigarette use (past 30 days) is reported by 18% of students, with Croatia and Hungary both at 32%, whilst Iceland (4.2%) and Sweden (8.2%) show the lowest prevalence. Additionally, daily cigarette consumption affects 7.9% of students, with Bulgaria and Croatia leading at 20% and Iceland showing the lowest rate at 0.8%.

Early Smoking Initiation

Early smoking initiation (at age 13 or younger) affects 15% of ESPAD students on average. Specifically, Slovakia (24%) and Kosovo (23%) report the highest proportions, whilst Iceland (6.4%) and Malta (7.1%) show the lowest rates. Importantly, in just over half the countries, early smoking initiation is more common among girls, particularly in Bulgaria (23% versus 17%).

Historical Trends in Cigarette Use

The 30-year trend data shows remarkable progress in cigarette smoking reduction. Significantly, lifetime prevalence has halved from 68% in 1995 to 32% in 2024, with the most notable decrease occurring between 2019 and 2024 (a drop of 10 percentage points). Consequently, the greatest reductions occurred in the Faroe Islands, Ireland, Iceland, and Sweden.

Likewise, daily smoking has declined from 20% in 1995 to 8% in 2024, whilst current use (past 30 days) has dropped from 33% to 18% over the same period.

The E-Cigarette Phenomenon

E-cigarette use represents a significant new challenge in European youth substance use patterns. On average, 44% of students report lifetime e-cigarette use, with national prevalence ranging from 22% in Portugal to 57% in Hungary. Remarkably, in 13 out of 37 ESPAD countries, at least half of all students have tried e-cigarettes.

Moreover, current e-cigarette use (past 30 days) affects 22% of students, with Poland leading at 36% and Serbia at 34%, whilst Portugal and the Faroe Islands both report 6.4% and Malta 10%.

E-Cigarette Trends and Gender Patterns

Girls (46%) report higher lifetime e-cigarette prevalence than boys (41%), with exceptions in Kosovo, Georgia, Moldova, the Faroe Islands, North Macedonia, Ukraine, and Portugal. The largest gender differences are found in Liechtenstein and Malta, where prevalence among girls exceeds boys by 13 percentage points.

Early e-cigarette initiation (at age 13 or younger) affects 16% of students on average, with Estonia (33%) and Lithuania (31%) showing the highest proportions, whilst Portugal (5.4%) and Montenegro (7.4%) report the lowest rates.

Dual Use Patterns

The concept of dual use—combining traditional cigarettes and e-cigarettes—reveals the true scope of nicotine consumption among European youth. When considering both products together, lifetime use increases from 32% to 47%, whilst current use rises from 18% to 28%.

Daily dual consumption affects 14% of students (15% among girls versus 12% among boys), with Bulgaria and Hungary both reporting 25%. Daily use initiated at an early age increases from 3.9% to 6% when dual use is considered.

Cannabis Use: Trends and Accessibility Patterns

Prevalence and Country Variations

Cannabis remains the most commonly used illicit drug across all ESPAD countries, with 12% of students reporting lifetime use on average. Czechia leads with 24% lifetime prevalence, followed by Liechtenstein at 23%, whilst Georgia (3.3%) and Moldova (2.5%) show the lowest rates.

Current cannabis use (past 30 days) remains below 10% in all ESPAD countries, with Italy and Slovenia both at 8.6% and Liechtenstein at 9.6%. The lowest figures, below 2%, are observed in Moldova, Georgia, Romania, and the Faroe Islands.

Early Initiation and High-Risk Use

Early cannabis initiation (at age 13 or younger) affects 2.4% of ESPAD students on average. Ukraine (4.9%) and Czechia (4.1%) record the highest proportions, whilst Moldova shows the lowest at 0.7%.

High-risk cannabis use, assessed through the Cannabis Abuse Screening Test (CAST) among past-year users, ranges from below 1% in Moldova and Georgia to a maximum of 5.9% in both Czechia and Slovenia.

Perceived Accessibility

Cannabis is perceived as the most accessible illicit substance, with 26% of ESPAD students considering it fairly or very easy to obtain. Availability perception is highest in Denmark, Germany, and Slovenia (all 41%) and Norway (40%), whilst the lowest perceived availability is reported in Moldova (5.3%), Ukraine (7.1%), and the Faroe Islands (11%).

Gender Patterns in Cannabis Use

Although the overall gender gap has decreased over time, boys continue to report higher cannabis use than girls on average (13% versus 11%). This trend is particularly evident in Ukraine (15% versus 6.7%) and Montenegro (13% versus 6.8%). However, Malta stands out as an exception, where cannabis use is more prevalent among girls (14%) than boys (8.6%).

Historical Trends in Cannabis Use

Cannabis use has shown notable fluctuations over three decades. Lifetime prevalence peaked at 18% in both 2003 and 2011 but has since declined to 12% in 2024—the lowest level recorded since ESPAD began in 1995.

Current cannabis use remained relatively stable between 1999 and 2019, oscillating between 6.7% and 7.4%. However, 2024 data shows a significant drop to 5%, returning to levels close to those observed in 1995 (4.1%).

Other Illicit Drug Use: Emerging Patterns and Concerns

Overall Illicit Drug Statistics

On average, 13% of ESPAD students report having used any illicit drug at least once in their lifetime. Liechtenstein (25%) and Czechia (24%) show the highest rates, whilst Georgia and Moldova (both 3.9%) report the lowest prevalence.

Specific Substance Patterns

Following cannabis, cocaine represents the second most commonly used illicit drug at 2.3% lifetime prevalence, followed by ecstasy/MDMA (2.1%), LSD or other hallucinogens (1.8%), and amphetamine (1.8%). The average lifetime prevalence of methamphetamine, crack, heroin, and GHB use remains lower, at approximately 1% for each substance.

