The recently published National Survey of Tobacco and Alcohol Use in the Czech Republic 2024 provides data that not only confirm the current state of psychoactive-substance use in our country, but, above all, underscore the need for systematic implementation of a harm-reduction approach in Czech addiction policy. The results show that traditional abstinence-only approaches, which focus exclusively on complete cessation of legal psychoactive-substance use, are insufficient. We must pragmatically and rationally accept that a significant portion of the population will continue to use tobacco, nicotine and alcohol. The key task, therefore, is to minimize the health and social risks associated with their use.
Positive Trends in Switching to Less Harmful Alternatives
Tobacco-related data bring optimistic news about a gradual shift from the most harmful forms of smoking to less risky alternatives. A decrease in the prevalence of conventional smoking by 2.2 percentage points to 22.4%, together with an increase in e-cigarette use to 13.9% (+2.8 pp), documents precisely the outcome predicted by a harm-reduction strategy: people are seeking less harmful ways to satisfy their nicotine dependence.
This trend gains further significance when considering overall nicotine use across all age groups. While 25.9% of respondents report daily nicotine use from various products, inclusion of occasional users brings the figure to about one-third of the population (33.8%). Particularly alarming, but also central for harm reduction, is the finding that in the 15–24 age group, 41.6% use nicotine daily, rising to nearly half of that cohort (49.8%) when occasional users are included. These figures illustrate the spread of nicotine dependence among young people, making the harm-reduction approach not only desirable but essential.
A key finding supporting harm reduction is that over one-third of e-cigarette users (35.9%) are former smokers of combustible cigarettes, an increase from 20.8% in 2023. Almost one-quarter of users (23.5%) cite quitting or reducing conventional cigarettes as their reason for vaping, while another 29.5% believe e-cigarettes are less harmful to health. This confirms that alternative tobacco products genuinely fulfill their intended role, rather than merely serving as a new gateway for non-smokers to nicotine.
Crucially, the switch to alternatives occurs predominantly among older age groups, most markedly in those aged 25–44 years (up 5.5 pp), and also in the 45–64 and 65+ brackets. More than half of e-cigarette users (61%) began vaping after age 25, indicating this is not a “gateway effect” leading youth into nicotine, but rather a transition of already dependent smokers to less harmful forms. This behavioral pattern aligns with the objective of harm-reduction strategies: to reduce damage among established users while minimizing risk to new users.
Also encouraging is increasing public awareness of relative harm among nicotine products. In 2023, over half of respondents (56.3%) saw no difference in harm between conventional cigarettes and alternatives; in 2024, that fell to 44.3%. Simultaneously, those who regard conventional cigarettes as the most harmful rose from 29.6% to 39.3%, reflecting improved health literacy.
NAUTA 2024 also documents growing diversification of nicotine products on the Czech market. Use of tobacco-free nicotine pouches rose to 4.9% of respondents (2.5% daily), with the highest uptake in the youngest group (15–24 years) at 15.4%. Heated tobacco products are used by 5.3% (3.6% daily), and smokeless tobacco by 4.8% (2.4% daily). Such diversification is important because different smokers may prefer different alternatives based on individual needs and preferences.
Stable Situation Demanding a Systematic Approach in Alcohol
In the alcohol domain, survey confirms a long-standing stable yet problematic situation requiring a comprehensive approach. Harmful alcohol consumption is reported by 7.4% of the population, and binge drinking by 14.8%. An average annual consumption of 7.1 liters of pure alcohol per person (8.7 liters excluding abstainers) places the Czech Republic among high-consumption countries, with significant public-health impacts.
Analysis of the alcohol-consumer pyramid reveals a troubling picture of risky drinking. The prevalence of problem drinkers is estimated at 6.3%, and high-risk drinkers at 12.0%. In total, 18.3% of the adult population faces increased health, social and economic risks from excessive alcohol consumption. This nearly one-fifth of adults constitutes the target group for harm-reduction interventions capable of substantially lowering the health and social burdens of problematic drinking.
Of concern is the low level of self-reflection among risky drinkers: only 2.1% recognize the need to reduce consumption, despite medical guidelines recommending reduction for 16.6% of respondents. This gap between objective need and subjective perception highlights insufficient health literacy and the necessity for more systematic interventions. Such an approach in alcohol policy involves not only treatment of dependence, but also support for controlled drinking, reduction in frequency and intensity of consumption, and minimization of high-risk situations.
Significantly, only 17.6% of respondents reported being asked about alcohol use by a physician, the lowest rate ever recorded, indicating poor implementation of screening and brief interventions in primary care. Brief interventions can reduce alcohol consumption among risk drinkers by 13–34% and represent one of the most effective public-health measures.
A newly included analysis of the most recent drinking episode offers insights into drinking contexts in the Czech population. The most common setting reported was an ordinary social gathering (43.7%), while celebrations accounted for one-third (32.8%). Average consumption was highest in entertainment settings (104.5 ml of pure alcohol), compared with 71.1 ml at ordinary gatherings. These contextual data are crucial for designing targeted interventions for high-risk environments.
Harm Reduction as a Rational, Evidence-Based Strategy
The survey confirms a link between risky alcohol use and smoking: 48.1% of harmful drinkers are smokers, underscoring the need for an integrated approach to both legal substances. Such comorbidity poses a major public-health challenge, as combined alcohol and tobacco use multiplies health risks and complicates treatment.
Harm reduction is not capitulation to addiction, but a pragmatic, evidence-based approach that recognizes complete abstinence is not always achievable or necessary for improved health and quality of life. It emphasizes minimizing adverse health, social and economic consequences of substance use, rather than substance use per se.
NAUTA 2024’s results clearly show that harm reduction works and should be more systematically integrated into Czech addiction policy. Positive tobacco trends, shifting from the most harmful forms of smoking to less risky alternatives, demonstrate that people can make rational health decisions if given less harmful options.
In alcohol policy, the situation is stable but demands a more systematic blend of structural measures and individual interventions. It is crucial to strengthen screening and brief interventions in primary care and to improve public health literacy.
Harm reduction is not an alternative to prevention, but its complement. While the ultimate goal remains minimizing psychoactive-substance use, we must pragmatically accept that not everyone will be able or willing to abstain completely. For those individuals, society must provide less harmful alternatives and support risk-reduction efforts.