Alcohol, tobacco & other drugs in Australia

The consumption of alcohol is widespread within Australia and associated with many social and cultural activities. Provided compliance with certain conditions, consuming and selling alcohol is legal in Australia and it is widely accepted. When consumed, alcohol produces a number of central nervous system depressant effects.

Alcohol concentration varies considerably with the type of drink. In Australia, beer contains 0.9–6% alcohol, wine contains 12–14%, fortified wines such as sherry and port contain around 18–20%, and spirits such as scotch, rum, bourbon and vodka contain 40–50% (NSW Ministry of Health 2017).

Key findings

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Availability

Data about the volume of alcohol available for consumption are collated by the Australian Bureau of Statistics (ABS) from information about import clearance, excise and domestic alcohol sales (ABS 2019a).

• In 2017–18, there were 191.2 million litres of pure alcohol available for consumption through alcoholic beverages in Australia, an increase from 187.6 million litres available in 2016–17 (Figure ALCOHOL1). 
• The volume of pure alcohol available for consumption in the form of beer increased by 2.5%, and spirits and ready to drink (RTD) (pre-mixed beverages) by 7.0% between 2016–17 and 2017–18. The volume of pure alcohol available for consumption in the form of wine decreased by 0.2% and cider by 9.0% during this period.
• Beer continues to lead the alcohol supply, contributing to 39.0% of all pure alcohol available for consumption in 2017–18, followed by wine (38.6%), spirits and RTDs (19.9%) and cider (2.5%) (Table S2.3).
• There were 9.51 litres of pure alcohol available for consumption per person aged 15 years and over in 2017–18. However, over the last decade, there was a decline of around 1.1% per year in the overall per capita trend (Figure ALCOHOL1).
• Australia was above the OECD average for litres per capita of alcohol consumed by people aged 15 and over, at 9.5 compared with 8.7 litres per capita in 2020 (OECD 2021).
• As the standard drink consists of 12.5mls of pure alcohol, the apparent consumption of alcohol in 2017–18 is equivalent to an average of 2.72 standard drinks per day per consumer of alcohol aged 15 and over. This is similar to the 2.70 standard drinks observed in 2016–17 (ABS 2019a).
• On average, Australian households spend $32 on alcoholic beverages per week and this has remained stable between 2009–10 and 2015–16 (ABS 2017) (Table S2.4).

Over the past 50 years, levels of apparent consumption of different alcoholic beverages have changed substantially. In particular, over the period 1967–68 to 2017–18:

• The proportion of pure alcohol available for consumption in the form of beer has decreased considerably, from 73.5% to 39.0%.
• Wine consumption as a proportion of total pure alcohol consumption has increased from 14.4% to 38.6%.
• Spirits (including RTDs) have also increased from 12.2% to 19.9% (ABS 2019a).

Figure ALCOHOL1: Apparent consumption of pure alcohol available for consumption, by alcohol type, year ended 30 June 1961 to 2018 (litres per capita and total volume)

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Consumption

The majority of Australians aged 14 and older have consumed alcohol in their lifetime. The 2019 National Drug Strategy Household Survey (NDSHS) found that:

• Of the population aged 14 and over, around three-quarters (77%) had consumed a full serve of alcohol in the previous 12 months, and 23% had not consumed alcohol (Figure ALCOHOL2; Table S2.25).
• The proportion of the population aged 14 and over who consumed alcohol daily declined significantly between 2016 (6.0%) and 2019 (5.4%) (Table S2.25).
• The proportion of ex‑drinkers increased significantly from 7.6% in 2016 to 8.9% in 2019 (Table S2.25).
• Alcohol was the only drug where approval of regular use by an adult (45%) was higher than disapproval (21%) (AIHW 2020).

Figure ALCOHOL2: Alcohol drinking status, people aged 14 and over, 2001 to 2019 (per cent)

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These findings are consistent with the National Health Survey (NHS) which found that in 2017–18 among Australians aged 18 and over, 79% had consumed alcohol in the past year (ABS 2018b). A further 8.5% had consumed alcohol 12 or more months ago, and 11.6% had never consumed alcohol (ABS 2018b) (Table S2.27).

