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Objective:

Recently, an increased trend toward nondrinking among adolescents has arisen. Thus, the aim of this study was to evaluate the popular view in Sweden that adolescents have replaced alcohol with illicit drugs or other substances and to examine whether the use of illicit drugs, cigarettes, and/or snus among moderate and heavy alcohol users has changed.

Method:

Data were taken from a large population-based health survey distributed in 1995, 1997, 2001, 2004, 2006, 2008, 2010, 2012, 2014, 2017, and 2020, covering all students in 9th grade (15–16 years) and 11th grade (17–18 years) in a mid-sized Swedish county.

Results:

The proportion of nondrinkers who used other substances was very low, varying from 1.1% to 3.3% for illicit drugs, from 1.0% to 7.6% for current smoking, and from 1.2% to 6.2% for snus use. Further, no change was found in illicit drug use among moderate and heavy alcohol users from 2004 to 2017, but current smoking and snus use decreased. However, when compared with low alcohol users, moderate and heavy alcohol users had a higher probability of illicit drug use, cigarette smoking, and snus use.

Conclusions:

Adolescents have not replaced alcohol with other substances. When compared with low alcohol users, moderate and heavy alcohol users are more likely to use illicit drugs and nicotine. The low prevalence of substance use among nondrinkers may indicate that preventing alcohol use could have additional positive effects on illicit drug and nicotine use.