A survey of the drinking, smoking and illicit drug use of more than 90 000 teenage school students was carried out in 1999. This exercise, known as the European School Survey Project on Alcohol and other Drugs (ESPAD), revealed marked differences in the substance use patterns of those surveyed in different countries. Teenagers in a group of northern countries reported the highest rates of heavy drinking and intoxication (drunkenness). Teenagers in southern Europe reported much lower levels of such behaviours and experiences. Some of these findings are presented and discussed in relation to aetiology and health promotion.