Conclusion

Overall, a general decreasing trend can be observed in cigarette use and alcohol use among adolescents. However, despite rather strict regulations on tobacco in most countries and on alcohol in some countries, adolescents still report relatively easy access to tobacco and alcohol. Moreover, trends over the past two decades indicate a closing of the gender gap in the use of tobacco and alcohol. The data suggest that cannabis remains an ‘established’ drug. Although prevalence peaked in 2003 and decreased slightly thereafter, the prevalence rates in lifetime and current cannabis use are higher in 2015 than in 1995. In many countries, prevalence rates for NPS suggest that these substances are more attractive than the ‘old drugs’ amphetamine, ecstasy, cocaine or LSD. Availability of NPS and adolescents’ use of these substances need to be closely monitored.

With the popularity of smartphones and tablets, internet use has become more popular and increasingly mobile. The students were using the internet quite regularly and most commonly reported using it for social media, for instance to stay in contact with friends. Since the internet has become an integral part of life and is used on a daily basis, the development of patterns of addictive use among children and adolescents needs to be closely monitored and investigated in further studies. Associated with the increased internet use, online gaming has also become more popular, especially among boys. Moreover, youth gambling has become a popular form of recreation. Measures to prevent adolescents from developing problems associated with gambling, such as debts, psychological deficits and social disadvantages, are of high priority.

Substance or internet use should not always be considered individually: there seems to be a high association between the use of different drugs, including alcohol and tobacco, and risky behaviours such as gambling. These associations have frequently been discussed in the light of the gateway theory, assuming that progression from one drug to another increases with the frequency of use of the former drug (Kandel et al., 1992). Others have suggested a connection between different types of problem behaviour and that certain risk-imbued behaviour patterns are caused by identical underlying common factors (Jessor and Jessor, 1977; Morral et al., 2002).

It seems necessary to make particular efforts to prevent early substance use and gambling as well as excessive use of the internet and gaming in childhood and adolescence. As a basis for decisions or approaches to achieve this goal, ESPAD provides data on such behaviours over a period of up to 20 years. In the following years, ESPAD will not only monitor substance use behaviour but will also assess future developments in internet use as well as online gaming and gambling, and strive to increase its contribution to the protection of children and adolescents from the negative consequences of substance use and addictive behaviours.