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% [1].

Availability

Data about the volume of alcohol available for consumption is collated by the ABS from information about import clearance, excise and domestic alcohol sales [2].

• In 2016–17, there were 185.8 million litres of pure alcohol available for consumption through alcoholic beverages in Australia, a decrease from 188.2 million litres available in 2015–16 (Figure ALCOHOL1).
• The volume of pure alcohol available for consumption in the form of beer decreased by 3.4%, cider by 1.3% and ready to drink (RTD) (pre-mixed beverages) by 0.7% between 2015–16 and 2016–17. The volume of pure alcohol available for consumption in the form of wine increased by 0.4% and spirits by 0.2% during this period.
• Beer continues to dominate the alcohol supply, contributing to 39% of all pure alcohol available for consumption in 2016–17, followed by wine (38%), spirits and RTDs (19.1%) and cider (3.4%) (Table S2.3).
• Accounting for population increases, the apparent consumption of alcohol per capita has decreased to the lowest level in over 50 years. There were 9.4 litres of pure alcohol available for consumption per person in 2016–17, less than the amount in 2015–16 (9.7 litres) and the lowest since 1961–62 (9.4 litres).
• As the standard drink consists of 12.5mls of pure alcohol, the apparent consumption of alcohol in 2016–17 is equivalent to an average of 2.6 standard drinks per day per consumer of alcohol aged 15 and over [2] (Figure ALCOHOL1).
• On average, Australian households spend $32 on alcoholic beverages per week and this has remained stable between 2009–10 and 2015–16 [3] (Table S2.4).

Consumption

Over the past 50 years, levels of apparent consumption of different alcoholic beverages have changed substantially. In particular, over the period 1961–62 to 2016–17:

• The proportion of pure alcohol available for consumption in the form of beer has decreased considerably, from 75% to 39%.
• Wine consumption as a proportion of total pure alcohol consumption has increased from 12.4% to 38%, although the 2016–17 figure for wine remains similar to 2015–16 (38%).
• Spirits (including RTDs) have also increased from 12.7% to 19.1% [2].

The majority of Australians aged 14 and older have consumed alcohol in their lifetime. The 2016 NDSHS found that:

• Just under half (46%) of Australians approved of regular use of alcohol by adults (the highest for all licit and illicit drugs) and this has remained stable since 2007.
• Of the population aged 14 and older, around three-quarters (77%) had consumed a full serve of alcohol in the previous 12 months, and 23% had not consumed alcohol [4] (Figure ALCOHOL2; Table S2.25).

The National Health Survey reported that in 2014–15 among Australians aged 18 and over, 81% had consumed alcohol in the past year. A further 8.2% had consumed alcohol 12 or more months ago, and 10.7% had never consumed alcohol. Adult males were more likely to consume alcohol in the past year (86%) than females (76%) [5] (Table S2.27).

The National Wastewater Drug Monitoring Program (NWDMP), measures the presence of substances in sewerage treatment plants across Australia. The most recent data indicates that alcohol was among the most commonly consumed substances monitored by the program, with marginal differences in average alcohol consumption in capital city and regional sites [6].

Lifetime risk

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

Data from multiple sources indicates that there has been a decline in the proportion of Australians exceeding the NHMRC guidelines for lifetime risk by consuming more than two standard drinks per day, on average.

• The NDSHS found that the proportion of people aged 14 and older exceeding lifetime risk guidelines declined significantly from 18.2% in 2013 to 17.1% in 2016 (Table S2.28).
• Similarly, the National Health Survey reported that in 2014–15, 17.4% of adults aged 18 and over exceeded the lifetime risk guideline, a decrease from 19.5% in 2011–12 [5] (Table S2.27).

Males are far more likely than females to drink at risky levels. Approximately one in four men and one in ten women exceeded the lifetime risk guidelines, according to the NDSHS (24% compared to 9.5%) [4] and the National Health Survey (26% compared to 9.3%) [5].

Single occasion risk

There are a considerable number of Australians who report consuming alcohol in excess of the NHMRC’s single occasion risk guidelines—that is, more than four standard drinks on any one occasion.

• In 2016, the NDSHS showed that more than 1 in 3 (37%) Australians aged 14 and older had exceeded the single occasion risk guideline at least yearly. Just over 1 in 4 (26%) did so at least once a month, and 1 in 7 (13%) did so at least once a week. These proportions remain unchanged from 2013 [4] (Table S2.28).
• Similarly, the National Health Survey reported that in 2014–15, 44% of adults aged 18 and older consumed more than four standard drinks on a single occasion at least once in the past year, exceeding the NHMRC single occasion risk guidelines [5] (Table S2.29). As with lifetime risk, adult males (57%) were more likely than females (31%) to exceed the single occasion risk guideline in the last 12 months (Table S2.29).

