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November 01, 2009

The proportion of people in the United States who have used cocaine at some time during their lives is higher—by a factor of four—than in 16 other nations surveyed by the World Health Organization (WHO). The United States also leads in lifetime use of cannabis and tobacco.

NIDA scientists suggest that the high U.S. rates are, in part, artifacts of drug epidemics of the 1970s and 1980s, and they note that U.S. drug use rates are now lower.

Between 2001 and 2006, WHO researchers asked 54,069 people about their lifetime exposure to cocaine, cannabis, tobacco, and alcohol. The survey is the first to publish directly comparable self-report data from a large number of countries. The analysis includes data from the first 17 countries participating in the WHO World Mental Health Survey Initiative.

Sixteen percent of U.S. respondents said they had ever used cocaine, as compared with about 4 percent of people surveyed in Colombia, Mexico, New Zealand, and Spain. Rates of lifetime cocaine use dipped much lower in the other nations. For cannabis, New Zealand is the only nation to nearly match the U.S. rate of 42.4 percent. Lifetime tobacco use in the United States is 73.6 percent, with Lebanon next, at 67.4 percent.

Rates of lifetime alcohol use, which exceed 90 percent in 8 of the 17 countries surveyed, are far higher than for the three other substances. Ukraine reports the highest rate (97 percent), and the United States ranks sixth with 91.6 percent. Alcohol use is much more common in the Americas, Europe, Japan, and New Zealand than in Africa, China, and the Middle East.

Lifetime Versus Current Use

The WHO survey did not query past-year or current substance use as do most U.S. nationwide surveys. "A survey of lifetime use does not provide the entire picture because it does not reflect current use or trends over time," notes NIDA Director Dr. Nora D. Volkow. "For example, although lifetime use of tobacco was reported by this study to be roughly 74 percent in the United States, current use has been documented at approximately 30 percent."

Dr. Wilson Compton of NIDA's Division of Epidemiology, Services and Prevention Research agrees that the study "does not take into account improvements in current drug use." But the fundamental finding that drug-use rates are generally higher in the United States than in most other countries has been confirmed, he says, by indirect indicators, such as drug-treatment admissions, hospitalization rates, and criminal justice data published by the United Nations Office on Drugs and Crime.

Use of Addictive Substances Around the World: Among 17 nations surveyed by the World Health Organization, the United States ranks first in lifetime use of three substances - cocaine, cannabis, and tobacco - and is in sixth place for alcohol use. The five highest rates of use in each drug category appear in bold. Rates are reported as percentages.
Country Cocaine Cannabis Tobacco Alcohol
Colombia 4.0 10.8 48.1 94.3
Mexico 4.0 7.8 60.2 85.9
US 16.2 42.4 73.6 91.6
Belgium 1.5 10.4 49.0 91.1
France 1.5 19.0 48.3 91.3
Germany 1.9 17.5 51.9 95.3
Italy 1.0 6.6 48.0 73.5
Netherlands 1.9 19.8 58.0 93.3
Spain 4.1 15.9 53.1 86.4
Ukraine 0.1 6.4 60.6 97.0
Israel 0.9 11.5 47.9 58.3
Lebanon 0.7 4.6 67.4 53.3
Nigeria 0.1 2.7 16.8 57.4
South Africa 0.7 8.4 31.9 40.6
Japan 0.3 1.5 48.6 89.1
People's Republic of China 0.0 0.3 53.1 65.4
New Zealand 4.3 41.9 51.3 94.8

Dr. Compton suggests that one reason for the high U.S. lifetime rates might be that drug-use epidemics in the United States, including a major cocaine epidemic in the 1970s and another in the late 1980s, preceded those of other nations by a decade or more. "For people of middle age, lifetime exposure [to cocaine] in the United States would be greater than for the rest of the world," he says. "The differences are less pronounced when you look at young people."

Other Findings

The WHO researchers report substance-use patterns that transcend national boundaries. Among them:

  • The period of high risk for initiating use of the surveyed substances—previously late adolescence through the early 20s—now extends into the late 20s.
  • Men are more likely than women to use cocaine, cannabis, tobacco, and alcohol, but this gender gap appears to be narrowing in the younger cohorts. Dr. Compton says one factor in gender-based patterns is opportunity to use. "In the past, adolescent boys had more exposure than girls," he says. "Given equal opportunity to use drugs, the rates are similar."
  • The higher a person's income, the more likely he or she is to use each of the four substances surveyed.


Degenhardt, L. et al. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: Findings from the WHO World Mental Health Surveys. PLoS Medicine 5(7):1-14, 2008. [Full Text]