Experiences of alcohol and other drugs among First Nations people

Introduction

In 2021, there were approximately 983,700 Aboriginal and Torres Strait Islander (First Nations) people living in Australia, accounting for 3.8% of the Australian population (ABS 2024). There are substantial differences in measures of health and welfare between First Nations people and non-Indigenous Australians, including alcohol and other drug use. The gap in the disease burden between First Nations people and non-Indigenous Australians is due to a range of factors including disconnection to culture, traditions and country, social exclusion, discrimination and isolation, trauma, poverty, and lack of adequate access to services (Department of Health 2017). The gap in disease burden has decreased between 2003 and 2018 (AIHW 2022). 

This page focuses on alcohol and other drug use, harms and treatment among First Nations people in Australia. The reporting uses data from a range of sources, mostly national administrative and survey data. For related content on policies related to alcohol and other drug use among First Nations people, see Policy context.

What data sources are available?

There are a range of data sources that contain information about alcohol and other drug use harms and treatment among First Nations people. These include self-report surveys that ask First Nations people about their use of alcohol and other drugs, burden of disease analysis, and administrative data from health services. Each data set uses a different methodology, and the language used to describe First Nations people may also differ across sources.

Information on alcohol and other drug use among First Nations people primarily comes from the following surveys:

• The National Aboriginal and Torres Strait Islander Health Survey (NATSIHS; ABS 2024), National Aboriginal and Torres Strait Islander Social Survey (NATSISS; ABS 2016) and the Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS; ABS 2013) are designed to obtain a representative sample of First Nations people. In relation specifically to tobacco smoking, the ABS has consolidated data from 6 large, national, multistage random household surveys to identify trends between 1994 and 2014–15 (ABS 2017).
• The AIHW’s National Drug Strategy Household Survey (NDSHS) also captures information about drug and alcohol use among the general population in Australia, though it is not specifically designed to obtain reliable national estimates for First Nations people. In 2022–2023, 2.6% of the NDSHS (unweighted) sample aged 14 and over (551 respondents) were First Nations people. The estimates produced by the NDSHS should be interpreted with caution due to the low sample size (AIHW 2024).

Differences between the results of the NATSIHS and the NDSHS may be due to the limited data collected from Remote First Nations communities in the NDSHS (which in the NATSIHS are deliberately oversampled) and the use of different weighting approaches (AIHW 2024).

For more information about each data source, see Technical notes.

What do we know about alcohol and other drug use among First Nations people in Australia?

Tobacco smoking

A priority area of the National Tobacco Strategy 2023–2030 is to expand and strengthen partnerships to prevent and reduce tobacco use among First Nations people. Programs will continue to invest in priority groups within the First Nations population including people in remote areas, pregnant women, young people, and prisoners (Department of Health and Aged Care 2023).

While tobacco smoking is declining in Australia, rates remain disproportionately high among First Nations people. In 2022–23, 29% of First Nations people aged 15 and over smoked daily (excluding e-cigarettes or vaping devices), down from 37% in 2018–19 (ABS 2024). First Nations people smoked a median of 10 cigarettes a day in 2018–19, a decrease from 12 cigarettes a day in 2008 (AIHW 2020). 

Among First Nations adults aged 18 and over in 2022–23: 

• almost 2 in 5 (38%) people had never smoked  
• more than 1 in 3 (34%) people currently smoked (Figure 1). Males were more likely than females to currently smoke tobacco (37% compared with 32%) (ABS 2024, Table 14.3).

This trend was similar for young First Nations people aged 15–24, with the proportion of people who smoke daily decreasing from 45% in 2002 to 31% in 2014–15 (AIHW 2018a). More young First Nations females (61% or 41,600) than males (53% or 36,300) had never smoked and more males than females smoked daily (35% or 23,600 and 27% or 18,200, respectively) in 2014–15 (AIHW 2018a).

Smoking rates among First Nations people have historically been higher than non-Indigenous people in the NDSHS, and this remained true in 2022–2023. After adjusting for differences in age, First Nations people were 2.6 times as likely as non-Indigenous people to smoke daily (AIHW 2024). 

How many First Nations people smoke during pregnancy?

Data from Australia's mothers and babies showed that the proportion of First Nations mothers who reported smoked at any time during pregnancy decreased from 49% in 2011 to 38% in 2023 (AIHW 2025b).

