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oject on Alcohol and Other Drugs
ESPAD Report
2015
opean School Survey Pr
Results from the European 
om the Eur
School Survey Project on 
Results fr
Alcohol and Other Drugs
The ESPAD Group
AD Report 2015
ESP


ESPAD Report
2015
Results from the European 
School Survey Project on 
Alcohol and Other Drugs
ESPAD Group
Ludwig Kraus, Ulf Guttormsson, Håkan Leifman, Sharon Arpa, Sabrina Molinaro, 
Karin Monshouwer, Marcis Trapencieris, Julian Vicente, Ársæll Már Arnarsson, 
Olga Balakireva, Elin K. Bye, Anina Chileva, Mihai Ciocanu, Luke Clancy, Ladislav 
Csémy, Tatijana Djurisic, Zsuzsanna Elekes, Fernanda Feijão, Silvia Florescu, Iva 
Pejnović Franelić, Esther Kocsis, Anna Kokkevi, Patrick Lambrecht, Tanja Urdih Lazar, 
Alojz Nociar, Silvana Oncheva, Kirsimarja Raitasalo, Liudmila Rupšienė, Janusz 
Sierosławski, Mette Vinther Skriver, Stanislas Spilka, Julian Strizek, Lela Sturua, Ervin 
Toçi, Kyriacos Veresies, Sigrid Vorobjov, Pál Weihe, André Noor, João Matias, Nicki-Nils 
Seitz, Daniela Piontek, Johan Svensson, Anna Englund and Björn Hibell
Coordinating Committee
Ludwig Kraus, Håkan Leifman and Julian Vicente
Steering Committee
Sharon Arpa, Ludwig Kraus, Håkan Leifman, Sabrina Molinaro, Karin Monshouwer, Marcis Trapencieris and Julian Vicente

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Luxembourg: Publications Office of the European Union, 2016
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Preface ............................................................................................................................................................................................ 7
List of authors .......................................................................................................................................................................... 9
Summary ....................................................................................................................................................................................11
Introduction .............................................................................................................................................................................17
Background to ESPAD ................................................................................................................................................18
ESPAD Report 2015 ....................................................................................................................................................20
Methodology ...........................................................................................................................................................................21
ESPAD 2015 .....................................................................................................................................................................22
Trend analyses ................................................................................................................................................................26
Reporting ............................................................................................................................................................................27
The situation in 2015 ....................................................................................................................................................29
Availability of substances .........................................................................................................................................30
Early onset of substance use .................................................................................................................................33
Cigarette use ....................................................................................................................................................................36
Alcohol use ........................................................................................................................................................................37
Illicit drug use ...................................................................................................................................................................39
Inhalant use ......................................................................................................................................................................42
New psychoactive substance use .......................................................................................................................43
Conditional probabilities of substance use ...................................................................................................44
Patterns of current use ...............................................................................................................................................46
Internet use, gaming and gambling ....................................................................................................................64
Trends 1995-2015 ...........................................................................................................................................................69
Trends across 25 countries .....................................................................................................................................70
Country-specific trends .............................................................................................................................................76
Discussion and conclusion .....................................................................................................................................83
Cigarette use ....................................................................................................................................................................84
Alcohol use ........................................................................................................................................................................85
Illicit drug use ...................................................................................................................................................................86
Internet use, gaming and gambling ....................................................................................................................87
Limitations .........................................................................................................................................................................89
Conclusion .........................................................................................................................................................................89

Acknowledgements ........................................................................................................................................................91
References ...............................................................................................................................................................................95
ESPAD Report 2015 
3

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Table 1. 
Overview of countries participating in ESPAD. 1995-2015 
19
Table 2. 
Sampling characteristics of ESPAD 2015 
24
Table 3a. 
Perceived availability of substances: prevalence of students responding substance 
‘fairly easy’ or ‘very easy’ to obtain (percentage) 

31
Table 3b. 
Perceived availability of substances: prevalence of students responding substance 
‘fairly easy’ or ‘very easy’ to obtain (percentage) 

32
Table 4a. 
Early onset of substance use: prevalence of students experiencing substance 
use (cigarettes, daily smoking, alcohol, intoxication) at the age of 13 or younger 
(percentage) 34

Table 4b. 
Early onset of substance use: prevalence of students experiencing substance use 
(cannabis, ecstasy, amphetamine/methamphetamine, cocaine/crack) at the age of 13 or 
younger (percentage) 

35
Table 5. 
Cigarette use: prevalence of lifetime and 30-day use (percentage) 
36
Table 6. 
Alcohol use: prevalence of lifetime use, 30-day use and intoxication (percentage) 
38
Table 7a. 
Illicit drug use: lifetime prevalence of the use of any drug, cannabis, ecstasy, 
amphetamine and methamphetamine (percentage) 

40
Table 7b. 
Illicit drug use: lifetime prevalence of the use of cocaine, crack, LSD or other 
hallucinogens, heroin and GHB (percentage) 

41
Table 8. 
Inhalants and new psychoactive substances (NPS): prevalence of lifetime 
use (percentage) 42

Table 9. 
Pharmaceuticals: lifetime prevalence of the use of painkillers to get high, tranquillisers or 
sedatives without prescription and anabolic steroids (percentage) 

44
Table 10. 
Prevalence of lifetime use of substance B conditional on the lifetime use of substance A 
(percentage) and number of users of substance A (n) 45

Table 11a. 
Average number of days on the internet (mean number of days) and prevalence of 
internet activities on 4 or more days in the last 7 days (percentage) 

65
Table 11b. 
Prevalence of internet activities on 4 or more days in the last 7 days by gender 
(percentage) 66

Table 12. 
Gambling for money: prevalence in the last 12 months (percentage) 
67
Table 13. 
Overview of ESPAD surveys conducted between 1995 and 2015 by country: 
sample size and participation rate 

71
Table 14. 
ESPAD average for selected indicators based on 25 countries: 1995-2015 
72
Figures
Figure 1a. 
Daily cigarette use: prevalence in the last 30 days (percentage) 
46
Figure 1b. 
Daily cigarette use: prevalence in the last 30 days by gender (percentage) 
47
Figure 2a. 
Frequency of alcohol intake in the last 30 days (mean number of occasions 
among users) 48

Figure 2b. 
Frequency of alcohol intake in the last 30 days by gender (mean number of occasions 
among users) 

49
Figure 3a. 
Average alcohol intake on the last drinking day in centilitres of ethanol among users 
50
Figure 3b. 
Average alcohol intake on the last drinking day in centilitres of ethanol among users by 
gender 51

Figure 4a. 
Preferences of alcoholic beverages on the last drinking day; proportion of alcohol 
volume in centilitres of ethanol for each beverage on total consumption 
53

ESPAD Report 2015

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Preferences of alcoholic beverages on the last drinking day by gender; proportion of 
alcohol volume in centilitres of ethanol for each beverage on total consumption 
53
Figure 5a. 
Prevalence of five or more drinks at least once in the last 30 days; one drink contains 
approximately 2 centilitres of ethanol (percentage) 

54
Figure 5b. 
Prevalence of five or more drinks at least once in the last 30 days by gender; one drink 
contains approximately 2 centilitres of ethanol (percentage) 

55
Figure 6a. 
Prevalence of cannabis use in the last 30 days (percentage) 
56
Figure 6b. 
Prevalence of cannabis use in the last 30 days by gender (percentage) 
57
Figure 7a. 
Frequency of cannabis use in the last 12 months (mean number of occasions 
among users) 58

Figure 7b. 
Frequency of cannabis use in the last 12 months by gender (mean number of occasions 
among users) 

59
Figure 8a. 
Prevalence of inhalant use in the last 30 days (percentage) 
60
Figure 8b. 
Prevalence of inhalant use in the last 30 days by gender (percentage) 
 
  61
Figure 9a. 
Prevalence of new psychoactive substance use in the last 12 months (percentage) 
62
Figure 9b. 
Prevalence of new psychoactive substance use in the last 12 months by gender 
(percentage) 63

Figure 10. 
Countries included in the 25-country average (marked in blue) 
70
Figure 11. 
Perceived availability of cannabis by gender; students responding cannabis 
‘fairly easy’ or ‘very easy’ to obtain: 25-country trend 1995-2015 (percentage) 

73
Figure 12. 
Daily cigarette use at the age of 13 or younger by gender: 25-country trend 1995-2015 
(percentage) 73

Figure 13. 
Cannabis use at the age of 13 or younger by gender: 25-country trend 1995-2015 
(percentage) 74

Figure 14. 
Lifetime use of cigarettes by gender: 25-country trend 1995-2015 (percentage) 
74
Figure 15. 
Cigarette use in the last 30 days by gender: 25-country trend 1995-2015 (percentage)  74
Figure 16. 
Daily cigarette use by gender: 25-country trend 1995-2015 (percentage) 
74
Figure 17. 
Lifetime alcohol use by gender: 25-country trend 1995-2015 (percentage) 
74
Figure 18. 
Alcohol use in the last 30 days by gender: 25-country trend 1995-2015 (percentage) 
74
Figure 19. 
Heavy episodic drinking (five or more drinks on one occasion) during the last 30 days 
by gender: 25-country trend 1995-2015 (percentage) 

74
Figure 20. 
Lifetime use of illicit drugs by gender: 25-country trend 1995-2015 (percentage) 
74
Figure 21. 
Lifetime use of cannabis by gender: 25-country trend 1995-2015 (percentage) 
75
Figure 22. 
Cannabis use in the last 30 days by gender: 25-country trend 1995-2015 (percentage)  75
Figure 23. 
Lifetime use of illicit drugs other than cannabis by gender: 25-country trend 
1995-2015 (percentage) 75

Figure 24. 
Lifetime use of inhalants by gender: 25-country trend 1995-2015 (percentage) 
75
Figure 25. 
Lifetime use of tranquillisers or sedatives without a doctor’s prescription by gender: 
25-country trend 1995-2015 (percentage) 

75
Figure 26. 
Lifetime use of cigarettes by country: 1995-2015 (percentage) 
77
Figure 27. 
Lifetime alcohol use of alcohol by country: 1995-2015 (percentage) 
78
Figure 28. 
Lifetime use of cannabis by country: 1995-2015 (percentage) 
79
Figure 29. 
Lifetime use of inhalants by country: 1995-2015 (percentage) 
80
Figure 30. 
Lifetime use of tranquillisers or sedatives without a doctor’s prescription by country: 
1995-2015 (percentage) 

81
ESPAD Report 2015 
5


Preface
This report presents the results of the sixth data-collection wave of the European School 
Survey Project on Alcohol and Other Drugs (ESPAD). The report marks the 20th anniversary 
of ESPAD data collection (1995-2015), which increases considerably the value of the 
information presented, allowing the identification of long-term trends with a standardised and 
comparable methodology.
This report is based on the information provided by 96 043 students from 35 European 
countries, 24 of them being Member States of the European Union. About 600 000 students 
have participated in the successive ESPAD data-collection waves, making the project the 
most extensive, harmonised data collection on substance use in Europe.
The immediate objective of ESPAD is to collect comparable and reliable information in as 
many European countries as possible, but the final purpose is to provide a solid basis to help 
formulate policies, in particular those aimed at young people.
The first ESPAD report, based on 1995 data, included information from 26 countries. The 
number of participating countries increased notably in the following waves of data collection. 
In the last two waves (2011 and 2015), the number of countries has stabilised at 35-36. A 
total of 46 countries have participated in at least one of the project’s data-collection rounds.
ESPAD has a long history and a promising future. The project was initiated by the Swedish 
Council for Information on Alcohol and Other Drugs (CAN) following initial work carried out 
by the Pompidou Group of the Council of Europe. For 20 years CAN coordinated ESPAD with 
the support of the Swedish government. In recent years the European Monitoring Centre for 
Drugs and Drug Addiction (EMCDDA) has progressively increased its support to the network, 
and since 2013 it has been involved in the coordination of ESPAD. These developments have 
taken place at the instigation of the Swedish government and the EMCDDA Management 
Board, and in agreement with the ESPAD network. The EMCDDA is pleased now to have 
assumed responsibility for ensuring the production of this report and its accompanying 
website.
The results presented here are based on the substantial contribution of leading national 
experts, their collaborators and the institutions that supported and funded the data collection. 
The report would not have been possible without the contribution of many schools, teachers, 
research assistants and, notably, students who volunteered to give their time and information 
to the ESPAD project so that we can obtain a better understanding of European students’ 
substance use and their attitudes towards it.
Alexis Goosdeel
Ludwig Kraus, Håkan Leifman and 
EMCDDA Director
Julian Vicente
ESPAD Coordination Committee
ESPAD Report 2015 
7


List of authors
Ludwig Kraus 
IFT Institut für Therapieforschung, Munich, Germany and Centre 
for Social Research on Alcohol and Drugs (SoRAD), Stockholm 
University, Stockholm, Sweden
Ulf Guttormsson 
Swedish Council for Information on Alcohol and Other Drugs (CAN), 
Stockholm, Sweden
Håkan Leifman 
Swedish Council for Information on Alcohol and Other Drugs (CAN), 
Stockholm, Sweden
Sharon Arpa 
Foundation for Social Welfare Services, Santa Venera, Malta
Sabrina Molinaro 
National Research Council, Institute of Clinical Physiology, Pisa, Italy
Karin Monshouwer 
Trimbos Institute, Utrecht, the Netherlands
Marcis Trapencieris 
Institute of Philosophy and Sociology, University of Latvia, Riga, 
Latvia
Julian Vicente 
European Monitoring Centre for Drugs and Drug Addiction 
(EMCDDA), Lisbon, Portugal
Ársæll Már Arnarsson 
Centre for Prevention Studies, University of Akureyri, Akureyri, 
Iceland
Olga Balakireva 
Department for Monitoring of the Social and Economic 
Transformations, Institute for Economy and Forecasting, NAS, Kiev, 
Ukraine
Elin K. Bye 
Norwegian Institute of Public Health, Oslo, Norway
Anina Chileva 
National Centre for Public Health and Analyses, Sofia, Bulgaria
Mihai Ciocanu 
National Centre for Health Management, Chisinau, Moldova
Luke Clancy 
TobaccoFree Research Institute Ireland, Focas Research Institute, 
Dublin, Ireland
Ladislav Csémy 
National Institute of Mental Health, Klecany, Czech Republic
Tatijana Djurisic 
Institute of Public Health of Montenegro, Podgorica, Montenegro
Zsuzsanna Elekes 
Corvinus University of Budapest, Institute of Sociology and Social 
Policy, Budapest, Hungary
Fernanda Feijão 
General-Directorate for Intervention on Addictive Behaviours 
and Dependencies (SICAD), Lisbon, Portugal
Silvia Florescu 
National School of Public Health, Management and Professional 
Development, Bucharest, Romania
Iva Pejnović Franelić 
Mental Health Promotion and Addiction Prevention Department with 
Counselling Centre, Health Promotion Division, Reference Centre 
of the Ministry of Health for Health Promotion, Croatian Institute of 
Public Health, Zagreb, Croatia
Esther Kocsis 
Amt für Soziale Dienste, Schaan, Liechtenstein
Anna Kokkevi 
Epidemiology and Psychosocial Research Unit, University Mental 
Health Research Institute (UMHRI), Athens, Greece
Patrick Lambrecht 
Department of Clinical and Lifespan Psychology (KLEP), Free 
University of Brussels (VUB), Brussels, Belgium
Tanja Urdih Lazar 
University Medical Centre Ljubljana, Clinical Institute of 
Occupational, Traffic and Sports Medicine, Ljubljana, Slovenia
Alojz Nociar 
St. Elizabeth University of Health and Social Work, Bratislava, 
Slovakia
ESPAD Report 2015 
9

List of authors
Silvana Oncheva 
Institute for Public Health, Skopje, former Yugoslav Republic of 
Macedonia
Kirsimarja Raitasalo 
National Institute for Health and Welfare (THL), Helsinki, Finland
Liudmila Rupšienė 
Klaipėda University, Klaipėda, Lithuania
Janusz Sierosławski 
Institute of Psychiatry and Neurology Department of Studies on 
Alcoholism and Drug Dependencies, Warsaw, Poland
Mette Vinther Skriver 
Department of Public Health, Aarhus University, Aarhus, Denmark
Stanislas Spilka 
French Monitoring Centre for Drugs and Drug Addiction (OFDT), 
Paris, France
Julian Strizek 
Gesundheit Österreich GmbH (GÖG), Vienna, Austria
Lela Sturua 
Non-communicable Diseases Department, National Centre for 
Disease Control and Public Health, Tiblisi, Georgia
Ervin Toçi 
Institute of Public Health, Tirana, Albania
Kyriacos Veresies 
Centre for Education about Drugs and Treatment of Drug-Addicted 
Persons (Kenthea), Nicosia, Cyprus
Sigrid Vorobjov 
National Institute for Health Development, Tallinn, Estonia
Pál Weihe 
Department of Occupational Medicine and Public Health, Tórshavn, 
Faroes
André Noor 
European Monitoring Centre for Drugs and Drug Addiction 
(EMCDDA), Lisbon, Portugal
João Matias 
European Monitoring Centre for Drugs and Drug Addiction 
(EMCDDA), Lisbon, Portugal
Nicki-Nils Seitz 
IFT Institut für Therapieforschung, Munich, Germany
Daniela Piontek 
IFT Institut für Therapieforschung, Munich, Germany
Johan Svensson 
Swedish Council for Information on Alcohol and Other Drugs (CAN), 
Stockholm, Sweden
Anna Englund 
Swedish Council for Information on Alcohol and Other Drugs (CAN), 
Stockholm, Sweden
Björn Hibell 
Former ESPAD Coordinator
10 
ESPAD Report 2015


Summary

Summary
The main purpose of the European School Survey Project on 
who were enrolled in regular, vocational, general or academic 
Alcohol and Other Drugs (ESPAD) is to collect comparable 
studies were included, excluding those who were enrolled 
data on substance use among 15- to 16-year-old students in 
in either special schools or special classes for students 
order to monitor trends within as well as between countries. 
with learning disorders or severe physical disabilities. In 
Between 1995 and 2015, six surveys were conducted in 
each participating country, a cluster sampling design was 
48 European countries. The present report differs from the 
used to sample the target population, except in the Faroes, 
earlier ESPAD reports in that it presents selected key results 
Iceland, Liechtenstein, Malta, Monaco and Montenegro, 
of the 2015 ESPAD survey rather than the full range of 
where all 1999-born target students were included. Data 
results and tables. The full set of data on which the current 
were collected by self-administered questionnaires. All 
report is based, including all the usual tables in the familiar 
countries used a paper-and-pencil questionnaire except for 
ESPAD format, is available online (http://www.espad.org). All 
Austria, Latvia, Liechtenstein and the Netherlands, where 
of the tables can be downloaded in Excel format and used 
students answered a web-based questionnaire. The students 
for further analysis.
answered the questionnaires anonymously in the classroom. 
All samples were nationally representative, apart from 
The present report provides information on the perceived 
Belgium (Flanders), Cyprus (government-controlled areas) 
availability of substances, early onset of substance use and 
and Moldova (Transnistria region not included). Sample 
prevalence estimates of substance use (cigarettes, alcohol, 
sizes varied from 316 students in Liechtenstein to 11 822 in 
illicit drugs, inhalants, new psychoactive substances and 
Poland.
pharmaceuticals). The descriptive information includes 
indicators of intensive substance use and prevalence 
estimates of internet use, gaming and gambling by country 
Cigarette use
and gender. Secondly, overall ESPAD trends between 
1995 and 2015 are presented. For selected indicators, 
On average, over 60 % of the students in the participating 
ESPAD trends are shown based on data from 25 countries 
countries replied that they would find it fairly or very easy 
that participated in at least four (including the 2015 data 
(hereafter referred to as easy) to get hold of cigarettes if they 
collection) of the six surveys. Finally, for some indicators, 
wanted to. Students in the Czech Republic were most likely 
country-specific trends are shown.
to find it easy (80 %), followed closely by Austria (79 %), 
Liechtenstein (77 %) and Denmark (76 %). Low figures of 
In the 2015 ESPAD data collection, 96 043 students took 
perceived availability were found in Moldova (22 %) and 
part from 35 countries: Albania, Austria, Belgium (Flanders), 
in three other countries in the eastern part of Europe: the 
Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, 
former Yugoslav Republic of Macedonia (38 %), Romania 
Estonia, the Faroes, Finland, the former Yugoslav Republic 
(37 %) and Ukraine (39 %). Gender differences were 
of Macedonia, France, Georgia, Greece, Hungary, Iceland, 
negligible at the aggregate level (62 % for boys versus 60 % 
Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, Moldova, 
for girls).
Monaco, Montenegro, the Netherlands, Norway, Poland, 
Portugal, Romania, Slovakia, Slovenia, Sweden and Ukraine. 
More than one in five ESPAD students (23 %) had smoked 
For comparative reasons, the tables of the 2015 ESPAD 
cigarettes at the age of 13 or younger. The proportions vary 
results contain, in addition to country-specific estimates, 
considerably across countries, from 46 % in Estonia and 
an average across all participating countries as well as 
45 % in Lithuania to 9-13 % in the former Yugoslav Republic 
prevalence estimates for two non-ESPAD countries: Spain 
of Macedonia, Iceland, Malta and Norway. Both on average 
and the United States. The instruments used in the Spanish 
and in most individual countries, more boys than girls have 
and US surveys overlap to a large degree with the ESPAD 
smoked cigarettes at the age of 13 or younger. On average, 
questionnaire, and the methodology used in all three surveys 
4 % of the students began smoking cigarettes on a daily 
allows for rough comparisons across the countries.
basis at the age of 13 or younger. The rates were highest in 
Estonia and Slovakia (8 % each) and lowest in Norway (1 %).
Methodology
In general, the results on cigarette smoking among 
European students can be interpreted as showing positive 
The ESPAD target population is defined as regular students 
developments. Today, the majority of adolescents have 
who turn 16 in the calendar year of the survey and are 
never smoked (54 %) and less than one quarter (21 %) of 
present in the classroom on the day of the survey. Students 
the sample can be considered current smokers, i.e. having 
12 
ESPAD Report 2015

Summary
smoked in the last 30 days. The average lifetime prevalence 
students (32 %). Countries with levels of 10 % or less were 
of cigarette smoking was about the same among boys 
Albania, Estonia, the Faroes, the former Yugoslav Republic of 
(47 %) and girls (44 %). More than 10 % of the students 
Macedonia, Georgia, Greece, Iceland, Moldova, Montenegro, 
reported that they had smoked every day in the last 30 days. 
Norway, Portugal, Sweden and Ukraine. On average, slightly 
Comparatively high percentages of daily smoking were found 
more boys (13 %) than girls (12 %) reported that they had 
in Bulgaria, Croatia, Italy, Liechtenstein and Romania (20 % 
been intoxicated during the last 30 days.
or more). Lower rates were observed in Albania, Iceland, 
Moldova and Norway (5 % and less).
Students who reported alcohol use in the last 30 days 
drank alcohol on an average of 5.4 occasions. Students 
The trend data indicate an overall decrease in lifetime, last-
from Cyprus and Liechtenstein consumed alcohol on 8.2 
30-day and daily cigarette use. Moreover, gender differences 
and 9.1 occasions, respectively, and students from Estonia, 
have narrowed over time. In 1995, boys showed higher 
Finland, Iceland, Lithuania, Moldova, Norway and Sweden 
rates than girls with regard to all indicators. In 2015, these 
drank alcohol on four or fewer occasions on average. In 
differences were no longer apparent or became smaller. 
most countries, boys who drank did so more frequently than 
However, gender convergence is more marked in prevalence 
girls, with a difference of up to three occasions or more 
of use, whereas problematic patterns of use (daily smoking, 
in the last 30 days in Bulgaria and the former Yugoslav 
early onset) are still more prevalent among boys.
Republic of Macedonia. Every third student (35 %) reported 
heavy episodic drinking in the past month. This drinking 
pattern was found more often in Austria, Cyprus and 
Alcohol use
Denmark, where it was reported by about every second 
student. The lowest figures were found in Norway (19 %) 
Alcoholic beverages were perceived to be easily available 
and Iceland (8 %). The difference between boys and girls 
in most countries. More than three in four students (78 %) 
was about 5 percentage points on average, with generally 
stated that alcoholic beverages would be easy to obtain if 
higher percentages for boys. Students drank an average of 
they wanted to. In the Czech Republic, Denmark and Greece, 
4.7 centilitres of ethanol on the last drinking day. Drinking 
more than 90 % of the students reported easy access. The 
volume was highest in Denmark (9.3 centilitres), Estonia 
lowest proportions were found in Moldova (52 %), the former 
(6.2 centilitres), Sweden (6.1 centilitres), Finland and Ireland 
Yugoslav Republic of Macedonia (53 %) and Romania 
(6.0 centilitres each), and lowest in Moldova (2.1 centilitres) 
(60 %). In most countries, perceptions of availability among 
and Romania (2.8 centilitres). Boys reported higher volumes 
boys and girls were rather similar.
than girls, with significant differences in most countries. On 
average, beer (35 %) and spirits (34 %) were the preferred 
Nearly half of the students (47 %) reported alcohol use at the 
alcoholic beverages. In Albania (68 %), Belgium (Flanders) 
age of 13 or younger. The highest proportions were found 
(58 %), the former Yugoslav Republic of Macedonia (54 %), 
in Georgia (72 %), the Czech Republic (68 %) and Cyprus 
Romania (52 %) and Poland (52 %), more than half of the 
(66 %). The countries with the lowest rates were Iceland 
students preferred beer. Spirits were preferred in Malta 
(14 %) and Norway (19 %). Boys were more likely than girls 
(60 %), Portugal (53 %), Slovakia (53 %), France (48 %) 
to have used alcohol at an early age. One in twelve students 
and Monaco (48 %). A preference for wine was found in 
had experienced intoxication at the age of 13 or younger. The 
Ukraine (44 %), Moldova (41 %) and Georgia (39 %), and 
proportion of students reporting intoxication at an early age 
for alcopops in Liechtenstein (36 %). In Denmark, Estonia, 
varied quite substantially across countries: Georgia (22 %) 
the Faroes, Ireland, Norway and Sweden, cider accounted 
and Estonia (15 %) were at the high end of the scale, and 
for approximately one quarter or more of total alcohol 
Iceland (2 %) and Belgium (Flanders) (3 %) were at the low 
consumption. In these countries, cider was the second 
end. Higher rates were more likely to be found in the eastern 
preferred alcoholic beverage next to beer or spirits.
part of Europe.
Despite the continued high rates of alcohol use, in particular 
In all ESPAD countries except Iceland (35 %), 50 % or more 
of heavy alcohol use, temporal trends over the past two 
of the students have drunk alcohol at least once during their 
decades indicate a positive development, with an overall 
lifetime. The ESPAD average was 80 % (range: 35-96 %). The 
decrease in lifetime and last-30-day use of alcohol between 
highest rates of lifetime alcohol prevalence (93 % or more) 
1995 and 2015 from 89 % to 81 % and from 56 % to 47 %, 
were found in the Czech Republic, Greece and Hungary. 
respectively. Most interestingly, both lifetime and last-30-
In addition to Iceland, countries with relatively low rates 
day prevalence decreased markedly after a peak in 2003. 
(60 % or less) were Albania, the former Yugoslav Republic 
Unfortunately, changes in heavy episodic drinking were less 
of Macedonia and Norway. A total of 13 % of the students 
pronounced and only observed among boys, with overall 
reported having been intoxicated during the last 30 days. 
rates declining from 36 % to 35 % over the past 20 years.
Denmark scored highest, with almost one third of the 
ESPAD Report 2015 
13