Lifetime risk

Many drinkers consume alcohol responsibly; however, a substantial proportion of drinkers consume alcohol at a level that exceeds that recommended by the NHMRC and in doing so, increase their risk of alcohol-related harm (see Box ALCOHOL1).

There has been a decline in the proportion of Australians exceeding the guidelines for lifetime risk by consuming more than 2 standard drinks per day, on average (Figure ALCOHOL3). The 2019 NDSHS found that:

• The proportion of people aged 14 and older exceeding lifetime risk guidelines declined from 21% in 2001 to 16.8% in 2019. However, there has been little change since 2016 (17.2%) (Table S2.28).
• Of people aged 14 and over, males are far more likely than females to drink at risky levels—about 1 in 4 (24%) males and 1 in 10 (9.4%) females exceeded the lifetime risk guidelines (AIHW 2020). 

Similarly, after adjusting for age, the NHS reported that in 2017–18, 16.0% of adults aged 18 and over exceeded the lifetime risk guideline, a decrease from 17.3% in 2014–15 and 19.4% in 2011–12 (Table S2.26). A higher proportion of males than females exceeded the lifetime risk guidelines (23.7% compared with 8.8%) (Table S2.27).

Single occasion risk

There are a considerable number of Australians who report consuming alcohol in excess of the single occasion risk guidelines—that is, more than 4 standard drinks on any one occasion. Specifically, 2019 NDSHS findings showed that:

• 1 in 4 (25%) people aged 14 and over drank at a risky level on a single occasion at least monthly, a similar proportion to 2016 (26%) (Table S2.28).
• As with lifetime risk, a higher proportion of males (33%) than females (16.6%) exceeded the single occasion risk guideline (AIHW 2020).
• While people aged 18–24 (41%) and 25–29 (36%) were most likely to exceed the single occasion risk guideline in 2019, there were significant increases in the proportions for people aged 50–59 (27%, up from 25% in 2016) and 70 and over (8.8%, up from 7.2% in 2016). Conversely, there was a significant decrease in the proportion of people aged 30–39 who exceeded the single occasion risk guideline in 2019 (28%, compared with 31% in 2016) (Table S3.35).

The 2017–18 NHS results reported about 2 in 5 (42.1%) adults aged 18 and older consumed more than 4 standard drinks on a single occasion at least once in the past year, exceeding the single occasion risk guidelines (ABS 2018b). Adult males (54.2%) were more likely than females (30.5%) to exceed the single occasion risk guideline in the last 12 months (Table S2.29).

Figure ALCOHOL3: Abstainers, lifetime risk or single occasion risk (at least monthly), people aged 14 and over, by age and sex, 2007 to 2019 (per cent)

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Geographic trends

As with the national trends for the 2019 NDSHS, there were no significant differences in the proportion of people exceeding the lifetime and single occasion risk guidelines across jurisdictions between 2016 and 2019. However, the proportions reported across jurisdictions in 2019 were lower than those reported in 2007 (AIHW 2020). The proportion of ex‑drinkers increased significantly between 2016 and 2019 in New South Wales (from 7.2% to 9.3%), Victoria (from 7.0% to 8.8%) and South Australia (from 6.6% to 8.5%) (AIHW 2020).

In general, people living in Regional and Remote areas of Australia are more likely than people in Major cities to exceed risk guidelines.

• The 2019 NDSHS findings showed that people aged 14 or over living in Remote and very remote areas of Australia are about 1.5 times as likely as people living in Major cities to exceed lifetime risk guidelines (26% compared with 15.6%) and the single occasion risk guidelines (at least monthly) (38% compared with 24%) (Figure ALCOHOL4; Table S2.12). These findings were still apparent after adjusting for differences in age (AIHW 2020).
• The 2017–18 NHS results showed that adults (aged 18 or older) in Outer regional and Remote areas were 1.7 times as likely to exceed lifetime risk guidelines as those in Major cities (24.4% and 14.7%, respectively) (Table S2.26; age-standardised proportions).

Figure ALCOHOL4: Exceeded lifetime risk or single occasion risk (at least monthly) guidelines, by remoteness area or socioeconomic area, people aged 14 and over, 2010 to 2019 (per cent)

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The National Wastewater Drug Monitoring Program (NWDMP) measures the presence of substances in sewerage treatment plants across Australia. Alcohol is typically one of the most commonly detected substances monitored by the program. Since the beginning of the Program, the estimated population-weighted average consumption of alcohol has remained relatively steady, averaging out short-term fluctuations (ACIC 2021b).