Alcohol use

The 2022–23 NATSIHS found that 12.8% of First Nations people aged 15 years and over had never consumed alcohol, while a further 16.9% had consumed alcohol 12 or more months ago (ABS 2024, Table 1.3). Around 1 in 3 (34%) First Nations people consumed alcohol in ways that put their health at risk (ABS 2024, Table 1.3).

Data from the NDSHS indicate that abstinence among First Nations people has increased over time, rising from 25% in 2010 to 28% in 2022–2023 (AIHW 2024, Table 10.1). Additionally:

• The proportion of First Nations people who consumed alcohol in ways that put their health at risk declined from 48% in 2010 to 33% in 2022–2023 (AIHW 2024, Table 10.1). 
• The proportion of First Nations people who consumed 11 or more drinks in a day at least once a month declined from 22% in 2010 to 12% in 2022–2023 (AIHW 2024, tables 10.1 and 10.3).

In 2022–2023, First Nations people had similar rates of risky drinking to non-Indigenous people. Drinking behaviours, however, differed between the two groups. After adjusting for differences in age in 2022–2023:

• First Nations people were 1.2 times as likely as non-Indigenous people to have consumed no alcohol in the previous year.
• First Nations people were 1.2 times as likely to have consumed more than 4 standard drinks in a single day at least once a month.
• Non Indigenous people were 1.1 times as likely to have consumed more than 10 standard drinks per week on average.
• First Nations people were 1.4 times as likely to have consumed 11 or more standard drinks in a single day in the previous year (AIHW 2024).

Illicit drug use

According to the 2022–23 NATSIHS, around 1 in 4 (27%) First Nations people aged 15 years and over had used any substances in the last 12 months (ABS 2024, Table 16.3). The most common substances that people reported using were cannabis (22%), cocaine (4.2%), and non-medical use of analgesics and sedatives (3.6%; Figure 2).

Males were substantially more likely than females to have used illicit substances (34% compared with 20%) (Figure 2). People aged 15–29 years were the most likely to report recent substance use (35% compared with 18% for those aged 45 years and over) (ABS 2024, Table 16.3).

The overall findings are consistent with the 2014–15 NATSISS, which also showed that there was an increase between 2008 (22%) and 2014–15 (30%) in the proportion of First Nations people aged 15 and over who reported using illicit substances in the last 12 months (ABS 2016).

There are differences in the proportions of First Nations and non-Indigenous people using illicit substances. After adjusting for differences in age, in 2022–2023:

• First Nations people were 1.4 times as likely as non-Indigenous people to have used any illicit drug in the previous 12 months
• non-Indigenous people were 3.3 times as likely as First Nations people to have used ecstasy in the previous 12 months. 
• First Nations people were 2.3 times as likely as non-Indigenous people to have used methamphetamine and amphetamine in the previous 12 months
• First Nations people were 2.2 times as likely as non-Indigenous people to have used pain-relievers and opioids for non-medical purposes in the previous 12 months (AIHW 2024).

Does alcohol and other drug use among First Nations people vary by geographic area?

Data from the 2022–23 NATSIHS indicate that:

• Most of the decline in smoking over the past decade has occurred in non-remote areas. The proportion of First Nations people aged 15 and over in non-remote areas who smoked tobacco fell from 40% in 2012–13 to 27% in 2022–23, while the proportion in remote areas remained similar, from 52% to 53% (ABS 2024). 
• The proportion of people aged 15 years and over who consumed alcohol at risky levels was about the same for people living in non-remote (34%) and remote areas (35%) (ABS 2024).

Detailed information on alcohol and other drug use among First Nations people by state and territory is available in the National Aboriginal and Torres Strait Islander Health Survey.

What do we know about health and harms for First Nations people who use alcohol and other drugs?

Exposure to second-hand tobacco smoke

Data from the Aboriginal and Torres Strait Islander Health Performance Framework showed that in 2018–19:

• 1 in 10 (10% or 83,900) First Nations people lived in a household with someone who smoked tobacco daily and smoked indoors
• almost 1 in 7 (15% or 23,900) First Nations children aged 0–14 lived in a household with someone who smoked indoors (AIHW 2020).

