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Alcohol is consumed widely in Australia. However, harmful levels of consumption are a major health issue, associated with increased risk of chronic disease, injury and premature death (AIHW 2014).
The harmful use of alcohol has both short-term and long-term health effects. In the short term, the effects are mainly related to injury of the drinker or others that the drinker's behaviour affected (Laslett, Room & Ferris 2011). With its ability to impair judgment and coordination, excessive drinking contributes to crime, violence, anti-social behaviours and accidents. Over the longer term, harmful drinking may result in alcohol dependence and other chronic conditions, such as high blood pressure, cardiovascular diseases, cirrhosis of the liver, types of dementia, mental health problems and various cancers (AIHW 2014).
In 2004–05, the cost to the Australian community of alcohol-related social problems such as crime, road accidents or lost workplace productivity, was estimated to be $15.3 billion (Collins & Lapsley 2008). In 2010, alcohol use was estimated to be responsible for 2.7% of the total burden of disease and injury in Australasia (IHME 2014).
The Ministerial Council on Drug Strategy recommended a number of strategies to reduce alcohol harms: demand reduction strategies to prevent the uptake of excessive alcohol consumption; supply reduction strategies to control and manage the supply of alcohol; and harm reduction strategies to reduce alcohol-related harm for individuals, families and communities (MCDS 2011).
In this chapter, information is presented on: changes to alcohol use over time; age and sex comparisons; type of alcohol consumed; measures undertaken to reduce consumption; and the health and harms associated with alcohol use. Results presented about the risks associated with alcohol intake are based on the 2009 Australian guidelines to reduce health risks from drinking alcohol and are reported against Guideline 1 (lifetime risk) and Guideline 2 (single occasion risk). See Box 4.1 for more details.
Please refer to Chapter 8 'Specific population groups' for information on alcohol use among: Indigenous people; pregnant women; people who identified as being homosexual/bisexual; people with mental health conditions; and geographical breakdowns.
All data presented in this chapter are available through the online alcohol tables.
Australian governments use a range of measures to minimise alcohol-related harm in the community, including legislation such as placing restrictions on the times and places that alcohol can be purchased, taxation on alcoholic products, regulating promotion and advertising, providing education and information, and supporting treatment programs (ANPHA 2014).
Alcohol-related harm to people of any age remains an issue of ongoing concern for the Australian community and a challenging area for public policy response by Australian governments at all levels. Governments have adopted a number of initiatives and strategies aimed at minimising the harmful effects of alcohol use in Australian society.
In Australia, the National Health and Medical Research Council (NHMRC) produces guidelines about alcohol use. The most recent version of these guidelines, Australian guidelines to reduce health risks from drinking alcohol, was released in 2009. These guidelines help Australians make an informed choice in reducing their health risks arising from drinking alcohol.
Strategies to minimise alcohol-related harm have been in place for a number of decades. Strategies and activities have focused on a variety of issues including intoxication, public safety and amenity, the health impacts of drinking and the availability of alcohol.
To complement the national policy framework, all states and territories have developed strategies and plans to address alcohol issues in their own jurisdictions. Recently, some state and territory governments have introduced initiatives aimed at reducing alcohol-related harm such as lock-outs and last drink laws.
State and territory regulators have also moved to address the risks of alcohol intake for adolescents. The principal regulatory mechanism for controlling the supply of alcohol in Australia is state and territory liquor licensing legislation, which establishes a minimum legal purchasing age for alcohol and dictate where, when and how alcohol may be sold (ANPHA 2014).
Between 1993 and 2007, the daily drinking rate for people aged 14 or older remained largely unchanged, at around 8% (Figure 4.1). However, in 2010, there was a significant fall compared to 2007, and in 2013, the proportion drinking daily again declined from 7.2% to 6.5%.
Figure 4.1: Alcohol drinking status, people aged 14 or older, 1991 to 2013 (per cent)
Source: Online Table 4.1.
Drinking status varied noticeably between males and females and different age groups. In particular:
Figure 4.2: Daily drinking, people aged 12 or older, by age, 2004 to 2013 (per cent)
Source: Online Table S4.14.