Cyprus records notably high prevalence rates across multiple substances: LSD and other hallucinogens (6.8%), cocaine (6.2%), ecstasy/MDMA (4.7%), crack and heroin (both 4.1%), and GHB (3.4%).

Non-Cannabis Illicit Drug Use

Illicit drug use excluding cannabis affects 5% of students on average, with rates varying from 1.7% in Georgia to 9.9% in Cyprus. Iceland (7.9%) and Montenegro (7.6%) also report relatively high prevalence.

New Psychoactive Substances

The average lifetime prevalence of new psychoactive substances (NPS) use is approximately 3%, with Poland (6.4%) and Slovenia (6%) recording the highest rates, whilst the Netherlands, Liechtenstein, the Faroe Islands, and Moldova all report below 1%.

Among specific synthetic substances, 3.5% of students report lifetime use of synthetic cannabinoids (ranging from 0.7% in Georgia to 16% in Slovakia), 1.1% report synthetic cathinone use (highest in Hungary at 3.7%), and 1.1% report synthetic opioid use (ranging from 0.6% in Georgia, Ireland, and Portugal to 2.2% in Estonia).

Inhalant Use and Pharmaceutical Misuse

Inhalant Use Statistics

Lifetime inhalant use affects 6.4% of students on average, with Sweden (17%) and Liechtenstein (16%) showing the highest rates, whilst Kosovo (1.3%) and North Macedonia (2.1%) report the lowest prevalence. In 2024, inhalant use is higher among girls (7.9%) than boys (6.7%) and exceeds male rates in 25 out of 37 ESPAD countries.

Nitrous oxide use, surveyed for the first time in 18 countries, shows an average lifetime prevalence of 3.1%. Bulgaria (9.4%) and Liechtenstein (7.2%) record the highest rates, with both countries showing higher figures for girls than boys.

Pharmaceutical Misuse Patterns

The non-medical use of pharmaceuticals affects 14% of ESPAD students on average, with higher rates among girls (16%) than boys (11%). Lithuania reports the highest prevalence at 29% overall (36% among girls).

Non-prescribed tranquillisers and sedatives represent the most commonly misused pharmaceuticals (8.5%), followed by painkillers used to get high (6.9%). Attention/hyperactivity drugs, included for the first time in 18 countries, show a 3.4% usage rate.

Mental Health and Substance Use Connections

Mental Well-being Statistics

For the first time, ESPAD 2024 included the WHO-5 Well-Being Index, revealing that 59% of students report good mental well-being on average. Regional variations are significant, with northern European countries showing the highest rates: the Faroe Islands (77%), Iceland (75%), and Denmark (72%).

Ukraine shows the lowest well-being rate at 43%, followed by Czechia (46%), Hungary (47%), and Cyprus and Poland (both 49%).

Gender Disparities in Mental Health

Mental well-being shows consistent gender disparities, with boys (69%) reporting significantly higher rates than girls (49%) across all ESPAD countries. The largest gender differences are observed in Italy (66% among boys versus 35% among girls), Poland (64% versus 33%), and Sweden (78% versus 48%).

Prevention Programme Participation and Effectiveness

Overall Prevention Engagement

Approximately 72% of ESPAD students report participating in at least one prevention intervention in the two years preceding the survey. More than half (56%) have attended awareness or information events on licit and illicit substances or risk behaviours.

Substance-Specific Prevention

Alcohol represents the most frequently addressed topic, with 49% of students reporting participation in related information events. Slovakia (70%) and Croatia (67%) show the highest participation rates, whilst Kosovo reports the lowest at 18%.

Tobacco-related prevention events are attended by 38% of students on average, with Slovakia and Hungary both reaching 59%, whilst Cyprus (22%) and Georgia (23%) show the lowest attendance rates.

Illicit substance prevention receives less attention, with only 31% of students participating in related events. Slovakia (60%) and Iceland (56%) lead participation rates, whilst Kosovo (10%), Georgia, and Sweden (both 11%) report the lowest engagement.

Skills-Based Prevention Programmes

Interactive training activities focusing on social skills, personal skills, or media literacy engage 55% of ESPAD students. Participation ranges from 35% in the Faroe Islands and 36% in Sweden to 71% in Malta and Spain and 72% in Finland.

Social skills training is the most common type, affecting 41% of students on average, with Finland recording the highest participation rate (64%) and Sweden the lowest (25%). Media literacy training engages 40% of students, most prevalent in Finland (60%) and Denmark (59%), and least common in Kosovo (20%).

Implications for Teenage Substance Abuse in Europe Prevention

Evidence-Based Prevention Needs

The comprehensive ESPAD 2024 data demonstrates that whilst some traditional substance use patterns are declining, new challenges are emerging that require updated prevention strategies. The rise of e-cigarette use, the persistence of early initiation patterns, and the strong connections between mental health and substance use demand evidence-based, comprehensive approaches.

Regional and Cultural Considerations

The significant variations between countries highlight the importance of culturally adapted prevention strategies. Countries showing high substance use prevalence require intensive intervention, whilst those with low rates can focus on maintaining protective factors and preventing initiation.

Gender-Specific Approaches

The evolving gender patterns in substance use—particularly the increased involvement of girls in e-cigarette use and certain substance categories—necessitate gender-specific prevention approaches that address the unique risk factors and motivations affecting different demographic groups.

The ESPAD 2024 findings provide crucial evidence for developing targeted, effective prevention strategies that address the complex landscape of European youth substance use in the contemporary context. With over 100,000 students providing data across 37 countries, this represents the most comprehensive picture available of adolescent substance behaviours across Europe.

Source: dbrecoveryresources