Summary
Illicit drug use
High prevalence rates (30 % or more) were also reported 
in France, Liechtenstein and Monaco. The lowest levels of 
About three in ten students (30 %) rated cannabis to be 
cannabis use (4-7 %) were reported in Albania, Cyprus, the 
easily available. In the Czech Republic (50 %), more students 
Faroes, the former Yugoslav Republic of Macedonia, Iceland, 
than in any other ESPAD country reported easy access. High 
Moldova, Norway and Sweden. On average, more boys than 
proportions were also found in Slovenia (45 %), as well as in 
girls reported lifetime cannabis use (19 % versus 14 %). 
Bulgaria and Liechtenstein (44 % each). The countries with 
On average, 7 % of the students had used cannabis in the 
the lowest perceived availability of cannabis were Moldova 
last 30 days. Cannabis use in the last month was highest in 
(5 %) and Ukraine (11 %). Boys were more likely than girls to 
France (17 %), Italy (15 %) and the Czech Republic (13 %). 
consider cannabis to be easily available (32 % versus 29 %).
Cannabis use in the last 30 days was also reported by more 
boys than girls (8 % versus 5 %). Among students who had 
The perceived availability of other illicit drugs was relatively 
used cannabis in the last 12 months, the drug was used 
low: ecstasy (12 %), cocaine (11 %), amphetamine (9 %), 
on average on 8.9 occasions, with higher frequencies in 
methamphetamine (7 %) and crack (8 %). In Bulgaria (e.g. 
France, Iceland, Ireland, Italy and the Netherlands (11.5 or 
amphetamine 23 %, methamphetamine 17 %), illicit drugs 
more times). Low frequencies of cannabis use were found 
were perceived as more easily available than elsewhere in 
in the Faroes and Moldova (3.6 or fewer times). Reported 
Europe. The perceived availability of ecstasy was highest in 
frequency of use was higher among boys than among girls.
Bulgaria, the Czech Republic and Ireland (20 % or more), 
whereas for cocaine it was highest in Bulgaria, Ireland, 
Trends in cannabis use indicate a general increase in both 
Liechtenstein and Poland (17-19 %). Countries with the 
lifetime and last-30-day use between 1995 and 2015, 
lowest perceived availability of nearly all illicit drugs were the 
from 11 % to 17 % and from 4 % to 7 %, respectively, 
Faroes, Finland, Georgia, Moldova and Ukraine.
with prevalence peaking in 2003 and slightly decreasing 
thereafter.
On average, 3 % of the students reported that they had 
first used cannabis at the age of 13 or younger. The 
On average, 1-2 % of the ESPAD students have used an illicit 
highest proportions were found in Monaco (8 %), France 
drug other than cannabis at least once. After cannabis, the 
and Liechtenstein (6 % each). Rates of early onset of 
most frequently tried illicit drugs are ecstasy, amphetamine, 
amphetamine/methamphetamine use were lower (1 % on 
cocaine and LSD or other hallucinogens. Less frequently 
average), with the highest proportions in Bulgaria (3 %) and 
tried illicit drugs were methamphetamine, crack, heroin and 
Cyprus (2 %). Boys were more likely than girls to have used 
GHB (1 % lifetime prevalence). At the country level, rates of 
cannabis, amphetamine/methamphetamine, ecstasy or 
5 % or more were found in Bulgaria (ecstasy, amphetamine, 
cocaine/crack at the age of 13 or younger.
methamphetamine, cocaine) and Poland (LSD or other 
hallucinogens).
Lifetime use of illicit drugs varied considerably across 
the ESPAD countries. In the Czech Republic, 37 % of the 
students reported having used any illicit drug at least once, 
Other substance use
which was more than twice the average of 18 %. Students in 
Bulgaria, France, Liechtenstein and Monaco also exhibited 
Across the ESPAD countries, 4 % of the students reported 
high levels of drug use experience (30-32 %). Particularly low 
lifetime experience with new psychoactive substances 
levels (10 % or less) of illicit drug use were noted in Albania, 
(NPS), with the highest rates in Estonia and Poland (10 % 
Cyprus, the Faroes, Finland, the former Yugoslav Republic of 
each) and the lowest rates in Belgium (Flanders), Denmark, 
Macedonia, Iceland, Moldova, Montenegro, Norway, Sweden 
Finland, Norway and Portugal (1 % each). The average 
and Ukraine. In all ESPAD countries apart from the Czech 
prevalence of lifetime use of NPS was slightly higher among 
Republic, prevalence rates were higher among boys than 
boys (5 %) than girls (4 %). On average, 3 % of the students 
girls. On average, 21 % of boys and 15 % of girls have tried 
had used NPS in the last 12 months, with the highest 
illicit drugs at least once during their lifetime.
prevalence in Bulgaria, Croatia, Estonia, Ireland, Italy and 
Poland (5-8 %) and lowest in Belgium (Flanders), Denmark, 
A general upward trend between 1995 and 2003 can be 
the Faroes, Finland, the former Yugoslav Republic of 
seen in the prevalence of illicit drug use. Since 2003, the 
Macedonia, Moldova, the Netherlands, Norway and Portugal, 
prevalence has remained largely unchanged.
all at 1 %. Generally, differences in NPS use in the last 
12 months between boys and girls were small.
The most prevalent illicit drug in all ESPAD countries was 
cannabis. On average, 16 % of the students have used 
The average prevalence of lifetime inhalant use was 7 %, 
cannabis at least once in their lifetime. The country with 
with large differences between countries. The country with 
the highest prevalence was the Czech Republic (37 %). 
the highest rate was Croatia (25 %), followed by Slovenia 
14 
ESPAD Report 2015

Summary
(14 %). The lowest prevalence rates (1-2 %) were found in 
78 % of the students had used the internet for social media 
the Faroes, the former Yugoslav Republic of Macedonia and 
activities on 4 or more days in the last week and this was the 
Moldova. The average prevalence of lifetime inhalant use 
predominant internet activity in all countries, with between 
among ESPAD students was the same for boys and girls. The 
58 % (Albania) and 94 % (Finland) of students reporting this 
use of inhalants shows generally stable lifetime prevalence 
activity.
rates over the observed period. The gender-specific trends 
reveal a narrowing of the gender gap, with rates among boys 
More than one in five students (23 %) regularly (at least four 
slightly decreasing but rather unchanged rates among girls.
times in the last 7 days) used the internet for online gaming. 
Nearly half of the students from Denmark played regularly 
Lifetime use of tranquillisers or sedatives without 
online (45 %). Regular online games were not so common in 
prescription was most prevalent in Poland (17 %) and the 
Georgia (13 %), the former Yugoslav Republic of Macedonia 
Czech Republic (16 %). The lowest level of non-prescription 
and Moldova (16 % each). More boys (39 %) than girls (7 %) 
use of tranquillisers or sedatives (1-2 %) was reported by 
reported playing online.
students from Denmark, the Faroes, Moldova, Romania and 
Ukraine. On average, slightly more girls than boys reported 
On average, 14 % of the students reported gambling for 
use of tranquillisers or sedatives without prescription (8 % 
money at least once in the last 12 months, and 7 % gambled 
versus 5 %). Use of painkillers to get high was reported by 
frequently (2-4 times a month or more often). The highest 
4 % of the girls and 3 % of the boys on average. Over the past 
rates of students with gambling experience (30 %) and 
two decades, the lifetime prevalence rates for tranquillisers 
frequent gambling (16 %) in the last 12 months were found 
or sedatives show a slightly downward trend, with rather 
in Greece. Between a fifth and a quarter of the students 
parallel trends for boys and girls.
in Cyprus, Finland, Montenegro and Slovenia reported 
gambling experience, and more than one in ten students 
in Finland and Ireland gambled frequently. In all countries, 
Conditional probabilities of substance use
considerably more boys than girls have gambling experience 
(23 % versus 5 % on average) or gambled frequently (12 % 
Among the users across all countries who have used 
versus 2 %) in the last 12 months.
cigarettes at least once, 93 % have also used alcohol, 32 % 
cannabis, 12 % inhalants, 10 % tranquillisers or sedatives 
and 8 % NPS. Almost every student (87 % or more) that 
Acknowledgements
has used a licit or illicit substance also reported having 
The EMCDDA and the ESPAD group would like to 
used alcohol. Conversely, not every student who has tried 
acknowledge the contributions made to this report. In 
alcohol has tried another substance. Among students who 
particular we are grateful to: the national authorities who 
have used alcohol, 54 % have also used cigarettes, 19 % 
have funded ESPAD studies; the Pompidou Group of the 
cannabis, 9 % inhalants, 7 % tranquillisers or sedatives and 
Council of Europe and the European Commission for 
supporting participation in the study: the generosity of 
5 % or less NPS or other illicit drugs. Of the students that 
the Swedish government who have provided long-term 
have used cannabis, 91 % have also used cigarettes, 96 % 
financial and practical support for both coordination and 
alcohol, 18 % inhalants, 20 % NPS and 16 % tranquillisers 
analytical activities; the technical input provided by CAN 
or sedatives. Around one in ten has used ecstasy, cocaine, 
(Swedish Council for Information on Alcohol and Other 
LSD or other hallucinogens (11 % each), painkillers (10 %) 
Drugs) and IFT Institut für Therapieforschung for the 
or amphetamines (9 %). Among the students who have used 
reporting and analysis of the data. Finally, we note our 
NPS, about a quarter have also used inhalants (26 %) or 
immense gratitude to the schools, teachers and students 
tranquillisers or sedatives (25 %) and around three quarters 
without whose participation this report would not have 
(74 %) have used cannabis.
been possible (a full list of acknowledgements can be 
found on page 91).
Internet use, gaming, gambling
Overall, the students stated that they had used the internet 
on average on 5.8 days within the last 7 days. The frequency 
of use was lower in Albania, Bulgaria, the former Yugoslav 
Republic of Macedonia, Georgia, Montenegro, Romania 
and Ukraine. Students in Denmark (6.8 days), Iceland 
(6.7 days), Finland, the Netherlands, Sweden (6.6 days 
each) and Estonia (6.5 days) were online every day of the 
week. No gender differences were observed. On average, 
ESPAD Report 2015 
15



Introduction

Introduction
Young people’s well-being is of special concern in all societies 
resilience factors (Kraus et al., 2010; Vorobjov et al., 2014), 
and there are constant efforts to reduce all types of dangerous 
polysubstance use (Kokkevi et al., 2012; Mammone et al., 
behaviour. These include consumption of tobacco, alcohol, 
2014; Olszewski et al., 2010), attitudes (Beck et al., 2014) 
illicit drugs and the use of non-prescribed pharmaceuticals, 
and risk perceptions (Piontek et al., 2013). In addition, ESPAD 
as well as extensive internet use, gaming and gambling. All 
results have been used for the development of international 
countries have laws in place that restrict the availability of 
action plans and strategies related to alcohol and other drugs 
psychoactive substances and access to gambling activities. 
and as such have impacted on public discussion and served as 
The legal framework may vary between countries but often 
a basis for policy measures and preventive activities targeting 
includes restrictions specially meant to protect young people. 
young people.
Moreover, major international bodies such as the United 
Nations and the European Union are constantly looking for 
Although the comparison of cross-sectional data on 
policy measures to reduce the negative impact of the use of 
substance use across similar populations in countries of 
different substances, for example the global strategy to reduce 
various social, economic and cultural origins is important, 
the harmful use of alcohol (World Health Organisation, 2014), 
the possibility of investigating temporal changes across the 
the WHO Framework Convention on Tobacco Control (World 
majority of European countries is quite unique. The ESPAD 
Health Organisation, 2005), the European drugs strategy 
project provides data that can be used to monitor trends in 
(Council of the European Union, 2012; Culley et al., 2012), or 
substance use among students in Europe and to compare 
the European alcohol strategy (COWI Consortium, 2012).
trends between countries and between groups of countries 
(Fotiou et al., 2014; Molinaro et al., 2011). With the 2015 
Over the years, many studies have been conducted to improve 
survey, ESPAD data cover substance use behaviours of 15- to 
the understanding of consumption patterns. However, despite 
16-year-old students over a period of 20 years. Since 1995, 
the significant number of studies conducted in many countries, 
when information on substance use was collected in 26 
it has remained difficult to obtain a comprehensive picture of 
countries (Hibell et al., 1997), the survey has been repeated 
substance use in different European countries, especially of 
every fourth year in the same age group. In the second wave, in 
patterns of use among young people. With the launch of the 
1999, data were collected in 30 countries (Hibell et al., 2000), 
European School Survey Project on Alcohol and Other Drugs 
and the surveys of 2003 and 2007 covered 35 countries each 
(ESPAD) in 1995, data on substance use and risky behaviours 
(Hibell et al., 2004, 2009), with an additional five countries 
became available that serve as a basis for the monitoring 
collecting data in 2008. The number of participating countries 
of substance use in Europe, as well as for analysing the risk 
in the 2011 survey was 36 (Hibell et al., 2012), with three 
factors, protective factors and time trends of such behaviours.
more countries collecting data in the autumn (Hibell and 
Guttormsson, 2013), and 35 countries collected data in the 
The main purpose of the ESPAD project is to collect 
most recent (2015) survey.
comparable data on substance use among 15- to 16-year-
old students in as many European countries as possible. The 
target group consists of students who turn 16 during the year 
Background to ESPAD
of data collection, which in 2015 meant students born in 1999. 
The surveys are conducted in schools in the participating 
In the 1980s, a subgroup of collaborating investigators 
country, during the same period of time and using a common 
was formed within the Pompidou Expert Committee on 
methodology. The ESPAD project provides comparable 
Drug Epidemiology of the Council of Europe to develop 
data in databases that have been and will be used by the 
a standardised school-survey questionnaire and methodology. 
research community for in-depth analyses to increase the 
The purpose of the work was to produce a standard survey 
understanding of substance use among European students 
instrument that would enable different countries to compare 
(see http://www.espad.org/en/References--Literature).
alcohol and drug use in student populations. A common 
questionnaire was used by eight countries, but the pilot study 
Because of its common methodology, analyses based on 
differed in sample size, representativeness and age range, and 
ESPAD data have substantially contributed to the field of 
was not performed at the same time. The survey instrument, 
substance use. For instance, studies have been conducted 
however, proved to be valid and reliable (Johnston et al., 1994). 
on validity issues (Gmel et al., 2010; Molinaro et al., 2012; 
With the exception of Sweden, where school surveys had 
Steppan et al., 2013), methodological (Thrul et al., 2016) and 
already been conducted on an annual basis since 1971, only 
theoretical issues (Brunborg et al., 2014), substance use 
a few countries conducted school surveys related to substance 
policies (Bjarnason et al., 2010; Müller et al., 2010), risk and 
use on a more or less regular basis. In light of a growing 
18 
ESPAD Report 2015

Introduction
Table 1. 
Overview of countries participating in ESPAD. 1995-2015
Country
Principal investigator
1995
1999
2003
2007
2011
2015
Albania
Ervin Toçi
.
.
.
.
Yes
Yes
Armenia
Artak Musheghyan 
.
.
.
Yes
.
.
Austria
Julian Strizek; Alfred Uhl 
.
.
Yes
Yes
.
Yes
Belgium (Flanders)
Patrick Lambrecht
.
.
Yes
Yes a
Yes b
Yes b
Belgium (Wallonia)
Danielle Piette
.
.
Yes
.
.
.
Bosnia and 
Aida Pilav
.
.
.
Yes c
Yes a
.
Herzegovina (FBiH)
Bosnia and 

Sladjana Siljak
.
.
.
Yes c
Yes
.
Herzegovina (RS)
Bulgaria

Anina Chileva 
.
Yes
Yes
Yes
Yes
Yes
Croatia
Iva Pejnović Franelić
Yes
Yes
Yes
Yes
Yes
Yes
Cyprus
Kyriakos Veresies 
Yes
Yes
Yes
Yes
Yes
Yes
Czech Republic
Ladislav Csèmy
Yes
Yes
Yes
Yes
Yes
Yes
Denmark
Mette Vinther Skriver
Yes
Yes
Yes
Yes
Yes
Yes
Estonia
Sigrid Vorobjov
Yes
Yes
Yes
Yes
Yes
Yes
Faroes
Pál Weihe 
Yes
Yes
Yes
Yes
Yes
Yes
Finland
Kirsimarja Raitasalo
Yes
Yes
Yes
Yes
Yes
Yes
FYR Macedonia e
Silvana Oncheva
.
Yes
.
Yes c
.
Yes
France
Stanislas Spilka
.
Yes
Yes
Yes
Yes
Yes
Georgia
Lela Sturua
.
.
.
.
.
Yes a
Germany
Ludwig Kraus 
.
.
6 Bundesl. 7 Bundesl. 5 Bundesl.
.
Greece
Anna Kokkevi
.
Yes
Yes
Yes
Yes
Yes
Greenland
Vacant
.
Yes
Yes
.
.
.
Hungary
Zsuzsanna Elekes 
Yes
Yes
Yes
Yes
Yes
Yes
Iceland
Ársæll Már Arnarsson 
Yes
Yes
Yes
Yes
Yes
Yes
Ireland
Luke Clancy
Yes
Yes
Yes
Yes
Yes
Yes
Isle of Man
Andreea Steriu 
.
.
Yes
Yes
Yes d
.
Italy
Sabrina Molinaro
Yes
Yes
Yes
Yes
Yes
Yes
Kosovo (under 
Mytaher Haskuka 
.
.
.
.
Yes a
.
UNSCR 1244) 
Latvia

Marcis Trapencieris 
Yes
Yes
Yes
Yes
Yes
Yes
Liechtenstein
Esther Kocsis
.
.
.
.
Yes
Yes
Lithuania
Liudmila Rupšienė
Yes
Yes
Yes
Yes
Yes
Yes
Malta
Sharon Arpa
Yes
Yes
Yes
Yes
Yes
Yes
Moldova
Mihai Ciocanu
.
.
.
Yes c
Yes
Yes
Monaco
Stanislas Spilka
.
.
.
Yes
Yes
Yes
Montenegro
Tatijana Djurisic 
.
.
.
Yes c
Yes
Yes
Netherlands
Karin Monshouwer
.
Yes
Yes
Yes
Yes a
Yes a
Norway
Elin K. Bye
Yes
Yes
Yes
Yes
Yes
Yes
Poland
Janusz Sieroslawski 
Yes
Yes
Yes
Yes
Yes
Yes
Portugal
Fernanda Feijão 
Yes
Yes
Yes
Yes
Yes
Yes
Romania
Silvia Florescu
.
Yes
Yes
Yes
Yes
Yes
Russia
Eugenia Koshkina
.
Moscow
Moscow
Yes
Moscow
.
Serbia
Spomenka Ciric-Jankovic
.
.
.
Yes c
Yes
.
Slovakia
Alojz Nociar 
Yes
Yes
Yes
Yes
Yes
Yes
Slovenia
Tanja Urdih Lazar 
Yes
Yes
Yes
Yes
Yes
Yes
Sweden
Håkan Leifman
Yes
Yes
Yes
Yes
Yes
Yes
Switzerland
Gerhard Gmel
.
.
Yes
Yes
.
.
Turkey
Nesrin Dilbaz
Istanbul
.
6 cities
.
.
.
Ukraine
Olga Balakireva
Yes
Yes
Yes
Yes
Yes
Yes
United Kingdom
Mark Bellis
Yes
Yes
Yes
Yes
Yes
.
a Data collected in autumn.    b Data collected in previous autumn.    c Data collected in spring 2008.    d Data collected but not delivered.
e Official name former Yugoslav Republic of Macedonia.
ESPAD Report 2015 
19

Introduction
interest in school surveys in general and cross-country 
ESPAD Report 2015
comparisons in particular, the Swedish Council for Information 
on Alcohol and Other Drugs (CAN) initiated a collaborative 
This report presents the key results of the 2015 ESPAD 
project in 1993 by contacting researchers in most European 
surveys that have been conducted in 35 countries: 
countries to explore the possibility of conducting simultaneous 
Albania, Austria, Belgium (Flanders), Bulgaria, Croatia, 
school surveys on tobacco, alcohol and drug use in association 
Cyprus, the Czech Republic, Denmark, Estonia, the Faroes, 
with the Pompidou Group. This enterprise resulted in the first 
Finland, the former Yugoslav Republic of Macedonia, 
ESPAD study in 1995.
France, Georgia, Greece, Hungary, Iceland, Ireland, Italy, 
Latvia, Liechtenstein, Lithuania, Malta, Moldova, Monaco, 
In 2008, a cooperation framework was set up between the 
Montenegro, the Netherlands, Norway, Poland, Portugal, 
European Monitoring Centre for Drugs and Drug Addiction 
Romania, Slovakia, Slovenia, Sweden and Ukraine. Firstly, 
(EMCDDA) and ESPAD. This framework was meant to 
the present report provides information on the availability of 
deepen the collaboration that had already existed on an 
substances, early onset of substance use and prevalence 
ad hoc basis since the mid 1990s. ESPAD data have been 
estimates of substance use (cigarettes, alcohol, cannabis, 
regularly included in the EMCDDA’s annual reporting on the 
illicit drugs, inhalants, new psychoactive substances and 
drug situation in Europe. These data have provided crucial 
pharmaceuticals). The descriptive information also includes 
information on substance use among 15- to 16-year-old 
indicators of intensive substance use and prevalence 
students, allowing trends over time to be assessed. The 
estimates of internet use, gaming and gambling by country 
areas of collaboration covered in the cooperation framework 
and gender. Secondly, overall ESPAD trends between 
included: (1) the integration of the ESPAD approach into 
1995 and 2015 are presented. For selected indicators, 
the broader data-collection system at EU level; (2) the 
ESPAD trends are shown based on data from 25 countries 
encouragement of countries’ participation in ESPAD; (3) an 
that participated in at least four (including the 2015 data 
agreement on analytical use of ESPAD data, by placing them 
collection) of the six surveys. Finally, for some indicators, 
in the context of EMCDDA data; and (4) contact between 
country-specific trends are shown. For comparative reasons 
ESPAD experts and those working within the EMCDDA. 
the tables of the 2015 ESPAD results contain, in addition to 
Furthermore, it was agreed to enhance the exchange of 
country-specific estimates, an unweighted average across 
information and expertise, improve the availability, quality 
all participating countries as well as prevalence estimates 
and comparability of school survey data and gain maximum 
for Spain and the United States, which are both non-ESPAD 
analytical insight from data available in this area (see 
countries. Data for Spain come from the Spanish national 
http://www.espad.org/Uploads/Documents/EMCDDA_
school survey collected between November 2014 and April 
Cooperation_Agreement-2008.pdf).
2015 (Spanish Observatory on Drugs and Drug Addiction, 
2016a, b), and the US data stem from the 2015 ‘Monitoring 
ESPAD still is and will continue to be an independent 
the future’ project (Johnston et al., 2016). The instruments 
research project owned by the researchers involved. The 
used in the Spanish and US surveys overlap to a large degree 
main researcher in each participating country is appointed 
with the ESPAD questionnaire, and the methodology used 
by ESPAD and is referred to either as a ‘principal investigator’ 
in all three surveys allows for rough comparisons across 
(PI) or as an ‘ESPAD contact person’. Each of them should 
the countries. Many of the ESPAD questions were originally 
raise funds in his or her country and participate in ESPAD 
taken from the ‘Monitoring the future’ study.
and the general assemblies independently and at his or 
her own expense. The data collected in the framework of 
the project are owned by each country independently (see 
Acknowledgements). The PI or contact person is responsible 
for the use of his or her national data set. Table 1 gives an 
overview of data that have been collected since 1995 in 
participating countries and the responsible persons.
20 
ESPAD Report 2015


Methodology
ESPAD Report 2015 21

Methodology
ESPAD 2015
varied between 17 % and 100 %. The proportion of students 
of selected classes that were present on the day of the 
Sample
survey and answered the questionnaire was high (80-84 %). 
At the time of data collection, students were on average 
The ESPAD target population is defined as students who 
15.8 years old, with country means varying between 15.7 
turn 16 in the calendar year of the survey and are present 
and 16.4 years. The coverage of students was very high, with 
in the classroom on the day of the survey. Students who 
30 countries reaching 90 % of the target population or more. 
were enrolled in regular, vocational, general or academic 
Lower rates were reported in Denmark (78 %) and Georgia 
studies were included, excluding those who were enrolled 
(73 %). Data were weighted in 11 countries to account for the 
in either special schools or special classes for students with 
cluster sampling design and/or to adjust the sample to the 
learning disorders or severe physical disabilities. Table 2 
sociodemographic composition of the target population.
shows the main sample characteristics. The methods 
are largely comparable in all countries, although there 
Measures
are characteristics, for example sample type, mode of 
administration or time of data collection, that may differ 
The questionnaire covers young people’s awareness of and 
between countries.
experience with different licit and illicit substances, internet, 
gaming and gambling with money. The questions are 
In each participating country, a cluster sampling design was 
designed to collect information on the use of psychoactive 
used to sample the target population, except in the Faroes, 
substances and the use of the internet for various activities 
Iceland, Liechtenstein, Malta, Monaco and Montenegro, 
in the lifetime, the last 12 months, the last 30 days or the last 
where all 1999-born target students were included. Data 
week previous to the survey, and consumption patterns such 
were collected by self-administered questionnaires. All 
as frequency or quantity (e.g. volume, hours).
countries used a paper-and-pencil questionnaire, except for 
Austria, Latvia, Liechtenstein and the Netherlands, where 
students answered a web-based questionnaire. Based on 
Availability of substances
a methodological study in Latvia, only small differences in 
students’ responses to online and traditional paper-and-
The perceived availability of substances is a proxy measure 
pencil questionnaires were found (Trapencieris, 2013), and 
for how easy or difficult it is for students to get a particular 
comparability was considered satisfactory. The students 
substance (cigarettes, alcohol or illicit drugs). Students 
answered the questionnaires anonymously in the classroom, 
were asked how easy they estimate it would be to get hold 
with teachers or research assistants functioning as survey 
of particular substances within 24 hours if they wanted to. 
leaders. The questionnaires were provided by school staff 
The response categories were ‘impossible’, ‘very difficult’, 
(18 countries), teachers (13 countries) or research assistants 
‘fairly difficult’, ‘fairly easy’, ‘very easy’ and ‘don’t know’. The 
(four countries). In the majority of countries, data collection 
proportions of students in each country answering ‘fairly 
took place between February and May 2015, except for 
easy’ or ‘very easy’ were merged to indicate easy availability. 
Belgium (Flanders), where data were collected 6 months 
Availability of each type of different alcoholic beverage (beer, 
earlier (autumn 2014), and Georgia and the Netherlands, 
wine and spirits) was evaluated separately. If considered 
where data were collected 6 months later (autumn 2015). 
relevant, countries included optional beverages such as cider 
In most countries, class was the last unit in a multistage 
or alcopops in the questionnaire.
stratified sampling process.
All samples were nationally representative, except for 
Age of first substance use
Belgium (only the Dutch-speaking part, Flanders), Cyprus 
(only government-controlled areas) and Moldova (Transnistria 
Students were asked how old they were when they used 
region not included). Sample sizes varied between 316 
a particular substance for the first time, started to use it 
in Liechtenstein and 11 822 in Poland. In 2015, data on 
on a daily basis (cigarettes) or experienced excessive use 
96 043 students were collected in 35 countries covering 
(alcohol intoxication). The response categories ranged from 
2.9 % of the population of adolescents born in 1999. The 
‘9 years old or less’ to ‘16 years or older’, in increments of 
school participation rate (share of selected schools taking 
1 year, and ‘never’. An age of initiation of 13 years or younger 
part in the survey) ranged from 21 % to 100 % and the class 
was taken as an indicator of early onset.
participation rate (share of selected classes participating) 
22 
ESPAD Report 2015

Methodology
Cigarette use
‘6-9’,’10-19’, ‘20-39’ and ‘40 or more’. Prevalence of any use 
of inhalants was based on intake on at least one occasion.
Students were asked on how many occasions they had ever 
smoked cigarettes, with the response categories being ‘0’, 
‘1-2’, ‘3-5’, ‘6-9’,’10-19’, ‘20-39’ and ‘40 or more’. Quantity 
New psychoactive substance use
of cigarette use in the last 30 days was also collected. The 
response categories ‘not at all’, ‘less than 1 cigarette per 
New psychoactive substances (NPS) were defined as 
week’, ‘less than 1 cigarette per day’, ‘1-5 cigarettes per 
‘substances that imitate the effects of illicit drugs such as 
day’, ‘6-10 cigarettes per day’, ‘11-20 cigarettes per day’ and 
cannabis or ecstasy and are sometimes called “legal highs”, 
‘more than 20 cigarettes per day’. Lifetime prevalence (any 
“ethnobotanicals” or “research chemicals” and can come 
use) and prevalence of daily use (at least 1-5 cigarettes per 
in different forms (herbal mixtures, powders, crystals or 
day) were calculated. Daily use of cigarettes was considered 
tablets)’. Students were asked how often they had used NPS 
as having smoked a minimum of one cigarette each day.
in their life, with the response categories being ‘0’, ‘1-2’, ‘3-5’, 
‘6-9’,’10-19’, ‘20-39’ and ‘40 or more’. Prevalence of any use 
of NPS was based on intake on at least one occasion.
Alcohol use
Students were asked on how many occasions they had 
Pharmaceutical use
consumed alcoholic beverages and had been intoxicated 
in their lifetime and during the last 30 days. The response 
To measure lifetime experience of use of pharmaceuticals, 
categories ‘0’, ‘1-2’, ‘3-5’, ‘6-9’, ‘10-19’, ‘20-39’ and ‘40 or 
students were asked on how many occasions they had used 
more’. The average number of occasions was calculated 
tranquillisers or sedatives without a doctor’s prescription, 
as the average based on the mean value of each response 
anabolic steroids or painkillers in order to get high, with the 
category, for example 29.5 for the category ‘20-39’. For the 
response categories being ‘0’, ‘1-2’, ‘3-5’, ‘6-9’,’10-19’, ‘20-39’ 
category ‘40 or more’, the value 41 was used. Prevalence 
and ‘40 or more’. Prevalence of any use was based on intake 
of any use (lifetime, last-30-day) and prevalence of 
on at least one occasion.
experiencing any intoxication were also calculated (≥ 1-2 
times). Moreover, heavy episodic drinking is defined as 
drinking a minimum of five alcoholic beverages on one 
Conditional probabilities of substance use
occasion at least once in the last 30 days, which corresponds 
to a cut-off of approximately 9 centilitres of pure alcohol. The 
Conditional prevalence rates were calculated as the 
volume of alcohol intake was calculated as the total volume 
prevalence of use of one substance conditional on the use 
of pure ethanol summed across different alcoholic beverages 
of another substance. This analysis is based on substance 
(beer, wine, spirits, alcopops and cider).
users across all countries. It is neither assumed that the use 
of a particular substance has occurred before the use of 
another substance nor assumed that the use of a substance 
Illicit drug use
is caused by the use of another substance.
To measure lifetime experience with illicit drugs, students 
were asked on how many occasions they had tried different 
Internet use, gaming and gambling
drugs in their lifetime, with the response categories being ‘0’, 
‘1-2’, ‘3-5’, ‘6-9’,’10-19’, ‘20-39’ and ‘40 or more’. Frequency 
To assess patterns of internet use, including online gaming 
of use was asked for cannabis (marijuana or hashish), 
and gambling (online and offline), students were asked on 
ecstasy, amphetamine, methamphetamine, cocaine, crack, 
how many of the last 7 days had they used the internet, 
LSD or other hallucinogens, heroin and GHB (gamma-
and how many hours had they spent on the internet on 
hydroxybutyrate). The average number of occasions using 
an average day on which they had used the internet. This 
cannabis was calculated as the average based on the mean 
information was asked for various online activities such 
value of each response category, for example 29.5 for the 
as social media (communicating with others), searching 
category ‘20-39’. For ‘40 or more’ the value 41 was used.
for information, streaming or downloading music, buying/
selling, gaming (which is defined for the purpose of this 
study as playing games) and gambling for money. Based 
Inhalant use
on that, the average number of days using the internet and 
the prevalence of using the internet at least four times for 
Students were asked how often they had used inhalants in 
each of these activities in the last 7 days (also referred to 
their life, with the response categories being ‘0’, ‘1-2’, ‘3-5’, 
as regular use) was calculated. Gambling for money was 
ESPAD Report 2015 
23