The Australian guidelines to reduce health risks from drinking alcohol aim to assist Australians with decisions about whether to drink alcohol and, if so, how much (See Box 4.1). Furthermore, under these guidelines, pregnant women and young people (aged under 18) are advised not to drink at all (NHMRC 2009).
The alcohol risk data in this section is reported against guideline 1 and guideline 2 (see NHMRC 2009 for more details).
Guideline 1: Reducing the risk of alcohol-related harm over a lifetime
Drinking no more than 2 standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.
Guideline 2: Reducing the risk of injury on a single occasion of drinking
Drinking no more than 4 standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.
Many drinkers consume alcohol responsibly; however, a substantial proportion of drinkers consume alcohol at a level that is considered to increase their risk of alcohol-related harm.
The consumption of alcohol in quantities that placed Australians at risk of an alcohol-related disease, illness or injury had remained fairly stable between 2001 and 2010. However, in 2013 there were some changes to peoples' drinking patterns (Figure 4.3). Between 2010 and 2013 for those aged 14 and over:
Figure 4.3: Lifetime and single occasion risky (at least monthly) drinking, people aged 14 or older, 2001 to 2013 (per cent)
Source: Online Table 4.4.
Age is an important determinant of health risks related to alcohol. Younger people experience harm from alcohol-related accident or injury disproportionately. For example, over half of all serious alcohol-related road injuries occur among those aged 15–24, while harm from alcohol-related disease is more evident among older people (NHMRC 2009).
In 2013, most people in Australia aged 12 and older drank at levels that did not place them at risk of harm over their lifetime—they either drank at low-risk levels (58%) or abstained (24%) (Online Table 4.5). A similar proportion of adults (about 1 in 5), in all age groups, drank at levels that exceeded the lifetime risk guidelines. Some drinkers though were more likely than others to drink alcohol in a way that increased their lifetime risk of alcohol-related harm. For example:
Among people in Australia aged 12 and older in 2013, more than 1 in 3 (37%) had consumed 5 or more standard drinks on a single occasion at least once in the past year, therefore exceeding the NHMRC single occasion risk guidelines (Figure 4.4). About 1 in 4 (26%) did so at least once a month, and 1 in 7 (13.8%) did so at least once a week. Risky alcohol intake differed by sex, for example:
The NHMRC drinking guidelines also recommend that for anyone aged under 18, not drinking alcohol is the safest option. Alcohol use among adolescents in Australia was prevalent in 2013, with 15.4% of males and 11.3% of females aged 12–17 exceeding the adult guidelines for single occasion risk. However, these proportions were lower than in 2010, when 19.9% of males and 19.7% of females aged 12–17 exceeded these guidelines.
Although people aged 70 and over were the most likely to drink daily, they were the least likely to consumed alcohol in risky quantities with only 1 in 10 (9.3%) consuming 5 or more standard drinks on a single occasion in the past year. People aged 18–24 were more likely than any other age group to exceed the single occasion risk guidelines, although people in their 40s and 50s were most likely to consume 5 or more standard drinks on a single drinking occasion more regularly, with around 6% doing so on most days or every day. In comparison, people aged 18–24 were most likely to exceed single occasion risk guidelines weekly or monthly.
Figure 4.4: People aged 12 or older at risk of injury on a single occasion of drinking(a), by age, 2013 (per cent)
Source: Online Table 4.6.
Almost 2 in 5 (38%) people in Australia drank at levels considered low risk of harm, that is from any single drinking occasion (at least once a year) and over a lifetime (Online Table 4.7). In the previous 12 months, males were far more likely than females (24% compared with 8.8%) to have shown drinking patterns that simultaneously placed them at risk of lifetime harm and single occasion harm at least once a year.
Drinking alcohol in adolescence can be harmful to young people's physical and psychosocial development. Alcohol-related damage to the brain can be responsible for memory problems, an inability to learn, problems with verbal skills, alcohol dependence and depression (MCDS 2011). There are various strategies and initiatives in place that focus on raising awareness of the short- and long-term impacts of risky drinking among young people which will, over time, contribute to the development of a more responsible drinking culture within Australian society (DoH 2013).
