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Nordic Studies on Alcohol and Drugs

The Journal of Nordic Centre for Welfare and Social Issues

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Volume 31, Issue 4 (Oct 2014)


Polydrug Use by European Adolescents in the Context of Other Problem Behaviours

Anna Kokkevi
  • University Mental Health Research Institute, Athens, Greece
  • Email:
/ Eleftheria Kanavou
  • University Mental Health Research Institute, Athens, Greece
  • Email:
/ Clive Richardson
  • Panteion University of Social and Political Sciences, Athens, Greece
  • Email:
/ Anastasios Fotiou
  • University Mental Health Research Institute, Athens, Greece
  • Email:
/ Sonia Papadopoulou
  • University Mental Health Research Institute Athens University Medical School
  • Email:
/ Karin Monshouwer
  • Department of Disciplinary Social Science Utrecht, The Netherlands
  • Email:
/ Joao Matias
  • European Monitoring Centre for Drugs and Drug Addiction, Lisbon
  • Email:
/ Deborah Olszewski
  • European Monitoring Centre for Drugs and Drug Addiction, Lisbon
  • Email:
Published Online: 2014-10-02 | DOI: https://doi.org/10.2478/nsad-2014-0026


Aim – Previous studies of the association between polydrug use and other risk behaviours have generally been limited to specific substances and a small number of behaviours. The aim of this study is to obtain better insight into polydrug use (comprising legal and illegal substances: tobacco, alcohol, tranquillisers/sedatives, cannabis, and other illegal drugs) and its association with co-occurring problem behaviours drawn from various broad domains (sexual, aggressive, delinquent, school achievement, relationships) among European adolescents. METHODS – Data were obtained from 101,401 16-year-old students from 35 European countries participating in the 2011 ESPAD survey. Associations between polydrug use and other problem behaviours were examined by multinomial and binary logistic regression analyses. RESULTS – Tranquillisers/sedatives appeared among the commonest combinations in the polydrug use pattern, especially for females. A strong trend was found between levels of involvement with polydrug use and other problem behaviours for both genders. The highest associations with polydrug use were for problems with the police, risky sexual behaviour and skipping school. Gender differences showed higher prevalences among boys than girls of problem behaviours of aggressive, antisocial type, while girls prevailed over boys in relationship problems. CONCLUSION – An incremental relationship exists between the level of involvement with polydrug use and the co-occurrence of problem behaviours. Preventative interventions should consider the misuse of tranquillisers/sedatives within the context of polydrug use by adolescents and expand their target groups towards multiple problem behaviours.

Keywords: polydrug use; adolescents; ESPAD; problem behaviours


  • Arenliu, A., Kelmendi, K., Haskuka, M., Halimi, T., & Canhasi, E. (2014). Drug use and reported suicide ideation and attempt among Kosovar adolescents. Journal of Substance Use, 19(5), 358–363.

  • Bachman, R., & Peralta, R. (2002). The relationship between drinking and violence in an adolescent population: Does gender matter? Deviant Behavior, 23(1), 1–19. [Crossref]

  • Beratis, S., Lekka, N. P., & Gabriel, J. (1997). Smoking among suicide attempters. Comprehensive Psychiatry, 38(2), 74–79. [PubMed] [Crossref]

  • Biglan, A., Brennan, P. A., Foster, S. L., Holder, H. D., Miller, T. L., Cunningham, P. B. … Zucker, R. A. (2004). Helping adolescents at risk: Prevention of multiple problem behaviors. New York: Guilford.

  • Bjarnason, T. (2012). What is the European average? In: Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T.,

  • Kokkevi, A., & Kraus, L. (2012). The 2011 ESPAD report. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN) and the Pompidou Group at the Council of Europe.

