The Health Behaviour in School-aged Children (HBSC) survey is a WHO collaborative cross-national study that monitors the health behaviours, health outcomes and social environments of boys and girls aged 11, 13 and 15 years every four years. HBSC has collected international data on adolescent health, including alcohol consumption and drinking behaviours, for over 30 years, allowing prevalence to be compared across countries and over time. This report presents the latest trends in alcohol consumption and drinking behaviours among 15-year-olds across the WHO European Region, taken from the HBSC study. It highlights gender and socioeconomic inequalities across the Region. Trends have previously been reported separately, but this report brings together for the first time a broader range of HBSC data on adolescent alcohol consumption and drinking behaviours to review the latest evidence and highlight differences in alcohol use by gender, socioeconomic position and geographic subregion.