As discussed earlier in the chapter, the proportion of the population abstaining from alcohol rose between 2010 and 2013 with the increase in abstainers most evident among people aged 12–17 (the proportion choosing to abstain increased from 64% to 72%) (Online Table 4.8). Some age groups also reduced their intake of alcohol as the proportion drinking at risky levels between 2010 and 2013 declined, while for other age groups, particularly people aged over 40, there were no changes in the proportion exceeding the lifetime and single occasion risk guidelines.
Between 2001 and 2010 people in their late teens and 20s were more likely to consume more than 2 standard drinks per day on average than other age groups (Figure 4.5). Males aged 25–29 were most likely to exceed guidelines for lifetime risk (32%) (Online Table 4.5); however, as the proportion of those aged 18–29 consuming alcohol at this level declined in 2013, their level of risky drinking became more similar to that of older age groups. Considering males and females together, people in their 40s are now more likely to drink at lifetime risky levels than any other age group. There has been little change in lifetime risky drinking patterns of people aged 40–69 since 2004.
Figure 4.5: Proportion of people exceeding the lifetime risk(a) guidelines, people aged 12 or older, by age, 2001 to 2013 (per cent)
Source: Online Table 4.8.
The reduction in people exceeding the single occasion risk guideline (at least monthly) appears to be mainly due to the proportion of people under 40 reducing their alcohol use (Figure 4.6). While people aged 40 or older were generally less likely than people in younger age groups to drink alcohol in these quantities (5 or more drinks on a single occasion at least once a month), there has been little change in the drinking patterns of people in these age groups over the past decade.
Figure 4.6: Proportion of people exceeding the single occasion risk(a) guidelines (at least monthly), people aged 12 or older, by age, 2001 to 2013 (per cent)
While it's important to understand the proportion of the population drinking at risky levels according to the NHRMC 2009 alcohol guidelines, it's also important to explore drinking patterns among these drinkers further and examine those who are drinking well in excess of the guidelines. In 2013:
Guideline 3 of the NHMRC alcohol guidelines is based on an assessment of the potential harms of alcohol for young people. Epidemiological research has shown that alcohol may adversely affect brain development and lead to alcohol-related problems in later life (NHMRC 2009). Therefore the guidelines state that young people aged under 15 should not drink at all as they are at the greatest risk of harm, and that for those aged 15–17, the safest option is to delay the initiation of drinking as long as possible (NHMRC 2009). Despite these guidelines, most people try alcohol during adolescence. However, the age at which people first tried alcohol has been increasing over time. More specifically:
Beverage preferences differ by sex and by age. Consistent with findings in 2010, male drinkers most commonly consumed regular strength beer and female drinkers mainly consumed bottled wine in 2013 (Online Table 4.11). The exceptions to these preferences were for people aged 12–17 and females aged 18–24 who preferred to consume pre-mixed spirits. There were no significant changes in drink preferences among drinkers overall between 2010 and 2013.
Underage drinkers (those aged 12–17) were more likely to consume alcohol at private parties (62%) (Online Table 4.13) and mainly sourced their alcohol from a friend (45%) (Online Table 4.12). Adults on the other hand tended to mainly drink in their own home (80%) and buy alcohol themselves (86%).
Nearly half (47%) of people (aged 12 or older) had their first glass of alcohol supplied by a friend and almost one-quarter (24%) were supplied their first glass by their parent (Online Table 4.14). Younger people were slightly more likely to say their parents supplied their first alcoholic drink while older people (aged 40 or older) were more likely to report buying their first serve themselves. This remained stable in 2013.
While almost 4 in 10 (37%) people aged 14 and over drink at least once a week (Online Table 4.2), a substantial number have taken action to reduce their drinking. In 2013, 49% of recent drinkers (those who had consumed at least 1 full drink of alcohol in the last 12 months) had taken action/s to reduce their consumption (Online Table 4.15). The most common intake reduction actions were to reduce the amount of alcohol consumed at one time (30%) and/or to reduce the number of drinking occasions (29%). Lifetime risky drinkers were slightly more likely to have made changes to their drinking behaviour than low-risk drinkers.
Some age groups were more likely than others to take actions to reduce their use. Among lifetime risky drinkers:
Figure 4.7: Reduction in alcohol consumption, lifetime risky drinkers(a) aged 12 or older, by age, 2013 (per cent)
Note: Base is lifetime risky drinkers.
Source: Online Table 4.29.
