Epidemiology of Alcohol Use and Alcohol Problems
Part 5. International Comparisons of Drinking and Drug Use
The European School Survey Project on Alcohol and Other Drugs (ESPAD)
It is difficult to judge the seriousness and extent of drinking and drug problems in the U.S. without comparative data on alcohol and drug use in other societies. Is illegal drug use and problematic alcohol use more or less common in the U.S. than in other advanced industrial societies? Comparisons with other societies are especially valuable in assessing the effectiveness or limitations of different policies and approaches to dealing with drug-related problems. Fortunately, comparative data like these are available through ESPAD, the European School Survey Project on Alcohol and Other Drugs, a massive cross-national survey program involving more than 100,000 students in 35 European nations. Many of the items on drug and alcohol use in the ESPAD surveys have been adapted from the Monitoring the Future (MTF) surveys in the United States. The ESPAD surveys are administered every four years to samples of European students who are 15-16 years old. Therefore, the results for this age group are generally comparable to those for 10th grade students in the U.S. who participate in the annual MTF survey. Some selected findings from the 2003 ESPAD report are shown below.
Illegal Drug Use: U.S. Students Rank Near the Top
The first graph below shows the lifetime prevalence of the use of any illegal drug for European students from the ESPAD surveys and for 10th graders who participated in the 2003 Monitoring the Future survey. For that year, 41 percent of the MTF 10th grade sample reported having used an illegal drug at least once during their lives, a figure exceeded only by ESPAD respondents in the Czech Republic and in Switzerland. Most of this illegal drug use for students everywhere involved marijuana use. It is interesting that the Netherlands and Denmark, which have more tolerant policies toward marijuana than does the U.S., rank considerably lower in illegal drug use among teenagers. From this comparative perspective, the American "War on Drugs" does not appear to have been a great success.
Lifetime Prevalence of Any Illegal Drug Use, 2003
Source: European School Survey Project on Alcohol and Other Drugs (ESPAD)
Alcohol Use: U.S. Students are Near the Bottom
In contrast to the relatively high rate of illegal drug use in the U.S., the prevalence of alcohol use among American teenagers stands almost at the bottom of the nations included in ESPAD. Only the results from Turkey (which are based on schools in only six cities) fall below the U.S. figure of 8 percent of 10th graders using alcohol 20 or more times in the past year. Teenagers in many European nations are three to five times more likely to drink in the past year than are their U.S. counterparts. In most parts of Europe, the legal age for purchasing alcohol is 18 and, in many nations, including Denmark and the Netherlands, there is no minumum drinking age. Several of the European nations that rank relatively low in alcohol use among teenagers, such as Iceland, Norway, and Finland, have a history of alcohol prohibition similar to the U.S. It is unclear whether the low rate of alcohol use among American teenagers is due to the relatively high drinking age in this country or to other factors, such as the prohibitionist cultural tradition that continues to be influential in certain regions of the U.S.
Use of Alcoholic Beverages 20 Times or More in Past Year, 2003
Source: European School Survey Project on Alcohol and Other Drugs (ESPAD)
"Binge Drinking": U.S. Students Rank Low Here Too
Finally, evidence from ESPAD raises questions about the extent to which American teenagers are prone to be "binge drinkers." This concept is measured in the ESPAD data as consumption of at least five drinks "in a row" three times or more in the past 30 days. By that criterion, approximately one out of ten U.S. 10th graders were classified as "binge drinkers" in the 2003 Monitoring the Future survey. However, this places the U.S. near the bottom of this ranking. Again, students from most European nations report substantially higher levels of "binge drinking," with Ireland ranking at the top overall with approximately a third of students engaging in this pattern of heavy episodic drinking. Interestingly, 15-16 year old girls in Ireland, the Isle of Man, and the United Kingdom are slightly more likely to report "bingeing" than are boys. Clearly, this particular social problem is far more widespread throughout Europe than it is in the United States.
