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).

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 2018b).

• 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 8.8 litres per capita in 2018 (OECD 2020). For more information see Interactive data: Alcohol.
• 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).

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 (AIHW 2020b) (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 2020b).

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 NHMRC 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 2020b). 

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 NHMRC’s 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 2020b)
• 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 NHMRC 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).

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 2020b). 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 2020b).

Explore state and territory data on alcohol consumption in Australia

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 2020b).
• 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).

The National Wastewater Drug Monitoring Program (NWDMP) measures the presence of substances in sewerage treatment plants across Australia. Alcohol is typically among the most commonly detected substances monitored by the program, with the most recent data indicating that population-weighted average consumption of alcohol in regional areas continues to exceed consumption in capital cities.

The estimated population-weighted average consumption of alcohol has fluctuated over time since the program commenced, with consumption decreasing in capital cities and remaining relatively stable in regional areas from August 2016 to August 2020. Alcohol consumption increased in both regional and capital city sites in June and August 2020, before declining in capital cities in October 2020 (ACIC 2021).

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).

Deaths, illness and injury

There were 1,366 alcohol-induced deaths recorded in 2017, with an additional 2,820 (alcohol-related) deaths where alcohol was mentioned as a contributing factor to mortality (ABS 2018a).

Alcohol is the sixth highest risk factor contributing to the burden of disease in Australia (AIHW 2019b). Revised estimates from the Australian Burden of Disease Study 2015 found that alcohol use was responsible for 4.5% of the total burden of disease and injury in 2015 (AIHW 2019b) (Table S2.62). The total burden attributable to alcohol use was slightly lower in 2015 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
• 28% of the burden due to chronic liver disease
• 22% of the burden due to road traffic injuries involving motor vehicle occupants
• 14% of the burden due to suicide and self-inflicted injuries (AIHW 2019b) (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 2020b).

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 ALCOHOL5).

Hospitalisations

The National Hospital Morbidity Database showed that in 2018–19, there were about 140,000 hospital separations for a drug-related principal diagnosis. On its own, alcohol accounted for 54% of all drug-related separations (Table S1.8a).

Alcohol was the drug-related principal diagnosis with the highest number of hospital separations across the 5-year period from 2014–15 to 2018–19, with the number of separations increasing from 65,701 to 75,772 in that time (Table S1.8b).

In 2018–19, the rate of drug-related hospital separations for alcohol was higher for people usually residing in Major cities than in Regional and remote areas (304 per 100,000 population compared with 277.7 per 100,000 population). Of all remoteness areas, the rate of drug-related hospital separations for alcohol was highest for people usually residing in Remote and very remote areas (649.7 per 100,000 population)—more than twice as high for people usually residing in Major cities (Table S1.8c).

Ambulance attendances

Data on alcohol and other drug-related ambulance attendances are sourced from the National Surveillance System for Alcohol and Other Drug Misuse and Overdose report. Data for 2019 are available for New South Wales, Victoria, 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.

The rate of alcohol intoxication-related attendances ranged from 142.2 per 100,000 population in New South Wales to 177.9 per 100,000 population in the Australian Capital Territory. The median age for alcohol intoxication-related attendances ranged from 36 years in the Australian Capital Territory to 41 years in Victoria, and the majority of attendances were for males.

Higher rates for alcohol intoxication-related ambulance attendances were reported in regional areas for New South Wales (146.0 per 100,000 population compared with 139.8 for metropolitan areas) and Victoria (180.9 per 100,000 population compared with 158.6 for metropolitan areas). However, in Tasmania the rate for these attendances was higher for Greater Hobart (175.4 per 100,000) than for Regional Tasmania (127.3 per 100,000). Similar proportions of alcohol intoxication-related attendances were transported to hospital in metropolitan and regional areas for New South Wales (82% and 79%, respectively), Victoria (79% and 81%, respectively) and Tasmania (75% and 74%, respectively) (Table S2.81) (Moayeri et al. 2020).

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).

See also: Social impacts in the Impacts section for information about other impacts of alcohol use.

Treatment

The 2018–19 AODTS NMDS showed that alcohol was the most common principal drug of concern for clients’ own drug use (36% of all closed treatment episodes) (Table S2.76).

• Client demographics where alcohol was the principal drug of concern:
  • nearly two-thirds of clients were male (65%) (Table 2.77) and around 1 in 6 were Indigenous (17.2%) (Table 2.78; Figure ALCOHOL6).
  • Indigenous Australians (1,249 per 100,000 population) were 7 times as likely as non-Indigenous Australians (173 per 100,000 population) to have received treatment for alcohol (AIHW 2020a).
• Source of referral for treatment:
  • Where alcohol was the principal drug of concern, the most common source of referral was self/family (43% of treatment episodes), followed by a health service (37%) (Table S2.79).
• Treatment type:
  • The most common main treatment type was counselling (40% of closed treatment episodes); followed by assessment only (17.5%) and withdrawal management (15.9%)—this was consistent across all age groups (Table S2.80).
  • The median treatment length for closed treatment episodes where alcohol was the principal drug of concern was 26 days.
  • Over the 5 years to 2018–19, 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 (AIHW 2020a).

Where the most common 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 2019a). 

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. See also: Alcohol consumption in the Aboriginal and Torres Strait Islander people section.

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. See also: Alcohol consumption in the Older people section.

People aged 18–24 were the most likely to exceed the single occasion risk guideline, at least monthly. See also: Alcohol consumption in the Younger people section.

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. See also: Alcohol consumption in the People with mental health conditions section.

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).

Access the National Alcohol Strategy 2019-2028.

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 2020b).