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Broad Differences in Alcohol, Tobacco and Illegal Drug Use Across Countries

For Release June 30, 2008

A survey conducted by the World Health Organization (WHO) research consortium found that the United States had among the highest lifetime rates of tobacco and alcohol use and led in the proportion of participants reporting cannabis (marijuana) or cocaine use at least once during their lifetime. The study, led by Dr. Louisa Degenhardt of the University of New South Wales, Sydney, Australia and colleagues, looked at patterns in the use of alcohol, tobacco, cannabis and cocaine in 17 countries representing all six WHO regions (the Americas, Europe, Asia, the Middle East, Africa and Oceania). The study, funded in part by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH) is published in the July 1, 2008 issue of the open access journal PLoS Medicine.

“These findings add to our understanding of substance abuse world-wide, and suggest that drug use is still a major problem in this country, pointing to the need for more effective prevention interventions,” said Dr. Elias A. Zerhouni, NIH director.

“A survey of lifetime use does not provide the entire picture; however, because it does not reflect current use or trends over time,” said Dr. Volkow, sounding a note of caution. “For example, although lifetime use of tobacco was reported by this study to be 74 percent in the U.S., current use has been documented at approximately 30 percent. Moreover, NIDA’s Monitoring the Future survey has been consistently reporting a decrease in the past year use of illicit drugs over the past decade, so this survey may reflect a longer history of drug use in certain countries relative to others, but not necessarily current trends.”

Among the significant findings of this study were:

  • Across countries and across the drug types in this survey, drug use is becoming more common over time.
  • Males were more likely than females to have used all drug types in all countries and all age groups.
  • Younger adults were more likely than older adults to have used these substances.
  • Those with higher incomes were more likely to have used legal and illegal drugs.
  • Alcohol had been used by the vast majority of survey participants in the Americas, Europe, Japan, and New Zealand, compared to smaller proportions in the Middle East, Africa and China.
  • Alcohol use by age 15 was far more common in European countries than in the Middle East or Africa.
  • Lifetime tobacco use was most common in the United States (74 percent), Lebanon (67 percent) Mexico and the Ukraine (60 and 61 percent), followed by the Netherlands (58 percent.)

“In addition to the factors measured in this study, the role of culture, drug availability and knowledge about drug use are likely to be important in the types and patterns of drug use throughout the world,” said Dr. Nora D. Volkow, NIDA director. “Even within the United States, rates and patterns of substance use differ based on geographical location and ethnicity, among other factors.”

The authors point out that the survey is limited to those countries that had the resources and willingness to participate, and that efforts were made to account for possible cultural differences in participants’ willingness to answer truthfully, which could impact measures of actual drug use. For more information about the survey, Toward a Global View of Alcohol, Tobacco, Cannabis and Cocaine Use: Findings from the WHO Mental Health Surveys go to http://www.plosmedicine.org.


The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice.  Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.


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