Geographic trends

Adult daily drinking rates have been declining nationally, yet daily drinking rates varied across states and territories.

• While there was a significant decrease in daily drinking between 2013 and 2016 (from 6.5% to 5.9%), the fall was only significant in the Australian Capital Territory (from 6.6% to 3.6%). The highest proportion of daily drinkers in 2016 were in the Northern Territory (7.3%) followed by Queensland and Western Australia (6.4% respectively).
• Long-term trends show that between 2001 and 2016 all states and territories have decreased daily consumption of alcohol [4].
• In 2016, the proportion of people never consuming a full serve of alcohol increased from 2013 in Western Australia (10.3% compared to 15.2%) and the Northern Territory (8% to 14%).
• Between 2010 and 2016, lifetime risky drinking behaviour (drinking on average more than two standard drinks a day) declined across all jurisdictions, but remains the highest in the Northern Territory (28%), well above the national average of 17% (Table S2.30).

People living in Remote and Very Remote areas of Australia are about 1.5 times more likely than people living in Major cities to exceed lifetime risk guidelines (26% compared with 15%) and the single occasion risk guidelines (at least monthly) (37% compared with 24%). Australians living in the most advantaged socioeconomic areas were slightly more likely than those from the most disadvantaged areas to exceed lifetime risk guidelines (18% compared with 16%) and the single occasion risk guidelines (at least monthly) (26% compared with 24%) (Figure ALCOHOL4; Tables S2.12 and S2.13).

Explore state and territory data on alcohol consumption in Australia.

Harms

Alcohol is absorbed rapidly in the bloodstream and affects the brain within about five minutes, though this may vary from person to person depending on body mass and general state of health [1]. 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).

Table ALCOHOL1: Effects of alcohol consumption

Short-term effects	Long-term effects
Reduced inhibitions A sense of relaxation Loss of alertness or coordination, and slower reaction times Impaired memory and judgement Nausea, shakiness and vomiting Blurred or double vision Disturbed sleep patterns Disturbed sexual functioning	Oral, throat and breast cancers Liver cirrhosis Brain damage and dementia Some forms of heart disease and stroke

Source: [1]

Deaths, illness and injury

The National Drug Research Institute's analysis of alcohol-attributable deaths and hospitalisations in Australia estimates that in 2015, 5,785 Australians died of alcohol-attributable disease and injury [8].

Alcohol is among the top five risk factors contributing to the burden of disease in Australia [9]. Revised estimates from the AIHW of data from the Australian Burden of Disease Study 2011 found that alcohol use was responsible for 4.6% of the total burden of disease and injury in 2011 [10] (Table S2.62). The total burden attributable to alcohol use was slightly lower in 2011 than in 2003. 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
• 30% of the burden due to road traffic injuries involving motor vehicle occupants
• 28% of the burden due to chronic liver disease
• 15% of the burden due to suicide and self-inflicted injuries [11] (Table S2.63).

The National Hospital Morbidity Database showed that in 2016–17, there were approximately 135,000 hospital separations for a drug-related principal diagnosis. On its own, alcohol accounted for 50% of all drug-related separations. Alcohol has consistently been the drug-related principal diagnosis with the highest number of hospital separations from 2011–12 to 2016–17, with the number of separations increasing from 62,359 to 70,011 in that time [12].

The 2016 NDSHS reported that 2.8% of recent drinkers were injured while under the influence of alcohol and required medical attention while 1.3% required admission to hospital for their injuries. Just 1.0% of recent drinkers required medical attention and/or hospitalisation because they were intoxicated (Table S2.64).

This risk increased for people who consumed alcohol at risky quantities. Specifically, 5.5% of people that exceeded lifetime risk guidelines required medical attention or admission to hospital due to injuries sustained while drinking or due to intoxication, compared with 2% for low risk drinker. Further, 8.4% of people who consumed 11 or more standard drinks at least monthly, required medical attention for their injuries [4] (Figure ALCOHOL5).

Victimisation

The 2016 NDSHS showed that among recent drinkers, 1 in 4 (24%) had been a victim of an alcohol-related incident in the previous 12 months. In the NDSHS, alcohol-related incidents include being verbally, physically abused or put in fear in the last 12 months, by persons under the influence of, or affected by alcohol.