Methodology
Table 2. 
Sampling characteristics of ESPAD 2015
Student 
Data 
Class 
Students’ 
Geograph-
Sampling 
Data 
represen-
Mean 
Country
collection 
Sample type
participation  presence 
n
ic coverage
unit(s) 
weighted
tativeness 
age d
mode
rate (%) b
rate (%) c
(%) a
Albania
National
Pen and 
Stratified 
School/class
No
95
100
94
15.9
2 553
paper
random
Austria
National
Web 
Proportionate  School/class
Yes
90
17 e
90
15.9
3 684
survey
random
Belgium f
Flanders g
Pen and 
Stratified 
School/class
Yes
94
56 i
94
15.8
1 771
paper h
random
Bulgaria
National
Pen and 
Simple 
Class
No
99
98
84
16.0
2 922
paper
random
Croatia
National
Pen and 
Stratified 
School/class
No
94
98
89
15.7
2 558
paper
simple random
Cyprus
National j
Pen and 
Stratified 
Class
No
>90
85
n.a.
15.8
2 098
paper
random
Czech 
National
Pen and 
Stratified 
School/class
Yes
>95
96 i
83
16.0
2 738
Republic
paper
random
Denmark
National
Pen and 
Stratified 
School/class
No
78 k
26 i
88
15.8
1 670
paper
simple random
Estonia
National
Pen and 
Stratified 
School/class
No
97 l
90
83
15.7
2 452
paper
random
Faroes
National
Pen and 
Total
No sample
No
88
100
92
15.7
511
paper
Finland
National m
Pen and 
Stratified 
School/class
No
93
85
89
15.8
4 049
paper
random
FYR 
National
Pen and 
Systematic 
Class
No
 92 q
98
88
15.8
2 428
Macedonia w
paper
random
France
National n
Pen and 
Stratified 
School/class
Yes
94
93
87
15.9
2 714
paper
random
Georgia o
National
Pen and 
Proportionate  School/class
No
73
98
86
16.4
1 966
paper
simple random
Greece
National
Pen and 
Stratified 
Class
Yes
91
95
92
15.8
3 202
paper
random
Hungary
National
Pen and 
Stratified 
Class
Yes
97
93
85
15.7
2 735
paper
random
Iceland
National
Pen and 
Total
No sample
No
96
79
86
15.8
2 663
paper
Ireland
National
Pen and 
Stratified 
School/class
No
98
18 e
86
15.9
1 470
paper
systematic 
random
Italy
National
Pen and 
Stratified 
Class
No
99
85
88
15.7
4 059
paper
proportionate 
random
Latvia
National
Web 
Stratified 
Class
Yes
95 p
42
85
15.9
1 119
survey
random cluster 
sampling
Liechtenstein National
Web 
Total
No sample
No
~99
100
93
15.7
316
survey
Lithuania
National
Pen and 
Stratified 
School/class
No
85
99
88
15.7
2 573
paper
random
Malta
National
Pen and 
Total
No sample
No
93
98
83
15.7
3 326
paper
Moldova
National r
Pen and 
Simple 
Class
No
90
100
87
15.9
2 586
paper
random
Monaco
National
Pen and 
Total
No sample
No
~99
100
91
15.8
397
paper
24 
ESPAD Report 2015

Methodology
Student 
Data 
Class 
Students’ 
Geograph-
Sampling 
Data 
represen-
Mean 
Country
collection 
Sample type
participation  presence 
n
ic coverage
unit(s) 
weighted
tativeness 
age d
mode
rate (%) b
rate (%) c
(%) a
Montenegro
National
Pen and 
Proportionate  Student
No
94
100
87
15.9
3 844
paper
simple random
Netherlands o National
Web 
Stratified 
School/class
Yes
94
43 i
90
15.9
1 684
survey
simple random
Norway
National
Pen and 
Stratified 
School/class
Yes
98 s
53
93
15.8
2 584
paper
random
Poland
National
Pen and 
Stratified 
School/class
Yes
95
94
83
16.0
11 822
paper
random
Portugal
National t
Pen and 
Stratified 
Class
No
86 q
96
93
15.9
3 456
paper
systematic 
random
Romania
National
Pen and 
Systematic 
School/class
No
91 s
100
84
15.9
3 500
paper
random
Slovakia
National
Pen and 
Stratified 
School/class
No
98
100
89
15.8
2 208
paper
proportional 
random
Slovenia
National
Pen and 
Stratified 
Class
No
94
99
88
15.8
3 484
paper
random
Sweden
National
Pen and 
Simple 
School/class
No
95
83
86
15.7
2 551
paper
random
Ukraine
National u
Pen and 
Stratified 
School/class
Yes
92
98
80
16.0
2 350
paper
systematic 
random
AVERAGE or SUM
93
87 v
88
15.8
96 043
a  Proportion of ESPAD target students covered by the sampling frame.
b  Proportion of selected classes participating in the survey.
c  Proportion of students of participating classes answering the questionnaire.
d  Based on the data collection period.
e  Estimated from the maximum number of classes that could participate.
f  Data collected in previous autumn instead of spring.
g  Geographic population coverage 61 %: only Flanders and Dutch-speaking schools in the Brussels Capital region are covered by the sampling frame.
h  A few classes in the ESPAD sample answered the online version.
i  School participation rate (class participant rate unknown).
j  Geographic population coverage approx. 80 %: only government-controlled areas are covered by the sampling frame.
k  Boarding schools not included.
l  Vocational schools not included (less than 2 % of students born in 1999).
m Geographic population coverage 99 %: the Åland Islands are not covered by the sampling frame.
n  Geographic population coverage 96.5 %: DOM-TOM territories (overseas departments and territories such as French Guiana, Réunion and those in 
the Caribbean) are not covered by the sampling frame.
o  Data collected in autumn instead of spring.
p  Vocational schools not included (1.7 % of students born in 1999).
q  Private schools not included.
r  Geographic population coverage 85 %: the Transnistria region is not covered by the sampling frame.
s  Estimations by principal investigator.
t  Geographic population coverage 95 %: the islands of the Azores and Madeira are not covered by the sampling frame.
u  Geographic population coverage 95 %: AR Crimea is not covered by the sampling frame.
v  Only countries with class participation rates excluding Belgium (Flanders), the Czech Republic, Denmark and the Netherlands.
w Official name former Yugoslav Republic of Macedonia.
ESPAD Report 2015 
25

Methodology
further assessed by asking students about the frequency of 
student population in Denmark (78 %), the former Yugoslav 
particular gambling activities in the last 12 months (playing 
Republic of Macedonia (79 %) and Georgia (73 %) was 
slot machines, cards or dice, lotteries or betting on sports 
below average. Finally, a relatively high proportion of parents 
or animals). The response categories were ‘not gambled’, 
refused permission for their child to participate in the survey 
‘monthly or less’, ‘2-4 times a month’, ‘2-3 times a week’, 
in Portugal and Romania (6.9 % each).
‘4-5 times a week’ and ‘6 or more times a week’. Prevalence 
rates were calculated for last-12-month (at least once) and 
Due to the uncertainty of data-collection procedures, Latvia 
frequent (2-4 times a month or more) gambling.
is excluded from the standard reporting and the calculation 
of the ESPAD average. In all tables, Latvia is reported 
separately to illustrate difficulties in comparability. More 
Data processing and data quality
details on the ESPAD methodology are available online 
(http://www.espad.org).
Data were centrally cleaned in two steps. First, all cases 
with missing information on gender were excluded from the 
database. The other major reason for exclusion was poor 
Analysis
data quality. All cases with responses to less than half of 
the core items were discarded, as were all cases where the 
Prevalence estimates and means were calculated for 
respondent appeared to have followed patterns involving 
each participating country, taking weights into account 
repetitive marking of extreme values. Across all ESPAD 
where necessary. In all tables, totals and gender-specific 
countries, an average of 1.8 % (0.0-7.6 %) of cases were 
estimates for boys and girls are presented by country. 
excluded because of poor data quality or missing information 
Gender differences reported in Figures 1-9 were tested 
on gender.
using either simple linear regression for quasi-continuous 
frequency measures or logistic regression for prevalence, 
Second, logical substitution of missing values was performed 
with gender as predictor. Conditional probabilities expressing 
in a rather conservative way. In cases where students had 
the use of one substance given the use of another substance 
indicated that they had never used a specific substance and 
were calculated for cigarettes, alcohol, cannabis, ecstasy, 
subsequently did not respond to further questions about 
amphetamine, methamphetamine, cocaine, crack, LSD 
such use, any missing values were substituted with no use 
or other hallucinogens, heroin, GHB, inhalants, NPS, 
for that particular substance. However, no substitutions were 
tranquillisers or sedatives, painkillers and anabolic steroids. 
made if any contradictory indications of use were at hand. 
The ESPAD average is based on 35 countries assigning 
For the seven substance use variables where substitutions 
equal weight to each country. Latvia was excluded from the 
were performed, the average reduction of the non-response 
calculation of the ESPAD average due to validity concerns. 
rate was rather small, ranging from 0.1 % to 0.5 %. The 
All percentages in the report were calculated on the basis 
single highest country-specific reduction was found in 
of valid responses and are shown for totals, boys and girls. 
Norway, where the non-response rate for lifetime inhalant 
With the exception of frequency of alcohol use (Figures 2a, 
use was reduced by 2.7 percentage points. Norway, the 
2b), alcohol intake (Figures 3a, 3b), preference of alcoholic 
former Yugoslav Republic of Macedonia and Latvia were the 
beverages (Figures 4a, 4b) and frequency of cannabis 
countries where the logical substitution of missing values 
use (Figures 7a, 7b), where the estimates are based on 
had the biggest impact. However, the reductions in non-
consumers of a particular substance, all estimates are based 
responses had only minor effects on the final prevalence 
on the total sample and represent population estimates.
estimates.
A few countries experienced modest methodological 
Trend analyses
problems but, with the exception of Latvia, not of such 
a magnitude as to seriously threaten the comparability of 
For temporal trends, country estimates were averaged 
the results. Compared to the ESPAD average, higher rates of 
across 25 countries with full coverage and valid estimates 
inconsistencies indicate a somewhat lower data quality in 
on at least four (including 2015) out of six time points. The 
Albania, Bulgaria and Cyprus. Low school/class participation 
countries included are Bulgaria, Croatia, Cyprus, the Czech 
rates in Austria (17 %), Denmark (26 %), Ireland (18 %), 
Republic, Denmark, Estonia, the Faroes, Finland, France, 
Latvia (42 %) and the Netherlands (43 %) resulted in turn in 
Greece, Hungary, Iceland, Ireland, Italy, Lithuania, Malta, the 
relatively small net sample sizes. In Austria (4.2 %), Cyprus 
Netherlands, Norway, Poland, Portugal, Romania, Slovakia, 
(3.8 %), Latvia (7.6 %) and Norway (4.2 %), a relatively high 
Slovenia, Sweden and Ukraine. The average across the 25 
proportion of cases had to be discarded in the central data-
country means was calculated using a weight of 1, and 
cleaning process. Due to sampling of only one school grade 
data for each survey year were summed and divided by the 
or not including boarding schools, the coverage of the target 
number of countries with valid data for that particular year. 
26 
ESPAD Report 2015

Methodology
Data across all six time points were complete in 20 countries 
a glass of wine (approximately 15 centilitres), a glass of 
with data on five countries missing in 1995 (Bulgaria, France, 
spirits (approximately 5 centilitres) or a mixed drink.’ The 
Greece, the Netherlands and Romania), and data on one 
questionnaire test revealed no significant differences 
country missing in 1999 (the Netherlands; data collected 
between the two versions.
but not considered comparable) and 2007 (Denmark; data 
collected but not considered comparable). Trends across the 
25 countries are shown for a number of selected indicators 
Illicit drugs other than cannabis
by gender. Country-specific trends are shown for all 
countries with at least two valid data points over the period 
The questionnaire collects data on the use of illicit drugs 
1995-2015. Country-specific prevalence estimates before 
other than cannabis, including amphetamine, cocaine, crack, 
the 2007 ESPAD survey are only available on aggregate level, 
ecstasy, LSD or other hallucinogens, heroin, GHB (since 
preventing statistical testing of temporal changes. Instead, 
2007) and methamphetamine (since 2015). In 2015, crack 
a standardised procedure is used where a difference of 
was not included in Denmark, Estonia, Finland and Sweden.
less than ± 3 percentage points is not considered as ‘real 
difference’. Trends are illustrated graphically, with decreases 
of 3 or more percentage points between successive surveys 
Inhalant use
indicated in green, increases of 3 or more percentage 
points in red and unchanged situations in yellow (less than 
In the earlier rounds of the survey, the question on inhalant 
± 3 percentage points).
use read ‘Did you try inhalants (glue, etc.) to get high?’. 
In 2007, the question was rephrased to refer to ‘the use 
of inhalants to get high’. The questionnaire test found no 
Comparability of variables
significant differences between the old and new versions. 
Since 2011, countries have been instructed to add nationally 
After the 2003 survey, a working group was set up to improve 
relevant examples in the questionnaire.
and revise some of the questions that had caused problems 
in the previous surveys. Modified questions were tested 
on differences in outcome using a split-half design in eight 
Reporting
countries. In general, most of the revised questions were 
found to be comparable with the earlier versions (Hibell and 
Based on the 2015 ESPAD data, selected substance use 
Bjarnason, 2008).
indicators are presented comprising students’ perceptions 
of the availability of cigarettes, alcohol and illicit drugs, 
early onset of substance use and prevalence estimates of 
Availability of substances
substance use. Whenever available, corresponding figures of 
the two non-ESPAD countries, Spain and the United States, 
In the surveys until 2003, perceived availability of substances 
are also presented in tables and maps. The Spanish data 
was asked in one single question. Since 2007, the 
relate to students born in 1997 who took part in a broader 
questionnaire has contained separate questions for each 
national survey carried out in 2013. The US data relate to 
substance. A questionnaire test in eight countries showed 
students in grade 10, of whom just over half were born 
some differences between the two versions.
in 1999. The two samples differ from the ESPAD sample 
also with respect to age. The mean ages of the ESPAD, the 
Spanish and the US samples are 15.8, 15.6 and 16.2 years, 
Alcohol use
respectively. Due to differences in the sampling protocol and 
consequently in sample composition, comparisons should 
In the surveys until 2003, the question on heavy episodic 
be made with caution.
drinking read ‘How many times (if any) have you had 
five or more drinks in a row? A “drink” is a glass of wine 
In addition, patterns of current drug use among users of the 
(approximately 15 centilitres), a bottle or can of beer 
specific substance are presented for cigarettes (prevalence 
(approximately 50 centilitres), a shot glass of spirits 
for daily smoking), alcohol use (mean number of occasions in 
(approximately 5 centilitres) or a mixed drink.’ Cider or 
the last 30 days, beverage preference and volume on the last 
alcopops were not included. Since 2007, the definition 
drinking occasion), heavy episodic drinking (consumption 
has read: ‘How many times (if any) have you had five or 
of five or more drinks on at least one occasion in the last 
more drinks on one occasion? A “drink” is a glass/bottle/
30 days), cannabis use (prevalence in the last 30 days and 
can of beer (approximately 50 centilitres), a glass/bottle/
mean number of occasions of cannabis use in the last 
can of cider (approximately 50 centilitres), two glasses/
12 months), inhalant use (prevalence in the last 30 days) 
bottles of alcopops (approximately 50 centilitres), 
and NPS use (prevalence in the last 12 months). The results 
ESPAD Report 2015 
27

Methodology
are presented in maps and bar charts. Gender differences 
Changes in reporting
are also graphically shown by country, including tests for 
significance (Figures 1-9). In the maps, Belgium (Flanders), 
The results of the 2015 ESPAD survey are presented in 
both a print and an online report. The present print report 
Cyprus and Moldova are presented with a lined pattern, as 
contains selected key results rather than the full range of 
the Belgian data are representative only for Flanders, the 
results and tables. The online report, including all tables 
Cypriot data are representative only for the government-
in the usual ESPAD format, is available at http://www.
controlled part of Cyprus and in Moldova the Transnistria 
espad.org. All tables can be downloaded in Excel format 
region was not included.
and used for further analysis.
In the section on ‘Trends 1995-2015’ (pages 70-81), 
temporal trends between 1995 and 2015 are presented for 
the average across 25 country means (pages 70-75) and for 
all ESPAD countries separately (pages 76-81).
28 
ESPAD Report 2015


The situation 
in 2015

The situation in 2015
This chapter presents selected indicators of the drug 
Alcohol
situation in the 35 ESPAD countries in 2015. Each result 
section will start with a box containing a summary of the 
Alcoholic beverages were perceived to be easily available in 
main results with an ESPAD average estimate and the 
most countries and gender differences were rather uncommon 
country range: minimum (min.) and maximum (max.) for 
(Table 3a). More than three in four students (78 %) stated that 
each selected measure.
they would find it easy to acquire alcoholic beverages if they 
wanted to. In the Czech Republic, Denmark and Greece, more 
than 90 % of the students reported easy access. The lowest 
Availability of substances
proportions were found in Moldova (52 %), the former Yugoslav 
Republic of Macedonia (53 %) and Romania (60 %). In most 
ESPAD average 
countries, perceptions of availability among boys and girls 
Perceived availability of substances (%) a
were rather similar. Notable gender differences could be found 
Average
Min.
Max.
in Liechtenstein, Moldova and Romania (9-10 percentage 
Cigarettes
61
22
80
points), with rates among boys being higher than among girls, 
and in the Faroes and Sweden, with a higher rate among girls 
Alcohol
78
52
96
than boys (5 percentage points).
Cannabis
30
5
50
Ecstasy
12
2
24
Amphetamine
9
2
23
Illicit drugs
Methamphetamine
7
1
17
About three in ten students (30 %) rated cannabis to be 
Cocaine
11
2
19
easily obtainable (Table 3a). In the Czech Republic (50 %), 
Crack
8
1
14
more students than in any other ESPAD country perceived 
cannabis to be easily available. High proportions were 
a Percentage of students rating a substance as either ‘fairly easy’ or ‘very 
easy’ to obtain.
also found in Slovenia (45 %) as well as in Liechtenstein 
and Bulgaria (44 % each). The countries with the lowest 
perceived availability of cannabis were Moldova (5 %) and 
Cigarettes
Ukraine (11 %). Boys were more likely than girls to consider 
cannabis to be easily available (ESPAD average: 32 % versus 
Over 60 % of the students in the participating countries 
29 %). This was the case in most countries, with differences 
replied that they would find it fairly or very easy (hereafter 
between the genders of up to 15 percentage points. 
referred to as easy) to get hold of cigarettes if they wanted to 
Countries in which more girls than boys (5 percentage points 
(Table 3a). Students in the Czech Republic were most likely 
or more) reported easy availability of cannabis were Bulgaria 
to find it easy (80 %). In Austria, Liechtenstein and Denmark, 
(47 % versus 40 %) and Slovakia (46 % versus 41 %).
the perceived availability was also comparatively high, with 
79 %, 77 % and 76 % of the students, respectively, reporting 
Perceived availability of other illicit drugs was relatively low 
access to be easy. Particularly low figures of perceived 
(Table 3a, 3b): ecstasy (12 %), cocaine (11 %), amphetamine 
availability were found in Moldova (22 %) and figures of 
(9 %), methamphetamine (7 %) and crack (8 %). In Bulgaria 
less than 40 % were observed in three other countries in 
(e.g. amphetamine 23 %, methamphetamine 17 %), illicit 
the eastern part of Europe: the former Yugoslav Republic 
drugs were overall perceived as more easily available than 
of Macedonia (38 %), Romania (37 %) and Ukraine (39 %). 
elsewhere in Europe. In addition, 10 % or more of the students 
Gender differences were negligible at the aggregate level 
in Croatia, the Netherlands, Norway and Poland thought that 
(62 % for boys versus 60 % for girls). Where differences 
any of the listed illicit drugs were easily available. Perceived 
were observed, figures were generally higher for boys than 
availability of ecstasy was highest in Bulgaria, the Czech 
girls. In Albania, Belgium (Flanders), Finland and Moldova, 
Republic and Ireland (over 20 %), and perceived availability 
differences between the genders reached 10 percentage 
of cocaine was highest in Bulgaria, Ireland, Liechtenstein and 
points or more. In 10 countries, figures of availability were 
Poland (17-19 %). The countries with the lowest perceptions 
higher for girls than boys, with rates for girls 6 percentage 
of availability on nearly all illicit drugs were the Faroes, Finland, 
points higher in Bulgaria.
Georgia, Moldova and Ukraine. Countries with noticeable 
gender differences for all illicit drugs were Liechtenstein and 
the Netherlands (higher rates for boys than girls), Bulgaria and 
Slovakia (higher rates for girls than boys).
30 
ESPAD Report 2015

The situation in 2015
Table 3a. 
Perceived availability of substances: prevalence of students responding substance ‘fairly easy’ or ‘very easy’ to 
obtain (percentage)
Cigarettes
Alcohol
Cannabis
Ecstasy
Country
Cigarettes
Alcohol
Cannabis
Ecstasy
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Albania
51
71
22
14
56
46
72
69
28
16
14
14
Austria
79
89
39
12
80
79
88
90
40
37
12
12
Belgium (Flanders)
61
81
36
13
66
56
81
80
41
32
13
12
Bulgaria
68
88
44
21
65
71
87
90
40
47
18
25
Croatia
72
87
42
17
73
72
86
87
41
42
15
20
Cyprus
56
88
21
10
58
54
88
88
24
18
11
8
Czech Republic
80
92
50
24
79
81
91
93
48
51
23
24
Denmark
76
96
40
14
79
73
96
95
44
37
15
13
Estonia
58
73
34
11
60
56
71
75
34
33
10
13
Faroes
64
76
15
5
64
65
73
78
15
15
4
7
Finland
65
71
15
5
71
61
72
71
17
14
6
5
FYR of Macedonia a
38
53
14
7
39
36
56
50
17
10
9
6
France
59
76
41
10
62
56
78
75
43
38
10
9
Georgia
60
81
21
9
61
59
81
81
23
18
11
8
Greece
65
91
23
8
64
66
90
91
25
20
9
6
Hungary
68
84
25
13
68
67
85
83
25
26
11
14
Iceland
44
61
27
11
44
44
60
62
29
26
11
11
Ireland
62
77
43
22
65
58
75
79
47
39
26
19
Italy
63
81
37
8
62
65
81
81
41
34
9
8
Liechtenstein
77
88
44
13
81
74
93
84
52
38
18
9
Lithuania
64
70
25
9
65
63
69
72
26
24
7
10
Malta
56
85
26
13
54
57
83
87
26
26
12
15
Moldova
22
52
5
2
28
15
56
47
6
4
2
2
Monaco
58
75
34
6
56
60
74
75
36
31
6
7
Montenegro
63
72
27
18
64
61
75
69
30
23
19
17
Netherlands
61
78
42
18
64
59
78
77
50
34
21
15
Norway
64
74
30
10
66
63
72
76
33
27
11
10
Poland
73
82
39
16
73
73
81
83
41
38
16
16
Portugal
60
79
31
10
60
60
78
81
32
31
10
9
Romania
37
60
14
6
38
36
65
55
15
13
5
7
Slovakia
70
88
43
15
70
70
86
90
41
46
12
18
Slovenia
66
85
45
17
66
66
84
86
47
44
16
18
Sweden
74
77
28
13
72
75
75
80
27
29
13
13
Ukraine
39
66
11
3
42
37
65
68
13
8
3
3
AVERAGE
61
78
30
12
62
60
78
78
32
29
12
12
Latvia
60
70
24
9
62
58
68
72
24
23
7
11
Spain
78
92
45
10
75
81
91
92
47
43
12
9
United States
67
75
66
19
65
68
73
77
65
66
19
19
a Official name former Yugoslav Republic of Macedonia.
ESPAD Report 2015 
31

The situation in 2015
Table 3b. 
Perceived availability of substances: prevalence of students responding substance ‘fairly easy’ or ‘very easy’ to 
obtain (percentage)
Meth-
Metham-
Amphet-
Amphetamine
Cocaine
Crack
Country
amphet-
Cocaine
Crack
phetamine
amine
a mine
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Albania
6
6
11
6
6
6
6
6
13
9
7
4
Austria
13
7
13
9
13
14
6
7
12
13
9
8
Belgium (Flanders)
10
5
14
8
10
10
5
5
13
15
8
7
Bulgaria
23
17
19
13
19
28
14
20
16
23
11
16
Croatia
16
11
14
12
16
17
10
12
12
17
11
13
Cyprus
7
6
11
8
8
6
7
6
12
10
8
7
Czech Republic
7
12
11
8
7
8
12
13
10
12
9
8
Denmark
12
8
16
9
14
10
9
7
18
15
10
7
Estonia
9
.
10
.
8
10
.
.
6
13
.
.
Faroes
2
2
5
4
1
4
1
3
3
7
4
4
Finland
3
3
4
.
4
3
3
2
4
4
.
.
FYR Macedonia a
5
5
6
4
6
5
6
3
6
6
5
3
France
10
6
13
10
10
10
6
6
13
13
10
11
Georgia
6
5
3
3
7
4
7
3
4
3
3
2
Greece
5
4
8
5
6
4
5
4
9
8
6
4
Hungary
12
10
12
7
11
13
10
11
11
13
8
7
Iceland
12
7
9
6
12
12
7
7
9
10
6
7
Ireland
14
8
19
14
15
14
9
6
19
19
13
15
Italy
8
6
11
8
8
8
7
5
12
11
8
7
Liechtenstein
15
7
17
8
21
11
11
4
21
13
11
5
Lithuania
6
5
9
5
5
6
5
5
8
10
5
5
Malta
9
5
15
10
8
10
5
5
12
18
8
11
Moldova
2
1
2
1
2
2
2
1
2
1
1
1
Monaco
7
4
9
6
7
8
4
5
9
10
7
5
Montenegro
13
10
12
8
14
12
11
8
13
11
10
7
Netherlands
14
10
14
11
17
12
12
8
17
11
14
9
Norway
11
.
11
11
11
10
.
.
11
11
11
10
Poland
17
13
17
11
16
18
12
14
16
19
11
11
Portugal
7
6
11
6
8
7
6
5
11
12
7
5
Romania
4
4
7
4
4
5
4
4
6
8
4
4
Slovakia
8
11
12
8
7
9
9
13
9
16
7
9
Slovenia
8
8
16
12
8
8
8
9
14
19
11
12
Sweden
9
8
13
10
9
10
8
8
11
15
9
11
Ukraine
3
3
2
2
4
3
4
2
2
2
3
1
AVERAGE
9
7
11
8
9
9
7
7
11
12
8
7
Latvia
7
6
9
.
6
8
5
7
7
10
.
.
Spain
11
16
15
15
13
10
19
14
16
14
16
14
United States
27
.
16
14
26
28
.
.
15
17
13
16
a Official name former Yugoslav Republic of Macedonia.
32 
ESPAD Report 2015

The situation in 2015
Early onset of substance use
prevalence estimates for boys were Estonia, Lithuania and 
Slovakia (9 %). Among girls, Bulgaria and Estonia (7 %) were 
ESPAD average 
the countries with the highest rates.
Early onset of substance use (%) a
Average
Min.
Max.
Cigarettes
23
9
46
Alcohol
Daily smoking
4
1
8
Nearly half of the students (47 %) reported alcohol use at 
Alcohol
47
14
72
the age of 13 or younger (Table 4a). The highest proportions 
Intoxication
8
2
22
of students reporting alcohol use at an early age were found 
Cannabis
3
1
8
in Georgia (72 %), the Czech Republic (68 %) and Cyprus 
Ecstasy
1
0
2
(66 %). The countries with the lowest rates were Iceland 
Amphetamine/methamphetamine
1
0
3
(14 %) and Norway (19 %). Boys were more likely than girls 
Cocaine/crack
1
0
2
to have used alcohol at the age of 13 or younger, with the 
a Percentage of students using a substance at the age of 13 or younger.
highest gender difference found in Albania (61 % for boys 
versus 37 % for girls) and Montenegro (58 % versus 36 %).
Cigarettes
One in twelve students experienced intoxication at the 
More than one in five ESPAD students (23 %) had smoked 
age of 13 or younger. The proportion of students reporting 
cigarettes at the age of 13 or younger (Table 4a). The 
intoxication at an early age varied across countries: Georgia 
proportions vary considerably across countries, from 46 % 
(22 %) and Estonia (15 %) were at the high end and Iceland 
in Estonia and 45 % in Lithuania to 9-13 % in the former 
(2 %) and Belgium (Flanders) (3 %) were at the low end of 
Yugoslav Republic of Macedonia, Iceland, Malta and Norway. 
the scale. Higher rates were more likely to be found in the 
Both on average and in most individual countries, more boys 
eastern part of Europe. In general, more boys than girls 
than girls have smoked cigarettes at the age of 13 or younger. 
reported intoxication at an early age (ESPAD average: 9 % 
The largest difference between boys and girls was found in 
versus 6 %, respectively).
Moldova (33 % versus 8 %). The highest rates among boys 
(50-51 %) were found in Estonia and Lithuania. The Czech 
Republic and the three Baltic countries of Estonia, Latvia and 
Illicit drugs
Lithuania had the highest rates among girls (40-41 %).
On average, 3 % of the students reported that they had first 
The ESPAD average for students who began smoking 
used cannabis at the age of 13 or younger (Table 4b). The 
cigarettes on a daily basis at the age of 13 or younger is 
highest proportions were found in Monaco (8 %), France 
4 %. The rates were highest in Estonia and Slovakia (8 %) 
and Liechtenstein (6 % each). Rates of early onset of 
and lowest in Norway (1 %). Due to the small proportion of 
amphetamine/methamphetamine use were lower (ESPAD 
students reporting onset of daily smoking at an early age, 
average: 1 %), with the highest proportions in Bulgaria (3 %) 
gender differences were generally less than 3 percentage 
and Cyprus (2 %). Boys were more likely than girls to have 
points (ESPAD average: boys 5 %, girls 3 %), even though 
used cannabis or amphetamine/methamphetamine at the 
in the majority of countries more boys than girls reported 
age of 13 or younger. Similar results were found for early 
early onset of daily smoking. The countries with the highest 
onset of ecstasy and cocaine/crack use.
ESPAD Report 2015 
33

