This overview of the situation contains the introductory part of the Summary Report on Addiction in the Czech Republic 2022, which was published in May 2023. This report is the main part of the information package of annual reports on the situation in the field of addiction in the Czech Republic. The report is complemented by more detailed reports focusing on specific thematic areas.
Full texts of the reports are only available in the Czech language.
In the Czech Republic, approximately 20% of the population aged 15 and over smoke every day, i.e. approximately 2 million people. The proportion of smokers in the adult population declined slightly until 2015, but has not changed substantially in recent years. The proportion of adolescent smokers has been declining over the long term. In 2019, ESPAD survey reported 10% of 16-year-old students smoked daily, three times less than in the late 1990s. The decline in traditional cigarette smoking among adolescents has been confirmed by studies conducted in 2021.
Between 16-18 000 people die each year as a result of smoking, most often due to cancers of the trachea, bronchi and lungs, or chronic obstructive pulmonary disease. For every deceased smoker, 15 years of life are estimated to be lost.
Approximately 1-2 thousand people per year are in contact with services and in treatment for tobacco addiction. Smoking cessation counselling is provided by outpatient doctors of various specializations, pharmacies and addictology programmes. A significant proportion of smokers attempt to quit without professional help.
In recent years, alternative products, especially electronic cigarettes (or vaporizers), heated tobacco products and nicotine pouches, have been growing in popularity, especially among young adults. E-cigarettes are currently used by approximately 5-7% of adults and heated tobacco products by 3-7%. These products are less risky from a health perspective than traditional cigarettes, cigars and pipes, and are also used for smoking cessation.
Alcohol consumption in the Czech population has long been at a high level. Alcohol consumption in the Czech Republic is equivalent to 10 litres of pure alcohol per capita. Almost 10% of the adult population drink alcohol daily and the proportion of daily drinkers has been stable for a long time. Frequent heavy drinking is reported by 12% of the population. While frequent heavy drinking is highest among young adults and decreases with age, daily alcohol consumption increases with age. Among adolescents, there has been a significant decline in drinking since 2011, including regular consumption and risky forms of drinking. The decline in drinking among adolescents has been confirmed by studies conducted in 2021. However, in the European context, the level of alcohol consumption among adolescents remains high.
Over the long term, an estimated 1.5-1.7 million adults are classified as high-risk alcohol users, with 800-900 thousand people falling into the category of harmful drinking. The proportion of people showing signs of hazardous and harmful drinking has remained stable over the long term, with the latest available data from 2021 suggesting a slight decline in the prevalence of harmful drinking in the adult population.
Each year, 6-7 thousand people die as a result of alcohol consumption, of which 2 thousand deaths are directly attributable to alcohol (e.g. deaths from alcoholic liver disease or alcohol intoxication). A further 600 cases a year are indirect deaths, i.e. deaths due to alcohol-related accidents or suicides. Injuries, traffic accidents and alcohol-related violence are also a burden on society and the health system. On average, alcohol addicts die 24 years earlier than the general population.
Approximately 30 thousand people are in contact with services and in treatment for alcohol addiction each year, of whom the largest part (approximately 27 thousand people) are in contact with psychiatric facilities (approximately 20 thousand in outpatient care, approximately 6 thousanf in inpatient care).
An estimated 13-15% of the population, equivalent to 1.3-1.5 million people, fall into the category of problematic use of psychoactive medicines, defined on the basis of the use of medicines for more than 6 weeks, subjective perception of overuse and/or obtaining medicines without a prescription. Sedatives and hypnotics are used problematically by an estimated 1.1 million people and opioid analgesics by 550 thousand people. Women are more likely to be concerned. Long-term trends are not available.
Misused psychoactive medicines are mainly obtained from the official health system, but also through family or the internet, but also appear on the illicit drug market.
In the long term, the quantities of benzodiazepines and barbiturates distributed to pharmacies are decreasing (calculated per million daily doses of medicines), while the quantities of Z-drugs, pregabalin and opioid analgesics distributed are increasing.
