BACKGROUND European School Survey Project on Alcohol and Other Drugs (ESPAD), the largest international research project, was conducted for the first time in Serbia in 2008. OBJECTIVE The objective was to analyze data obtained by ESPAD research on alcohol use among secondary school first grade students, and particularly the difference in the use of alcohol by gender, type of school students attend, their place of residence and the territory among secondary school students in Serbia in 2008. METHODS Attitudes and practice related to alcohol use of 6,553 secondary school first grade students were analyzed. A standardized, internationally approved questionnaire, structured and designed for self-filling was used on a stratified, one-stage sample of students. The data received from the ESPAD research were processed by X2 test to test the significance of differences between the observed characteristics, with the conclusion level of p<0.01. RESULTS Over three-quarters of students can easily buy beer or wine. More than one half can buy spirits and alcopops. 89.1% of students drank alcoholic beverages at least once in a lifetime and 78.2% in the last year. At least once in a lifetime 42.2% of students were drunk and 29.7% in the last year. At least once in the last month 32.0% of students had five or more drinks in a row. Boys consumed alcohol more frequently and got drunk more often than girls (p<0.01). CONCLUSIONS This research emphasizes the need for creating a prevention of alcohol use and alcohol abuse program among adolescents and more consistent application of the existing regulations aiming to decrease alcohol use among adolescents in Serbia.