The situation in 2015
Table 4a. 
Early onset of substance use: prevalence of students experiencing substance use (cigarettes, daily smoking, 
alcohol, intoxication) at the age of 13 or younger (percentage)
Daily 
Intoxi-
Cigarettes
Daily smoking
Alcohol
Intoxication
Country
Cigarettes
Alcohol
smoking
cation
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Albania
23
2
48
7
31
16
3
1
61
37
11
3
Austria
24
3
36
6
26
22
3
3
37
34
8
5
Belgium (Flanders)
14
3
32
3
16
12
3
2
35
29
4
2
Bulgaria
25
7
65
13
24
26
7
7
69
61
17
9
Croatia
32
5
64
11
35
29
7
4
70
59
14
7
Cyprus
17
4
66
8
22
11
6
3
73
60
12
5
Czech Republic
43
6
68
10
45
40
7
6
72
65
11
9
Denmark
14
2
50
7
16
13
2
2
55
45
7
6
Estonia
46
8
58
15
51
41
9
7
59
56
17
14
Faroes
21
2
31
5
27
15
2
2
36
26
7
3
Finland
27
6
33
8
32
23
8
4
37
28
9
8
FYR Macedonia a
12
3
32
5
17
7
4
2
41
23
9
2
France
27
5
57
4
30
24
5
5
60
53
5
3
Georgia
21
4
72
22
28
13
6
2
78
65
29
13
Greece
14
2
62
5
18
11
2
1
70
54
7
3
Hungary
28
5
63
10
32
25
6
5
69
58
12
8
Iceland
9
2
14
2
11
7
2
2
16
12
2
2
Ireland
16
3
27
7
19
13
4
2
31
23
8
6
Italy
21
4
45
4
23
20
4
3
51
38
6
2
Liechtenstein
23
5
35
8
22
24
4
5
34
36
9
8
Lithuania
45
7
52
9
50
40
9
5
53
51
11
6
Malta
13
3
54
8
11
14
3
4
54
53
8
8
Moldova
21
2
56
7
33
8
3
1
62
48
10
3
Monaco
31
6
61
7
33
28
6
6
65
56
9
6
Montenegro
17
3
47
6
19
14
4
2
58
36
10
2
Netherlands
16
3
26
4
19
14
4
3
28
24
4
4
Norway
13
1
19
4
15
11
1
1
21
16
4
3
Poland
28
4
41
6
32
24
5
4
45
38
8
5
Portugal
24
5
41
5
25
23
4
5
43
39
6
5
Romania
23
5
51
8
27
19
7
4
59
44
13
4
Slovakia
36
8
63
14
41
30
9
6
66
60
14
13
Slovenia
21
2
59
7
21
20
2
2
64
54
9
5
Sweden
16
3
26
6
16
16
2
3
29
23
6
6
Ukraine
31
5
53
6
37
25
8
2
54
53
8
5
AVERAGE
23
4
47
8
27
20
5
3
52
43
9
6
Latvia
47
10
63
15
54
41
11
8
65
61
16
13
Spain
14
3
.
.
14
14
3
3
.
.
.
.
United States
12
2
23
9
.
.
.
.
.
.
.
.
a Official name former Yugoslav Republic of Macedonia.
34 
ESPAD Report 2015

The situation in 2015
Table 4b. 
Early onset of substance use: prevalence of students experiencing substance use (cannabis, ecstasy, 
amphetamine/methamphetamine, cocaine/crack) at the age of 13 or younger (percentage)
Amphetamine/
Amphet-
Co-
Cannabis
Ecstasy
methap het-
Cocaine/crack
Country
Cannabis
Ecstasy
amine/meth-
caine/
amine
amphetamine
crack
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Albania
3
1
1
1
5
0
1
1
2
1
1
1
Austria
2
0
0
0
2
2
0
0
0
0
0
0
Belgium (Flanders)
2
0
0
0
3
1
0
0
0
0
0
0
Bulgaria
5
2
3
2
6
4
2
1
3
2
3
1
Croatia
3
1
1
1
4
2
1
0
1
0
1
0
Cyprus
2
2
2
2
3
1
3
0
3
1
3
0
Czech Republic
5
0
0
0
5
5
0
0
0
0
1
0
Denmark
2
0
0
0
3
1
1
0
0
0
1
0
Estonia
4
0
0
0
5
3
1
0
0
0
0
0
Faroes
2
0
0
0
1
3
0
0
0
0
0
0
Finland
1
0
0
0
1
1
0
0
0
0
0
0
FYR Macedonia b
1
0
1
0
2
1
1
0
1
0
1
0
France
6
1
1
1
8
5
1
1
1
0
1
1
Georgia
2
1
0
1
4
1
1
0
1
0
1
0
Greece
1
1
0
1
2
1
1
0
1
0
1
0
Hungary
2
1
1
0
2
1
1
1
1
1
0
1
Iceland
2
0
1
1
3
2
1
0
1
1
1
0
Ireland
5
1
1
1
6
3
2
0
1
0
1
0
Italy
4
1
1
1
6
3
1
0
1
0
1
0
Liechtenstein
6
0
0
0
6
6
1
0
1
0
1
0
Lithuania
2
1
1
1
3
2
1
0
1
0
1
0
Malta
3
1
0
0
3
2
1
0
0
0
0
0
Moldova
1
0
0
0
1
1
0
0
1
0
0
0
Monaco
8
1
1
1
10
7
1
0
1
1
1
1
Montenegro
2
1
1
1
3
1
2
0
2
0
2
0
Netherlands
5
1
1
1
6
3
1
1
1
0
0
1
Norway
1
0
0
0
2
0
0
0
0
0
0
0
Poland
5
1
1
1
6
3
1
1
2
1
1
1
Portugal
3
0
0
.
4
2
0
0
0
0
.
.
Romania
1
1
1
1
2
1
1
0
1
0
1
0
Slovakia
5
0
1
0
6
5
0
0
1
0
0
0
Slovenia
4
0
0
0
4
3
0
0
1
0
1
0
Sweden
1
0
1
0
2
1
1
0
1
0
1
0
Ukraine
1
0
0
0
2
0
1
0
1
0
1
0
AVERAGE
3
1
1
1
4
2
1
0
1
0
1
0
Latvia
4
1
1
2
5
2
2
1
2
0
2
1
Spain
4
0
0
0
5
3
0
0
0
0
1
0
United States a
13
1
3
1
.
.
.
.
.
.
.
.
a Used by end of 8th grade, approximate age is 13 (amphetamines only, cocaine only, tranquillisers only).
b Official name former Yugoslav Republic of Macedonia.
ESPAD Report 2015 
35

The situation in 2015
Cigarette use
Lifetime
ESPAD average 
Lifetime prevalence rates of cigarette smoking range 
Cigarette use (%) a
between 16 % and 66 % (Table 5). In 15 of the 35 ESPAD 
Average
Min.
Max.
countries, more than half of the students had tried smoking 
Lifetime
46
16
66
at least once. The highest prevalence rates were found in 
the Czech Republic (66 %), followed by Lithuania (65 %), 
Last 30 days
21
6
37
Croatia and Slovakia (62 % each). The lowest rates were 
a Percentage of students reporting use of cigarettes.
found in Iceland (16 %), Norway (28 %) and Malta (29 %). 
These rates were well below the average of 46 % for all 
Table 5. 
Cigarette use: prevalence of lifetime and 30-day use (percentage)
Lifetime
30-day
Country
Lifetime
30-day
Boys
Girls
Boys
Girls
Albania
37
11
49
27
18
5
Austria
53
28
54
53
27
28
Belgium (Flanders)
31
15
33
29
16
14
Bulgaria
55
33
51
60
30
37
Croatia
62
33
61
63
32
34
Cyprus
35
18
40
31
22
13
Czech Republic
66
30
65
67
27
32
Denmark
39
19
37
41
17
21
Estonia
60
21
62
57
22
21
Faroes
49
19
50
49
17
20
Finland
47
22
50
44
22
21
FYR Macedonia a
38
24
44
33
27
21
France
55
26
54
56
24
28
Georgia
43
18
54
30
26
9
Greece
39
19
41
37
21
17
Hungary
55
29
55
55
28
30
Iceland
16
6
16
16
5
7
Ireland
32
13
33
32
13
13
Italy
58
37
55
60
35
40
Liechtenstein
57
29
56
58
27
31
Lithuania
65
24
69
60
27
22
Malta
29
15
25
33
12
18
Moldova
33
9
50
15
16
3
Monaco
56
26
51
61
20
33
Montenegro
34
15
37
31
18
12
Netherlands
39
21
38
39
20
21
Norway
28
10
29
26
10
10
Poland
55
25
56
54
24
25
Portugal
37
19
37
37
18
21
Romania
52
30
53
51
31
30
Slovakia
62
31
62
61
29
34
Slovenia
47
22
44
50
19
25
Sweden
33
13
33
34
11
14
Ukraine
51
18
59
44
23
13
AVERAGE
46
21
47
44
22
21
Latvia
66
24
70
61
24
25
Spain
37
22
35
39
20
23
United States
20
6
20
19
6
6
a Official name former Yugoslav Republic of Macedonia.
36 
ESPAD Report 2015

The situation in 2015
ESPAD countries. The average prevalence of cigarette 
lifetime (Table 6). The ESPAD average was 80 % (range: 
smoking was about the same among boys (47 %) and girls 
35-96 %). The highest rates of lifetime alcohol prevalence 
(44 %). Across countries, boys were generally more likely 
(93 % or more) were found in the Czech Republic, Greece 
than girls to have tried cigarettes. Countries with the largest 
and Hungary. In addition to Iceland, countries with relatively 
gender differences were Moldova (50 % for boys versus 
low rates (60 % or less) were Albania, the former Yugoslav 
15 % for girls), Georgia (54 % versus 30 %) and Albania 
Republic of Macedonia and Norway. Large differences 
(49 % versus 27 %). The largest gender differences where 
between boys and girls were observed in Albania (71 % 
girls reported higher rates were found in Monaco (61 % for 
versus 51 %), the former Yugoslav Republic of Macedonia 
girls versus 51 % for boys), Bulgaria (60 % versus 51 %) and 
(64 % versus 51 %) and Montenegro (83 % versus 72 %). 
Malta (33 % versus 25 %).
A higher proportion for girls than boys was found in Belgium 
(Flanders) (83 % versus 77 %).
Last 30 days
Last 30 days
On average, 21 % of the students in the ESPAD countries 
had used cigarettes during the last 30 days. The highest rates 
Overall, 48 % of the students in the ESPAD countries had 
were found in Italy (37 %), Bulgaria and Croatia (33 % each). 
consumed alcohol during the 30 days prior to the survey. In 
Countries which reported last-30-day prevalence of 10 % or 
Austria, Cyprus, the Czech Republic, Denmark and Greece, 
lower include Iceland (6 %), Moldova (9 %) and Norway (10 %). 
two thirds (66 %) or more had done so. A particularly low 
Countries with high smoking rates for boys were Italy, Romania 
prevalence rate was reported from Iceland (9 %). All of the 
and Croatia (31-35 %), and countries with high smoking rates 
Nordic countries except Denmark reported relatively low 
for girls were Italy, Bulgaria, Slovakia and Croatia (34-40 %). 
rates (below 40 %). This was also the case for Albania, 
The average ESPAD rates for boys and girls were about the 
Estonia, the Faroes, the former Yugoslav Republic of 
same, and the gender rates were also close in most countries. 
Macedonia, Ireland, Lithuania and Ukraine. On average, 
In four countries, there are noticeable gender differences, with 
more boys than girls have drunk alcohol during the 30 days 
higher rates among boys than among girls: Georgia (26 % 
prior to the survey. Countries with particularly large gender 
versus 9 %), Moldova (16 % versus 3 %), Albania (18 % versus 
differences in this direction (18-20 percentage points) 
5 %) and Ukraine (23 % versus 13 %). In Monaco, rates were 
were Albania, Georgia, Montenegro and Romania. In four 
higher among girls than boys (33 % versus 20 %) as well as in 
countries, more girls than boys (5 percentage points and 
Slovenia (25 % versus 19 %) and Malta (18 % versus 12 %).
more) reported alcohol use during the last 30 days (Sweden, 
the Faroes, Monaco and Norway).
Alcohol use
Intoxication
ESPAD average 
Alcohol use (%) a
An average of 13 % of students reported having been 
Average
Min.
Max.
intoxicated during the last 30 days. Denmark had the highest 
Lifetime
80
35
96
prevalence at almost one third of the students (32 %). 
Countries with levels of 10 % or less were Albania, Estonia, 
Last 30 days
48
9
73
the Faroes, the former Yugoslav Republic of Macedonia, 
Intoxication b
13
3
32
Georgia, Greece, Iceland, Moldova, Montenegro, Norway, 
a Percentage of students reporting use of alcohol.
Portugal, Sweden and Ukraine. On average, slightly more 
b Percentage of students having been intoxicated at least once in the last 
boys (13 %) than girls (12 %) reported that they had been 
30 days.
intoxicated during the 30 days prior to the survey, with the 
highest differences in Cyprus (19 % for boys and 10 % for 
Lifetime
girls), Romania (16 % versus 7 %) and Montenegro (12 % 
versus 4 %). In the Faroes and Malta, noticeably more girls 
In all ESPAD countries except Iceland (35 %), over half of 
than boys reported intoxication.
the students have drunk alcohol at least once during their 
ESPAD Report 2015 
37

The situation in 2015
Table 6. 
Alcohol use: prevalence of lifetime use, 30-day use and intoxication (percentage)
Intoxication 
Lifetime use
30-day use
Intoxication
Country
Lifetime use
30-day use
last 30 days
Boys
Girls
Boys
Girls
Boys
Girls
Albania
60
32
7
71
51
42
23
10
4
Austria
88
68
21
86
90
67
69
22
19
Belgium (Flanders)
80
56
12
77
83
55
58
11
12
Bulgaria
86
59
17
88
85
60
57
20
14
Croatia
92
55
16
94
91
60
49
17
14
Cyprus
88
68
14
90
87
72
63
19
10
Czech Republic
96
68
15
95
97
70
67
18
12
Denmark
92
73
32
93
92
74
73
31
32
Estonia
86
38
8
87
86
36
39
8
7
Faroes
81
38
10
84
78
35
41
7
13
Finland
74
32
13
75
72
32
32
13
13
FYR Macedonia a
57
38
8
64
51
45
32
10
6
France
84
53
13
85
83
56
51
14
12
Georgia
85
43
10
86
83
53
33
13
7
Greece
94
66
10
95
93
68
65
11
9
Hungary
93
55
20
94
92
59
52
21
19
Iceland
35
9
3
36
33
9
10
3
3
Ireland
74
35
13
72
75
34
36
14
13
Italy
84
57
13
85
84
60
53
14
13
Liechtenstein
89
59
17
93
86
60
59
19
16
Lithuania
87
34
11
85
89
32
36
10
11
Malta
86
54
14
84
88
52
56
12
17
Moldova
82
56
8
86
78
62
50
11
5
Monaco
89
54
17
88
90
52
57
15
18
Montenegro
78
40
8
83
72
50
31
12
4
Netherlands
73
49
14
73
73
50
49
13
16
Norway
57
22
8
56
58
20
25
8
9
Poland
83
47
11
84
83
49
46
12
11
Portugal
71
42
9
73
70
43
41
9
9
Romania
78
47
12
84
72
56
38
16
7
Slovakia
91
49
13
90
91
48
51
12
13
Slovenia
89
52
14
90
88
55
50
14
14
Sweden
65
26
9
64
66
22
29
7
11
Ukraine
84
39
9
82
86
38
40
9
8
AVERAGE
80
48
13
81
79
49
46
13
12
Latvia
89
44
12
88
90
42
45
14
11
Spain
78
65
21
76
80
63
68
20
21
United States
47
22
10
44
50
21
22
10
10
a Official name former Yugoslav Republic of Macedonia.
38 
ESPAD Report 2015

The situation in 2015
Illicit drug use
Cannabis use
ESPAD average 
The most prevalent illicit drug in all ESPAD countries is 
Lifetime use of illicit drugs (%) a
cannabis. On average, 16 % of the students have used 
Average
Min.
Max.
cannabis at least once in their lifetime (Table 7a). The 
Any illicit drug
18
6
37
country with the highest prevalence of cannabis use was 
the Czech Republic (37 %). High prevalence rates (30 % 
Cannabis
16
4
37
or more) were also reported in France, Liechtenstein and 
Ecstasy
2
0
5
Monaco. The lowest levels of cannabis use (4-7 %) were 
Amphetamine
2
0
6
reported in Albania, Cyprus, the Faroes, the former Yugoslav 
Methamphetamine
1
0
5
Republic of Macedonia, Iceland, Moldova, Norway and 
Sweden. On average, boys reported cannabis use to a larger 
Cocaine
2
0
5
extent than girls (19 % versus 14 %). This was the case in 
Crack
1
0
3
nearly all countries except the Czech Republic, the Faroes, 
LSD or other hallucinogens
2
0
5
Hungary, Iceland, Malta, Slovenia and Sweden, where 
Heroin
1
0
3
rates were about the same for boys and girls. The largest 
gender differences (10 percentage points or more, higher 
GHB
1
0
3
rates among boys) were found in Albania, Georgia and 
a Percentage of students reporting use of illicit drugs.
Liechtenstein.
Any drug use
Other illicit drug use
Lifetime use of illicit drugs varied considerably across the 
ESPAD countries (Table 7a). In the Czech Republic, 37 % 
Besides cannabis, some students have also used other illicit 
of the students reported having used any illicit drug at 
substances. In some cases, they have done so without any 
least once, which was more than twice the ESPAD average 
experience of cannabis at all. Among the most frequently 
of 18 %. Students in Bulgaria, France, Liechtenstein and 
tried illicit drugs are ecstasy, amphetamine, cocaine and 
Monaco also exhibit high levels of drug use experience 
LSD or other hallucinogens (Tables 7a, 7b). In the case of 
(30-32 %). Particularly low levels (10 % or less) of illicit drug 
illicit drugs other than cannabis, on average, 1-2 % of the 
use were noted in Albania, Cyprus, the Faroes, Finland, the 
ESPAD students reported having used them at least once. 
former Yugoslav Republic of Macedonia, Iceland, Moldova, 
Lifetime prevalence rates for methamphetamine, crack, 
Montenegro, Norway, Sweden and Ukraine. On average, 21 % 
heroin and GHB were lower than those for the other illicit 
of boys and 15 % of girls have tried illicit drugs at least once 
drugs (1 % on average). At the country level, higher rates 
during their lifetime. In most ESPAD countries, prevalence 
(5 % or more) were found in Bulgaria (ecstasy, amphetamine, 
rates were higher among boys than among girls. Noticeable 
methamphetamine, cocaine) and Poland (LSD or other 
gender differences were found in Georgia (24 % for boys and 
hallucinogens). The most marked gender differences are 
6 % for girls), Liechtenstein (40 % versus 23 %) and Albania 
seen in Georgia (ecstasy: 7 % for boys and 1 % for girls) and 
(18 % versus 4 %).
Albania (cocaine: 6 % versus 1 %).
ESPAD Report 2015 
39

The situation in 2015
Table 7a. 
Illicit drug use: lifetime prevalence of the use of any drug, cannabis, ecstasy, amphetamine and 
methamphetamine (percentage)
Meth-
Metham-
Am-
Any drug
Cannabis
Ecstasy
Amphetamine
Any 
Can-
Ec-
am-
phetamine
Country
phet-
drug
nabis
stasy
phet-
amine amine Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls
Albania
10
7
3
2
2
18
4
13
2
4
1
2
1
2
1
Austria
21
20
2
3
1
23
19
22
18
2
2
3
3
1
1
Belgium 
18
17
3
2
1
21
15
21
14
3
3
2
3
1
1
(Flanders)
Bulgaria

30
27
5
6
5
32
27
29
25
6
4
7
6
6
4
Croatia
22
21
2
3
1
25
20
24
19
2
2
3
2
2
1
Cyprus
10
7
3
3
2
14
7
10
5
4
1
4
1
3
1
Czech Republic
37
37
3
1
1
36
38
36
38
3
2
1
1
1
2
Denmark
13
12
1
1
0
16
10
15
10
1
0
1
0
1
0
Estonia
26
25
3
2
.
30
22
30
21
3
2
2
2
.
.
Faroes
6
6
0
0
0
6
6
6
6
0
1
0
0
0
1
Finland
9
8
1
1
0
10
8
10
7
1
1
1
1
1
0
FYR 
7
5
2
1
1
10
4
8
3
3
2
2
1
2
0
Macedonia a
France
32
31
2
2
2
35
30
34
29
2
2
2
3
1
2
Georgia
15
11
4
2
1
24
6
19
3
7
1
3
1
2
0
Greece
11
9
1
2
1
15
6
12
6
2
0
2
1
1
1
Hungary
14
13
2
3
2
15
13
14
12
2
2
3
3
2
2
Iceland
8
7
2
2
1
8
8
7
8
2
2
2
2
1
1
Ireland
20
19
4
3
2
23
16
22
15
5
2
3
2
2
1
Italy
28
27
3
2
2
33
24
31
23
3
2
3
1
3
1
Liechtenstein
31
30
2
2
0
40
23
40
22
2
1
1
2
1
0
Lithuania
19
18
2
1
1
21
16
20
15
2
1
1
1
1
1
Malta
14
13
2
2
1
14
14
13
12
2
2
2
2
1
1
Moldova
6
4
1
1
0
9
3
7
2
2
1
1
0
1
0
Monaco
31
31
2
2
2
34
29
34
29
2
2
2
2
2
2
Montenegro
10
8
3
3
2
14
6
11
5
4
3
4
2
3
1
Netherlands
23
22
3
2
1
25
21
25
20
4
2
3
2
1
0
Norway
7
7
1
1
.
10
4
9
4
1
1
1
0
.
.
Poland
25
24
3
4
3
29
21
28
20
4
3
5
4
3
3
Portugal
16
15
2
1
1
17
15
17
14
2
2
1
1
1
1
Romania
11
8
2
1
1
14
8
10
6
2
2
2
1
1
1
Slovakia
28
26
3
1
2
29
27
28
25
3
4
1
1
2
1
Slovenia
26
25
2
1
2
27
25
26
24
2
2
1
1
2
2
Sweden
8
7
1
1
.
8
7
7
6
1
1
1
1
.
.
Ukraine
10
9
1
1
1
14
7
13
6
2
1
2
1
1
0
AVERAGE
18
16
2
2
1
21
15
19
14
3
2
2
2
2
1
Latvia
19
17
3
3
2
23
15
21
12
3
2
2
4
3
2
Spain
28
27
1
1
1
30
27
28
25
1
1
2
1
1
0
United States
35
31
4
10
1
35
35
32
30
4
3
9
11
1
2
a Official name former Yugoslav Republic of Macedonia.
40 
ESPAD Report 2015

The situation in 2015
Table 7b. 
Illicit drug use: lifetime prevalence of the use of cocaine, crack, LSD or other hallucinogens, heroin and GHB 
(percentage)
LSD/other 
LSD/other 
Cocaine
Crack
Heroin
GHB
Country
Cocaine Crack
hallucino-
Heroin
GHB
Hallucinogens
gens
Boys Girls Boys Girls
Boys
Girls
Boys
Girls
Boys
Girls
Albania
3
2
2
2
1
6
1
3
1
3
1
2
1
2
1
Austria
2
1
2
1
1
2
2
1
1
2
2
0
1
1
1
Belgium 
3
1
2
1
1
2
3
1
1
2
1
1
0
0
1
(Flanders)
Bulgaria

5
3
4
3
3
6
3
5
2
6
3
5
2
4
1
Croatia
2
1
2
1
1
2
2
2
1
3
2
1
1
1
0
Cyprus
3
2
3
3
2
5
2
4
1
5
2
4
1
4
1
Czech Republic
1
1
4
1
0
2
1
1
1
4
4
1
0
0
0
Denmark
2
.
1
1
0
3
1
.
.
2
1
1
0
1
0
Estonia
1
.
3
1
1
1
2
.
.
3
3
1
1
1
1
Faroes
0
0
0
0
0
0
1
0
0
0
1
0
0
0
0
Finland
1
.
1
1
0
1
1
.
.
1
1
1
1
1
0
FYR 
1
1
1
1
1
2
0
1
0
1
0
1
0
1
0
Macedonia a
France
4
3
2
2
1
4
4
3
3
2
2
2
2
1
1
Georgia
2
1
2
2
1
2
1
2
0
4
1
3
1
1
0
Greece
1
1
2
1
0
2
0
1
1
3
1
1
0
1
0
Hungary
2
1
2
1
1
3
2
1
1
3
2
1
1
1
2
Iceland
2
1
1
1
0
2
2
1
1
1
2
1
1
0
0
Ireland
3
2
3
1
1
4
2
3
1
3
2
2
0
1
0
Italy
3
3
3
2
1
5
2
4
2
4
2
3
1
2
1
Liechtenstein
2
1
2
0
1
2
2
1
0
2
2
0
1
1
1
Lithuania
2
1
2
1
1
2
2
1
1
2
2
2
1
1
0
Malta
3
1
1
1
0
2
3
1
1
1
1
1
1
0
0
Moldova
1
0
1
0
1
1
0
1
0
1
0
1
0
1
0
Monaco
3
2
1
2
1
2
3
2
2
2
0
2
2
1
1
Montenegro
3
2
3
2
2
5
2
3
1
4
1
3
1
3
1
Netherlands
2
1
2
1
1
2
1
1
1
2
1
1
1
1
1
Norway
1
1
1
0
0
1
0
1
0
1
1
0
0
0
0
Poland
4
2
5
2
2
4
3
2
2
5
5
3
2
2
1
Portugal
2
1
1
1
1
2
2
1
1
2
1
1
1
1
0
Romania
3
1
2
2
1
3
3
2
1
3
1
2
1
1
1
Slovakia
2
1
3
1
2
1
2
1
1
3
3
1
2
2
1
Slovenia
2
1
1
1
0
2
3
1
1
1
2
1
1
0
0
Sweden
2
.
1
1
0
2
2
.
.
2
1
1
1
0
0
Ukraine
1
1
1
1
0
1
1
1
1
1
1
1
0
1
0
AVERAGE
2
1
2
1
1
3
2
2
1
2
2
1
1
1
1
Latvia
2
2
4
2
1
3
2
4
1
3
4
3
1
1
1
Spain
2
3
2
1
1
2
2
3
2
2
1
1
0
1
1
United States
3
1
5
1
.
3
2
1
1
5
4
1
1
.
.
a Official name former Yugoslav Republic of Macedonia.
ESPAD Report 2015 
41

The situation in 2015
Inhalant use
The ESPAD average for lifetime inhalant use was 7 %, with 
large differences between countries (Table 8). The country 
ESPAD average 
with the highest proportion of students who have tried 
Lifetime use of inhalants (%) a
inhalants was Croatia (25 %), followed by Slovenia (14 %). 
Average
Min.
Max.
The lowest rates (1-2 %) were found in the Faroes, the former 
Inhalants
7
1
25
Yugoslav Republic of Macedonia and Moldova. The average 
prevalence of lifetime inhalant use among ESPAD students 
a Percentage of students reporting use of inhalants.
was the same for boys and girls. Similar rates for both 
genders were found in most countries. A noticeable gender 
difference in the rate of inhalant use was reported in Croatia 
(19 % for boys versus 32 % for girls).
Table 8. 
Inhalants and new psychoactive substances (NPS): prevalence of lifetime use (percentage)
Inhalants
NPS
Country
Inhalants
NPS
Boys
Girls
Boys
Girls
Albania
4
4
6
2
6
2
Austria
10
3
10
9
4
3
Belgium (Flanders)
3
1
3
3
1
0
Bulgaria
3
8
4
2
10
7
Croatia
25
7
19
32
7
7
Cyprus
8
4
9
7
6
2
Czech Republic
6
7
5
6
6
7
Denmark
4
1
4
3
2
1
Estonia
13
10
11
14
10
9
Faroes
2
3
3
2
3
4
Finland
8
1
7
8
2
1
FYR Macedonia a
2
4
3
1
5
3
France
6
4
5
7
5
4
Georgia
12
7
10
14
10
3
Greece
13
3
13
13
4
2
Hungary
7
4
6
7
3
4
Iceland
3
3
2
4
2
3
Ireland
11
7
11
10
8
5
Italy
3
6
4
3
6
5
Liechtenstein
8
4
11
6
6
3
Lithuania
8
5
9
7
6
5
Malta
8
4
7
9
4
4
Moldova
1
2
2
1
3
1
Monaco
8
4
7
9
4
5
Montenegro
7
3
8
6
4
2
Netherlands
5
2
6
4
3
2
Norway
5
1
5
5
2
1
Poland
11
10
11
11
10
9
Portugal
4
1
5
4
1
1
Romania
4
5
3
4
6
5
Slovakia
8
4
8
8
4
4
Slovenia
14
3
14
14
3
3
Sweden
7
4
7
7
3
4
Ukraine
5
4
4
5
5
4
AVERAGE
7
4
7
7
5
4
Latvia
18
7
14
22
8
5
Spain
1
4
1
1
5
3
United States
7
.
7
8
.
.
a Official name former Yugoslav Republic of Macedonia.
42 
ESPAD Report 2015