Approximately 40 people die each year as a result of overdose of psychoactive medicines, most often benzodiazepines. The category of opioids also includes overdoses on opioid analgesics (e.g. fentanyl, codeine, dihydrocodeine, hydromorphone, oxycodone). An additional 70 deaths due under the influence of psychoactive medicines are reported annually due to illness, accident or suicide. Between 150 and 200 people are annually admitted to hospitals for accidents under the influence of psychoactive medicines.
Approximately 3-4 thousand people a year are in treatment related to the use of psychoactive medicines use, most of them in outpatient treatment, including about 2 thousand cases related to sedatives and hypnotics. Long-term users of psychoactive medicines account for 5-6% of the total number of patients in outpatient addiction treatment.
Cannabis is the most commonly used illicit drug in the Czech Republic, while other illicit drugs are used in a much lesser extent. Among adolescents, the prevalence of experience with illicit drugs has been declining over the long term. Further declines are also confirmed by studies among adolescents in 2021.
Around a quarter to a third of adults report having used cannabis in their lifetime. Approximately 6-10% of adults report recent cannabis use (i.e. use in the last 12 months), corresponding to approximately 500-900 thousand people. Cannabis use is higher among men and in younger age groups.
The proportion of adults who use cannabis has been stable over the long term, but the proportion of cannabis users among young adults (up to 34 years of age) has been slightly increasing. About 5-7% of the adult population, an estimated 440-590 thousand people, used cannabis for self-treatment in the last year. An estimated 190-250 000 people have used cannabis exclusively for self-treatment, with the highest rates of self-treatment among people aged 65 and over. Ecstasy use has been reported by 4-6% of adults, hallucinogens use by 5-6% and methamphetamine and cocaine use by 2-3% of adults.
An estimated 45 thousand people are high-risk drug users, mostly users of methamphetamine (35 thousand) or opioids (10 thousand). The number of high-risk users has increased by about a quarter in the last ten years. An estimated 41 thousand people use drugs by injection.
HIV/AIDS prevalence in the Czech population and among injecting drug users has been on low level in long-term (5-7 cases per year). The incidence of HCV has been stable over the long term (approximately 300-500 cases per year), but it is the most prevalent infection among drug users and represents a burden on the health system.
Between 40 and 60 people die each year from an overdose of illicit drugs, and a further 150 cases of deaths associated to illicit drugs are reported annually due to illness, accident or suicide. Drug-related injuries and traffic accidents also represent a burden on society and the health system.
An estimated 14 thousand illicit drug users are treated annually in psychiatric outpatient clinics and approximately 5 thousand in inpatient facilities. Nearly 40 thousand drug users are in contact with low-threshold programmes each year. In the long term, there is an increase in the number of methamphetamine users. The average age of drug users in contact with addictology services is increasing, reaching 35 years among those in contact with low-threshold programmes.
Gambling in the last 12 months has been reported by 35-50% of adults, with lotteries being the most preferred game, which have long not been considered as gambling. After excluding lotteries, 13-20% of the adult population report gambling.
In the long term, there is a slight increase in the level of gambling in the adult population, both for lotteries and other games (technical games, casino games and betting). The proportion of males is several times higher compared to females, and the proportion of gamblers is also significantly higher among young adults (15-34 years).
In the long term, an estimated 150-250 thousand people have been identified at risk of developing gambling-related problems, with 80-100 thousand people falling into the high-risk category. The largest proportion of people at risk is among players of technical games and online betting. The estimated number of people at risk of problem gambling has been stable over the long term, but the number of people at high risk is increasing slightly.
Problem gambling leads to financial, family and work-related problems. The health consequences of problem gambling include a high incidence of psychiatric comorbidity. Compared to the general population, people at risk of problem gambling have significantly poorer mental health, including suicidal ideation and attempts.
Approximately 2-3 thousand people a year are in contact with gambling-related services, of which less than 1 thousand are in psychiatric care facilities. These are mainly men, who are treated for this problem 5 times more than women. The average age of gamblers in treatment is approximately 35 years. Most of those in treatment report problems with technical games (slot machines), but their proportion is decreasing. Significantly increasing proportion of people in treatment report problems related to online betting.
The excessive use of digital technologies affects a relatively large part of the population. On a typical working day, adults spend 130-150 minutes a day in average on the internet, and 160-180 minutes on weekend days.
