Policy framework for alcohol and other drugs and service response

Drug use in Australia

Health impacts

The health impacts associated with alcohol and other drug (AOD) use include hospitalisation, mental health conditions, physical injury, overdose and mortality. Tobacco, alcohol and illicit drug use together account for 16.5% of the burden of disease in Australia (AIHW 2019).

Social impacts

The social impacts of AOD use in Australia include involvement in criminal activity, engagement in risky behaviours, victimisation and road trauma. In 2016, 1 in 10 (9.9%) recent drinkers and 15.1% of people who had recently used illicit drugs had driven while intoxicated (AIHW 2017). In 2019, 1 in 5 (21%) Australians aged 14 and over were victims of an alcohol-related incident and 10.5% were victims of an illicit drug-related incident (AIHW 2020).

Economic impacts

The use and misuse of licit and illicit drugs imposes a heavy financial cost on the Australian community. In recent years, the separate costs of tobacco ($136.9 billion in 2015–16), opioid ($15.76 billion in 2015–16), methamphetamine (over $5 billion in 2013–14) and alcohol use ($14.35 billion in 2010) in Australia have been estimated, utilising different methodologies (Whetton et al. 2020; Whetton et al. 2019; Whetton et al. 2016; Manning, Smith & Mazerolle 2013).

Alcohol and tobacco are two of the most widely used drugs in Australia. The most recent 2019 National Drug Strategy Household Survey reported that of Australians aged 14 and over:

  • 77% drank alcohol in the previous 12 months and 14.0% were current smokers (AIHW 2020).
  • Around 1 in 6 (16.8%) drank at levels that increased the risk of alcohol-related harms over their lifetime (more than 2 standard drinks per day on average: NHMRC 2009), a decrease from 21% in 2001.
  • 25% of people drank at levels that put them at an increased risk of accident or injury (more than 4 standard drinks in a session: NHMRC 2009) at least monthly. This is a decrease from 26% in 2016 and 30% in 2001.

In 2019, illicit drug use was relatively common among Australians aged 14 and over (AIHW 2020):

  • 43% self-reported they had illicitly used a drug at some point in their life (including pharmaceuticals used for non‑medical purposes) and 16.4% had done so in the last 12 months.
  • Cannabis continued to be the most commonly used illicit drug with more than 1 in 3 (36%) having used it in their lifetime and 11.6% using it in the previous 12 months.
  • Ecstasy and cocaine were the second and third most common illicit drugs used in a lifetime (12.5% and 11.2%, respectively) and in the last 12 months (3.0% and 4.2%, respectively).

The National Drug Strategy

Australia has had a coordinated approach to dealing with alcohol and other drugs since 1985. The National Drug Strategy (NDS) 2017–2026 is the 7th and latest iteration of the cooperative strategy between the Australian Government, state and territory governments, and the non-government sector. The NDS provides a framework that identifies national priorities relating to alcohol, tobacco and other drugs, guides action by governments—in partnership with service providers and the community—and outlines a national commitment to harm minimisation through balanced adoption of effective demand, supply, and harm reduction strategies.

The objective of the NDS

The NDS has an overarching approach of harm minimisation and encompasses 3 pillars, each with specific objectives (NDSC 2017):

  • demand reduction: to prevent the uptake and/or delay the onset of use of alcohol, tobacco, and other drugs; reduce the misuse of alcohol, tobacco, and other drugs in the community; and support people to recover from dependence through evidence-informed treatment
  • supply reduction: to prevent, stop, disrupt, or otherwise reduce the production and supply of illegal drugs; and to control, manage, and/or regulate the availability of illegal drugs
  • harm reduction: to reduce the adverse health, social and economic consequences of the use of drugs for consumers, their families, and the wider community.

The collection of treatment services data, for example in the AODTS NMDS, forms part of the evidence base reinforcing harm reduction actions in the strategy, which include (NDSC 2017):

  • increasing access to pharmacotherapy treatment to reduce drug dependence and reduce the health, social, and economic harms to individuals and the community that arise from misuse of opioids
  • monitoring emerging drug issues to provide advice to the health, law enforcement, education, and social services sectors to inform individuals and the community regarding risky behaviours
  • developing and promoting culturally appropriate alcohol, tobacco, and other drug information and support resources for individuals, families, communities, and professionals in contact with people at increased risk of harm from alcohol, tobacco, and other drugs
  • providing opportunities for intervention among high-prevalence or high-risk groups and locations, including the implementation of settings-based approaches to modify risk behaviours
  • enhancing systems to facilitate greater diversion into health interventions from the criminal justice system, particularly for Aboriginal and Torres Strait Islander people, young people, and other at risk populations who may be experiencing disproportionate harm.