The situation in 2015
New psychoactive substance use
Tranquillisers or sedatives
ESPAD average 
Use of tranquillisers or sedatives without prescription was 
Lifetime use of NPS (%) a
most prevalent in Poland (17 %) and the Czech Republic 
Average
Min.
Max.
(16 %) (Table 9). The lowest levels of non-prescription 
NPS
4
1
10
use of tranquillisers or sedatives (1-2 %) were reported by 
students from Denmark, the Faroes, Moldova, Romania and 
a Percentage of students reporting use of NPS.
Ukraine. On average, slightly more girls than boys reported 
use of tranquillisers or sedatives without prescription (8 % 
The ESPAD average of lifetime experience with NPS was 
versus 5 %). In Belgium (Flanders), the Czech Republic, 
4 % (Table 8), with the highest rates in Estonia and Poland 
Estonia, France, the former Yugoslav Republic of Macedonia, 
(10 % each), and the lowest in Belgium (Flanders), Denmark, 
Hungary, Lithuania, the Netherlands, Poland, Portugal and 
Finland, Norway and Portugal, with rates of 1 %. The average 
Slovakia, more girls than boys have used non-prescription 
prevalence of lifetime use was 5 % among boys and 4 % 
tranquillisers or sedatives (difference: 5 percentage points or 
among girls. Gender differences within ESPAD countries are 
more).
generally small, with the exception of Georgia, where 10 % of 
boys and 3 % of girls reported NPS use, Albania and Cyprus 
(both 6 % versus 2 %).
Painkillers
On average, use of painkillers to get high was reported 
Pharmaceutical use
by 4 % of the students. The countries with the highest 
prevalence rates are Romania (12 %) and Croatia (10 %). 
ESPAD average 
Like tranquillisers, slightly more girls (4 %) than boys (3 %) 
Lifetime use of pharmaceuticals (%) a
reported the use of painkillers. Larger gender differences 
Average
Min.
Max.
(5 percentage points or more) were found in Belgium 
Tranquillisers or sedatives 
6
1
17
(Flanders), Croatia, Hungary, Poland and Romania.
without prescription
Painkillers to get high
4
1
12
Anabolic steroids
1
0
4
Anabolic steroids
a Percentage of students reporting use of pharmaceuticals.
Few students in the ESPAD countries reported experience 
with anabolic steroids (ESPAD average: 1 %). The highest 
proportions were found in Bulgaria (4 %), Cyprus, the 
Czech Republic and Poland (3 % each). Noticeable gender 
differences are seen in Bulgaria (7 % for boys and 2 % for 
girls) and Cyprus (5 % versus 1 %).
ESPAD Report 2015 
43

The situation in 2015
Table 9. 
Pharmaceuticals: lifetime prevalence of the use of painkillers to get high, tranquillisers or sedatives without 
prescription and anabolic steroids (percentage)
Tranquillisers/
Tranquillisers/ 
Anabolic 
Painkillers
Anabolic steroids
Country
Painkillers
sedatives
sedatives
steroids
Boys
Girls
Boys
Girls
Boys
Girls
Albania
4
8
1
3
4
7
8
2
1
Austria
2
4
1
2
3
3
5
1
0
Belgium (Flanders)
7
6
0
3
10
4
9
0
0
Bulgaria
4
4
4
5
3
4
3
7
2
Croatia
10
4
2
7
14
3
5
3
1
Cyprus
3
5
3
5
1
5
4
5
1
Czech Republic
.. a
16
3
.. a
.. a
11
20
4
3
Denmark
1
2
0
1
2
2
3
0
0
Estonia
2
9
1
1
2
6
12
2
1
Faroes
1
2
0
0
2
1
3
0
0
Finland
5
6
0
2
7
4
8
1
0
FYR Macedonia c
4
11
1
4
5
9
13
1
0
France
4
10
1
3
6
8
12
1
0
Georgia
2
11
1
3
1
10
13
1
0
Greece
2
4
2
2
2
4
4
2
1
Hungary
6
7
1
3
8
5
9
1
0
Iceland
3
5
1
2
3
5
6
1
1
Ireland
5
3
2
4
5
3
3
3
1
Italy
2
5
2
2
1
5
6
3
1
Liechtenstein
3
3
1
1
4
6
1
1
1
Lithuania
2
9
1
1
2
5
12
2
0
Malta
3
3
1
2
4
2
4
1
1
Moldova
2
1
1
2
2
1
1
1
0
Monaco
4
10
1
2
5
8
12
2
1
Montenegro
5
10
2
4
5
8
13
3
1
Netherlands
1
8
1
1
2
5
11
1
1
Norway
3
6
0
2
4
5
7
1
0
Poland
7
17
3
4
10
11
23
3
2
Portugal
1
5
0
1
2
2
8
1
0
Romania
12
2
1
9
15
1
3
2
0
Slovakia
.
7
2
.
.
4
9
3
1
Slovenia
2
3
0
1
3
2
4
1
0
Sweden
3
7
1
2
4
5
9
1
0
Ukraine
1
2
1
1
1
2
2
1
0
AVERAGE
4
6
1
3
4
5
8
2
1
Latvia
2
5
1
2
3
4
6
2
1
Spain
.
8
1
.
.
6
9
1
0
United States
.
6 a
1
.
.
4 b
7 b
2
1
a Did not specify ‘in order to get high’.
b Data for tranquillisers only.
c Official name former Yugoslav Republic of Macedonia.
44 
ESPAD Report 2015

The situation in 2015
Table 10. 
Prevalence of lifetime use of substance B conditional on the lifetime use of substance A (percentage) and 
number of users of substance A (n)
Substance B
s
oids
Substance A
n
Lifetime 
prevalence
ettes
ack
oin
s/sedatives
NPS
Alcohol
Her
GHB
ainkiller
Cigar
Cannabis
Ecstasy
Cocaine
Cr
Inhalants
P
Amphetamine
Methamphetamine
Anabolic ster
LSD/other hallucinogens
Tranquilliser
Cigarette
39 914
46
.
93
32
4
4
2
4
2
4
2
2
12
8
10
6
2
Alcohol
69 189
79
54
.
19
3
2
2
3
1
2
1
1
9
5
7
4
1
Cannabis
13 988
16
91
96
.
11
9
7
11
6
11
6
4
18
20
16
10
5
Ecstasy
2 013
2
84
92
77
.
47
36
46
29
44
29
25
38
40
40
33
22
Amphetamine
1 693
2
86
92
77
56
.
45
51
33
46
33
28
44
42
46
39
27
Methamphetamine
1 162
1
85
92
79
62
66
.
60
47
55
44
36
50
46
49
46
35
Cocaine
1 959
2
85
91
79
48
44
36
.
34
43
37
26
44
39
39
35
24
Crack
1 074
1
83
89
79
55
52
51
62
.
51
47
38
55
43
45
45
36
LSD/other  
1 843
2
87
93
80
48
42
34
45
30
.
36
30
44
44
48
41
30
hallucinogens
Heroin
1 068
1
81
87
75
55
52
48
68
47
62
.
49
55
47
56
53
47
GHB
788
1
80
87
73
63
60
53
63
52
71
66
.
57
48
58
61
60
Inhalants
6 507
7
71
93
38
12
11
9
13
9
13
9
7
.
15
23
18
8
NPS
3 723
4
83
92
74
22
19
14
20
13
22
14
10
26
.
25
20
11
Tranquillisers/
5 605
6
70
90
39
14
14
10
13
9
16
11
8
27
17
.
25
10
sedatives
Painkillers
3 024
4
75
91
47
22
22
18
23
16
25
19
16
39
25
46
.
17
Anabolic steroids
1 094
1
77
90
60
41
41
37
44
35
50
46
43
48
36
49
48
.
crack, LSD or other hallucinogens, heroin or GHB, 80 % 
Conditional probabilities of substance use
or more have also used cigarettes and 73 % or more have 
tried cannabis. With respect to users of one of the drugs 
Among students who have used cigarettes at least once, 
other than cannabis, the lowest probability of using one of 
93 % have also used alcohol, 32 % cannabis, 12 % inhalants, 
the other drugs was 25 % of ecstasy users who said they 
10 % tranquillisers or sedatives and 8 % NPS Table 10. 
had also used GHB. The highest probability was seen with 
Almost every student (87 % or more) that has used a licit or 
respect to LSD use by students who had used GHB (71 %).
illicit substance also reported having used alcohol, but not 
every student who has tried alcohol has also tried another 
Finally, among the students that have used substances from 
substance. Among students that have used alcohol, 54 % 
the two groups, inhalants and tranquillisers or sedatives, 
have also used cigarettes, 19 % cannabis, 9 % inhalants, 7 % 
about a quarter have used substances from both of the 
tranquillisers or sedatives and 5 % or less NPS or other illicit 
groups. Among the users of both groups of substances, 70 % 
drugs.
stated they have also used cigarettes. Of the students that 
have used painkillers for getting high, almost half reported 
Of the students that have used cannabis, 91 % have also 
the use of tranquillisers or sedatives (46 %). Among students 
used cigarettes and 96 % alcohol, inhalants (18 %), NPS 
reporting use of NPS, a quarter have also used inhalants 
(20 %) or tranquillisers or sedatives (16 %). Approximately 
(26 %) or tranquillisers or sedatives (25 %) and 74 % have 
one in ten or fewer of these students (4-11 %) reported 
used cannabis. Use of illicit substances among the small 
having used each of the other illicit substances included 
group of students that have used anabolic steroids ranged 
in the questionnaire in addition to cannabis. Among users 
from 35 % (crack) to 60 % (cannabis).
of ecstasy, amphetamine, methamphetamine, cocaine, 
ESPAD Report 2015 
45

The situation in 2015
Patterns of current use
Considerably lower-than-average rates were observed 
in Albania, Iceland, Moldova and Norway (5 % or less). 
Daily cigarette use
Significant differences in daily smoking between boys and 
girls (Figure 1b) were found in Albania, Cyprus, Finland, the 
Overall, 12 % of the students smoked every day in the 
former Yugoslav Republic of Macedonia, Georgia, Greece, 
last 30 days (Figure 1a). Daily smoking at levels of 
Ireland, Lithuania, Moldova, Montenegro and Ukraine 
approximately twice the ESPAD average were found 
(higher rates for boys) and Bulgaria, Monaco and Sweden 
in Bulgaria, Croatia, Italy, Liechtenstein and Romania. 
(higher rates for girls).
Figure 1a. 
Daily cigarette use: prevalence in the last 30 days (percentage)
United States
≥ 20 %
15-19 %
10-14 %
5-9 %
≤ 4 %
Non-participating country 
or data not available
Cross-hatching indicates 
limited comparability or 
limited geographical coverage. 
46 
ESPAD Report 2015

The situation in 2015
Figure 1b. 
Daily cigarette use: prevalence in the last 30 days by gender (percentage)
Boys (%)
All students (%)
Girls (%)
23
Bulgaria (25)
28
23
Croatia (23)
23
21
Italy (21)
22
20
Liechtenstein (20)
20
21
Romania (20)
18
18
Austria (18)
19
19
Hungary (18)
17
17
Slovakia (18)
19
15
Czech Republic (16)
18
14
France (16)
17
17
Latvia 2 (16)
14
10
Monaco (15)
20
17
Lithuania (15)
12
Former Yugoslav Republic
16
10
of Macedonia (13)
13
Poland (13)
13
19
Georgia (12)
4
13
Estonia (12)
10
17
Cyprus 1 (12)
7
12
Netherlands (11)
11
11
Slovenia (11)
12
14
Greece (11)
9
12
Finland (11)
10
17
Ukraine (11)
5
13
Montenegro (10)
7
9
Portugal (9)
10
8
Denmark (9)
10
9
Belgium (Flanders) 1 (9)
9
10
Faroes (8)
6
7
Spain 2 (8)
8
6
Malta (7)
7
5
Sweden (6)
8
8
Ireland (6)
5
9
Albania (5)
2
9
Moldova 1 (5)
1
3
Iceland (3)
3
3
United States 2 (3)
3
2
Norway (2)
2
Colour indicates significant 
difference between boys and girls
(not tested for Spain and United States).
1  Belgium (Flanders), Cyprus and Moldova: limited geographical coverage.
2  Latvia, Spain and United States: limited comparability.
ESPAD Report 2015 
47

The situation in 2015
Frequency of alcohol use in the last 30 days
four occasions on average. In most countries, boys who 
drank did so more frequently than girls did, with differences 
Among all students who had used alcohol, the frequency 
of more than three occasions in the last 30 days in Bulgaria 
of drinking alcohol was 5.4 occasions on average in the last 
and the former Yugoslav Republic of Macedonia. Only in the 
30 days (Figure 2a). Students from Cyprus and Liechtenstein 
Faroes did girls drink alcohol more frequently than boys did, 
consumed alcohol on 8.2 and 9.1 occasions, respectively, 
with a difference of over one occasion in the last 30 days. In 
and students from Estonia, Finland, Iceland, Lithuania, 
most countries, the difference between boys and girls in the 
Moldova, Norway and Sweden drank alcohol on fewer than 
number of drinking occasions was significant (Figure 2b).
Figure 2a. 
Frequency of alcohol intake in the last 30 days (mean number of occasions among users)
United States
≥ 7.0 occasions
6.0-6.9 occasions
5.0-5.9 occasions
4.0-4.9 occasions
≤ 3.9 occasions
Non-participating country or 
data not available
Cross-hatching indicates 
limited geographical 
coverage. 
48 
ESPAD Report 2015

The situation in 2015
Figure 2b. 
Frequency of alcohol intake in the last 30 days by gender (mean number of occasions among users)
Boys
All students
Girls
9.6
Liechtenstein (9)
8.7
9.6
Cyprus 1 (8)
6.7
8.3
Belgium (Flanders) 1 (7)
6.5
7.7
Netherlands (7)
6.8
6.6
Malta (7)
7.4
7.9
Montenegro (7)
5.3
8.6
Bulgaria (7)
5.1
7.8
Croatia (7)
5.7
Former Yugoslav Republic
8.4
4.8
of Macedonia (7)
7.6
Austria (7)
6.1
7.2
Italy (6)
5.1
6.6
Denmark (6)
5.4
6.8
France (6)
4.8
5.8
Monaco (6)
5.5
6.3
Slovenia (6)
4.8
6.2
Albania (5)
4.2
6.3
Romania (5)
4.2
5.7
Slovakia (5)
4.6
5.7
Greece (5)
4.4
5.6
Poland (5)
4.3
5.8
Portugal (5)
4.0
5.7
Czech Republic (5)
3.9
5.2
Hungary (5)
4.2
4.6
Latvia 2 (5)
4.7
5.2
Georgia (5)
3.6
5.4
Ukraine (4)
3.5
4.8
Ireland (4)
3.8
3.6
Faroes (4)
4.7
4.5
Moldova 1 (4)
2.9
4.4
Lithuania (4)
3.1
3.8
Sweden (3)
3.2
3.7
Estonia (3)
3.2
3.2
Iceland (3)
3.3
3.2
Norway (3)
3.0
3.3
Finland (3)
2.8
Colour indicates significant 
difference between boys and girls.
1  Belgium (Flanders), Cyprus and Moldova: limited geographical coverage.
2  Latvia: limited comparability
ESPAD Report 2015 
49

The situation in 2015
Alcohol intake on the last drinking occasion
(6.1 centilitres), Finland and Ireland (each 6.0 centilitres), 
and lowest in Moldova (2.1 centilitres) and Romania 
The amount of alcohol consumed was calculated as the 
(2.8 centilitres). Boys reported consuming higher volumes 
average volume of ethanol (in centilitres) consumed 
than girls, with significant differences in most countries 
on the last drinking day. The students drank an average 
(Figure 3b). On average, the difference between boys and 
of 4.7 centilitres of alcohol on the last drinking day 
girls in the amount of alcohol consumed was 1.0 centilitres, 
(Figure 3a). The amount of alcohol consumed was highest in 
with the highest differences in Georgia (2.6 centilitres), 
Denmark (9.3 centilitres), Estonia (6.2 centilitres), Sweden 
Montenegro (2.1 centilitres) and Austria (2.0 centilitres).
Figure 3a. 
Average alcohol intake on the last drinking day in centilitres of ethanol among users
United States
≥ 6.0 cl
5.0-5.9 cl
4.0-4.9 cl
3.0-3.9 cl
≤ 2.9 cl
Non-participating country 
or data not available
Cross-hatching indicates 
limited comparability or 
limited geographical 
coverage. 
50 
ESPAD Report 2015

The situation in 2015
Figure 3b. 
Average alcohol intake on the last drinking day in centilitres of ethanol among users by gender
Boys
All students
Girls
9.3
Denmark (9)
9.3
7.0
Estonia (6)
5.5
5.9
Sweden (6)
6.3
6.4
Finland (6)
5.6
6.5
Ireland (6)
5.4
5.7
Netherlands (6)
5.9
6.0
Norway (6)
5.4
6.7
Austria (6)
4.7
5.5
Faroes (5)
5.3
6.0
Croatia (5)
4.4
5.8
Czech Republic (5)
4.5
5.8
Hungary (5)
4.5
5.8
Liechtenstein (5)
4.5
5.3
Belgium (Flanders) 1 (5)
4.7
5.4
Slovakia (5)
4.4
5.4
Slovenia (5)
4.2
5.6
Cyprus 1 (5)
4.0
5.9
Georgia (5)
3.3
4.9
Poland (5)
4.4
5.0
Latvia 2 (4)
3.9
4.6
Malta (4)
4.2
4.9
France (4)
3.8
4.3
Monaco (4)
4.0
4.4
Portugal (4)
3.9
4.9
Bulgaria (4)
3.1
4.0
Iceland (4)
3.8
4.8
Montenegro (4)
2.7
4.3
Lithuania (4)
3.3
4.1
Greece (4)
3.3
4.3
Italy (4)
3.1
4.2
Ukraine (4)
3.1
Former Yugoslav Republic
4.2
2.5
of Macedonia (3)
4.0
Albania (3)
2.6
3.4
Romania (3)
2.2
2.5
Moldova 1 (2)
1.6
Colour indicates significant 
difference between boys and girls.
1  Belgium (Flanders), Cyprus and Moldova: limited geographical coverage.
2  Latvia: limited comparability.
ESPAD Report 2015 
51

The situation in 2015
Preferences of alcoholic beverages on the last 
cider was the second most preferred alcoholic beverage after 
drinking day
beer or spirits.
The relative contribution of each beverage (in centilitres 
Differences in beverage preferences were found between 
of ethanol) to the total amount of alcohol consumed is 
boys and girls (Figure 4b). In more than half of the countries, 
taken as an indicator of preference in alcoholic beverages. 
boys preferred beer (overall average: 43 %) over other 
On average, beer (35 %) and spirits (34 %) were the 
alcoholic beverages. In Estonia, the Faroes, Greece, Hungary, 
preferred alcoholic beverages (Figure 4a). In Albania (68 %), 
Lithuania, Malta, Portugal, Slovakia and Sweden, boys 
Belgium (Flanders) (58 %), the former Yugoslav Republic 
preferred spirits over beer. A generally lower preference for 
of Macedonia (54 %), Romania (52 %) and Poland (52 %), 
cider and wine was found among boys than among girls in 
more than every second student who had drunk alcohol 
more than half of the countries. Among girls, in Sweden, 
preferred beer, and in Malta (60 %), Portugal (53 %), Slovakia 
Estonia, Denmark and the Faroes, cider was the second 
(53 %), France (48 %) and Monaco (48 %), every second 
choice after spirits, and in Norway cider was the most 
student preferred spirits. Wine was preferred over beer 
preferred alcoholic beverage (33 %). In Georgia, Moldova, 
and spirits in Ukraine (44 %), Moldova (41 %) and Georgia 
Montenegro and Ukraine, girls preferred wine over spirits. The 
(39 %), and alcopops were the alcoholic drink of preference 
preference for alcopops was generally higher among girls 
in Liechtenstein (36 %). In Denmark, Estonia, Faroes, Ireland, 
than among boys (11 % versus 7 %), with a share of 24 % or 
Norway and Sweden, cider accounted for at least one quarter 
more in Cyprus, Finland, Iceland and Italy among girls, and in 
of the total amount of alcohol consumed. In these countries, 
Liechtenstein among both genders.
52 
ESPAD Report 2015

The situation in 2015
Figure 4a. 
Preferences of alcoholic beverages on the last 
Figure 4b. 
Preferences of alcoholic beverages on the last 
drinking day; proportion of alcohol volume in 
drinking day by gender; proportion of alcohol 
centilitres of ethanol for each beverage on 
volume in centilitres of ethanol for each 
total consumption
beverage on total consumption
Beverage preferences (Total)
Beverage preferences: boys presented in the 
top horizontal bars, girls in the bottom bar
0 % 
20 % 
40 % 
60 % 
80 % 
100 % 
0 % 
20 % 
40 % 
60 % 
80 % 
100 % 
Albania 
Boys
Girls
Austria 
Belgium (Flanders) 
Bulgaria 
Croatia 
Cyprus 
Czech Republic 
Denmark 
Estonia 
Faroes 
Finland 
France 
Georgia 
Greece 
Hungary 
Iceland 
Ireland 
Italy 
Liechtenstein 
Lithuania 
Former Yugoslav Republic
of Macedonia
Malta 
Moldova 
Monaco 
Montenegro 
Netherlands 
Norway 
Poland 
Portugal 
Romania 
Slovakia 
Slovenia 
Sweden 
Ukraine 
Beer
Wine
Spirits
Alcopops
Cider
 
ESPAD Report 2015 
53

The situation in 2015
Heavy episodic drinking in the last 30 days
was about 5 percentage points on average, with generally 
higher figures for boys (Figure 5b). Significant gender 
Every third student (35 %) reported heavy episodic drinking 
differences were found in half of the countries, with the 
during the last 30 days (Figure 5a). This drinking pattern 
largest differences in Montenegro (22 percentage points), 
was found more often in Austria, Cyprus and Denmark, 
Georgia (21), Romania (15) and Albania (14). However, in 
with about every second student reporting heavy episodic 
Monaco, significantly more girls than boys reported heavy 
drinking. The lowest figures were found in Norway (19 %) 
episodic drinking at least once in the last 30 days (32 % for 
and Iceland (8 %). The difference between boys and girls 
girls versus 21 % for boys).
Figure 5a. 
Prevalence of five or more drinks at least once in the last 30 days; one drink contains approximately 2 centilitres 
of ethanol (percentage)
United States
≥ 50 %
40-49 %
30-39 %
20-29 %
≤ 19 %
Non-participating country 
or data not available
Cross-hatching indicates 
limited comparability or 
limited geographical 
coverage. 
54 
ESPAD Report 2015

The situation in 2015
Figure 5b. 
Prevalence of five or more drinks at least once in the last 30 days by gender; one drink contains approximately 
2 centilitres of ethanol (percentage)
Boys (%)
All students (%)
Girls (%)
57
Denmark (56)
56
53
Austria (53)
54
57
Cyprus 1 (51)
45
50
Liechtenstein (48)
46
45
Malta (47)
49
51
Croatia (47)
42
50
Bulgaria (46)
42
46
Slovenia (44)
42
46
Latvia 2 (42)
39
41
Slovakia (42)
44
47
Czech Republic (42)
37
46
Moldova 1 (41)
37
51
Georgia (41)
30
43
Hungary (39)
36
38
Netherlands (39)
40
43
Greece (38)
34
36
Estonia (36)
37
37
Lithuania (36)
35
37
Belgium (Flanders) 1 (35)
34
34
Poland (35)
35
42
Romania (35)
27
37
Italy (34)
31
35
France (31)
28
31
Spain 2 (31)
31
34
Ukraine (31)
27
41
Montenegro (30)
19
28
Ireland (28)
28
28
Faroes (28)
27
21
Monaco (27)
32
Former Yugoslav Republic
31
of Macedonia
21
 (26)
25
Finland (23)
20
30
Albania (23)
16
21
Sweden (22)
24
22
Portugal (20)
18
19
Norway (19)
20
11
United States 2 (11)
11
7
Iceland (8)
8
Colour indicates significant 
difference between boys and girls
(not tested for Spain and United States).
1  Belgium (Flanders), Cyprus and Moldova: limited geographical coverage.
2  Latvia, Spain and United States: limited comparability.
ESPAD Report 2015 
55

The situation in 2015
Current cannabis use
counterparts in other ESPAD countries. More boys than girls 
reported cannabis use in the last 30 days (8 % versus 5 %). 
Overall, 7 % of the students had used cannabis in the last 
In half of the countries, gender differences were statistically 
30 days (Figure 6a). About twice as many students had used 
significant (Figure 6b), with the largest differences found in 
cannabis at least once in the last month in France (17 %), Italy 
Albania, Belgium (Flanders), Bulgaria, Georgia, Ireland, Italy, 
(15 %) and the Czech Republic (13 %), compared with their 
Liechtenstein and the Netherlands (5-8 percentage points).
Figure 6a. 
Prevalence of cannabis use in the last 30 days (percentage)
United States
≥ 14 %
11-14 %
7-10 %
3-6 %
≤ 2 %
Non-participating country 
or data not available
Cross-hatching indicates 
limited comparability or 
limited geographical 
coverage. 
56 
ESPAD Report 2015

The situation in 2015
Figure 6b. 
Prevalence of cannabis use in the last 30 days by gender (percentage)
Boys (%)
All students (%)
Girls (%)
19
France (17)
16
16
United States 2 (15)
14
18
Italy (15)
11
16
Spain 2 (14)
12
13
Czech Republic (13)
12
15
Bulgaria (12)
10
13
Monaco (12)
11
15
Netherlands (12)
9
13
Slovenia (12)
11
15
Liechtenstein (11)
8
12
Ireland (10)
7
9
Slovakia (9)
9
11
Austria (9)
7
11
Poland (9)
7
9
Estonia (8)
6
8
Croatia (8)
7
8
Portugal (8)
8
10
Belgium (Flanders) 1 (8)
5
5
Malta (5)
5
6
Denmark (5)
4
7
Cyprus 1 (5)
3
5
Lithuania (4)
3
6
Latvia 2 (4)
3
6
Greece (4)
2
7
Georgia (4)
1
5
Hungary (4)
3
6
Albania (4)
1
5
Montenegro (3)
2
4
Romania (3)
2
2
Iceland (2)
3
4
Ukraine (2)
1
3
Sweden (2)
2
Former Yugoslav Republic
3
1
of Macedonia (2)
3
Finland (2)
2
3
Norway (2)
1
2
Moldova 1 (2)
1
1
Faroes (1)
2
Colour indicates significant 
difference between boys and girls
(not tested for Spain and United States).
1  Belgium (Flanders), Cyprus and Moldova: limited geographical coverage.
2  Latvia, Spain and United States: limited comparability.
ESPAD Report 2015 
57

The situation in 2015
Frequency of cannabis use in the last 12 months
Overall, boys reported a higher frequency of cannabis use 
than girls (Figure 7b), with significant gender differences 
Among all students who had used cannabis, on average, 
in Austria, Bulgaria, the Czech Republic, Denmark, Estonia, 
the drug was used on 8.9 occasions in the last 12 months 
France, Italy, the Netherlands, Poland and Ukraine. In Cyprus, 
(Figure 7a). In France, Iceland, Ireland, Italy and the 
Latvia, Monaco, Montenegro and Romania, cannabis was 
Netherlands, cannabis was used once a month on average 
used more frequently by girls than boys, even though these 
(11.5 or more times). The lowest frequencies of cannabis 
differences were not statistically significant.
use were found in the Faroes and Moldova (3.6 or fewer). 
Figure 7a. 
Frequency of cannabis use in the last 12 months (mean number of occasions among users)
United States
≥ 11.0 occasions
10.0-10.9 occasions
8.0-9.9 occasions
6.0-7.9 occasions
≤ 4.9 occasions
Non-participating country or 
data not available
Cross-hatching indicates 
limited comparability or 
limited geographical 
coverage. 
58 
ESPAD Report 2015

The situation in 2015
Figure 7b. 
Frequency of cannabis use in the last 12 months by gender (mean number of occasions among users)
Boys
All students
Girls
14.5
Iceland (14)
12.7
14.2
France (13)
11.5
15.3
Ireland (13)
8.8
13.8
Italy (12)
10.3
13.8
Netherlands (11)
8.7
10.0
Cyprus 1 (11)
12.3
12.6
Bulgaria (11)
8.6
11.6
Belgium (Flanders) 1 (11)
9.0
11.8
Austria (11)
8.7
12.2
Slovenia (10)
8.8
10.2
Latvia 2 (10)
10.8
10.7
Malta (10)
9.7
10.3
Liechtenstein (10)
9.5
9.5
Montenegro (10)
10.9
9.7
Croatia (9)
8.7
9.8
Greece (9)
8.0
10.5
Portugal (9)
7.8
9.2
Georgia (9)
5.6
9.1
Albania (9)
6.9
8.5
Monaco (9)
8.8
9.6
Poland (9)
7.3
9.5
Norway (8)
3.9
9.9
Sweden (8)
6.4
9.3
Czech Republic (8)
7.2
9.5
Denmark (8)
5.7
9.2
Slovakia (8)
6.4
Former Yugoslav Republic
8.3
5.6
of Macedonia (8)
9.1
Ukraine (7)
3.2
6.7
Romania (7)
7.7
8.1
Estonia (7)
5.0
7.2
Finland (7)
5.7
7.5
Hungary (6)
4.6
6.0
Lithuania (6)
4.9
3.8
Moldova 1 (4)
2.8
1.9
Faroes (2)
1.9
Colour indicates significant 
difference between boys and girls.
1  Belgium (Flanders), Cyprus and Moldova: limited geographical coverage.
2  Latvia: limited comparability.
ESPAD Report 2015 
59

The situation in 2015
Current inhalant use
reported inhalant use more frequently than boys in Estonia, 
Croatia and Latvia, whereas in Albania, Austria, Bulgaria, 
Use of inhalants in the last 30 days was relatively rare. On 
Cyprus, the former Yugoslav Republic of Macedonia, Ireland, 
average, 2 % of the students reported use of inhalants to get 
Italy, Liechtenstein and Lithuania, inhalant use was more 
high in the last 30 days (Figure 8a). The highest prevalence 
frequently reported among boys. Gender differences were 
rates were found in Croatia (7 %) and Cyprus (5 %). Girls 
generally small (Figure 8b).
Figure 8a. 
Prevalence of inhalant use in the last 30 days (percentage)
United States
≥ 7 %
5-6 %
3-4 %
2 %
≤ 1 %
Non-participating country 
or data not available
Cross-hatching indicates 
limited comparability or 
limited geographical 
coverage. 
60 
ESPAD Report 2015

The situation in 2015
Figure 8b. 
Prevalence of inhalant use in the last 30 days by gender (percentage)
Boys (%)
All students (%)
Girls (%)
6
Croatia (7)
8
7
Cyprus 1 (5)
4
4
Greece (4)
4
3
Latvia 2 (4)
5
3
Georgia (3)
4
4
Slovenia (3)
3
4
Montenegro (3)
2
3
Poland 3 (3)
3
4
Ireland (3)
2
4
Bulgaria (2)
1
4
Albania (2)
1
4
Liechtenstein (2)
1
3
Austria (2)
1
2
Malta (2)
2
2
Sweden (2)
2
1
Estonia (2)
3
3
Italy (2)
1
2
Lithuania (2)
1
2
Romania (1)
1
1
Hungary (1)
1
1
Slovakia (1)
1
2
Finland (1)
1
Former Yugoslav Republic
2
0
of Macedonia (1)
1
United States 2 (1)
1
1
Ukraine (1)
1
1
Czech Republic (1)
1
1
Iceland (1)
1
1
Netherlands (1)
0
1
Belgium (Flanders) 1 (1) 0
1
Denmark (1)
0
1
Spain 2 (0)
0
0
Faroes (0)
0
1
Moldova 1 (0)
0
Colour indicates significant 
difference between boys and girls
(not tested for Spain and United States). 
1  Belgium (Flanders), Cyprus and Moldova: limited geographical coverage.
2  Latvia, Spain and United States: limited comparability.
3  Significance tested using logistic regression on non-rounded figures for boys (3.3) and girls (2.7)
ESPAD Report 2015 
61

The situation in 2015
New psychoactive substance use
Moldova, the Netherlands, Norway and Portugal, with 1 % 
each (Figure 9a). Generally, differences in NPS use between 
Overall, an average of 3 % of the students had used NPS at 
boys and girls were small. However, significantly more 
least once in the last 12 months, with the highest prevalence 
boys than girls reported the use of NPS in Albania, Cyprus, 
figures in Bulgaria, Croatia, Estonia, Ireland, Italy and Poland 
Georgia, Greece, Moldova, Montenegro, the Netherlands, and 
(5-8 %), and the lowest in Belgium (Flanders), Denmark, the 
significantly more girls than boys in the Czech Republic and 
Faroes, Finland, the former Yugoslav Republic of Macedonia, 
Iceland (Figure 9b).
Figure 9a. 
Prevalence of new psychoactive substance use in the last 12 months (percentage)
United States
≥ 7 %
5-6 %
3-4 %
2 %
≤ 1 %
Non-participating country 
or data not available
Cross-hatching indicates 
limited comparability or 
limited geographical 
coverage. 
62 
ESPAD Report 2015

The situation in 2015
Figure 9b. 
Prevalence of new psychoactive substance use in the last 12 months by gender (percentage)
Boys (%)
All students (%)
Girls (%)
8
Estonia (8)
8
8
Poland (8)
8
6
Croatia (6)
5
6
Bulgaria (6)
5
6
Ireland (5)
4
5
Italy (5)
5
4
Lithuania (4)
4
5
France (4)
4
3
Czech Republic (4)
5
4
Latvia 2 (4)
3
3
Monaco (4)
4
4
Malta (3)
3
3
Romania (3)
3
3
Spain 2 (3)
2
5
Georgia (3)
1
3
Hungary (3)
3
3
Liechtenstein (3)
3
3
Ukraine (3)
2
3
Slovakia (3)
3
3
Austria (2)
2
2
Slovenia (2)
2
3
Albania (2)
1
3
Cyprus 1 (2)
1
2
Sweden (2)
2
3
Montenegro (2)
1
1
Iceland (2)
2
2
Greece (2)
1
2
Finland (1)
1
2
Moldova 1 (1)
0
1
Netherlands (1)
0
1
Portugal (1)
1
Former Yugoslav Republic
1
1
of Macedonia (1)
1
Norway (1)
1
1
Faroes (1)
1
1
Denmark (1)
1
1
Belgium (Flanders) 1 (1) 0
Colour indicates significant 
difference between boys and girls
(not tested for Spain).
1  Belgium (Flanders), Cyprus and Moldova: limited geographical coverage.   
2  Latvia and Spain: limited comparability.   
 