  • Brière, F. N., Fallu, J. S., Descheneaux, A., & Janosz, M. (2011). Predictors and consequences of simultaneous alcohol and cannabis use in adolescents. Addictive Behaviors, 36(7), 785–788. [PubMed] [Crossref]

  • Brooks, F. M., Magnusson, J., Spencer, N., & Morgan, A. (2012). Adolescent multiple risk behaviour: An asset approach to the role of family, school and community. Journal of Public Health, 34(suppl 1), i48–i56. [Crossref]

  • Collins, R. L., Ellickson, P. L., & Bell, R. M. (1999). Simultaneous polydrug use among teens: Prevalence and predictors. Journal of Substance Abuse, 10(3), 233–253.

  • Connell, C. M., Gilreath, T. D., & Hansen, N. B. (2009). A multiprocess latent class analysis of the co-occurrence of substance use and sexual risk behavior among adolescents. Journal of Studies on Alcohol and Drugs, 70(6), 943–951.

  • DuRant, R. H., Smith, J. A., Kreiter, S. R., & Krowchuk, D. P. (1999). The relationship between early age of onset of initial substance use and engaging in multiple health risk behaviors among young adolescents. Archives of Pediatrics & Adolescent Medicine, 153(3), 286–291.

  • Earleywine, M., & Newcomb, M. D. (1997). Concurrent versus simultaneous polydrug use: Prevalence, correlates, discriminant validity, and prospective effects on health outcomes. Experimental and Clinical Psychopharmacology, 5(4), 353–364. [Crossref]

  • EMCDDA. (2009). Selected issue, polydrug use: Patterns and responses. Lisbon: European Monitoring Centre for Drugs and Drug Addiction.

  • EMCDDA. (2013). European drug report: Trends and developments. Lisbon: European Monitoring Centre for Drugs and Drug Addiction.

  • Galaif, E. R., & Newcomb, M. D. (1999). Predictors of polydrug use among four ethnic groups: A 12-year longitudinal study. Addictive Behaviors, 24(5), 607–631. [Crossref]

  • Graham, K., & Vidal-Zeballos, D. (1998). Analyses of use of tranquilizers and sleeping pills across fve surveys of the same population (1985–1991): The relationship with gender, age and use of other substances. Social Science & Medicine, 46(3), 381–395.

  • Hacker, K. A., Suglia, S. F., Fried, L. E., Rappaport, N., & Cabral, H. (2006). Developmental differences in risk factors for suicide attempts between ninth and eleventh graders. Suicide and Life-Threatening Behavior, 36(2), 154–166. [Crossref]

  • Hair, E. C., Park, M. J., Ling, T. J., & Moore, K. A. (2009). Risky behaviors in late adolescence: Co-occurrence, predictors, and consequences. Journal of Adolescent Health, 45(3), 253–261. [Crossref]

  • Hawton, K., Rodham, K., Evans, E., & Weatherall, R. (2002). Deliberate self harm in adolescents: Self report survey in schools in England. British Medical Journal, 325(7374), 1207–1211. [Crossref]

  • Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., & Kraus, L. (2012). The 2011 ESPAD Report. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN) and the Pompidou Group at the Council of Europe.

  • Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., & Kraus, L. (2009). The 2007 ESPAD report – Substance use among students in 35 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN) and the Pompidou Group at the Council of Europe.

  • Höhne, B., Pabst, A., Hannemann, T.-V., & Kraus, L. (2013). Patterns of concurrent alcohol, tobacco, and cannabis use in Germany: Prevalence and correlates. Drugs: Education, Prevention, and Policy, 21(2), 102–109.

  • Huas, C., Hassler, C., & Choquet, M. (2008). Has occasional cannabis use among adolescents also to be considered as a risk marker? The European Journal of Public Health, 18(6), 626–629. [Crossref]

  • Jessor R., & Jessor S. L. (1977). Problem behavior and psychosocial development: A longitudinal study of youth. New York: Academic Press.

  • Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2008). Monitoring the Future national results on adolescent drug use: Overview of key fndings. Bethesda, MD: National Institute on Drug Abuse: NIH Publication No. 09-7401.

  • Kandel, D. B., Yamaguchi, K., & Chen, K. (1992). Stages of progression in drug involvement from adolescence to adulthood: Further evidence for the gateway theory. Journal of Studies on Alcohol and Drugs, 53(5): 447–457.

