The relationship between substance use and suicidal behaviour among adolescents in selected European countries: A test of normalisation theory

Objective: Normalization thesis assumes that high prevalence rates of substance use are associated with a shift in the recruitment of substance users from risky to a more well-adjusted population. This study tests the application of normalisation thesis by examining levels of substance use (smoking, alcohol and cannabis) and its relation to reported suicide ideation and attempt in 13 European countries. The hypothesis of the study is that in countries with low prevalence of substance use the correlation and predicting odds ratios between substance use and suicide ideation and suicide attempt will be higher than in high prevalence countries. Method: Data from the ESPAD (European School Survey Project on Alcohol and Other Drugs) study from 13 countries was used for the analysis. The data were collected from a sample of 15-year-old adolescents using ESPAD standardised sampling strategy and data collection methodology across countries. Results: Evidence is provided for normalisation thesis, specifically, in countries with low prevalence of substance use reported higher association between substance use and suicidal behaviour compared to countries with higher prevalence of substance use. Conclusion: The normalisation thesis is a useful scheme to understand the relation of adolescent alcohol, tobacco and cannabis use in relation to suicide ideation and attempt in different cultural circumstances. Implications: study findings highlight the importance of selective and universal drug prevention programmes in different cultural contexts.