Data from Report 13 of the NWDMP showed that nationally:

• Estimated population-weighted average alcohol consumption increased in capital cities and decreased in regional areas between August and December 2020.
• The estimated population-weighted average consumption of alcohol was higher in regional areas than in capital cities (ACIC 2021b).

From August 2016 to August 2020, the estimated population-weighted average alcohol consumption in capital cities has decreased overall and remained relatively stable in regional areas (ACIC 2021a; Figure ALCOHOL5).

For state and territory data, see the National Wastewater Drug Monitoring Program reports.

Figure ALCOHOL5: Estimated consumption of alcohol in Australia based on detections in wastewater, 2016 to 2020

(a) “Average consumption” refers to estimated population-weighted average consumption.

Note: Data are from 56 wastewater treatment sites, covering approximately 56% of the Australian population in 2020.

Source: AIHW. Adapted from NWDMP Report 12.

Poly drug use

Poly drug use is defined as the use of more than 1 illicit drug or licit drug in the previous 12 months. In 2019, the NDSHS showed more than 1 in 4 recent risky drinkers reported recent use of cannabis (27% for lifetime risky drinkers and 28% for single occasion risky drinkers). Around 1 in 5 reported that they were also daily smokers (21% for lifetime risky drinkers and 18.7% for single occasion risky drinkers) (Table S2.68).

Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System for Alcohol and Other Drug Misuse and Overdose. Data for 2020 are currently available for New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory. Data are presented for 4 snapshot months per year, specifically March, June, September and December. Please see the data quality statement for further information.

In 2020, the proportion of alcohol intoxication-related ambulance attendances where multiple drugs were consumed was low, ranging from 2.5% of attendances in the Australian Capital Territory to 4.7% of attendances in Victoria and Tasmania (Table S2.81).

Harms

Alcohol is absorbed rapidly in the bloodstream and affects the brain within about 5 minutes, though this may vary from person to person depending on body mass and general state of health (NSW Ministry of Health 2017). Short-term effects of alcohol such as a sense of relaxation and reduced inhibitions, may add to the appeal of its consumption. However, when consumed in excess, alcohol can also produce unpleasant effects such as nausea and vomiting and may influence people to engage in harmful behaviour (Table ALCOHOL1).

Source: NSW Ministry of Health (2017).

Burden of disease and injury

The Australian Burden of Disease Study 2018, found that alcohol use was the fifth highest risk factor contributing to the burden of disease in Australia, and was  responsible for 4.5% of the total burden of disease and injury (AIHW 2021b (Table S2.62). The age-standardised rate of total attributable burden due to alcohol use decreased from 9.5 DALY per 1,000 population to 8.5 in 2018 (a 10.5% decline from 2003 to 2018).

Alcohol use contributed to a number of diseases and injuries including:

• 100% of the burden due to alcohol use disorders
• 40% of the burden due to liver cancer
• 25% of the burden due to road traffic injuries involving motor vehicle occupants
• 19.2% of the burden due to chronic liver disease
• 14.2% of the burden due to suicide and self-inflicted injuries (AIHW 2021b) (Table S2.63).

The 2019 NDSHS reported that 1.2% of recent drinkers were injured while under the influence of alcohol and required medical attention while less than 1% (0.4%) required admission to hospital for their injuries. Less than 1.0% of recent drinkers required medical attention (0.3%) or hospitalisation (0.2%) because they were intoxicated (AIHW 2020).

This risk increased for people who consumed alcohol at risky quantities. Specifically, 3.0% of people that exceeded lifetime risk guidelines required medical attention due to injuries sustained while drinking or due to intoxication, compared with less than 1% (0.5%) for low risk drinkers. Further, 4.9% of people who consumed 11 or more standard drinks at least monthly, required medical attention for their injuries (Table S2.64; Figure ALCOHOL6).