  • Kokkevi, A. (2012). Polydrug use by European adolescents: Examining the prevalence of cannabis-related problems among adolescents in 13 European countries. In: Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., &

  • Kraus, L. (2012). The 2011 ESPAD Report. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN) and the Pompidou Group at the Council of Europe.

  • Kokkevi, A., Fotiou, A., Arapaki, A., & Richardson, C. (2008). Prevalence, patterns, and correlates of tranquilizer and sedative use among European adolescents. Journal of Adolescent Health, 43(6), 584–592. [Crossref]

  • Kokkevi, A., Richardson, C., Olszewski, D., Matias, J., Monshouwer, K., & Bjarnason, T. (2012). Multiple substance use and self-reported suicide attempts by adolescents in 16 European countries. European Child & Adolescent Psychiatry, 21(8), 443–450. [Crossref]

  • Kokkevi, A., Rotsika, V., Arapaki, A., & Richardson, C. (2010). Changes in associations between psychosocial factors and suicide attempts by adolescents in Greece from 1984 to 2007. The European Journal of Public Health, 21(6), 694–698.

  • Kokkevi, A., Rotsika, V., Arapaki, A., & Richardson, C. (2012). Adolescents’ self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries. Journal of Child Psychology and Psychiatry, 53(4), 381–389. [Crossref]

  • Lynne-Landsman, S. D., Graber, J. A., Nichols, T. R., & Botvin, G. J. (2011). Trajectories of aggression, delinquency, and substance use across middle school among urban, minority adolescents. Aggressive Behavior, 37(2), 161–176. [Crossref]

  • Mackesy-Amiti, M. E., Fendrich, M., & Goldstein, P. (1997). Sequence of drug use among serious drug users: Typical vs atypical progression. Drug and Alcohol Dependence, 45(3), 185–196. [Crossref]

  • McCabe, S. E., Boyd, C. J., & Teter, C. J. (2009). Subtypes of nonmedical prescription drug misuse. Drug and Alcohol Dependence, 102(1–3), 63–70. [Crossref]

  • McCabe, S. E., Cranford, J. A., Morales, M., & Young, A. (2006). Simultaneous and concurrent polydrug use of alcohol and prescription drugs: Prevalence, correlates, and consequences. Journal of Studies on Alcohol, 67(4), 529–537.

  • McCabe, S. E., West, B. T., Morales, M., Cranford, J. A., & Boyd, C. J. (2007). Does early onset of non-medical use of prescription drugs predict subsequent prescription drug abuse and dependence? Results from a national study. Addiction, 102(12), 1920–1930. [Crossref] [PubMed]

  • Miller, J. W., Naimi, T. S., Brewer, R. D., & Jones, S. E. (2007). Binge drinking and associated health risk behaviors among high school students. Pediatrics, 119(1), 76–85. [Crossref] [PubMed]

  • Newcomb, M. D. (1997). Psychosocial predictors and consequences of drug use: A developmental perspective within a prospective study. Journal of Addictive Diseases 16, 51–89. [Crossref]

  • NIDA. (2011). Prescription drugs: Abuse and addiction. Research Report Series National Institute on Drug Abuse. U.S. Department of Health and Human Services. National Institutes of Health. NIH Publication Number 11-4881.

  • O’Connell, M. E, Boat, T., & Warner, K. E. (Eds.) (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: National Academies Press.

  • O’Connor, R. C., Rasmussen, S., Miles, J., & Hawton, K. (2008). Self-harm in adolescents: Self-report survey in schools in Scotland. The British Journal of Psychiatry, 194(1), 68–72.

  • Olszewski, D., Matias, J., Monshouwer, K., & Kokkevi, A. (2009). Polydrug use among 15- to 16-year olds: Similarities and differences in Europe. Drugs: Education, Prevention and Policy, 17(4), 287–302.

  • ONDCP. (2007). Teens and prescription drugs: An analysis of recent trends on the emerging drug threat. Rockville, MD: Offce of National Drug Control Policy: Executive Offce of the President.