ESPAD Report 2015 
63

The situation in 2015
Internet use, gaming, gambling
Slightly less than half of the students were regularly (at 
least four times for each of these activities in the last 
ESPAD average 
7 days) using the internet for information seeking/surfing 
Internet use, gaming and gambling (mean, %)
(43 % on average) or streaming/downloading (48 %). The 
Average
Min.
Max.
highest figures for information seeking/surfing were found 
Days online (mean) a
5.8
3.8
6.8
in Monaco (63 %), Finland (61 %) and Denmark (58 %), and 
Internet activities (%) b
for streaming/downloading in Norway (80 %), Finland (74 %) 
Social media
78
58
94
and Cyprus (67 %). Lower rates (30 % or less) of information 
Information seeking/surfing
43
26
63
seeking/surfing were reported in Montenegro and Portugal, 
Streaming/downloading
48
28
80
and for streaming/downloading in the Czech Republic. 
Gaming
23
13
45
With few exceptions, in nearly all countries, more girls than 
Money gambling
3
1
8
boys used the internet for information seeking/surfing or 
Buying/selling
9
3
19
streaming/downloading. Nearly every 10th student (9 %) 
Gambling (%) c
regularly used the internet for buying/selling, ranging from 
At least once
14
5
30
3 % in Iceland and Liechtenstein to 19 % in Hungary and the 
Frequently d
7
3
16
Netherlands. On average, 11 % of the boys and 8 % of the 
a  Number of days spent on the internet in the last 7 days.
girls reported these activities.
b  Percentage of students spending 4 or more days on the internet in the 
last 7 days.
c  Percentage of students involved in gambling with money in the last 
12 months.
Online gaming and gambling
d  Percentage of students reporting gambling with money 2-4 times 
a month or more often.
More than one in five students (23 %) used the internet for 
online gaming regularly (at least four times in the last 7 days) 
Internet use
(Table 11b). Nearly half of the students from Denmark 
played regularly online (45 %). Regular online gaming was 
On average, the students reported use of the internet on 
not so common in Georgia (13 %), the former Yugoslav 
5.8 days within the last 7 days prior to the survey (Table 11a). 
Republic of Macedonia and Moldova (16 % each). Online 
The frequency of use was lower in Albania, Bulgaria, 
gaming was much more common among boys (39 %) than 
the former Yugoslav Republic of Macedonia, Georgia, 
girls (7 %). Among boys, the highest figures for the regular 
Montenegro, Romania and Ukraine (3.8-5.1 days). Students 
playing of online games were found in Denmark (64 %), 
in Denmark (6.8 days), Iceland (6.7 days), Finland, the 
Sweden (58 %), Estonia (55 %), Norway (52 %) and Finland 
Netherlands, Sweden (6.6 days each) and Estonia (6.5 days) 
(51 %), and the lowest in Georgia and Monaco (23 % each). 
were online every day of the week. No gender differences 
The countries with the highest proportion of girls reporting 
were observed.
regularly playing games online were Denmark (28 %) and 
Monaco (18 %).
Internet activities
Online money gambling was the least common of the 
internet activities (ESPAD average: 3 %), with the highest 
Overall, 78 % of the students had used the internet for social 
figures in Bulgaria (8 %), Albania, Cyprus and the former 
media activities regularly, i.e. on 4 or more days during the 
Yugoslav Republic of Macedonia (7 % each). Like online 
last 7 days (Tables 11a, 11b). Using social media was the 
gaming, online gambling for money is predominantly done 
predominant internet activity, and was reported by between 
by boys (6 % compared with 1 % of girls). The highest rates 
58 % (Albania) and 94 % (Finland) of the students. There 
of boys reporting online gambling for money were found in 
were gender differences in the use of social media, with 
Albania, Bulgaria, Croatia, Cyprus and the former Yugoslav 
higher figures overall for girls than boys. In two thirds of 
Republic of Macedonia (11-13 %).
the ESPAD countries, rates among girls were 10 or more 
percentage points higher than among boys. Exceptions were 
Albania (63 % for boys versus 54 % for girls) and Monaco 
(87 % versus 80 %), where more boys than girls reported 
social media use.
64 
ESPAD Report 2015

The situation in 2015
Table 11a. 
Average number of days on the internet (mean number of days) and prevalence of internet activities on 4 or 
more days in the last 7 days (percentage)
Infor-
Streaming/
Streaming/
Information 
Days 
Social 
mation 
download-
Days online
Social media
downloading 
Country
seeking, surfing
online
media
seeking, 
ing music, 
music, films, etc.
surfing
films, etc.
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Albania
4.1
58
38
46
4.4
3.8
63
54
32
43
46
46
Austria
6.1
85
42
39
6.1
6.1
80
91
37
47
42
36
Belgium (Flanders)
.
.
.
.
.
.
.
.
.
.
.
.
Bulgaria
5.1
75
49
48
4.9
5.2
70
81
43
54
48
48
Croatia
5.8
83
46
38
5.7
6.0
77
89
43
49
41
33
Cyprus
6.2
77
36
67
5.9
6.4
66
86
34
39
59
75
Czech Republic
6.2
83
42
28
6.1
6.3
77
88
42
42
29
27
Denmark
6.8
85
58
50
6.8
6.9
81
89
53
62
53
48
Estonia
6.5
85
53
42
6.5
6.5
80
90
48
58
42
43
Faroes
6.1
89
31
32
6.3
6.0
85
94
32
31
31
33
Finland
6.6
94
61
74
6.5
6.7
92
96
58
64
69
79
FYR Macedonia a
4.0
66
40
38
4.1
3.9
65
68
39
41
40
36
France
6.2
79
40
35
6.2
6.3
74
85
40
39
36
34
Georgia
3.8
64
36
48
3.9
3.7
60
67
31
42
47
49
Greece
5.8
79
33
64
5.6
5.9
74
83
32
35
60
68
Hungary
6.1
80
35
43
6.1
6.2
74
87
33
37
41
45
Iceland
6.7
83
45
62
6.7
6.6
77
88
45
45
60
65
Ireland
6.3
82
37
43
6.3
6.4
76
88
34
41
41
45
Italy
5.7
80
44
40
5.6
5.9
74
88
41
47
36
44
Liechtenstein
6.4
89
40
38
6.3
6.5
85
93
41
40
39
37
Lithuania
5.7
71
38
52
5.6
5.8
60
82
34
42
49
56
Malta
6.1
85
36
48
5.9
6.3
79
90
34
39
43
53
Moldova
5.5
63
47
57
5.3
5.7
56
69
38
57
55
60
Monaco
6.5
84
63
37
6.4
6.6
87
80
61
65
36
39
Montenegro
4.9
65
30
35
4.8
4.9
59
72
25
35
32
39
Netherlands
6.6
92
34
65
6.5
6.7
87
96
30
38
62
68
Norway
5.9
88
56
80
5.8
6.0
84
94
54
58
75
86
Poland
5.9
78
54
58
5.8
6.0
73
82
52
56
57
58
Portugal
5.9
74
26
43
5.8
5.9
68
80
25
27
45
41
Romania
4.4
67
33
33
4.2
4.6
60
74
27
39
32
34
Slovakia
6.0
65
36
43
6.0
6.0
59
71
36
36
39
46
Slovenia
6.3
78
41
63
6.1
6.4
69
86
37
44
57
68
Sweden
6.6
85
53
36
6.5
6.7
79
91
48
59
36
36
Ukraine
4.9
75
50
45
4.7
5.1
68
82
44
55
41
48
AVERAGE
5.8
78
43
48
5.7
5.9
73
83
39
46
46
49
Latvia
5.3
78
50
66
5.3
5.4
5
2
2
1
2
3
Spain
5.9
.
.
.
5.8
6.0
.
.
.
.
.
.
United States
.
.
.
.
.
.
.
.
.
.
.
.
a Official name former Yugoslav Republic of Macedonia.
ESPAD Report 2015 
65

The situation in 2015
Table 11b. 
Prevalence of internet activities on 4 or more days in the last 7 days by gender (percentage)
Money 
Gaming
Money gambling
Buying/selling
Country
Gaming
Buying/selling
gambling
Boys
Girls
Boys
Girls
Boys
Girls
Albania
19
7
10
28
11
11
3
13
8
Austria
21
1
7
37
5
2
0
8
5
Belgium (Flanders)
.
.
.
.
.
.
.
.
.
Bulgaria
25
8
16
41
10
13
4
18
14
Croatia
23
6
9
39
6
11
2
11
6
Cyprus
25
7
13
42
9
12
3
16
10
Czech Republic
26
3
11
44
7
4
1
11
10
Denmark
45
5
8
64
28
9
1
8
8
Estonia
31
3
4
55
6
6
1
6
3
Faroes
26
1
6
50
3
2
0
4
8
Finland
27
2
5
51
5
3
0
7
3
FYR Macedonia a
16
7
14
26
6
11
3
17
10
France
23
1
6
41
6
1
0
7
6
Georgia
13
6
10
23
2
10
1
13
6
Greece
18
3
5
33
3
5
1
6
4
Hungary
21
3
19
35
8
5
1
22
15
Iceland
22
1
3
41
4
2
0
3
3
Ireland
18
3
10
32
3
5
0
12
8
Italy
22
3
9
33
10
5
1
11
8
Liechtenstein
20
1
3
41
2
1
0
6
1
Lithuania
30
5
11
46
13
9
1
13
9
Malta
24
1
13
41
8
2
0
12
13
Moldova
16
2
12
28
4
3
1
17
6
Monaco
20
2
8
23
18
3
2
10
7
Montenegro
18
5
9
31
6
8
2
11
7
Netherlands
27
4
19
48
6
7
2
22
16
Norway
30
2
14
52
5
4
1
16
12
Poland
22
3
10
39
6
5
1
11
8
Portugal
20
2
5
39
5
5
0
8
3
Romania
21
4
9
36
7
6
2
12
6
Slovakia
20
4
11
31
9
5
2
12
10
Slovenia
18
3
9
33
4
5
1
10
7
Sweden
32
5
10
58
7
7
2
13
7
Ukraine
17
2
6
30
5
3
1
7
4
AVERAGE
23
3
9
39
7
6
1
11
8
Latvia
27
8
13
2
0
2
1
7
7
Spain
.
.
.
.
.
.
.
.
.
United States
.
.
.
.
.
.
.
.
.
a Official name former Yugoslav Republic of Macedonia.
Gambling
than girls had gambled in the previous year (23 % versus 5 % 
on average) or gambled frequently (12 % versus 2 %). About 
On average, 14 % of the students reported gambling for 
one third or more of the boys in Croatia, Cyprus, Finland, 
money at least once and 7 % had gambled frequently (2-4 
Greece, Montenegro and Slovenia reported gambling with 
times a month or more often; Table 12) in the last 12 months. 
money in the last 12 months. At least 20 % of the boys 
The highest rates of gambling in the past year (30 %) and 
reported having gambled frequently in Cyprus, Greece, 
frequent gambling (16 %) were found in Greece. About one 
Montenegro and Slovenia. In Greece, 12 % of the girls 
in five students in Cyprus, Finland, Montenegro and Slovenia 
reported gambling experience in the previous 12 months and 
reported gambling in the past 12 months, and, in addition to 
3 % gambled frequently. Comparably high proportions for 
Greece, more than every 10th student in Finland and Ireland 
girls were also found in Slovenia (11 % gambling experience, 
gambled frequently. In all countries, considerably more boys 
4 % frequent gambling).
66 
ESPAD Report 2015

The situation in 2015
Table 12. 
Gambling for money: prevalence in the last 12 months (percentage)
At least once
Frequently
Country
At least once
Frequently
Boys
Girls
Boys
Girls
Albania
8
3
15
2
10
1
Austria
7
4
11
2
5
0
Belgium (Flanders)
.
.
.
.
.
.
Bulgaria
18
7
30
7
19
3
Croatia
19
8
33
4
20
2
Cyprus
23
9
39
8
26
3
Czech Republic
9
5
15
3
7
1
Denmark
16
8
29
4
16
0
Estonia
12
6
20
4
10
2
Faroes
11
7
20
2
8
0
Finland
20
13
34
7
14
1
FYR Macedonia a
14
6
23
5
14
2
France
17
9
27
8
15
2
Georgia
14
4
24
3
17
2
Greece
30
16
49
12
27
3
Hungary
16
6
26
6
17
3
Iceland
7
4
12
2
4
1
Ireland
16
11
26
6
9
1
Italy
15
6
24
5
15
2
Liechtenstein
9
4
17
2
9
1
Lithuania
12
6
20
3
11
1
Malta
7
4
12
3
5
1
Moldova
5
3
9
2
4
1
Monaco
14
7
23
6
12
2
Montenegro
23
8
38
8
26
3
Netherlands
14
9
23
5
9
1
Norway
7
4
11
3
6
1
Poland
10
5
17
4
9
3
Portugal
8
4
14
4
8
1
Romania
13
6
22
5
12
2
Slovakia
14
7
24
5
12
2
Slovenia
21
9
32
11
20
4
Sweden
13
5
22
5
14
2
Ukraine
7
4
12
3
6
1
AVERAGE
14
7
23
5
12
2
Latvia
16
8
23
9
12
4
Spain
16
6
29
9
14
2
United States
.
.
.
.
.
.
a Official name former Yugoslav Republic of Macedonia.
ESPAD Report 2015 
67



Trends  
1995-2015

Trends 1995-2015
This chapter presents changes in substance use for selected 
the Faroes, Finland, France, Greece, Hungary, Iceland, 
indicators from 1995 to 2015. The indicators covered 
Ireland, Italy, Lithuania, Malta, the Netherlands, Norway, 
include students’ perceptions of substance use availability, 
Poland, Portugal, Romania, Slovakia, Slovenia, Sweden and 
early onset of substance use, substance use experience 
Ukraine (Figure 10). Trends for 15 key variables are shown 
and patterns of substance use. Sample sizes and class 
in Table 14 and trends by gender are graphically depicted in 
participation rates for all countries are shown in Table 13.
Figures 11-25.
Trends across 25 countries
In this section, overall trends measured across country-
specific means of 25 countries are reported between 
1995 and 2015. The 25 countries included are Bulgaria, 
Croatia, Cyprus, the Czech Republic, Denmark, Estonia, 
Figure 10. 
Countries included in the 25-country average (marked in blue)
United States
70 
ESPAD Report 2015

Trends 1995-2015
Table 13. 
Overview of ESPAD surveys conducted between 1995 and 2015 by country: sample size and participation rate
1995
1999
2003
2007
2011
2015
Country
n
% a
n
% a
n
% a
n
% a
n
%
n a
% a
Albania
.
.
.
.
.
.
.
.
3 189
100
2 553
100
Austria
.
.
.
.
2 402
73
2 571
63
.
.
3 684
17 b
Belgium (Flanders)
.
.
.
.
2 320 c
88
1 889 d
54 e
1 798 f
58 e
1 771 f
56 e
Bosnia and 
.
.
.
.
.
.
2 973 g
100
3 813 d
99
.
.
Herzegovina (FBiH)
Bosnia and 

.
.
.
.
.
.
2 609 g
97
3 132
98
.
.
Herzegovina (RS)
Bulgaria

.
.
5 391
100
2 740
100
2 353
100
2 217
100
2 922
98
Croatia
2 815
100
3 602
100
2 884
99
3 008
99
3 002
90
2 558
98
Cyprus
632
100
2 095
100
2 152
98 e
6 340
100
4 243
76
2 098
85
Czech Republic
2 962
100
3 579
99
3 195
100
3 901
100
3 913
98
2 738
96 e
Denmark
2 439
78
1 790
56
2 978
65
877
46
2 181
42 e
1 670
26 e
Estonia
3 118
94
3 254
89
2 463
80
2 372
90
2 460
95
2 452
90
Faroes
543
100
463
100
640
97
552
100
557
100
511
100
Finland
2 300
100
3 286
99 e
3 543
97
4 988
99
3 744
81
4 049
85
FYR Macedonia k
.
.
5 199
100
.
.
2 452 g
97
.
.
2 428
98
France
.
.
2 284
97
2 199
86
2 916
98
2 572
95
2 714
93
Germany h
.
.
.
.
5 110
91
5 011
90
2 796
40
.
.
Greece
.
.
2 259
94
1 906
97
3 060
88
5 908
87
3 202
95
Greenland
.
.
421
76 e 
555
n.a.
.
.
.
.
.
.
Hungary
2 571
99
6 421
92
2 677
98
2 817
94
3 063
85
2 735
93
Iceland
3 814
90
3 524
99 e
3 348
98
3 510
97
3 333
95
2 663
79
Ireland
1 849
81
2 277
100
2 407
91
2 221
76
2 207
72
1 470
18 b
Isle of Man
.
.
.
.
721
100 e
740
100
. i
.
.
.
Italy
1 555
99
4 106
100
4 871
97
9 981
99
4 837
88
4 059
85
Latvia
2 179
49
2 284
90
2 841
97
2 275
93
2 622
95
1 119
42
Liechtenstein
.
.
.
.
.
.
.
.
366
100
316
100
Lithuania
3 196
100
5 039
100
5 036
100
2 411
99
2 476
99
2 573
99
Malta
2 832
100
4 321
100
3 500
99
3 668
99
3 377
100
3 326
98
Moldova
.
.
.
.
.
.
3 176 g
99
2 162
100
2 586
100
Monaco
.
.
.
.
.
.
393
100
401
100
397
100
Montenegro
.
.
.
.
.
.
5 823 g
100
3 387
100
3 844
100
Netherlands
.
.
2 615
n.a.
2 095
97
2 091
98
2 044 d
50 e
1 684 d
43 e
Norway
3 910
90
3 918
86
3 833
77
3 482
58 e
2 938
28
2 584
53
Poland
8 940
96
3 330
n.a.
5 964
98
2 120
93
5 933
94
11 822
94
Portugal
2 033
100
3 609
100
2 946
98
3 141
95
1 965
90
3 456
96
Romania
.
.
2 393
94
4 371
100
2 289
98
2 770
100
3 500
100
Russia (Moscow)
.
.
2 937
95
1 925
92
3 939 j
96 e
1 757
77
.
.
Serbia
.
.
.
.
.
.
6 156 g
94 e
6 084
97
.
.
Slovakia
2 376
99
2 442
100
2 276
98
2 468
100
2 009
100
2 208
100
Slovenia
3 306
100
3 184
100
2 785
100
3 085
100
3 186
100
3 484
99
Sweden
3 472
94
3 445
89
3 232
87
3 179
87
2 569
80
2 551
83
Switzerland
.
.
.
.
2 613
86
2 499
88
.
.
.
.
Ukraine
7 193
99
2 994
97 e
4 173
98
2 447
98
2 210
99
2 350
98
United Kingdom
7 722
46 e
2 641
74 e
2 068
55 e
2 179
40
1 712
5
.
.
a  Class participation rate: proportion of selected classes participating in 
h  Five federal states: Bavaria, Berlin, Brandenburg, Mecklenburg-Western 
the survey.
Pomerania and Thuringia.
b  Estimated from the maximum number of classes that could participate.
i  Data collected but not delivered.
c  Flanders and Wallonia.
j Russia.
d  Data collected in autumn.
k  Official name former Yugoslav Republic of Macedonia.
e  School participation rate (class participation rates not available).
Red typeface: countries included in the 25-country average.
f  Data collected in previous autumn.
n.a. = not available.
g  Data collected in spring 2008.
ESPAD Report 2015 
71

Trends 1995-2015
Table 14. 
ESPAD average for selected indicators based on 25 countries: 1995-2015
Measure
1995
1999
2003
2007
2011
2015
Perceived availability of cannabis
22
30
33
33
32
32
Early onset of daily cigarette use a
10
9
10
7
7
4
Early onset of daily cannabis use a
2
2
3
3
3
3
Lifetime use of cigarettes
67
68
66
59
56
47
Current cigarette use b
32
36
33
29
29
22
Daily cigarette use b
20
24
23
18
18
13
Lifetime alcohol use
89
90
90
88
86
81
Current alcohol use b
56
61
63
60
58
47
Heavy episodic drinking c
36
39
40
42
41
35
Lifetime illicit drug use
11
17
20
18
19
18
Lifetime cannabis use
11
16
19
17
18
17
Lifetime use of illicit drugs other than cannabis
3
6
5
7
6
5
Current cannabis use b
4
6
8
7
7
7
Lifetime inhalant use
8
9
9
9
9
8
Lifetime use of tranquillisers or sedatives 
8
7
7
7
7
6
without a doctor’s prescription
a  At age 13 or younger.
b  Last 30 days.
c  More than five drinks on one occasion at least once in the last 30 days.
Availability of cannabis
Cannabis use
The average proportion of students who answered that they 
Rates of cannabis use at the age of 13 years or younger 
would find it easy (combined positive responses on ‘very 
increased slightly until 2003 among girls and until 2007 
easy’ and ‘fairly easy’) to obtain cannabis, if they wanted to, 
among boys and stabilised thereafter (Figure 13). Trends 
increased from 1995 to 2003 in both genders and levelled 
by gender are almost parallel, with girls’ rates being slightly 
off thereafter (Figure 11). Rates among boys are slightly 
lower than boys’ rates.
higher than among girls. Overall, the perceived availability 
of cannabis among boys increased from 23 % to 33 % and 
among girls from 21 % to 30 %.
Cigarette use
On average, lifetime prevalence rates of smoking showed 
Early onset of substance use
a stable trend between 1995 and 2003 and decreased 
thereafter (Table 14). Rates of lifetime smoking among boys 
Daily smoking
and girls follow this general trend. However, the gender 
gap in lifetime smoking rates, still visible in 1995, closed in 
On average, between 1995 and 2003 rates of early onset 
2015 (Figure 14). Similar trends can be observed for current 
of daily smoking (that is, at the age of 13 or younger) were 
smoking and daily smoking (Table 14). Rates of current (last-
rather stable at about 10 %, but rates dropped thereafter 
30-day) use decreased by 10 percentage points between 
to 4 % in 2015, indicating a strong decrease in early onset 
1995 and 2015 (Table 14; Figure 15); reductions in daily use 
daily smoking over the last 10 years (Table 14). Gender-
amounted to 7 percentage points (Figure 16).
specific trends are almost parallel, with slightly lower rates 
in girls than boys (1-2 percentage points difference in recent 
surveys; Figure 12).
Alcohol use
The prevalence of lifetime as well as current (last-30-day) 
use of alcohol decreased between 2003 and 2015 (Table 14; 
Figures 17 and 18). No gender differences in trends can 
be observed, with the exception of constantly higher rates 
among boys.
72 
ESPAD Report 2015

Trends 1995-2015
The prevalence of heavy episodic drinking, although showing 
rates appear to have slightly decreased. This trend is also 
the same level in 2015 as 20 years before, peaked in the 
seen for boys and girls, with a consistent gender gap of 
middle of the 2000s and has decreased since then. However, 
1-2 percentage points.
as shown in Figure 19, rates of heavy episodic drinking 
generally increased among girls, resulting in a narrowing of 
the gender differences over time.
Inhalant use
The use of other psychoactive substances such as inhalants 
Illicit drug use
shows generally stable lifetime prevalence rates over 
the observed period. The gender-specific curves reveal 
Generally, between 1995 and 2003, an increase can be seen 
a narrowing and, by the end, closure of the gender gap, with 
in the prevalence of illicit drug use, most of which occurred 
rates among boys slightly decreasing but rather unchanged 
between the first two surveys. Since then, the prevalence 
rates among girls (Figure 24).
has remained largely unchanged. Trends in illicit drug use 
experience among boys and girls follow the general trend, 
with girls’ rates being about 6 percentage points lower than 
Pharmaceutical use
boys’ rates (Figure 20). Trends for lifetime cannabis use are 
similar to the trends for any illicit drug use, with rates being 
The lifetime prevalence rates for the use of tranquillisers 
only slightly lower (Table 14 and Figure 21). Prevalence rates 
or sedatives without a doctor’s prescription show a slightly 
of lifetime cannabis use as well as current (last-30-day) use 
downward trend, with similar trends for boys and girls. 
for both genders peaked in 2003 and stabilised thereafter 
Tranquillisers or sedatives are the only psychoactive 
(Figures 21 and 22).
substances that were taken more frequently by girls than 
boys (Figure 25).
Lifetime use of illicit drugs other than cannabis rose to 
a peak in 2007 (Table 14; Figure 23). Since 2007, the 
Figure 11. 
Perceived availability of cannabis by gender; 
Figure 12. 
Daily cigarette use at the age of 13 or younger 
students responding cannabis ‘fairly easy’ or 
by gender: 25-country trend 1995-2015 
‘very easy’ to obtain: 25-country trend 1995-
(percentage)
2015 (percentage)
Boys
Girls
Boys
Girls
40
12
10
30
8
20
6
4
10
2
0
0
1995
1999
2003
2007
2011
2015
1995
1999
2003
2007
2011
2015
ESPAD Report 2015 
73

Trends 1995-2015
Figure 13. 
Cannabis use at the age of 13 or younger 
Figure 14. 
Lifetime use of cigarettes by gender: 25-country 
by gender: 25-country trend 1995-2015 
trend 1995-2015 (percentage)
(percentage)
Boys
Girls
Boys
Girls
7
80
6
70
5
60
50
4
40
3
30
2
20
1
10
0
0
1995
1999
2003
2007
2011
2015
1995
1999
2003
2007
2011
2015
Figure 15. 
Cigarette use in the last 30 days by gender: 
Figure 16. 
Daily cigarette use by gender: 25-country trend 
25-country trend 1995-2015 (percentage)
1995-2015 (percentage)
Boys
Girls
Boys
Girls
40
30
25
30
20
20
15
10
10
5
0
0
1995
1999
2003
2007
2011
2015
1995
1999
2003
2007
2011
2015
Figure 17. 
Lifetime alcohol use by gender: 25-country 
Figure 18. 
Alcohol use in the last 30 days by gender: 
trend 1995-2015 (percentage)
25-country trend 1995-2015 (percentage)
Boys
Girls
Boys
Girls
100
70
60
80
50
60
40
30
40
20
20
10
0
0
1995
1999
2003
2007
2011
2015
1995
1999
2003
2007
2011
2015
Figure 19. 
Heavy episodic drinking (five or more drinks on 
Figure 20. 
Lifetime use of illicit drugs by gender: 
one occasion) during the last 30 days by gender: 
25-country trend 1995-2015 (percentage)
25-country trend 1995-2015 (percentage)
Boys
Girls
Boys
Girls
50
25
40
20
30
15
20
10
10
5
0
0
1995
1999
2003
2007
2011
2015
1995
1999
2003
2007
2011
2015
74 
ESPAD Report 2015

