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ESPAD Report
2015
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Results from the European
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Alcohol and Other Drugs
The ESPAD Group
AD Report 2015
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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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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
4
ESPAD Report 2015

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
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ESPAD Report 2015

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ESPAD Report 2015
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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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