Drinking Motives, Mental Health, and Adolescent Alcohol Use Among Croatian Adolescents

Adolescence is a critical period during which alcohol is the most commonly used substance worldwide, and such use has detrimental effects on neurobiological, psychosocial, and physiological development. Despite substantial international evidence, little is known about the concurrent influence of drinking motives and internalizing symptoms on adolescent alcohol use, particularly in the Croatian context, where adolescent drinking rates remain high. A cross-sectional study using a survey questionnaire was conducted in 2024 in Split-Dalmatia County, Croatia. The final stratified cluster sample comprised 925 students (58.8% of the planned sample), with a mean age of 15.41 years. Using hierarchical regression analysis, the results showed that the final model, which included both drinking motives and mental health indicators, explained 39.6% of the variance in alcohol use, 37.2% of the variance in binge drinking, and 31.8% of the variance in alcohol intoxication. Male sex was consistently associated with all three outcomes, whereas age was positively associated with alcohol use and binge drinking. Drinking motives contributed the largest proportion of the explained variance. Furthermore, lower levels of loneliness and higher levels of anxiety were associated with more frequent alcohol use, while lower stress and higher anxiety were associated with more frequent intoxication. Drinking motives are stronger predictors of adolescent alcohol use and risky drinking patterns than internalizing symptoms whose predictive strength was generally small. Prevention programs should address aspects of drinking motives in addition to promoting mental health.