Alcohol and other drug treatment services

AOD treatment services provide support to people regarding their use of alcohol or drugs through a range of treatments. Treatment objectives can include reduction or cessation of substance use, as well as improving social and personal functioning. Treatment and assistance may also be provided to support the family and friends of people who have problems with alcohol or drug use. Treatment services include detoxification and rehabilitation, counselling, and pharmacotherapy, and are delivered in residential and non‑residential settings.

In Australia, publicly funded treatment services for AOD use are available in all states and territories. Most of these services are funded by state and territory governments, while some are funded by the Australian Government. Information on publicly funded AOD treatment services in Australia, clients, and drug treatment are collected through the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS). The AODTS NMDS is one of several NMDSs that collect data under the 2012 National Healthcare Agreement to inform policy and help improve service delivery (COAG 2012).

Other available data sources that support a more complete picture of AOD treatment in Australia include:


The AODTS NMDS

The AODTS NMDS contains information on treatment provided to clients by publicly funded AOD treatment services, including government and non-government organisations. Information on clients and treatment services are included in the AODTS NMDS when a treatment episode provided to a client is closed (see Glossary).

Information on the following types of treatment are reported:

  • assessment only
  • counselling
  • information and education
  • pharmacotherapy
  • rehabilitation
  • support and case management
  • withdrawal management (see Glossary).

The AODTS NMDS collects data about services provided to people who are seeking assistance for their own alcohol or drug use and those seeking assistance for someone else’s alcohol or drug use.

Client information is collected at the episode level in the AODTS NMDS. Further details on the estimation of client numbers and the imputation methodology can be found in the technical notes.

Data collected by treatment agencies are forwarded to the relevant state and territory health departments, who then extract required data according the specifications in the AODTS NMDS. Data are submitted to the AIHW annually for national collation and reporting.

Coverage and data quality

Although the AODTS NMDS collection covers the majority of publicly funded AOD treatment services, including government and non-government organisations, it is difficult to fully quantify the scope of AOD services in Australia.

People receive treatment for alcohol and other drug-related issues in a variety of settings not in scope for the AODTS NMDS. These include:

  • services provided by other not-for-profit organisations and private treatment agencies that do not receive public funding
  • alcohol and other drug treatment units in acute care or psychiatric hospitals that provide treatment only to admitted patients
  • prisons, correctional facilities and detention centres
  • primary health-care services, including general practitioner settings, community-based care, Indigenous Australian-specific primary health-care services and dedicated substance use services
  • health promotion services (for example, needle and syringe programs)
  • accommodation services (for example, halfway houses and sobering-up shelters) (Figure AODTS1).

In addition, agencies whose sole function is prescribing or providing dosing services for opioid pharmacotherapy are excluded from the AODTS NMDS. These data are captured in the AIHW’s National Opioid Pharmacotherapy Statistics Annual Data collection.

Figure AODTS1: Alcohol and other drug treatment and support services in Australia

The Venn diagram shows the scope of alcohol and other drug treatment and support services in Australia. They include specialised services (private, government, and not-for-profit), and other services (hospitals, prisons, primary health care services, accommodation and mental health services).

The Australian Government funds primary healthcare services and substance use services specifically for Indigenous Australians. These services may be in scope for the AODTS NMDS but the majority of the services currently do not report to the NMDS. These services previously reported via the Australian Government-funded Aboriginal and Torres Strait Islander substance use services, via the Online Services Report (OSR) data collection, however, the substance use services program was transferred to the Department of Prime Minister and Cabinet and then to the National Indigenous Australian Agency.

 

In 2019–20, 94% (1,258) of in-scope agencies submitted data to the AODTS NMDS. Overall, from 2018–19 to 2019–20, there was a decrease of 3 percentage points in the proportion of in-scope agencies that reported to the collection. For the 2014–15 and 2015–16 reporting periods, sector reforms and system issues in some jurisdictions affected the number of in‑scope agencies that reported. This led to an under-count of the number of closed treatment episodes reported for these years, so results, especially across reporting years, should be interpreted with caution.

Further details on scope, coverage and data quality are available from the AODTS NMDS Data Quality Statement.


References

See reference list.