An estimated 5% of the Czech population aged 15 and over, corresponding to approximately 445 thousand people, is at risk of digital addictions. An estimated 125 thousand people aged 15 and over fall into the high-risk category. The highest proportion of people at risk is in the 15-24 age group.
Approximately 15-25% of children and 10-15% of adolescents display signs of at-risk digital gaming, i.e. they spend 4 or more hours a day gaming. An estimated 5-13% of adolescents fall into the category of risk of gaming addiction. Excessive use of social media, i.e. spending 4 hours or more per day on social networks, is reported by 25-30% of children and 45-50% of adolescents. An estimated 7-30% of adolescents fall into the risk category of social media use.
The direct effects of excessive use of digital technologies include neglect of hygiene, eating and/or sleeping problems, fatigue, headaches, eye, back or other musculoskeletal pain. Long-term impacts include a decrease in physical activity, reduced social contacts and loss of friends, conflicts in personal relationships, neglect of leisure activities, lack of concentration and problems at work or school. Excessive use of digital technologies in adolescent clients has been linked to anxiety disorders, ADHD, depressive symptoms and suicidal ideation.
There are currently no treatment and counselling services in the Czech Republic directly targeted at clients at risk of digital addictions. Clients at risk of digital addictions are increasingly addressing to existing addictology services - the number of programmes working with clients at risk of digital addictions and the number of such clients has been rapidly growing over the long term. Digital addictions are increasingly encountered by services for children and adolescents (aged 10-18), particularly with respect to excessive online gaming and social media use. With few exceptions, clients with digital addiction are reported by outpatient services.
There are several online counselling sites in the Czech Republic that offer advice to clients on digital addictions and provide links to other services.
Prevalence of addictive behaviour in the adult population
- 17-23% of the population aged 15+ years, i.e. 1.5-2.1 million people, smoke cigarettes daily or almost daily
- 10% of people aged 15+ years, i.e. 800-980 thousand people, drink alcohol daily or almost daily
- 17-19% of the population, i.e. 1.5-1.7 million people, are classified as high-risk alcohol consumers, of which 9-10% (800-900 thousand people) fall into the category of harmful drinking
- 14-15% of adults, an estimated 1.3-1.5 million people, fall into the category of problematic use of psychoactive medicines
- 6-10% of people aged 15+, an estimated 500-900 thousand adults, have used cannabis in the last 12 months, and approximately 400 thousand adults are estimated to be at risk of developing problems related to cannabis use
- 5-7% of the adult population has used cannabis for self-treatment in the last 12 months, i.e. an estimated 400-600 thousand people
- 1% of adults have used ecstasy in the last 12 months, 2% hallucinogenic mushrooms, less than 1% methamphetamine (or amphetamines) and cocaine
- 44.9 thousand people are high-risk users of methamphetamine or opioids, including 34.7 thousand methamphetamine users, 5.3 thousand buprenorphine users, 3.1 thousand heroin users and 1.8 thousand users of other opioids
- 2-3% of the population aged 15 and over fall into the category of problem gambling (i.e. approximately 170-220 thousand people), including 90-120 thousand falling into the high-risk category
- 5-6% of people (375-510 thousand people) are at risk of digital addictions, including
- 1-2% (90-160 thousand people) falling into the high-risk category, most often in the 15-24 and 25-34 age groups
Table 1: Prevalence of risky forms of addictive behaviour in the Czech population aged 15+ years
The table is only available in attached PDF.