Overall, almost than 1 in 4 (24%) recent drinkers aged 14 and older had been a victim of an alcohol-related incident in 2016, although this proportion significantly declined from 2013 (down from 28%) (Table S2.65).

Since 2013, there were significant declines in the proportion of recent drinkers who experienced verbal abuse (24% to 21%), being put in fear (13% to 12%) and physical abuse (9.2% to 7.7%) [4] (Table S2.65).  

Risky behaviours

According to the 2016 NDSHS, about 1 in 6 (17.4%) Australians aged 14 and older put themselves or others at risk of harm while under the influence of alcohol in the last 12 months. Driving a motor vehicle was the most likely risky activity undertaken while under the influence of alcohol (9.9% of recent drinkers). Risky drinkers – that is, drinkers who drink on average two standard drinks per day or four standard drinks on any occasion – were far more likely to engage in risky behaviours or harmful activities than low-risk drinkers [4] (Table S2.66).

Data from Road Trauma Australia indicates that between 2008/2010 and 2016 there was a 37% reduction in the number of drivers and motorcycle riders killed with a blood alcohol concentration above the legal limit [11] (Table S2.67).

Poly drug use

Poly drug use is defined as the use of more than one illicit drug or licit drug in the previous 12 months. In 2016, the NDSHS showed around one in four recent risky drinkers reported recent use of cannabis and just over 1 in 5 reported that they were also daily smokers [4] (Table S2.68).

Treatment

The AIHW’s Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS NMDS) showed that in 2016–17:

• Alcohol was a drug of concern (principal or additional) in 46% of closed treatment episodes (Table S2.76).
• Alcohol was the most common principal drug of concern (32% or 62,438 of all closed treatment episodes) (Table S2.76).
• In 38% of episodes where alcohol was the principal drug of concern, the client reported additional drugs of concern, most commonly cannabis (32%) or nicotine (31%) (Tables S2.77 and S2.78).
• Client demographics:
  • More than two-thirds of clients whose principal drug of concern was alcohol were male (64%), and around 1 in 6 were Indigenous (16%) (Figure ALCOHOL6).
  • Indigenous Australians (1,204 per 100,000 population) were almost 8 times as likely as non-Indigenous Australians (155 per 100,000 population) were to have received treatment for alcohol as a principal drug of concern [13].
• Referral to treatment:
  • Where alcohol was the principal drug of concern, the most common source of referral for closed treatment episodes was self/family (43%), followed by a health service (37%) (Table S2.80).
• Treatment type:
  • The most common main treatment type was counselling (43% of closed treatment episodes); followed by withdrawal management (18%) and assessment only (16%)—this was consistent across all age groups (Table S2.81).
  • The median treatment length for closed treatment episodes where alcohol was the principal drug of concern was 28 days.
  • Over the 5 years to 2016–17, counselling, withdrawal management, and assessment only have remained the most common main treatment types for closed treatment episodes where alcohol was the principal drug of concern [13].

At-risk groups

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

Aboriginal and Torres Strait Islander people

The proportion of Indigenous Australians aged 15 years and over who exceeded the NHMRC lifetime risk guidelines for alcohol consumption (consuming more than 2 standard drinks per day on average) decreased between 2008 and 2014–15 (19% compared with 15%; non age-standardised proportions) [15] (Table S3.6).

Comparisons between Indigenous and non-Indigenous Australians are only available using age-standardised data from the 2012–13 AATSIHS and is not comparable to the 2014–15 NATSISS. The findings showed that lifetime risky drinking of Indigenous Australians aged 15 and over was similar to that of non-Indigenous Australians (18.3% compared with 18.6%; age-standardised) [15] (Table S3.7).

Over the 2013 to 2017 period—on average the rate of alcohol related deaths was 23.8 per 100,000 population compared with 4.7 per 100,000 population for non-Indigenous Australians [16].

People with mental health problems

In 2016, the diagnosis or treatment of a mental health condition was higher among people drinking at risky levels for both lifetime (19%) and single occasional risk (17%) than those drinking at low-risk levels or abstaining from alcohol (14%) [4] (Table S2.72).

Young people

The likelihood of exceeding the single occasion risk guideline decreases with age, meaning young people are more likely to drink at risky levels on a single occasion than older people. Yet the proportion of young people exceeding the single occasion risk guidance has decreased significantly since 2001. In 2016, 42% of Australians aged 18–24 reported exceeding the single occasion risk guideline, a significant decline from 57% in 2001.