Burden of disease and injury

The 2018 Australian Burden of Disease Study provides an indication of the risk factors that contribute to the burden of disease among First Nations people. In that year, tobacco and alcohol were the leading risk factors for disease burden among First Nations people (12% and 10% of total disease burden, respectively), and illicit drug use was the 4th highest risk factor (6.9%) (AIHW 2022). 

Data from the study show that:

• Tobacco use was the major contributor to fatal burden (23%, or over 800 deaths) and was the leading risk factor for both males and females (AIHW 2022).
• Alcohol use was previously the leading cause of disease burden among First Nations people but fell to second as the burden attributable to tobacco use increased. In 2018, alcohol use was the largest contributor to non-fatal burden (9.2%) (AIHW 2022). 
• Among illicit drug risk factors, the highest contributors to disease burden were opioid use (2.2% of the total burden), amphetamine use (1.9%) and cannabis use (1.6%) (AIHW 2022).

Alcohol-related deaths

Over the 2013 to 2017 period, the average rate of alcohol-related deaths was 23.8 per 100,000 population for First Nations people (ABS 2018). Data from the Aboriginal and Torres Strait Islander Health Performance Framework show that the rate of alcohol-related deaths among First Nations people was 18 deaths per 100,000 population in 2018, a 40% decrease from 2008 (31 deaths per 100,000) (AIHW 2020).

How many First Nations people try to quit smoking or receive treatment for alcohol and other drug use?

In 2022–23, almost half of First Nations people aged 18 and over who smoked tobacco (44%) had tried to quit in the previous 12 months (ABS 2024, Table 14.3). In 2014–15, 30% of First Nations people who currently smoked had tried to quit in the previous 12 months, 18% had tried to reduce their smoking and 21% had tried to do both (AIHW 2017).

Specialist alcohol and other drug treatment

The crude rate of First Nations people who receive treatment has increased over time, from 2,800 per 100,000 people in 2016–17 to 3,078 in 2023–24 (AIHW 2025a, Table SCR.26). 

In 2023–24, for First Nations people receiving treatment:

• 3 in 5 (58%) clients were male (AIHW 2025a, Table SC.7).
• 3 in 4 (77%) clients were aged 20 to 49 years (AIHW 2025a, Table SC.6).
• among clients receiving treatment for their own drug use, the most common drugs of concern were alcohol (36% of clients), amphetamines (27%), cannabis (20%), and heroin (5.1%) (AIHW 2025a, Table SC.11).

Data from the Online Services Report (OSR) show that in 2016–17, there were 80 organisations around Australia that provided alcohol and other drug treatment services to around 39,400 First Nations clients (AIHW 2018b). The OSR data also show that:

• All 80 organisations reported that alcohol was one of the top 5 common substance-use issue, followed by cannabis (95%) and amphetamines (80%).
• Treatment episodes were more likely to occur in non-residential settings (89%).
• One quarter of all treatment episodes were in Very remote areas (24%) and the highest proportion of clients were located in Major cities (37%). 

Opioid pharmacotherapy treatment

People who experience dependence on opioid drugs (including codeine, heroin, and oxycodone) can receive opioid pharmacotherapy treatment. This involves replacing the opioid drug of dependence with a longer-lasting, medically prescribed opioid (such as methadone or a buprenorphine formulation). 

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection provides information on clients receiving opioid pharmacotherapy treatment on a snapshot day each year. 

In June 2025, just over 7,000 clients who received pharmacotherapy treatment were First Nations people (67 clients per 10,000 people) (AIHW 2026b, Table S.9). Pharmacotherapy drug types have changed over time for First Nations clients:

• The proportion of First Nations clients receiving methadone as treatment fell from 46% in 2020 to 30% in 2025.
• By comparison, the proportion of First Nations clients receiving treatment with a buprenorphine formulation has increased from 40% in 2020 to 70% in 2025 (AIHW 2026b, Table S.9).

Data for Indigenous status should be interpreted with caution due to the high proportion of clients with an Indigenous status of ‘Not stated’ (12% in 2025). 

Where do I go for more information?

• Aboriginal and Torres Strait Islander Health Performance
• Australian Burden of Disease Study (First Nations people)
• First Nations people’s use of alcohol, tobacco, e-cigarettes and other drugs
• National Aboriginal and Torres Strait Islander Health Survey