Prevalence of addictive behaviour among children and adolescents
- 10-11% of 13- to 16-year-old school students report regular or daily tobacco smoking
- 17% of 11-year-olds, 43% of 13-year-olds, 76% of 15-year-olds and 95% of 16-year-olds have drunk alcohol in their lifetime, with more than half reporting drinking alcohol in the last 30 days
- 39% of 16-year-olds report binge drinking (i.e. drinking 5 or more glasses of alcohol on one occasion) in the last 30 days, 12% once a week or more often
- 24% of 16-year-olds have used illicit drugs in the last 12 months, 23% have used cannabis, 3.5% sedatives without doctor´s prescription, 3.3% volatile substances, 2.6% ecstasy, 1.1% hallucinogenic mushrooms, 1.9% LSD or other hallucinogens and approximately 1% cocaine or methamphetamine
- 9-11% of adolescents have gambled for money in the last 12 months
- 15-25% of 11-15-year-olds and 10-15% of 15-19-year-olds report excessive digital gaming
- 25-30% of children and 45-50% of adolescents report excessive use of social media, with an estimated 7% of children and up to 30% of adolescents falling into the category of risk of addiction
Impacts of substance use
- 16-18 thousand deaths a year are caused by tobacco smoking
- 6-7 thousand deaths per year are caused by alcohol drinking, with alcohol being the main or only cause of death in about 2 thousand cases, of which alcohol intoxication accounts for 400-500 cases per year
- 64 people died in 2021 as a result of fatal overdoses, of which 54 were overdoses of illicit drugs or volatile substances, and 10 cases related to benzodiazepines
- 150 cases of deaths were identified as being influenced by illicit drugs and psychoactive medicines for causes other than overdose, most of them due to illness, accidents and suicide
- 7 new HIV diagnoses in 2021 were likely to be related to injecting drug use, another 9 people had a history of injecting drug use
- 800-1,100 cases of hepatitis C viral are reported annually, including 400-600 cases among people who inject drugs
- 14-15 thousand hospital admissions are reported annually for injury under the influence of addictive substances, including 13.5-14 thousand cases under the influence of alcohol, 210-290 under the influence of illicit drugs, 160-200 persons under the influence of psychoactive medicines and 10-15 persons under the influence of volatile substances
- 4,500 traffic accidents a year are caused by alcohol, 320 by other drugs
- more than 70% of persons at risk of problem gambling report anxiety-depressive disorder, 46% report suicidal ideations and 14% report a suicide attempt
- children and adolescents at risk of digital addiction are 2-6 times more likely to have neglected leisure activities, report sleep or eating problems, problems at school and impacts on time with friends and family.
Table 2: Cases of deaths related annually to substance use in the Czech population
The table is only available in attached PDF.
Network of services for clients with addictions
- 250-300 facilities provide specialised addictology services, including 55-60 low-threshold centres, 50 outreach programmes, 90-100 outpatient treatment programmes (including 10 programmes for children and adolescents), 10-15 detoxification units, 25-30 inpatient healthcare units, 15-20 therapeutic communities, 35-45 outpatient aftercare programmes (including 20-25 with sheltered housing) and 5-7 homes with special regime for substance users; 60 facilities report patients in opioid substitution treatment and an estimated 600-700 general practitioners provide opioid substitution treatment
- 1/2 of addictology services work with the target group of gamblers, more than 1/3 of services work with people at risk of digital addiction
- 43 centres provide tobacco dependence treatment in hospital outpatient clinics, around 200 outpatient doctors and around 300 specialist pharmacies offer counselling.
Table 3: Estimated number of people in contact with addictology services and in treatment in the Czech Republic
The table is only available in attached PDF.
Financing, market, crime
- CZK 2,457.7 million (€ 100.2 million) were spent on addiction policy, of which 53% was spent on law enforcement, 17% on harm reduction, 11% on drug treatment, 3% on prevention, 4% on aftercare, 7% on sobering-up stations and less than 1% on coordination, research and evaluation
- CZK 938.0 million (€ 35.5 million) was spent by health insurance companies on the treatment of substance users
- CZK 55 billion (€ 2,241 million) is the state revenue from excise duty on tobacco products, CZK 13 billion (€ 530 million) from excise duty on alcoholic beverages
- 23 billion cigarettes are consumed annually in the Czech Republic, corresponding to approximately 2,000 cigarettes per capita
- 166.7 litres of alcohol per capita are consumed annually, corresponding to 10 litres of pure alcohol per person
- CZK 40 billion (€ 1,630 million) were lost by players in gambling in the Czech Republic
- 14 thousand offences were committed under the influence of addictive substances (68% under the influence of alcohol and 32% under the influence of other drugs).
Table 4: Estimated social costs of addictive behaviour in the Czech Republic
The table is only available in attached PDF.