Trends 1995-2015
Figure 21. 
Lifetime use of cannabis by gender: 25-country  Figure 22. 
Cannabis use in the last 30 days by gender: 
trend 1995-2015 (percentage)
25-country trend 1995-2015 (percentage)
Boys
Girls
Boys
Girls
25
10
20
8
15
6
10
4
5
2
0
0
1995
1999
2003
2007
2011
2015
1995
1999
2003
2007
2011
2015
Figure 23. 
Lifetime use of illicit drugs other than cannabis 
Figure 24. 
Lifetime use of inhalants by gender: 25-country 
by gender: 25-country trend 1995-2015 
trend 1995-2015 (percentage)
(percentage)
Boys
Girls
Boys
Girls
12
12
10
10
8
8
6
6
4
4
2
2
0
0
1995
1999
2003
2007
2011
2015
1995
1999
2003
2007
2011
2015
Figure 25. 
Lifetime use of tranquillisers or sedatives without 
a doctor’s prescription by gender: 25-country 
trend 1995-2015 (percentage)
Boys
Girls
12
10
8
6
4
2
0
1995
1999
2003
2007
2011
2015
ESPAD Report 2015 
75

Trends 1995-2015
Country-specific trends
Cannabis use
Individual country trends for five key variables of lifetime 
In most of the participating countries, the prevalence 
use of substances between 1995 and 2015 are shown 
of lifetime cannabis use increased between 1995 and 
in Figures 26-30. Trends are illustrated graphically, with 
2003/2007. Decreases in prevalence since then can be 
decreases of 3 or more percentage points between 
seen in the Czech Republic, Denmark, Finland, France, 
successive surveys indicated in green, increases of 3 or 
Iceland, Ireland, Slovenia and Ukraine. In contrast, increases 
more percentage points in red, and unchanged situations in 
in this period occurred in Bulgaria, Cyprus, Greece, 
yellow (less than ± 3 percentage points). Temporal changes 
Lithuania, Malta, Poland and Romania. Generally lower rates 
in countries with only two data points should be interpreted 
of lifetime cannabis use in 2015 compared to 1995 can 
with caution.
be observed in Denmark, the Faroes, Ireland and Ukraine 
(Figure 28).
Cigarette use
Inhalant use
Between 1995 and 2015, the lifetime prevalence of 
cigarette use decreased in all countries except Lithuania, 
The lifetime prevalence of inhalant use was quite stable 
where there was no change. In the Czech Republic, Estonia, 
in more than one third of the countries. A pronounced 
Hungary, Portugal, Slovakia, Slovenia and Ukraine, this 
peak can be observed in 2011 for Croatia, Estonia, Latvia, 
decrease followed an initial increase until 2003. In Austria, 
Monaco and Slovenia, although rates have since returned to 
Belgium (Flanders), Denmark, the Faroes, Finland, Iceland, 
approximately the level observed in 2007 in most countries. 
Ireland, Norway, Portugal, Slovenia and Sweden, the 
Decreases since 2011 were observed in Belgium (Flanders), 
reduction in prevalence between 2003 and 2015 amounts 
Croatia, the Faroes, France, Hungary, Malta, Monaco, 
to 20 percentage points or more (Figure 26). Only three 
Romania, Slovenia and Sweden (Figure 29).
countries do not follow the overall trend, but show stable 
prevalence rates over the last three surveys (Montenegro, 
Poland and Romania).
Pharmaceutical use
The prevalence of lifetime use of tranquillisers or sedatives 
Alcohol use
without a doctor’s prescription was generally quite stable. 
Between 2011 and 2015, decreasing rates were found in 
The prevalence of lifetime alcohol use showed reductions 
Cyprus, Greece, Iceland, Italy, Lithuania and Monaco. In 
between 1995 and 2015 in most countries. In Finland, 
contrast, the Czech Republic, Montenegro and Slovakia 
Iceland, Ireland, Norway and Sweden, substantial reductions 
showed an increase in lifetime use of tranquillisers and 
of about 15 percentage points or more can be observed 
sedatives in the same time period (Figure 30).
(Figure 27). Lifetime prevalence remained rather unchanged 
in Bulgaria, Cyprus, the Czech Republic, the Faroes, Hungary 
and Slovenia. The only country where alcohol use increased 
was Croatia, with prevalence rising by 10 percentage points.
76 
ESPAD Report 2015

Trends 1995-2015
Figure 26. 
Lifetime use of cigarettes by country: 1995-2015 (percentage)
%
Albania
%
Austria
% Belgium (Flanders)
% Bosnia and Herz. (RS) a
%
Bulgaria
90
90
90
90
90
45
45
45
45
45
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Croatia
%
Cyprus
%
Czech Republic
%
Denmark
%
Estonia
90
90
90
90
90
45
45
45
45
45
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
Former Yugoslav Republic
Faroes
Finland
of Macedonia a
%
%
%
France
% Germany (5 Bundesl.)
90
90
90
90
90
45
45
45
45
45
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Greece
%
Greenland
%
Hungary
%
Iceland
%
Ireland
90
90
90
90
90
45
45
45
45
45
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Isle of Man
%
Italy
%
Latvia
%
Liechtenstein
%
Lithuania
90
90
90
90
90
45
45
45
45
45
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
Malta
Moldova a
%
%
%
Monaco
%
Montenegro a
%
Netherlands
90
90
90
90
90
45
45
45
45
45
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Norway
%
Poland
%
Portugal
%
Romania
%
Russia (Moscow)
90
90
90
90
90
45
45
45
45
45
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Serbia a
%
Slovakia
%
Slovenia
%
Sweden
%
Switzerland
90
90
90
90
90
45
45
45
45
45
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Ukraine
%
United Kingdom
90
90
45
45
0
0
Increase
95 99 03 07 11 15
95 99 03 07 11 15
Decrease
Unchanged
a  Collected data from 2008 instead of 2007.
ESPAD Report 2015 
77

Trends 1995-2015
Figure 27. 
Lifetime alcohol use of alcohol by country: 1995-2015 (percentage)
%
Albania
%
Austria
% Belgium (Flanders)
% Bosnia and Herz. (RS) a
%
Bulgaria
100
100
100
100
100
50
50
50
50
50
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Croatia
%
Cyprus
%
Czech Republic
%
Denmark
%
Estonia
100
100
100
100
100
50
50
50
50
50
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
Former Yugoslav Republic
Faroes
Finland
of Macedonia a
%
%
%
%
France
% Germany (5 Bundesl.)
100
100
100
100
100
50
50
50
50
50
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Greece
%
Greenland
%
Hungary
%
Iceland
%
Ireland
100
100
100
100
100
50
50
50
50
50
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Isle of Man
%
Italy
%
Latvia
%
Liechtenstein
%
Lithuania
100
100
100
100
100
50
50
50
50
50
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
Malta
Moldova a
%
%
%
Monaco
%
Montenegro a
%
Netherlands
100
100
100
100
100
50
50
50
50
50
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Norway
%
Poland
%
Portugal
%
Romania
%
Russia (Moscow)
100
100
100
100
100
50
50
50
50
50
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Serbia a
%
Slovakia
%
Slovenia
%
Sweden
%
Switzerland
100
100
100
100
100
50
50
50
50
50
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Ukraine
%
United Kingdom
100
100
50
50
0
0
Increase
95 99 03 07 11 15
95 99 03 07 11 15
Decrease
a  Collected data from 2008 instead of 2007.
Unchanged
78 
ESPAD Report 2015

Trends 1995-2015
Figure 28. 
Lifetime use of cannabis by country: 1995-2015 (percentage)
%
Albania
%
Austria
% Belgium (Flanders)
% Bosnia and Herz. (RS) a
%
Bulgaria
50
50
50
50
50
25
25
25
25
25
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Croatia
%
Cyprus
%
Czech Republic
%
Denmark
%
Estonia
50
50
50
50
50
25
25
25
25
25
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
Former Yugoslav Republic
Faroes
Finland
of Macedonia a
%
%
%
%
France
% Germany (5 Bundesl.)
50
50
50
50
50
25
25
25
25
25
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Greece
%
Greenland
%
Hungary
%
Iceland
%
Ireland
50
50
50
50
50
25
25
25
25
25
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Isle of Man
%
Italy
%
Latvia
%
Liechtenstein
%
Lithuania
50
50
50
50
50
25
25
25
25
25
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
Malta
Moldova a
%
%
%
Monaco
%
Montenegro a
%
Netherlands
50
50
50
50
50
25
25
25
25
25
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Norway
%
Poland
%
Portugal
%
Romania
%
Russia (Moscow)
50
50
50
50
50
25
25
25
25
25
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Serbia a
%
Slovakia
%
Slovenia
%
Sweden
%
Switzerland
50
50
50
50
50
25
25
25
25
25
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Ukraine
%
United Kingdom
50
50
25
25
0
0
Increase
95 99 03 07 11 15
95 99 03 07 11 15
Decrease
a  Collected data from 2008 instead of 2007.
Unchanged
ESPAD Report 2015 
79

Trends 1995-2015
 Figure 29. 
Lifetime use of inhalants by country: 1995-2015 (percentage)
%
Albania
%
Austria
% Belgium (Flanders)
% Bosnia and Herz. (RS) a
%
Bulgaria
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Croatia
%
Cyprus
%
Czech Republic
%
Denmark
%
Estonia
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
Former Yugoslav Republic
Faroes
Finland
of Macedonia a
%
%
%
%
France
% Germany (5 Bundesl.)
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Greece
%
Greenland
%
Hungary
%
Iceland
%
Ireland
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Isle of Man
%
Italy
%
Latvia
%
Liechtenstein
%
Lithuania
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
Malta
Moldova a
%
%
%
Monaco
%
Montenegro a
%
Netherlands
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Norway
%
Poland
%
Portugal
%
Romania
%
Russia (Moscow)
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Serbia a
%
Slovakia
%
Slovenia
%
Sweden
%
Switzerland
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Ukraine
%
United Kingdom
30
30
15
15
0
0
Increase
95 99 03 07 11 15
95 99 03 07 11 15
Decrease
a  Collected data from 2008 instead of 2007.
Unchanged
80 
ESPAD Report 2015

Trends 1995-2015
Figure 30. 
Lifetime use of tranquillisers or sedatives without a doctor’s prescription by country: 1995-2015 (percentage)
%
Albania
%
Austria
% Belgium (Flanders)
% Bosnia and Herz. (RS) a
%
Bulgaria
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Croatia
%
Cyprus
%
Czech Republic
%
Denmark
%
Estonia
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
Former Yugoslav Republic
Faroes
Finland
of Macedonia a
%
%
%
%
France
% Germany (5 Bundesl.)
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Greece
%
Greenland
%
Hungary
%
Iceland
%
Ireland
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Isle of Man
%
Italy
%
Latvia
%
Liechtenstein
%
Lithuania
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
Malta
Moldova a
%
%
%
Monaco
%
Montenegro a
%
Netherlands
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Norway
%
Poland
%
Portugal
%
Romania
%
Russia (Moscow)
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Serbia a
%
Slovakia
%
Slovenia
%
Sweden
%
Switzerland
30
30
30
30
30
15
15
15
15
15
0
0
0
0
0
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
95 99 03 07 11 15
%
Ukraine
%
United Kingdom
30
30
15
15
0
0
Increase
95 99 03 07 11 15
95 99 03 07 11 15
Decrease
a  Collected data from 2008 instead of 2007.
Unchanged
ESPAD Report 2015 
81



Discussion  
and conclusion

Discussion and conclusion
According to the ‘Global burden of disease, injuries and risk 
Cigarette use
factors study’ 2013 (Forouzanfar et al., 2015), tobacco and 
alcohol use are among the leading risk factors worldwide 
In general, the results on cigarette smoking among 
for premature death and morbidity, expressed in terms of 
European students can be interpreted as showing positive 
disability-adjusted life years (DALYs). In Europe, of the 78 
developments. Today, the majority of adolescents have never 
risk factors investigated, tobacco ranks second and alcohol 
smoked (54 %) and less than one quarter (21 %) of the sample 
fifth in terms of DALYs. Although not being a major risk 
can be considered current smokers. With regard to national 
factor, illicit drug use also contributes significantly (rank 22) 
patterns, Italy stands out with the highest prevalence of 
to the global burden of years of life lost and years lived with 
current smoking (37 %), followed by Bulgaria and Croatia (both 
disability. Substance-related harms to the users and to others 
33 %), whereas Iceland has by far the lowest rate (6 %), with 
and public health and safety concerns are the main reasons 
Moldova (9 %) and Norway (10 %) ranking next lowest. Due to 
for the worldwide monitoring of such behaviours. Due to 
the relatively high addictive potential of nicotine, a particularly 
age restrictions on access to tobacco and alcohol, as well 
problematic pattern of use is early onset of smoking (Nutt 
as the drug control measures covering illicit psychoactive 
et al., 2010). International studies suggest that the risk for 
substances, in most countries there is a particular emphasis 
dependence is higher when adolescents start smoking at 
on monitoring consumption among youths and adolescents. 
an earlier age (Breslau and Peterson, 1996; Everett et al., 
For instance, surveys on substance use among adolescents 
1999). Therefore, it is important to note that the proportion of 
have a long tradition in Sweden (Swedish school surveys on 
adolescents who have started daily smoking at a very early age 
substance use), England (‘Smoking, drinking and drug use 
(before age 13) has largely decreased over the last 20 years. 
among young people in England’), Germany (‘Drug affinity 
Most ESPAD countries follow this general pattern, with only 
study’) and the United States (‘Monitoring the future’ study) 
a few exceptions showing stable rates of early onset of daily 
and were implemented as early as 1970. With the initiation 
smoking over time (Cyprus, France, Italy and Romania).
of the European School Survey Project on Alcohol and Other 
Drugs (ESPAD) in 1995, Europe created an instrument that 
Looking at the overall ESPAD trends for cigarette smoking, 
enables comparisons between participating countries, due 
gender differences seem to narrow over time. In 1995, boys 
to a common methodology. After six waves of data collection 
showed higher rates than girls with regard to all indicators. 
over the past 20 years and the expansion of the European 
In 2015, these differences no longer existed or had become 
Union to now include 28 countries, the ESPAD survey also 
smaller. However, gender convergence is more marked in 
allows the analysis of temporal trends in over 40 countries, 
terms of prevalence of use, whereas problematic patterns of 
including 24 Member States of the European Union.
use (daily smoking, early onset) are still more prevalent among 
boys.
In the last few years, evidence has accumulated that 
behaviours such as internet use, gaming and gambling have 
The trend data indicate an overall decrease in lifetime, 
the same potential to become addictive as psychoactive 
last-30-day and daily cigarette use. Although the ‘Health 
substances. However, while gambling has been included 
behaviour in school-aged children’ (HBSC) study has 
in the revised DSM-5 chapter ‘Substance-related and 
a shorter observation time (2002-2010), trends on weekly 
addictive disorders’, there is still no consensus for classifying 
tobacco use support the ESPAD results (Hublet et al., 2015). 
excessive internet use and gaming as addictive behaviours 
Tobacco use decreased in all observed European countries 
(Regier et al., 2013). Independently of how these behaviours 
between 2002 and 2010, and this trend may be considered 
are treated by the international classification systems, 
to be at least partially driven by policy measures that have 
extensive internet use, gaming or gambling in adolescents 
been implemented in the majority of European countries in 
has long raised public concerns. This led the ESPAD 
the context of the Framework Convention of Tobacco Control 
researchers to extend the scope of the survey. In addition, 
(FCTC) over the past two decades (Shibuya et al., 2003). The 
new psychoactive substances, which are a public health 
most important preventive guiding principles are information 
and safety problem and have been monitored since the late 
on the health hazards of tobacco and comprehensive 
2000s, received special attention in the 2015 survey.
multisectoral measures including price and tax measures, 
protection from exposure to environmental tobacco smoke, 
packaging and labelling, restriction of tobacco advertising, 
promotion and sponsorship, the implementation of cessation 
measures and limiting the access of underage persons to 
tobacco products. Increases in tobacco prices, which have 
84 
ESPAD Report 2015

Discussion and conclusion
made tobacco products less accessible to adolescents, are 
riskier patterns of drinking and other health-risk behaviours 
very likely to have played an important role (Agrawal et al., 
(Siegel et al., 2011). However, it is difficult to draw firm 
2012). Although smoke-free legislation, as a measure to 
conclusions from the limited evidence available. Improved 
protect the population from exposure to second-hand smoke, 
surveillance of alcoholic beverage preference, particularly 
does not target smoking behaviour per se, there is evidence 
with regard to spirits, may help to elucidate the factors 
that smoke-free legislation reduces tobacco use (Müller 
related to youth drinking and the negative consequences 
et al., 2010). In the global context, the total tax burden on 
associated with beverage types.
cigarettes is highest in the European region, nevertheless, in 
most European countries other important measures, such as 
Despite the still high rates of alcohol use and, in particular, 
plain packaging and full restrictions on tobacco advertising, 
of heavy use, temporal trends over the past two decades 
are still pending (World Health Organisation, 2012).
indicate a positive development, with an overall decrease in 
lifetime and 30-day use between 1995 and 2015 from 89 % 
to 81 % and from 56 % to 47 %, respectively. Interestingly, 
Alcohol use
both lifetime and 30-day prevalence have decreased 
markedly from a peak reached in 2003. Unfortunately, 
Alcohol use among adolescents in Europe is still rather high. 
changes in heavy episodic drinking have been less 
On average, four in five students reported lifetime alcohol 
pronounced and only observed among boys (42 % to 37 %), 
experience and every second student reported alcohol use 
with overall rates declining by one percentage point (36 % to 
in the last 30 days. Nevertheless, countries vary to a large 
35 %) over the past 20 years. The reported decline in weekly 
extent in the prevalence of lifetime and current use. The 
alcohol use among 15-year-olds in the HBSC study between 
Nordic countries Finland, Iceland, Norway and Sweden are 
2002 and 2010 supports the present findings (de Looze et 
traditionally among the countries with the lowest rates of 
al., 2015). Although changes in alcohol use prevalence varied 
current alcohol use. However, low rates can also be found 
in magnitude, there are only a few countries with stable or 
in Albania, the Faroes, the former Yugoslav Republic of 
increasing lifetime prevalence (Croatia, Cyprus, the Czech 
Macedonia, Ireland and Ukraine and in the Baltic states 
Republic, the Faroes, Hungary and Slovenia).
Estonia and Lithuania. In countries with low consumption 
rates, the prevalence of heavy episodic drinking is also 
Factors that may have played some part in the general 
generally low. Conversely, high alcohol use prevalence 
decrease observed in alcohol consumption include 
generally coincides with high rates of heavy episodic 
changes in norms on drinking and intoxication, competing 
drinking. Among the countries with the highest rates are 
responsibilities and attractions that demand or favour 
Austria, Bulgaria, Croatia, Denmark, Hungary, Liechtenstein 
sobriety, structural changes, external influences and the 
and Monaco.
range of societal or cultural responses to alcohol problems 
(Room et al., 2009). Others have argued that the observed 
Beverage preference is rather differently spread across 
change in adolescent drinking behaviour was due to 
the ESPAD countries. Countries where beer accounts for 
changes in adult prevalence, shifts in teen culture or parental 
more than 50 % of total alcohol consumption are Albania, 
control (Ryan et al., 2010; Simons-Morton et al., 2009; van 
Belgium (Flanders), the former Yugoslav Republic of 
der Vorst et al., 2006). More recently, based on age, period 
Macedonia, Poland and Romania. In Croatia, Georgia, 
and cohort analyses, results clearly indicate that younger 
Moldova, Slovenia and Ukraine, wine accounts for at least 
cohorts reported abstinence more frequently and drank 
30 % of all alcohol consumed. In approximately every second 
less than older cohorts (Härkönen and Mäkelä, 2011; Kraus 
ESPAD country, spirits make up the largest share of total 
et al., 2015; Meng et al., 2014; Pabst et al., 2010). In all 
ethanol consumption. In a small number of countries, other 
western European countries, policies are in place to limit 
beverages such as alcopops or cider account for more than 
underage access to alcohol (Brand et al., 2007). In addition, 
20 % of total alcohol consumption. In Cyprus, Finland, Italy 
stricter prevention policies are emerging in many countries 
and Liechtenstein, alcopops account for one fifth or more, 
(Anderson and Baumberg, 2006; Anderson et al., 2012). 
and in Denmark, Estonia, the Faroes, Ireland, Norway and 
Some countries in the east of Europe deviate from the 
Sweden, the share of cider is 20 % or more.
generally observed decline in adolescent alcohol use. These 
exceptions have been explained by rapid increases in wealth 
Evidence for the existence of associations between beverage 
since 1990 and opportunities for adolescents to acquire 
preferences, drinking patterns, alcohol-related consequences 
and consume goods, including alcohol, that were previously 
and the use of other substances is scarce. In a study among 
unavailable or difficult to obtain (Zaborskis et al., 2006).
Swiss young men, beer preference was associated with 
risky drinking patterns and illicit drug use (Dey et al., 2014), 
Our findings on trends in alcohol use suggest a closure of the 
and a study on youths in the United States revealed that 
gender gap in heavy alcohol use among adolescents in Europe 
a preference for hard liquor and beer was associated with 
and support earlier findings (Kuntsche et al., 2011; Simons-
ESPAD Report 2015 
85

Discussion and conclusion
Morton et al., 2009). The gender convergence, however, is 
that protect public health, wealth and well-being (Alice Rap, 
more visible for heavy episodic drinking than for more regular 
2014). The high prevalence of perceived cannabis availability 
drinking behaviours, such as monthly alcohol use.
and cannabis use among adolescents in many European 
countries seems to support their view.
Illicit drug use
Trends in cannabis use indicate an increase in both lifetime 
and current use between 1995 and 2015, from 11 % to 
Cannabis use
17 % and from 4 % to 7 %, respectively. However, prevalence 
peaked in 2003 and decreased slightly thereafter. The 
Cannabis is by far the most commonly used illicit drug used 
observed decrease in cannabis prevalence after 2003 is 
in developed countries, with use more recently spreading 
supported by the results of the HBSC study. Temporal trends 
to low- and middle-income countries (Hall and Degenhardt, 
in last-12-month cannabis use among 15-year-olds in Europe 
2007; United Nations Office on Drugs and Crime, 2014). 
between 2002 and 2010 showed, with the exception of 
The average lifetime prevalence of cannabis use among 
eastern Europe, a general decrease in all regions (Hublet et 
adolescents in ESPAD countries (16 %) was considerably 
al., 2015). However, the pattern of change in ESPAD countries 
lower than that recorded in comparable school surveys in the 
since 2003 is not uniform. In contrast to the general trend, 
United States (31 %) or Spain (27 %). Nevertheless, rates of 
lifetime cannabis use increased in Bulgaria, Cyprus, Greece, 
use varied substantially between ESPAD countries. Lifetime 
Lithuania, Malta, Poland and Romania. Thus, when discussing 
experience of cannabis in the Czech Republic (37 %) even 
the reasons for the change in cannabis use, factors other 
exceeded the level observed in the United States. At the low-
than legal regulations may play a significant role. For instance, 
prevalence end, rates of under 10 % could be found in five 
in addition to drug control measures, other factors such as 
of the Nordic countries (the Faroes, Finland, Iceland, Norway 
norms of use, competing responsibilities and attractions that 
and Sweden), in several Balkan states (including Albania, 
demand or favour drug use abstinence, as well as societal 
the former Yugoslav Republic of Macedonia, Moldova, 
or cultural responses to drug problems, may impact on 
Montenegro and Romania) and in Cyprus and Greece.
consumption, in an upward or downward direction. It has been 
argued that the increasing trend in cannabis use, particularly 
The reasons for the large differences in cannabis use 
evident in eastern European countries, may be explained by 
between European countries are unclear. The frequently 
factors related to post-communist transition (Hublet et al., 
found strong relationship between cannabis availability 
2015). Firstly, the relative isolation of the former Soviet Union 
and use has often been interpreted as evidence for the 
countries led to a delay in the development of cannabis-
preventive effect of restrictive drug policies (Gervilla et al., 
distribution networks, with the subsequent growth igniting an 
2011; Gillespie et al., 2009; Höfler et al., 1999; von Sydow 
upward trend; secondly, social and economic changes, along 
et al., 2002). Moreover, a study among adolescents in 32 
with increases in wealth and leisure opportunities, have driven 
European countries, investigating the effects of perceptions 
substance use; and thirdly, because public health authorities 
about cannabis on the use of the drug, identified strong and 
and decision-makers were not prepared for the growth in illicit 
persistent individual-level effects for perceived availability, 
drug use, countermeasures were slow to be implemented 
perceived harm and the number of cannabis-using friends. 
(Elekes and Kovacs, 2002).
The effects on cannabis use prevalence and frequency 
were more pronounced than country-level effects such as 
cannabis price and last-12-month cannabis use prevalence 
New psychoactive substances
in the adult population (Piontek et al., 2013). It has generally 
been assumed that drug availability is inversely related to 
New psychoactive substances (NPS) are narcotic or 
the level of drug law enforcement and the severity of the 
psychotropic drugs that are not controlled by the United 
legal sanctions. However, when comparing changes in 
Nations drug conventions, but may pose a public health 
cannabis policy with subsequent changes in prevalence, 
threat comparable to that caused by substances listed 
only in a few countries did the prevalence of use follow the 
in these conventions. On average, 4 % of the students 
expected pattern of change, i.e. a decrease in prevalence 
surveyed have tried NPS — substances that imitate the 
following an increase in sanctions and vice versa (European 
effects of illicit drugs — and 3 % have used them in the past 
Monitoring Centre for Drugs and Drug Addiction, 2011). 
12 months. On average, these substances seem to be more 
In a recent paper on cannabis policy prepared within the 
commonly used than amphetamine, ecstasy, cocaine or LSD, 
‘Addiction and lifestyles in contemporary Europe reframing 
all of which have lower lifetime prevalence rates. Several 
addictions project’ (Alice Rap), the authors argued that the 
countries could be identified that showed above-average 
prohibition approach has largely failed and, drawing on 
last-12-month use of NPS. Students in Estonia and Poland 
global and European experience in regulating tobacco and 
(both 8 %) were most likely to have experiences with NPS, 
alcohol, they called for legal regulatory cannabis policies 
followed by Bulgaria and Croatia (6 %) and Ireland and Italy 
86 
ESPAD Report 2015

Discussion and conclusion
(5 %). Rather low lifetime rates of NPS use were reported in 
Internet use, gaming and gambling
Belgium (Flanders), Denmark, the Faroes, Finland, the former 
Yugoslav Republic of Macedonia, Moldova, the Netherlands, 
Internet use
Norway and Portugal (1 %).
With widespread access to the internet, online 
The 2015 ESPAD study is one of the first international 
communication has become an integral part of life, 
epidemiological studies to assess NPS use. On an 
especially for adolescents (Inchley et al., 2016; Valkenburg 
international scale, there is not much information available 
and Peter, 2011). Not only has interacting with peers 
against which to compare the results. As an exception, the 
expanded to the virtual world, but also the internet plays 
Flash Eurobarometer, a comprehensive EU-wide survey 
an important role in learning and entertainment. Therefore, 
among young people aged 15 to 24 years, reported an 
questions on the amount and purpose of use were included 
overall lifetime prevalence of 8 % (European Commission, 
in the current ESPAD questionnaire.
2016). The regional patterns in the Eurobarometer study 
were slightly different to those observed in the present 
In 2015, students were using the internet on an average of 
study, with France, Ireland, Slovenia and Spain being the top 
5.8 days per week. Fewer online days per week were reported 
four countries regarding the prevalence of use. Differences 
in Albania, Bulgaria, the former Yugoslav Republic of 
in NPS prevalence rates between ESPAD and the Flash 
Macedonia, Georgia, Italy, Lithuania, Moldova, Montenegro, 
Eurobarometer, although the same definition was used, 
Romania and Ukraine, mostly countries in the east of Europe. 
may be due to differences in the sampling frame (schools 
Differences between countries in time spent online may 
versus general population) and age (15-16 years versus 15-
not necessarily reflect cultural differences but may be due 
24 years). NPS comprise a variety of substances ranging from 
to differences in access to the internet and devices with 
synthetic cannabinoids simulating the effects on the brain of 
internet capability, for example smartphones or personal 
THC (the principal psychoactive substance in cannabis) to 
computers, although a wide coverage of internet access 
synthetic cathinones that mimic the effects of amphetamine, 
in most countries in Europe can be assumed. Comparable 
methamphetamine or ecstasy (Hohmann et al., 2014). These 
data on internet use based on representative studies, even 
substances are variously marketed as ‘research chemicals’, 
if recently published, may not reflect current behaviour in 
‘plant food’, ‘bath salts’ or other misleading product names, 
internet use (Boniel-Nissim et al., 2015; Inchley et al., 2016). 
with false content descriptions, in efforts to avoid control 
This may be because, in the last 5 or 6 years, devices with 
measures. Identification of the substance in question is very 
internet capability have become increasingly affordable for 
difficult, for the consumer, law enforcement and, critically in 
young people, and being on the internet every day or every 
the event of poisoning, medical staff.
hour is much more common. Official data can be found 
at internet service providers, television stations, polling 
In a recent document on the outcome of the UN General 
institutes or public agencies, but the figures differ greatly 
Assembly Special Session on Drugs (2016), NPS are 
and it is difficult to make between-country comparisons. For 
mentioned in 10 paragraphs and dominate the section on 
instance, data in the United Kingdom suggest that more than 
emerging and persistent challenges and threats (https://
four in five adults used the internet anywhere on any device 
www.incb.org/documents/News/A_S-30_L.1.pdf). The UN 
(Office of Communication, 2015), and in Germany 14- to 
promotes data collection and early warning systems (EWS) 
29-year-olds were using the internet for 187 minutes per day 
and prioritises the review of the most prevalent, persistent 
in 2015 (Engel and Breunig, 2015).
and harmful NPS. To this end, an international action group 
on NPS has been established, consisting of UN member 
Apart from information on how often and for how much 
states and international organisations, to coordinate and 
time adolescents are using the internet, their online 
drive the international response to NPS. At European level, 
activities are of particular interest. The ESPAD questionnaire 
the EMCDDA is responsible for a well-established EWS. The 
focused on six general activities: using social media, 
European EWS on NPS is a multidisciplinary network of 30 
information seeking/surfing, streaming/downloading, 
national early warning mechanisms that collect, appraise 
online gaming, online money gambling and buying/selling. 
and rapidly disseminate information on new drugs and 
The results suggest that the internet plays an important 
products (http://www.emcdda.europa.eu/attachements.
role for adolescents: in 2015, using the internet for social 
cfm/att_157279_EN_EWS %20profiles.pdf). The challenge 
media, for example to have daily social media contact with 
associated with NPS is demonstrated by the increasing 
friends, was the most common online activity; 78 % of the 
number, type and availability of new substances. Within the 
students stated that they have used social media on 4 or 
European EWS, almost 100 new substances were reported 
more days in the last 7 days. Students reported that using 
for the first time in 2015. Overall, the total number of new 
online communication made it easier to talk to friends of 
substances monitored by the EWS since its inception 
both sexes, making the internet a powerful tool for helping 
amounts to over 560.
adolescents to connect. Overall, girls used social media more 
ESPAD Report 2015 
87