Data from the Australian Secondary Students’ Alcohol and Drug survey (ASSAD) shows similar trends with the proportion of single occasion risky drinkers aged 16–17 decreasing since from 20% in 1984 to 13% in 2014 [17].

Specifically, the NDSHS showed that more teenagers aged 12–17 abstained from drinking in 2016 (82% in 2016, up from 72% 2013) and young people are delaying drinking for longer (average age of their first drink was 16.1 years up from 14.7 in 2001) [4].

According to the NDSHS, in 2016, people in their 20s were more likely than other age groups to have experienced verbal abuse (29%), physical abuse (13%) or to be put in fear (19%) by someone under the influence of alcohol. However, there have been some improvements observed among young people over time.

For adolescents and young adults, non-fatal burden was the main contributor to alcohol attributed burden. While for people aged 55 years and over, fatal burden was the main contributor to alcohol attributed burden [10].

Policy context

Draft National Alcohol Strategy 2018 – 2026

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

• Identifying agreed national priority areas of focus and opportunities for action;
• Promoting and facilitating collaboration, partnership and commitment from the government and non-government sectors to provide effective interventions –as alcohol related harms can impact on a wide range of other issues which including mental health problems, lack of income, employment and appropriate housing; 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.

Access the Draft National Alcohol Strategy 2018-2026.

Policy support for measures to reduce problems associated with alcohol

The NDSHS includes questions aimed as measuring the level of public support for policies to reduce problems associated with alcohol. In 2016, of the 18 policy measures included, 13 of these received less support than in 2013. The policies with the most support to reduce alcohol related harm were:

• To establish more severe penalties for drunk driving (84%).
• The stricter enforcement of enforcement of the law against supplying alcohol to minors (81%). 

The least supported policy measure was to increase the price of alcohol (28%) [4].

References

1. NSW Ministry of Health 2017. A quick guide to drugs & alcohol, 3^rd edn. Sydney: National Drug and Alcohol Research Centre.
2. Australian Bureau of Statistics (ABS) 2018. Apparent consumption of alcohol, Australia, 2016–17. Cat. no. 4307.0.55.001. Canberra: ABS. Viewed 5 September 2018.
3. ABS 2017. Australian Demographic Statistics, Mar 2017. Cat no. 3101.0. Canberra: ABS. Viewed 30 May 2018.
4. Australian Institute of Health and Welfare (AIHW) 2017. National drug strategy household survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. Viewed 14 December 2017.
5. ABS 2015. National health survey: first results, 2014-15. Cat. no. 4364.0.55.001. Canberra: ABS. Viewed 12 October 2017.
6. Australian Criminal Intelligence Commission 2018. National wastewater drug monitoring program, report 5. Canberra: ACIC. Viewed 10 October 2018.
7. NHMRC (National Health and Medical Research Council) 2009. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC. Viewed 12 October 2017.
8. Lensvelt, E., Gilmore, W., Liang, W., Sherk, A. and Chikritzhs, T. 2018. Estimated alcohol-attributable deaths and hospitalisations in Australia 2004 to 2015. National Alcohol Indicators, Bulletin 16. Perth: National Drug Research Institute, Curtin University.
9. AIHW 2016. Australian burden of disease study: Impact and causes of illness and death in Australia 2011. Series no.3. BOD 4. Canberra: AIHW. Viewed 18 October 2017.
10. AIHW 2018a. Impact of alcohol and illicit drug use on the burden of disease and injury in Australia: Australian Burden of Disease Study 2011. Australian Burden of Disease Study series no. 17. Cat. no. BOD 19. Canberra: AIHW.
11. BITRE (Bureau of Infrastructure, Transport and Regional Economics) 2018. Road trauma Australia 2017 statistical summary, Canberra: BITRE.
12. AIHW 2018a. Drug related hospitalisations. Canberra: AIHW. Viewed 30 November 2018.
13. AIHW 2018b. Alcohol and other drug treatment services in Australia 2016-17. Drug treatment services no. 31. Cat. no. HSE 207. Canberra: AIHW.
14. ABS 2016. National Aboriginal and Torres Strait Islander social survey, 2014–15. Cat. no. 4714.0. Canberra: ABS.
15. ABS 2013. Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13. Cat. no. 4727.0.55.001. Canberra: ABS. Viewed 19 January 2018.
16. ABS 2018. Causes of death, Australia, 2017. Cat. no. 3303.0. Canberra: ABS. Viewed 12 October 2018.
17. White V & Williams T 2016. Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2014. Victoria: Centre for Behavioural Research.