OBJECTIVE:To examine trends in the prevalence of monthly alcohol use and lifetime drunkenness among 15 year olds in 20 European countries, the Russian Federation, Israel, the United States of America, and Canada. METHODS:Alcohol use prevalence and drunkenness were assessed in the Health Behavior in School-aged Children Survey conducted in each country in 1998, 2002, and 2006. Trends were determined using the Cochran-Mantel-Haenszel test for trends. RESULTS:Average monthly alcohol use across all countries declined from 45.3% to 43.6% and drunkenness declined from 37.2% to 34.8. There was substantial variability across countries, with decreases in some countries and increases or no change in use or drunkenness in others. The overall decline was greater among boys, from 41.2% to 36.7% than among girls, 33.3% to 31.9%. In most of the countries where drinking or drunkenness increased, it was due mainly to increases among girls. CONCLUSIONS:Trends in alcohol use and drunkenness varied by country. Drinking and drunkenness remained higher among boys than girls, but the gap between boys and girls declined and girls appear to be catching up with boys in some countries.