Figure ALCOHOL6: People who have been injured or intoxicated and required medical attention while under the influence of alcohol, recent drinkers aged 14 and over, by alcohol risk, 2019 (per cent)

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Ambulance attendances

Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System for Alcohol and Other Drug Misuse and Overdose.The highest number and rate of ambulance attendances continues to be alcohol intoxication-related (tables 12 and S2.81).

In 2020, for alcohol intoxication-related ambulance attendances:

• Rates of attendances ranged from 143.3 per 100,000 population in New South Wales to 198.9 per 100,000 population in Queensland.
• The majority of attendances were for males, ranging from 57% of attendances in the Australian Capital Territory to 62% in New South Wales.
• The median age of patients for alcohol intoxication-related attendances ranged from 38 years in Tasmania to 43 years in New South Wales (Table S2.81).

The characteristics of alcohol intoxication-related ambulance attendances varied by region. In 2020:

• Higher rates of attendances were reported in regional areas than in metropolitan areas in New South Wales (157.1 per 100,000 population and 136.4, respectively), Victoria (182.4 per 100,000 population and 145.5, respectively) and Queensland (237.3 per 100,000 population and 154.8, respectively).
• In contrast, Tasmania reported higher metropolitan rates of attendance (201.7 per 100,000 population metropolitan and 96.9 in regional areas).
• Similar proportions of alcohol intoxication-related attendances were transported to hospital in metropolitan and regional areas for New South Wales, Victoria and Queensland, ranging from 79% to 83% of attendances.
• In Tasmania, more metropolitan attendances were transported to hospital than in regional areas (81% and 74%, respectively).
• The Australian Capital Territory (metropolitan only) reported that 70% of alcohol intoxication-related attendances were transported to hospital (Table S2.81).

Hospitalisations

Drug-related hospitalisations are defined as hospitalisations with a principal diagnosis relating to a substance use disorder or direct harm relating to use of selected substances (AIHW 2018).

AIHW analysis of the National Hospital Morbidity Database showed that alcohol accounted for over 1 in 2 (53%) drug-related hospitalisations in 2019–20 (Table S1.8a). Alcohol has remained the most common drug recorded in drug-related hospitalisations across the 5 years to 2019–20.

The number and rate of alcohol-related hospitalisations increased between 2015–16 (68,236 hospitalisations, or 284.5 per 100,00 population) and 2018–19 (75,765, or 301 per 100,000), then declined in 2019–20 (74,511, or 291.5 per 100,000) (Table S1.8b).

In 2019–20, almost 3 in 4 (71%) alcohol-related hospitalisations occurred in Major cities. Previous analysis by the AIHW indicates that the relative proportions of hospitalisations by drug type were different in each remoteness area with a higher proportion of drug-related hospitalisations for alcohol (as opposed to other drugs) in Remote and very remote areas of Australia than in Major cities and Regional areas (AIHW 2019). In 2019–20, there were 696.7 alcohol-related hospitalisations per 100,000 population in Remote and very remote areas (3,419 hospitalisations) (Table S1.8c).

Deaths

Alcohol-induced deaths are defined as those that can be directly attributable to alcohol use (that is, where an alcohol-related condition is recorded as the underlying cause of death), as determined by toxicology and pathology reports (for example, alcoholic liver cirrhosis or alcohol poisoning). Alcohol-related deaths include deaths directly attributable to alcohol use and deaths where alcohol was listed as an associated cause of death (for example, a motor vehicle accident where a person recorded a high blood alcohol concentration) (ABS 2018a). See also Health impacts: Deaths due to harmful alcohol consumption.

Alcohol-induced deaths are defined as those that can be directly attributable to alcohol use (that is,  where an alcohol-related condition is recorded as the underlying cause of death), as determined by toxicology and pathology reports (for example, alcoholic liver cirrhosis or alcohol poisoning). Alcohol-related deaths include deaths directly attributable to alcohol use and deaths where alcohol was listed as an associated cause of death (for example, a motor vehicle accident where a person recorded a high blood alcohol concentration) (ABS 2018a). See also Health impacts: Deaths due to harmful alcohol consumption.