Discussion and conclusion
often than boys did. A gender difference in social media use 
least four times in the last 7 days) used the internet for online 
was also found in the HBSC study, with 35 % of the girls and 
gaming. Online gaming was more prevalent among boys 
32 % of the boys reporting daily social media contact with 
(39 %) than among girls (7 %). Countries varied substantially 
friends (Boniel-Nissim et al., 2015). In a longitudinal survey 
in online gaming and gambling activities. While nearly half of 
in the United Kingdom focusing on adolescents and adults 
the students from Denmark played regularly online (45 %), 
(16 years and older), nearly three quarters of internet users 
gaming was not so common in Georgia (13 %), the former 
had a social media profile in 2014, compared with 22 % in 
Yugoslav Republic of Macedonia and Moldova (16 % each).
2007. Furthermore, 81 % reported using social media at 
least once a day, which equals an increase of 51 percentage 
Online money gambling was the least common of the 
points compared to 2007. As expected, 16- to 24-year-olds 
internet activities (ESPAD average: 3 %). Like online gaming, 
reported higher levels of social media use compared with 
online gambling for money was predominantly reported by 
older users (Office of Communication, 2015). This is also 
boys (6 %) rather than girls (1 %). The highest participation 
in line with recent results from Germany: 58 % of the 14- to 
rates in online money gambling were found in Bulgaria 
29-year-olds used the internet every day for social media, 
(8 %), Albania, Cyprus and the former Yugoslav Republic of 
with an average of 139 minutes (Engel and Breunig, 2015).
Macedonia (7 % each).
The next most common internet activities were streaming/
Data from the United Kingdom indicate an increase in 
downloading and information seeking/surfing, with 48 % and 
the prevalence of gaming on any device between 2007 
43 % of the students, respectively, reporting these internet 
and 2014 from 31 % to 44 % (Office of Communication, 
activities on 4 or more days in the last 7 days. These activities 
2015). The most active gamers were young people aged 
reflect the use of the internet as a tool, for example to listen 
16-24 years. Research on factors associated with gaming 
to music or to watch a video, but young people spend only 
indicates that early onset, opposite-sex friends and minimal 
some of their internet time on these activities. For instance, 
parental mediation increase the risk for gaming. A high level 
among 14- to 29-year olds in Germany, only 48 minutes 
of game playing was related to bullying in boys and lower life 
from an estimated total online time of 187 minutes per day 
satisfaction in girls (Brooks et al., 2016).
was spent on these activities (Engel and Breunig, 2015). 
However, it can be assumed that this time will expand in the 
next few years, especially for streaming and downloading. 
Gambling
Recent figures indicate that over a quarter of internet users 
watch TV or films online at least once a week, compared to 
Although generally prohibited by law, youth gambling has 
one in ten in 2007. At the same time, watching video clips 
become a popular form of recreation. In the 2015 ESPAD 
online has doubled among the internet users during this 
study, 14 % of the students reported gambling for money 
time, from 21 % to 39 %. YouTube, launched in 2005, is now 
at least once in the last 12 months and 7 % gambled 
cited by one third of internet users as an important source 
frequently (2-4 times a month or more often). In all countries, 
for information (Office of Communication, 2015). This trend 
considerably more boys than girls had gambling experience 
may continue, with new online services like film or music 
or gambled frequently.
streaming services becoming more and more available in the 
coming years.
With prevalence rates of problematic gambling between 
2 % and 13 % worldwide (Volberg et al., 2010), adolescent 
Research has raised concern that internet use and online 
gambling has become a major public health concern 
communication contributes to loneliness and isolation 
(Ariyabuddhiphongs, 2013; Blinn-Pike et al., 2010). Gambling 
(Hampton et al., 2011). Other studies, however, stress the 
involvement in youth may lead to adverse consequences 
importance of the internet as a powerful tool for helping 
such as strained relationships, delinquency and criminal 
people to connect (Boniel-Nissim et al., 2015; Kuntsche et 
behaviour (Derevensky et al., 2004), depressive symptoms 
al., 2009; Valkenburg and Peter, 2011).
(Bonnaire et al., 2009), comorbid mental disorders (Lorains 
et al., 2011), low self-esteem (Bergh and Kühlhorn, 1994), 
impaired relations with family and friends (Dickson-Swift et 
Online gaming and gambling
al., 2005), greater risk for suicide ideation and attempts and 
poor general health (Potenza, 2008).
Over the last 10 years, mainly driven by the increasing 
popularity of smartphones and tablets, gaming has become 
Gambling, as a social activity and its social context, is still 
more popular and increasingly mobile. Since 2005, gaming, 
not very well studied. Research suggests that parents’ levels 
both online and mobile, has doubled in terms of weekly use 
of schooling, family structure and family socio-demographic 
(Office of Communication, 2015). According to the present 
characteristics are not related to adolescent gambling 
study more than one in five students (23 %) regularly (at 
behaviours or problem gambling (Langhinrichsen-Rohling 
88 
ESPAD Report 2015

Discussion and conclusion
et al., 2004; Vitaro et al., 1998). Similar to findings on 
size of the city, school or class, on school environment or on 
substance abuse, family structural characteristics seem to 
schools’ substance use policies, resulted in significant but 
be less influential in the development of problem gambling 
rather small changes in prevalence estimates. (3) In some 
than family relational characteristics (Velleman et al., 2005). 
countries, sampling was only possible in particular regions 
In a recent study on the role of family and socioeconomic 
of the country. In Belgium, only schools from Flanders 
indicators of welfare state in the development of problem 
(representing approximately 60 % of the population) 
gambling in adolescent students, those receiving more 
participated in the survey; in Cyprus, data collection was 
parental caring and monitoring had a lower risk for 
restricted to government-controlled areas, representing 
involvement in problem gambling (Molinaro et al., 2014). 
approximately 80 % of the population; and in Moldova, the 
Moreover, family support and parental supervision were 
sample represents approximately 85 % of the Moldovan 
identified as preventive factors (Hardoon et al., 2004; 
population, with the Transnistria region not included. In 
Magoon and Ingersoll, 2006). Supportive families seem to 
these cases, estimates only represent the population of the 
offer social resources that adolescents can turn to when 
region where the survey took place. (4) In the 2015 ESPAD 
getting into trouble, and good family relations imply that 
survey, four countries (Austria, Latvia, Liechtenstein and the 
parents are aware of how and with whom their children 
Netherlands) conducted data collection online, deviating 
spend their free time. Contrary to this, high levels of 
from the usual paper-and-pencil mode of administration. 
disciplinary parental ruling were related to higher levels of 
While experience suggests a number of advantages of online 
adolescent problem gambling (Molinaro et al., 2014).
data collection, such as interactivity, minimising mistakes 
of data entry and saving time and costs, the comparability 
Country variation in rates of adolescent problem gambling 
of results from online and paper-and-pencil questionnaires 
has been found to be related to country-level characteristics. 
is of concern. Research on differences when comparing 
Higher health expenditure was associated with lower 
online and paper-and-pencil responses on substance use 
levels of gambling problems, while country-specific family 
behaviour suggests only small mode effects (Brener et al., 
spending had no effect (Molinaro et al., 2014).
2004; Eaton et al., 2010; Lygidakis et al., 2010; Raghupathy 
and Hahn-Smith, 2013; Wyrick and Bond, 2011). This is 
corroborated by a methodological study carried out in Latvia 
Limitations
(Trapencieris, 2013). A sample of nearly 2 800 students 
aged 14-16 years in grades 8-10 was randomly selected 
Although the ESPAD survey is based on a common 
to answer the ESPAD questionnaire, either in the schools’ 
methodology, some limitations that may possibly weaken the 
computer lab or via the traditional paper-and-pencil mode. In 
validity of the estimates need to be discussed. (1) In Belgium 
only three of thirty-two variables measuring substance use 
(Flanders), data were collected half a year earlier than in the 
were prevalence statistically significant differences found. 
majority of countries (in autumn of the previous year), and in 
Although in the majority of studies small mode differences 
Georgia and the Netherlands, half a year later (in the autumn 
were reported, the differences in most studies indicate 
of the same year). In the former case, students were on 
higher rates of substance use and other sensitive behaviours 
average half a year younger, while in the latter case they were 
if paper-and-pencil questionnaires were used. Thus, 
on average half a year older. With the exception of Georgia, 
comparisons between studies using online and paper-and-
the target population was, however, redefined to give an 
pencil questionnaires should be interpreted with caution.
average age in line with the other participating countries that 
collected data in spring. With students being on average 
16.4 years compared to the ESPAD average of 15.8 years, 
Conclusion
rates of substance use may be slightly overestimated in 
Georgia due to students having had more time to experience 
Overall, a general decreasing trend can be observed in 
or continue substance use. (2) The school/class participation 
cigarette use and alcohol use among adolescents. However, 
rates in Austria (17 %), Ireland (18 %) and Denmark (26 %) 
despite rather strict regulations on tobacco in most countries 
were exceptionally low compared with the ESPAD average 
and on alcohol in some countries, adolescents still report 
of 87 %. In addition, school/class participation rates were 
relatively easy access to tobacco and alcohol. Moreover, 
also slightly below 50 % in Latvia and the Netherlands. 
trends over the past two decades indicate a closing of 
Low participation rates, however, may not necessarily lead 
the gender gap in the use of tobacco and alcohol. The 
to biased estimates, unless the behaviour in question is 
data suggest that cannabis remains an ‘established’ drug. 
rather unequally distributed across schools and classes. 
Although prevalence peaked in 2003 and decreased 
A recent simulation study from Germany found that school 
slightly thereafter, the prevalence rates in lifetime and 
non-participation in surveys assessing substance use 
current cannabis use are higher in 2015 than in 1995. In 
among students is not as worrisome as expected (Thrul et 
many countries, prevalence rates for NPS suggest that 
al., 2016). Systematic exclusion of schools, based on the 
these substances are more attractive than the ‘old drugs’ 
ESPAD Report 2015 
89

Discussion and conclusion
amphetamine, ecstasy, cocaine or LSD. Availability of NPS 
the use of different drugs, including alcohol and tobacco, 
and adolescents’ use of these substances need to be closely 
and risky behaviours such as gambling. These associations 
monitored.
have frequently been discussed in the light of the gateway 
theory, assuming that progression from one drug to another 
With the popularity of smartphones and tablets, internet 
increases with the frequency of use of the former drug 
use has become more popular and increasingly mobile. 
(Kandel et al., 1992). Others have suggested a connection 
The students were using the internet quite regularly and 
between different types of problem behaviour and that 
most commonly reported using it for social media, for 
certain risk-imbued behaviour patterns are caused by 
instance to stay in contact with friends. Since the internet 
identical underlying common factors (Jessor and Jessor, 
has become an integral part of life and is used on a daily 
1977; Morral et al., 2002).
basis, the development of patterns of addictive use among 
children and adolescents needs to be closely monitored and 
It seems necessary to make particular efforts to prevent 
investigated in further studies. Associated with the increased 
early substance use and gambling as well as excessive use 
internet use, online gaming has also become more popular, 
of the internet and gaming in childhood and adolescence. 
especially among boys. Moreover, youth gambling has 
As a basis for decisions or approaches to achieve this goal, 
become a popular form of recreation. Measures to prevent 
ESPAD provides data on such behaviours over a period of 
adolescents from developing problems associated with 
up to 20 years. In the following years, ESPAD will not only 
gambling, such as debts, psychological deficits and social 
monitor substance use behaviour but will also assess future 
disadvantages, are of high priority.
developments in internet use as well as online gaming 
and gambling, and strive to increase its contribution to the 
Substance or internet use should not always be considered 
protection of children and adolescents from the negative 
individually: there seems to be a high association between 
consequences of substance use and addictive behaviours.
90 
ESPAD Report 2015

Acknowledgements
The planning and implementation of the ESPAD 2015 project 
ESPAD researchers at project meetings, worked together 
has been a collaborative effort between the coordination 
with the Coordination Committee. All important decisions 
and all the research teams in each participating country. The 
relating to the planning of ESPAD meetings and the 2015 
importance of the ESPAD researchers and their supporting 
study have been taken jointly with the Steering Committee. 
research groups and institutions cannot be overestimated. 
Together with the three members of the Coordination 
Since the project cannot provide funding for the data 
Committee, the Steering Committee consists of Sharon Arpa 
collection in participating countries, it relies on the ability 
(Malta), Sabrina Molinaro (Italy), Karin Monshouwer (the 
of each principal investigator and ESPAD contact person to 
Netherlands) and Marcis Trapencieris (Latvia).
raise that money.
The Swedish Council for Information on Alcohol and Other 
Much of the coordination has been supported by the 
Drugs (CAN) was responsible for collecting country reports 
Swedish Ministry of Health and Social Affairs. Its grant 
and datasets and for constructing the 2015 international 
has covered costs for holding international meetings, 
database. CAN also produced result tables and texts for the 
constructing the international 2015 database and producing 
full online version of the ESPAD Report 2015. The persons 
this report. The European Monitoring Centre for Drugs and 
at CAN involved are Anna Englund, Ulf Guttormsson, Håkan 
Drug Addiction (EMCDDA) in Lisbon has co-funded data 
Leifman, Jonas Raninen (statistical tests) and Johan 
collection in Georgia, Moldova and Ukraine through the ENP 
Svensson.
first technical cooperation project (ENPI/2013/325-486), 
and has covered costs for some of the ESPAD meetings 
Ludwig Kraus, Nicki-Nils Seitz and Daniela Piontek from the 
and coordination. Furthermore, the EMCDDA has provided 
IFT Institut für Therapieforschung drafted the print version 
editing, design and ensure the production of this report and 
of the report, with financial support from the Swedish 
the updating and hosting of the ESPAD website. The persons 
government.
at the EMCDDA involved with ESPAD are Paul Griffiths, João 
Matias, André Noor, Sandrine Sleiman, Rosemary Martin de 
In addition to the results of the ESPAD 2015 survey, the 
Sousa and Julian Vicente.
report also includes data from the ‘Monitoring the future’ 
project in the United States and from the Spanish national 
The Pompidou Group at the Council of Europe has supported 
school survey, kindly provided by Lloyd Johnston (US) and 
the project ever since the first project meeting in 1994. In 
Begoña Brime Beteta (Spain), respectively.
particular, the support of the Pompidou Group has enabled 
some researchers from eastern and central parts of Europe 
Each country was represented in the project by a principal 
to participate in meetings. Special thanks are due to Florence 
investigator or an ESPAD contact person, who is 
Mabileau and                               a
Jan Malinowski t the Pompidou Group for 
a contributing author of this report (see title page). In 
their much-appreciated assistance and support.
addition, a number of other persons have carried out 
important work in the context of the 2015 ESPAD study. 
A Coordination Committee, consisting of Ludwig Kraus 
The main persons from the national research teams in the 
(Germany), Håkan Leifman (Sweden) and Julian Vicente 
35 countries participating in the 2015 data collection are 
(EMCDDA), coordinated the project in the transition period 
listed on the following pages, followed by a list of important 
from 2015 to 2016. A Steering Committee, appointed by the 
funding agencies and supportive organisations.
ESPAD Report 2015 
91

Acknowledgements
Collaborating persons
Below are listed, for each of the 35 countries participating 
in the 2015 data collection, the most important persons 
involved, beginning with the principal investigator (PI).
Albania
Hungary
Ervin Toçi (PI); Arjan Bregu; Genc Burazeri; Enver Roshi; Eduard 
Zsuzsanna Elekes (PI); Tamás Domokos; Eszter Szilágyi; Zita 
Kakarriqi; Gentiana Qirjako
Szűcsné Kovács; Tamás Kosztolnyik
Austria
Iceland
Julian Strizek (PI); Alfred Uhl; Andrea Kadlik
Ársæll Már Arnarsson (PI); Thoroddur Bjarnason
Belgium (Flanders)
Ireland
Patrick Lambrecht (PI); Caroline Andries; Christiane Janssens; 
Luke Clancy (PI); Kate Babineau; Sheila Keogan; Hannah Murphy; 
Brigitte Bronselaer; Peter Van Rossem; Martin Verstegen; Katleen 
Mark Morgan; Keishia Taylor; Ellen Whelan
De Bont; Lieve Van Gompel; Esra Hortens; Michel Vermeersch; 
Elisabeth Cuypers; Vicky Reynaerts; Isabelle Rojaz; Roxanne Vega 
Italy
Fernandez; Thais Distelmans; Sarah Leysen
Sabrina Molinaro (PI); Valeria Siciliano; Loredana Fortunato; Cristina 
Doveri; Stefanella Pardini; Rita Taccini; Chiara Sbrana; Lucia 
Bulgaria
Fortunato; Silvia Gazzetti; Antonella Pardini; Gabriele Trivellini; 
Anina Chileva (PI); Momtchil Vassilev; Plamen Dimitov; Sophia 
Arianna Cutilli; Lorena Mezzasalma; Elisa Benedetti; Francesca 
Kandilarova-Georgieva; Ralitsa Bardarova
Denoth; Rodolfo Cotichini; Marco Scalese; Luca Bastiani
Croatia
Latvia
Iva Pejnović Franelić (PI); Martina Markelić; Ljiljana Muslić; Irena 
Mārcis Trapencieris (PI); Ansis Petersons; Sigita Snikere; Jelena 
Rojnić Palavra; Sanja Musić Milanović; Ivana Pavić Šimetin; Mario 
Vrublevska; Ildze Abele; Silga Priekule; Eva Mezaraupe
Hemen; Dijana Mayer; Marina Kuzman
Liechtenstein
Cyprus
Esther Kocsis (PI); Jennifer Rheinberger
Kyriakos Veresies (PI); Andreas Pavlakis; Byron Gaist; D. Mappouras; 
S. Ioannou; N. Georgiades
Lithuania
Liudmila Rupšienė (CP); Tadas Tamošiūnas; Irena Šutinienė; Aelita 
Czech Republic
Skarbalienė; Algimantas Šimaitis; Regina Saveljeva
Ladislav Csémy (PI); Pavla Chomynová; Viktor Mravčík; Jiří Nepala
Malta
Denmark
Sharon Arpa (PI); Sandra Cortis; Stephen Spiteri; Carmen Dimech; 
Mette Vinther Skriver (PI); Kim Moesgaard Iburg
Lawrence Bonello; Antoine Saliba; Christiana Bajada; Daniela 
Estonia
Bugeja; Isabelle Anastasi; Ruth Stivala
Sigrid Vorobjov (PI).
Moldova
Faroes
Mihai Ciocanu (PI); Igor Condrat; Oleg Barba; Valeriu Plesca
Pál Weihe (PI); Ólavur Jøkladal
Monaco
Finland
Stanislas Spilka (PI); Julie Marty; Olivier Le-Nézet
Kirsimarja Raitasalo (PI); Petri Huhtanen
Montenegro
Former Yugoslav Republic of Macedonia
Tatijana Đurišić (PI); Džona Džeksona bb; Boban Mugosa; Ljiljana 
Silvana Oncheva (PI); Elena Kosevska
Golubovic; Biljana Popovic
France
Netherlands
Stanislas Spilka (PI); Carine Mutatayi; François Beck; Olivier Le-
Karin Monshouwer (PI); Saskia van Dorsselaer; Marlous Tuithof; 
Nézet
Jacqueline Verdurmen
Georgia
Norway
Lela Sturua (PI); Sophiko Alavidze; Lela Kvachantiradze; Levan 
Elin K Bye (PI); Astrid Skretting
Baramidze
Poland
Greece
Janusz Sierosławski (PI); Katarzyna Dąbrowska; Łukasz Wieczorek
Anna Kokkevi (PI); Anastasios Fotiou; Clive Richardson; Eleftheria 
Portugal
Kanavou; Myrto Stavrou
Fernanda Feijão (PI); Rui Lima; Nuno Rodrigues
92 
ESPAD Report 2015

Acknowledgements
Romania
Estonia
Silvia Florescu (PI); Sorin Oprea; Ruxanda Iliescu; Milica Georgescu; 
National Institute for Health Development
Catalina Chendea; Liliana Preoteasa; Constanta Mihaescu Pintia
Faroes
Slovakia
Ministry of Education, Research and Culture; Faroese Board of 
Alojz Nociar (PI); Alena Kopányiová; Ján Luha; Jana Hamade; Mária 
Public Health
Slovíková
Finland
Slovenia
National Institute for Health and Welfare (THL)
Tanja Urdih Lazar (PI); Eva Stergar; Metoda Dodič Fikfak; Maja Zupe
Former Yugoslav Republic of Macedonia
Sweden
National Institute of Public Health and Centres for Public Health in 
Håkan Leifman (PI); Anna Englund; Isabella Gripe; Ulf Guttormsson; 
Skopje; Tetovo; Kumanovo; Stip; Veles; Prilep; Bitola; Ohrid; Strumica 
Siri Thor
and Kocani; Kontakt non-governmental organisation; Ministry of 
Health; Ministry of Education and Science
Ukraine
Olga Balakireva (PI); Tatyana Bondar; Dmitro Dmitruk; Lidia 
France
Romanovska; Iuliia Pryimak
French Monitoring Centre on Drugs and Drug Addictions (OFDT); 
Ministry of Education; Ministry of Agriculture; French National 
Funding agencies and 
Institute of Health and Medical Research (Inserm)
supportive organisations
Georgia
National Centre for Disease Control and Public Health (NCDC); 
Below are listed, for each of the 35 countries participating in 
Ministry of Education and Science; European Monitoring Centre for 
the 2015 data collection, the most important organisations 
Drugs and Drug Addiction (EMCDDA), EMCDDA-ENP technical co-
and funding agencies involved.
operation project (ENPI/2013/325-486) funding
Greece
Albania
Greek Organisation Against Drugs (OKANA); OKANA/local authority 
Institute of Public Health; Ministry of Health; Ministry of Education 
drug prevention centres; Ministry of Education
and Sport
Hungary
Austria
OTKA K111740 (Hungarian Scientific Research Fund); Emberi 
Bundesministerium für Gesundheit (BMG); Bundesministerium für 
Erőforrások Minisztériuma (Ministry of Human Resources); Corvinus 
Bildung und Frauen (BMBF)
University of Budapest, Institute of Sociology and Social Policy; 
Belgium (Flanders)
ECHO Survey Sociological Research Institute
Department of Clinical and Lifespan Psychology (KLEP — VUB); 
Iceland
Ministry of Welfare, Public Health and Family of the Government of 
Icelandic Directorate of Health; University of Akureyri
Flanders; Research Council of the Free University of Brussels
Ireland
Bulgaria
Department of Health; TobaccoFree Research Institute Ireland; 
National Centre for Public Health and Analyses (NCPHA); National 
Focas Research Institute; DIT Dublin; Seefin DM; Kerry
Centre for Drug Addictions (NCDA); Ministry of Education and 
Science (MoES)
Italy
National Research Council (CNR), Unit of Epidemiology and Health 
Croatia
Service Research of the Institute of Clinical Physiology
Croatian Institute of Public Health (CIPH); Ministry of Health; 
Ministry of Science, Education and Sports
Latvia
Centre for Disease Prevention and Control
Cyprus
Kenthea; Ministry of Education and Culture; CMCDDA; Cyprus 
Liechtenstein
Anti-drugs Council
School Board
Czech Republic
Lithuania
Czech National Monitoring Centre for Drugs and Addiction; National 
Lithuanian Ministry of Education and Science; Qualifications and 
Institute of Mental Health; Office of the Government of the Czech 
Vocational Education and Training Development Centre; Klaipėda 
Republic
University
Denmark
Department of Public Health, Aarhus University; Danish Health 
Authority
ESPAD Report 2015 
93

Acknowledgements
Malta
Romania
Aġenzija Sedqa (National Agency against Drug and Alcohol Abuse 
National Anti-drug Agency; Ministry of National Education and 
and Compulsive Gambling), Foundation for Social Welfare Services; 
Scientific Research; National School of Public Health, Management 
Directorate for Educational Services (DES). Student Services 
and Professional Development
Department, Education Psycho-Social Services; Anti-Substance 
Slovakia
Abuse Service within the Education Psycho-Social Services; 
Research Institute for Child Psychology and Pathopsychology; St. 
Directorate for Education, Secretariat for Catholic Education, 
Elizabeth University of Health and Social Sciences; Public Health 
Archdioceses of Malta; ISA-Independent Schools Association and 
Authority of the Slovak Republic; Slovak Centre of Scientific and 
the participating independent schools
Technical Information; National Monitoring Centre for Drugs
Moldova
Slovenia
Ministry of Education of Republic of Moldova; European Monitoring 
University Medical Centre Ljubljana; Clinical Institute of 
Centre for Drugs and Drug Addiction (EMCDDA), EMCDDA-ENP 
Occupational, Traffic and Sports Medicine; Ministry of Education, 
technical cooperation project (ENPI/2013/325-486) funding
Science and Sport
Monaco
Sweden
French Monitoring Centre on Drugs and Drug Addiction (OFDT); 
Swedish Ministry of Health and Social Affairs; Swedish Council for 
Monaco Statistics (Monegasque Institute of Statistics and 
Information on Alcohol and Other Drugs (CAN)
Economic Studies — IMSEE); Department of Education, Youth and 
Sport of Monaco (DENJS)
Ukraine
Ukrainian Institute for Social Research after Olexander Yaremenko 
Montenegro
(UISR); Institute for Economics and Forecasting National Academy 
Institute of Public Health of Montenegro; Ministry of Education of 
of Science of Ukraine (IEP NASU); Social Monitoring Centre (SMC); 
Montenegro; Ministry of Health of Montenegro
Ministry of Education and Science of Ukraine; European Monitoring 
Netherlands
Centre for Drugs and Drug Addiction (EMCDDA), EMCDDA-ENP 
Dutch Ministry of Health, Welfare and Sport; Regional Health 
technical cooperation project (ENPI/2013/325-486) funding; United 
Services; Trimbos-instituut
Nations Children’s Fund (Unicef) in Ukraine
Norway
Norwegian Institute for Alcohol and Drug Research (SIRUS)
Poland
National Bureau for Drug Prevention (KBPN); State Agency for 
the Prevention of Alcohol-Related Problems (PARPA); Institute of 
Psychiatry and Neurology (IPiN)
Portugal
General-Directorate for Intervention on Addictive Behaviours 
and Dependencies (SICAD), Ministry of Health; Direção-Geral de 
Estatísticas da Educação e Ciência and Direçao-Geral da Educação, 
Ministry of Education
94 
ESPAD Report 2015

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TD-01-16-475-EN-
N
About this report
This report presents the results from the sixth wave of data collection, conducted in 35 
countries during the spring and autumn of 2015. It gives a comprehensive picture of the 
present situation among European young people as regards the use of tobacco, alcohol, 
cannabis and other substances, as well as an overview of trends in 1995-2015.
About the EMCDDA
 
The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the central 
source and confirmed authority on drug-related issues in Europe. For over 20 years, it has 
oject on Alcohol and Other Drugs
been collecting, analysing and disseminating scientifically sound information on drugs and 
drug addiction and their consequences, providing its audiences with an evidence-based 
picture of the drug phenomenon at the European level.
The EMCDDA’s publications are a prime source of information for a wide range of audiences, 
including: policymakers and their advisors; professionals and researchers working in the 
drugs field; and, more broadly, the media and general public. Based in Lisbon, the EMCDDA 
is one of the decentralised agencies of the European Union.
opean School Survey Pr
About ESPAD
om the Eur
The European School Survey Project on Alcohol and Other Drugs (ESPAD) is a collaborative 
effort of independent research teams in more than 40 European countries, making it the 
largest cross-national research project on adolescent substance use in the world.
Results fr
ESPAD was founded in 1993, on the initiative of the Swedish Council for Information on 
Alcohol and Other Drugs (CAN) and with the support of the Pompidou Group at the Council 
of Europe. In later years, ESPAD has also established increasingly close cooperation with 
the EMCDDA, and at present the agency plays an important role in the coordination of the 
ESPAD project.
Most of the European continent is now covered by ESPAD, meaning that it provides a reliable 
overview of trends in substance use among 15- to16-year-old European students. Data are 
collected every 4 years.
AD Report 2015
ISBN-978-92-9168-919-4
ESP

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