Stoned Nation: International study of drug use places US in the lead.

A study released today in PLoS Medicine compares alcohol, tobacco, and illegal drug use across seventeen different countries participating in the World Health Organization World Mental Health Survey Initiative.Alcohol seems to be widely used in the studied countries, tobacco less so but fairly evenly used. Major variation was found with marijuana and cocaine use, with the US and New Zealand at the top of the list for pot, and the US as a significant outlier with cocaine use, to the extent that if cocaine was not used in the US, it seems unlikely that it would even be a major part of a study such as this one.How the study was done:

Eighteen surveys were carried out in 17 countries in theAmericas (Colombia, Mexico, US), Europe (Belgium, France,Germany, Italy, Netherlands, Spain, Ukraine), the Middle Eastand Africa (Israel, Lebanon, Nigeria, South Africa), Asia(Japan, and separate surveys in Beijing and Shanghai in thePeople’s Republic of China), and Oceania (New Zealand). Thisset of countries was determined by availability of collaboratorsin the country who were able to obtain funding for thesurvey and complete the World Mental Health Surveys(WMHS) protocol.

The sample sizes are in the thousands, with a total sample of 85,052 individuals.The results:This study looked at a lot of different aspects of substance use (see conclusions, below) but the most interesting results are summarized in the following table. (See the original paper for a more detailed breakdown.) This is based on the study’s Table 2 and presents the percentage of use by respondents in each country of alcohol, tobacco, cannabis (marijuana) and cocaine.i-416e3695b2788603f31f076afc0a809a-drug_use_study_PLoS_Medicine.jpgThe study concluded:

  • Drug use is unevenly distributed across countries.
  • The US had among the highest use rates of all drugs.
  • Lower levels of drug use are seen in poorer countries, espeically in Africa and the Middle East.
  • Greater drug use is seen in younger than older adults globallly, suggesting change in drug use over historic time.
  • There is more drug use among males than among females, but this gender gap seems to be closing.
  • The period in their lives during which people used illegal drugs is lenthening, into older ages.
  • Generally speaking, the higher the income, unmarried status, amd male-ness are linked to a higher chance of illegal drug use within countries, and generally, more affluent countries are associated with more drug use.

The study does have a number of limitations that re clearly reported. For example, the poorest of countries are not represented because resources from the countries in which the study was carried out were required. Also, there was a great deal of variation in response and participation for other reasons.Questions that I have about this study include:The African and Middle Eastern countries where drug use rate is lower may also be more Islamic. Does this have an effect? Christianity seems more widespread in the countries with more drug use. Is this relevant? Does the observed age difference (younger cohorts with more drug use) reflect a reporting bias or a reality? It seems that over the last several decades the evidence that younger people are using more drugs is so often reported that all people must be using all drugs by now, but they aren’t! Do studies that show declines in drug use get less press, or go unfinished? (Is there a reporting bias or a confirmation bias at work here?)


Degenhardt L, Chiu W-T, Sampson N, Kessler RC, Anthony JC, et al. (2008) Toward a global view of alcohol, tobacco, cannabis, and cocaine use: Findings from the WHO World Mental Health Surveys. PLoS Med 5(7): e141. doi:10.1371/journal. pmed.0050141 Received: June 26, 2007

The original paper is HERE.

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15 Responses to Stoned Nation: International study of drug use places US in the lead.

  1. Stephanie Z says:

    Thanks for highlighting this one. 0Also interesting:

    The US, which has been driving much of the world’s drug research and drug policy agenda, stands out with higher levels of use of alcohol, cocaine, and cannabis, despite punitive illegal drug policies, as well as (in many US states), a higher minimum legal alcohol drinking age than many comparable developed countries. The Netherlands, with a less criminally punitive approach to cannabis use than the US, has experienced lower levels of use, particularly among younger adults. Clearly, by itself, a punitive policy towards possession and use accounts for limited variation in nation-level rates of illegal drug use.

    The age of onset data is worth a look too. I always knew I was precocious.

  2. Pierce R. Butler says:

    Generally speaking, the higher the income, unmarried status, and male-ness are linked to a higher chance of illegal drug use within countries, and generally, more affluent countries are associated with more drug use.What were you inhaling when you generated the syntax for that summary?And where’d ya score it?

  3. Joel says:

    We’re number 1, we’re number 1!!!!

  4. Blaidd Drwg says:

    It would be interesting to compare these findings with a per capita ranking of how much each country spends on drug enforcement, drug rehabilitation, drug treatments, and drug education. (I include alcohol and tobacco as drugs, of course).Just a SWAG, the more a country spends on drug education, the less it has to spend on enforcement, treatment,and rehab. (You know, sort of like the figures on comprehensive sex education versus unmarried/unwanted pregnancies and STDs)

  5. FutureMD says:

    All this shows is that the US has the highest rate of consumption for those particular drugs. I don’t see too many Americans chewing qat or smoking opium, but those are drugs as well and I expect some regions of the world do a great deal of those two.

  6. Greg Laden says:

    There is some information on drug laws and their severity, and it does not associate with any of the indicators of use.FutureMD: I had the same questions about Chat and other drugs. Also, there are huge areas (not necessarily in this study, but elsewhere) where patterns would be very different. There are parts of the world where everyone is always stoned that I doubt will ever get into a survey of this sort.

  7. Ian says:

    Greg – are you trying to suggest that we’re living in the stoned age?!

  8. Jason Dick says:

    As far as Christianity being “more widespread” in areas with less drug use, the US is the most strongly Christian nation of any of the developed nations. Even Italy, for instance, is only at around 50% self-identified as Christian, while the US is at around 80%.

  9. Greg Laden says:

    Jason, I had not suggested what you suggest I suggested. I suggested, rather, I suggest what you suggest. Also, I was actually thinking as well of Christianity vs. non-Christianity, not degree of adherence to it or specific sects or cults.

  10. Jon D says:

    I find it very surprising they left out the UK.I’m pretty sure we would give the US a run for its money in most categories.

  11. jim says:

    It would be interesting to understand how the severity of punishment varies by country. Some countries have very harsh penalties regarding illegal drug use. The study would have to take into account the measure of how often these penalties were enforced. My guess is that if a country has harsh penalties, but doesn’t enforce them then that is not much different than a country with mild or no penalties.I think Japan has some very harsh penalties on cocaine and marijuana.Just a thought.

  12. Tex says:

    I am pretty suspicious of the 73.6% value for US tobacco users. Is this survey counting everyone who even once puffed a cigarette on a dare in junior high? If not, this number seems far too high and makes me distrustful of the rest of the survey.

  13. Andrew says:

    If it was everybody who ever smoked (not just a puff, but who regularly smoked) I could see this as the number. Back in the day, EVERYBODY smoked.

  14. Stephanie Z says:

    Tex, the study is measuring lifetime use.

  15. Greg Laden says:

    Tex!Any study worth reading will cause you to run into the conflict of what you thought was true and what the study says. If you assume that the study is not valid because what you thought was true is violated, then you will walk away unchanged by a potential learning experience.I do agree with you, however, that if something does not conform to expectations, check it out. In this case, the study is Open Access, so you can read the thing!!!!Report back with your conclusions, please.

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