  • Rees, D. I., Argys, L. M., & Averett, S. L. (2001). New evidence on the relationship between substance use and adolescent sexual behavior. Journal of Health Economics, 20(5), 835–845. [Crossref]

  • Reyes, J. C., Robles, R. R., Colón, H. M., Negrón, J. L., Matos, T. D., & Calderón, J. M. (2011). Polydrug use and attempted suicide among Hispanic adolescents in Puerto Rico. Archives of Suicide Research, 15(2), 151–159. [Crossref]

  • SAMHSA. (2013). The DAWN report: Highlights of the 2011 Drug Abuse Warning Network (DAWN) fndings on drug-related emergency department visits. Rockville: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality.

  • Sen, B., Averett, S., Argys, L., & Rees, D. I. (2009). The effect of substance use on the delinquent behaviour of adolescents. Applied Economics Letters, 16(17), 1721–1729. [Crossref]

  • Simons, J. S., Maisto, S. A., & Wray, T. B. (2010). Sexual risk taking among young adult dual alcohol and marijuana users. Addictive Behaviors, 35(5), 533–536. [Crossref] [PubMed]

  • Smit, F., Monshouwer, K., & Verdurmen, A. (2002). Polydrug use among secondary school students: Combinations, prevalences and risk profles. Drugs: Education, Prevention and Policy, 9(4), 355–365. [Crossref]

  • Smith, G. W., Farrell, M., Bunting, B. P., Houston, J. E., & Shevlin, M. (2011). Patterns of polydrug use in Great Britain: Findings from a national household population survey. Drug and Alcohol Dependence, 113(2–3), 222–228. [Crossref]

  • Sung, H.-E., Richter, L., Vaughan, R., Johnson, P. B., & Thom, B. (2005). Nonmedical use of prescription opioids among teenagers in the United States: Trends and correlates. Journal of Adolescent Health, 37(1), 44–51. [Crossref]

  • Terzian, M. A., Andrews, K. M., & Anderson Moore, K. (2011). Preventing multiple risky behaviors among adolescents: Seven strategies. Child Trends nonproft, nonpartisan research center. Washington, DC. Retrieved November 21, 2013, from: http://www.childtrends.org

  • Townsend, L., Flisher, A. J., & King, G. (2007). A systematic review of the relationship between high school dropout and substance use. Clinical Child and Family Psychology Review, 10(4), 295–317. [Crossref]

  • Tubman, J. G., Gil, A. G., & Wagner, E. F. (2004). Co-occurring substance use and delinquent behavior during early adolescence: Emerging relations and implications for intervention strategies. Criminal Justice and Behavior, 31(4), 463–488. [Crossref]

  • White, A., Chan, G. C. K., Quek, L.-H., Connor, J. P., Saunders, J. B., Baker, P., … Kelly, A. B. (2013). The topography of multiple drug use among adolescent Australians: Findings from the National Drug Strategy Household Survey. Addictive Behaviours, 38(4), 2068–2073. [Crossref]

  • White, H. R., & Labouvie, E. W. (1994). Generality versus specifcity of problem behavior: Psychological and functional differences. Journal of Drug Issues, 24(1–2), 55–74.

  • World Health Organisation (2010). Violence prevention: The evidence. Geneva, Switzerland. [PubMed]

  • Wu, J., Witkiewitz, K., McMahon, R. J., & Dodge, K. A. (2010). A parallel process growth mixture model of conduct problems and substance use with risky sexual behavior. Drug and Alcohol Dependence, 111(3), 207–214. [Crossref]

About the article

Received: 2014-01-24

Received: 2014-07-24

Published Online: 2014-10-02

Citation Information: Nordic Studies on Alcohol and Drugs, ISSN (Online) 1458-6126, DOI: https://doi.org/10.2478/nsad-2014-0026. Export Citation

© 2014 Anna Kokkevi et. al.. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. (CC BY-NC-ND 3.0)

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