In 2020, ABS Causes of Death reported 1,452 alcohol-induced deaths registered (1,056 males and 396 females):

• The alcohol-induced death rate for males was 2.8 times higher than females (7.7 per 100,000 population for males, compared with 2.8 deaths per 100,000 population for females).
• The highest age-specific rates were for older people­—14.6 per 100,000 population for those aged 55–64 years and the lowest rates were for those aged 15–34 (0.5 per 100,000 population).
• For both males and females, the highest age-specific death rate was in those aged 55–64y ears (22.4 per 100,000 population for males and 7.1 per 100,000 for females (ABS 2021).

Australian Institute of Health and Welfare (AIHW) analysis of the AIHW National Mortality Database showed that of the 1,317 alcohol-induced deaths registered in 2019, the most common cause of death was liver disease, followed by mental and behavioural disorders due to psychoactive substance use. Mental and behavioural conditions due to psychoactive substance use was also the most common contributor to alcohol-related deaths (Table S1.1f).

Treatment

The Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) provides information on treatment provided to clients by publicly funded AOD treatment services, including government and non-government organisations. Data from the AODTS NMDS show that alcohol is the most common principal drug of concern among clients seeking treatment for their own drug use (AIHW 2021a). In 2019–20, over 1 in 3 (34%) closed treatment episodes were for alcohol—a similar proportion to 2018–19 (36% of episodes) (Table S2.76; Figure ALCOHOL7).

In 2019–20, where alcohol was the principal drug of concern:

• Around two-thirds (65%) of clients were male and over 1 in 6 (18%) were Indigenous Australians (tables S2.77 and S2.78; Figure ALCOHOL7).
• Around half (51%) of clients were aged 30–49 with 26% of clients aged 40–49 and 25% aged 30–39.
• The most common source of referral was self or family (42% of closed treatment episodes), followed by a health service (41%) (Table S2.79).
• The most common main treatment type was counselling (38% of closed treatment episodes), followed by assessment only (18%) and withdrawal management (14%) (Figure ALCOHOL7). These 3 main treatment types have remained the most common over the 10-year period to 2019–20.
• The median treatment duration of closed treatment episodes for alcohol was just under 4 weeks (26 days) (AIHW 2021a).

Figure ALCOHOL7: Treatment provided for own use of alcohol, 2019–20 (per cent)

Source: AIHW. Supplementary Tables S2.76, S2.78 and S2.80.

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Where the principal drug of concern was alcohol, the proportion of clients who travelled 1 hour or longer to treatment services in 2016–17 was higher in Regional and remote areas than in Major cities (29% compared with 7%) (AIHW 2019).

At-risk groups

While alcohol is widely consumed in Australia, some population groups are at a greater risk of problematic consumption.

• The proportion of Aboriginal and Torres Strait Islander people exceeding lifetime and single occasion risk guidelines is slightly higher than that of non-Indigenous Australians. There has been an increase in the proportion of Indigenous Australians who exceeded single occasion risk guidelines for drinking between 2002 and 2018–19.
• People aged 70 and over are the most likely to drink alcohol daily and those aged 50–59 were one of the age groups most likely to exceed the lifetime risk guideline. 
• People aged 18–24 were the most likely to exceed the single occasion risk guideline, at least monthly. 
• A higher proportion of people with a mental health condition reported drinking at risky levels (for both lifetime and single occasion risk) compared with people who had not been diagnosed or treated for a mental health condition.

Policy context

National Alcohol Strategy 2019–2028

The National Alcohol Strategy aims to provide a national framework to prevent and minimise alcohol-related harms among individuals, families and communities by:

• Identifying agreed national priority areas of focus and policy options;
• Promoting and facilitating collaboration, partnership and commitment from the government and non-government sectors; and
• Targeting a 10% reduction in harmful alcohol consumption.
  • Alcohol consumption at levels that puts individuals at risk of injury from a single occasion of drinking, at least monthly.
  • Alcohol consumption at levels that puts individuals at risk of disease or injury over a lifetime (DoH 2019).

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Policy support for measures to reduce problems associated with alcohol

The NDSHS includes questions aimed at measuring the level of public support for policies to reduce problems associated with alcohol. In 2019, public support declined for the majority of measures to reduce the harms from alcohol. The policies with the most support to reduce alcohol related harm were:

• more severe penalties for drunk driving (85%)
• the stricter enforcement of the law against supplying alcohol to minors (79%).

The least supported policy measure was to increase the price of alcohol (26%) (AIHW 2020).