The main reason drinkers changed their drinking behaviour in 2013 was for health reasons (50%), followed by lifestyle reasons (37%). Lifetime risky drinkers were more likely to reduce their alcohol intake due to financial reasons than low-risk drinkers (16.4% for lifetime risky drinkers compared with 10.3% for low risk) (Online Table 4.16). Drinkers were less likely to be motivated by social reasons (decreasing from 32% in 2010 to 28% in 2013) and drink driving regulations (declined from 18.9% to 13.2%), particularly those drinkers aged 40 or older (Online Table 4.30). Drinkers aged 25–29 were considerably more likely to be motivated by financial reasons in 2013 (from 18.4% in 2010 to 31% in 2013).
The excessive intake of alcohol not only affects the drinkers' health by putting them at risk of an alcohol-related disease, illness or injury, but also affects other people around them. Results from the 2013 NDSHS showed that risky drinkers were more likely to:
Risky drinkers were less likely to be aware of the number of standard drinks an adult could drink before putting their health at risk—55% of male lifetime risky drinkers (Online Table 4.18) and 26% of female lifetime risky drinkers (Online Table 4.19) thought they could consume 3 or more standard drinks per day without adversely affecting their health (compared with 22% and 5.8% of low-risk drinkers). The majority of single occasion risky drinkers also thought they could consume 5 or more standard drinks in a 6-hour period before putting their health at risk (Online tables 4.20 and 4.21) and male risky drinkers were more likely to believe this than female risky drinkers (79% and 53% respectively).
Compared to 2010, a higher proportion of males thought that no amount of alcohol was safe to drink without putting their health at risk over a lifetime, and a higher proportion correctly reported that 1–2 standard drinks could be consumed every day. Overall, there was little change in females' perception of the number of standard drinks they thought they could safely consume on a single occasion, but a higher proportion of female risky drinkers thought they could consume 7 or more standard drinks without putting their health at risk (from 22% to 27%).
Much of the alcohol-related disease burden arises from unintentional and intentional injuries, including those due to road traffic accidents, violence and suicide (WHO 2011).
An objective of the NDS is to minimise the harmful effects on the population of both licit and illicit drugs. The NDSHS contributes to this by exploring and reporting on the experiences of drug-related incidents and harm for Australians.
In 2013, 1 in 5 (21%) recent drinkers aged 14 or older put themselves or others at risk of harm while under the influence of alcohol in the previous 12 months (Online Table 4.24). Driving a motor vehicle was the most likely risky activity undertaken while under the influence of alcohol (12.2% of recent drinkers). Between 2010 and 2013, there was a drop in the proportion of the population who went to work while under the influence (from 5.0% to 4.2%) and who verbally abused someone (from 5.7% to 4.0%) (Figure 4.8). Risky drinkers were also more likely to report loss of memory after drinking at least once in the last 12 months than low-risk drinkers (55% compared with 16%) (Online Table 4.17).
Figure 4.8: Victims and perpetrators of alcohol-related harm, recent drinkers aged 14 or older, 2010 and 2013 (per cent)
Note: Base is recent drinkers.
Source: Online tables 4.24 and 4.25.
Respondents were asked if they had been verbally or physically abused, or put in fear, in the past 12 months, by persons affected or under the influence of alcohol. More than 1 in 4 (26%) Australians aged 14 and over (equivalent to 5 million people) had been a victim of an alcohol-related incident in 2013 (Online Table 4.25). Most of these incidents involved verbal abuse (22%), although this proportion declined from 2010 (from 24% to 22%). While there was no change in the proportion of people experiencing physical abuse between 2010 and 2013, the number of people who were physically abused rose from 1.5 million to 1.7 million.
Certain groups were also more likely to have undergone alcohol-related incidents than others. For example:
Females were more likely than males to report their abuser being their current or former spouse or partner, while males were more likely to report their abuser being a stranger (Online Table 4.27).
Of people who had been physically abused by someone under the influence of alcohol, bruising or abrasions was the most frequent injury sustained, and 8.3% of all injuries were serious enough to require hospital admission (Online Table 4.28).
Figure 4.9: Victims of alcohol-related incidents in the previous 12 months, people aged 14 or older, by single occasion risk, 2010 and 2013 (per cent)
Source: Online Table 4.22.