BACKGROUND:
Alcohol consumption among university students is an important public health concern, as habits formed during studies may affect long-term health and professional behavior. This is particularly relevant for medical students, who are expected to promote healthy lifestyles in their future careers.

METHODS:
A cross-sectional study was conducted in April 2025 among 147 medical students (75 first-year and 72 sixth-year; 116 females). Data were collected through an anonymous online questionnaire based on the WHO AUDIT instrument, including information on demographics, academic stress, perceived health, social pressure, and family history of alcohol dependence. Statistical analysis was performed using SPSS 25.0, with Chi-square test, Fisher’s exact test, and Spearman’s correlation coefficient (p<0.05).

RESULTS:
Alcohol consumption was reported by 84.35% of students. First-year students most commonly consumed alcohol once a month or less, while sixth-year students more often drank 2–4 times per month or 2–3 times per week, without significant differences in frequency or quantity. The predominant pattern was consumption of 1–2 drinks per occasion. According to the AUDIT scale, 98% of students were classified as low-risk drinkers and 2% as risky drinkers. Daily academic stress was significantly more frequent among first-year students (37.33% vs 16.67%, p=0.0049) and showed a weak but significant correlation with heavy episodic drinking. Memory loss and alcohol-related injuries were more commonly reported by first-year students. Sixth-year students rated their physical and mental health more favorably. Social pressure was significantly associated with alcohol use, while family history was not.

CONCLUSIONS:
Аlthough alcohol consumption among medical students in Skopje is widespread, it remains low-risk. Increased vulnerability among first-year students underscores the need for early preventive interventions.