What This Means
This research suggests that while teenagers in different countries drink alcohol and use drugs at very different rates, the same underlying factors tend to predict substance use regardless of where adolescents live. The study surveyed over 5,100 high school students aged 15–19 across the United States, Sweden, Serbia, Morocco, and Vietnam, finding that Swedish and Serbian teens reported more alcohol use than American teens, while Moroccan and Vietnamese teens reported less. For drug use, American teens reported the highest rates, with all other countries reporting lower use. Despite these country-level differences in how much substances are used, the factors that predict who is more or less likely to use them were remarkably similar across all five nations.
The strongest predictor of both alcohol and drug use was psychological distress — teens who reported more mental health struggles were more likely to use both alcohol and drugs. Early life adversity also mattered, though differently depending on the substance: growing up with family members who had alcohol or drug problems predicted higher alcohol use, while experiences of physical or psychological abuse — along with family drug problems — predicted higher drug use. Personality traits also played a consistent role across countries: teens who scored higher on extraversion tended to use more substances, while those who scored higher on conscientiousness, agreeableness, and openness tended to use less. Older teens and young men were more likely to report drug use, while gender did not predict alcohol use.
This research suggests that prevention programs do not need to be entirely reinvented for each cultural context — instead, approaches that address mental health, trauma, and personality-based risk and protective factors may be broadly applicable across different countries. The findings point toward the value of combining trauma-informed mental health support with programs designed to build protective personality traits like conscientiousness and agreeableness in adolescents. The authors note limitations including uneven numbers of participants across countries and the fact that data collection occurred during the COVID-19 pandemic, which may have affected results.