Alcohol, tobacco & other drugs in Australia

Older people make up a considerable proportion of Australia’s population. In 2017, over 1 in 7 people were aged 65 and over and the number and proportion of older Australians is expected to continue to grow (AIHW 2018). Older people have unique health circumstances including pain, co-morbidities, and social circumstances such as isolation (DoH 2017). These factors are important to consider in the context of alcohol and other drug use. Refer to Box OLDER1 for how ‘older people’ are defined in this report.        

Tobacco smoking

Tobacco is one of the leading risk factors contributing to the burden of disease for older Australians. Specifically, tobacco is the leading risk factor for males and females aged 65–74 and 75–84 and also for males aged 45–64 (AIHW 2019).

Data from the 2019 National Drug Strategy Household Survey (NDSHS) showed that the proportion of people in their 60s who smoke daily is not declining at the same rate as that for younger age groups, while for people in their 50s it has increased slightly (AIHW 2020b). 

Daily smoking

In 2019, people in their 50s were the most likely age cohort to smoke daily (15.9%). In 2007, the proportion of people who smoked daily was highest for people aged 25–29 (26%) (Table S3.30). This effect is largely driven by a shift in the age distribution of daily smokers. Between 2016 and 2019, the proportion of daily smokers who were aged in their 50s increased from 17.7% to 21.2%, while for those in their 60s it increased from 10.6% to 12.7% (Table S3.24). This reflects an ageing cohort of daily smokers, and the tendency for younger people to not take up smoking. Notably, however, daily smoking among those aged 70 and over is lower than for people in their 50s and 60s, and decreased from 6.2% in 2016 to 5.4% in 2019 (AIHW 2020b).

Number of cigarettes

Data from the NDSHS showed that people in older age groups (50 and over) tend to smoke more cigarettes than people in younger age groups. In 2019:

• people in their 50s (16.7 cigarettes), 60s (16.5 cigarettes), and aged 70 and over (15.5 cigarettes) smoked the highest number of cigarettes per day on average. This was around double the number of cigarettes smoked by people aged 18–24 (8.1 cigarettes) (Table S3.25)
• smokers in their 50s (41%), 60s (45%), and aged 70 and over (39%) were the most likely to smoke 20 or more cigarettes per day (pack-a-day smokers)
• the proportion of people aged 14 and over who are pack-a-day smokers significantly declined from 2016 (37%) to 2019 (33%), but remained stable for people in older age groups (50 and over) (AIHW 2020b) (Table S3.26).

Intentions to quit

Estimates from the NDSHS also showed that people in older age groups are the least likely to have intentions to quit smoking (AIHW 2020b). In 2019:

• the proportion of current smokers who were not planning on quitting smoking was higher among people in their 50s (33%), 60s (40%), and aged 70 and over (46%) compared with all current smokers (30%) (Table S3.28)
• the main reason that people in older age groups did not intend to quit was because they enjoy smoking (ranging from 59% for people in their 50s to 69% for those in their 60s).This was consistent with other age groups (Table S3.29).

Alcohol consumption

Data from the 2019 NDSHS indicated that a higher proportion of people in older age groups have given up alcohol, compared with younger people. In 2019, people in their 50s (9.6%), 60s (12.7%), and those aged 70 and over (16.1%) were more likely to be ex-drinkers than were people aged 14 and over (8.9%) (AIHW 2020b) (Table S3.33).

However, people in older age groups who do consume alcohol are more likely to drink in quantities that exceed the NHMRC lifetime risk guidelines (people in their 50s and 60s) or drink daily (those aged 70 and over) (AIHW 2020b). Among people aged 55 years and over, fatal burden was the main contributor to alcohol-attributed burden (AIHW 2019b).

Daily drinking

Estimates from the NDSHS show that the proportion of people who drink daily increases with age. In 2019:

• there was an overall decline in the proportion of people who drink daily from 2016 (6.0%) to 2019 (5.4%) (Table S3.32)
• people aged 70 and over continued to be the most likely to drink daily (12.6%), followed by people in their 60s (9.6%) and 50s (7.3%)
• a higher proportion of males than females were daily drinkers for people in their 50s (8.8% compared with 5.8%), 60s (12.4% and 7%), and aged 70 and over (16.8% and 9.1%) (AIHW 2020b) (Table S3.33).

Lifetime risk

The proportion of people in older age groups who exceed the NHMRC lifetime risk guidelines for alcohol varies according to age (AIHW 2020b). Estimates from the NDSHS show that, in 2019:

• people in their 50s (21%) and 60s (17.4%) were more likely to drink at levels that exceeded the lifetime risk guidelines than the general population aged 14 and over (16.8%), while people aged 70 and over (12.2%) were less likely to do so
• males in their 50s were the most likely age cohort to drink at levels exceeding lifetime risk guidelines (Table S3.34). This is consistent with data from the National Health Survey, where males aged 45–54 and 55–64 were the most likely to exceed lifetime risk guidelines (Table S2.27)
• both females (12.2%) and males (30%) in their 50s were more likely to drink at levels that exceeded the lifetime risk guidelines than the general population (9.4% of females and 24% of males aged 14 and over) (Table 3.34).

Single occasion risk

Similar to lifetime risk, the proportion of people in older age groups who exceed NHMRC single occasion risk guidelines for alcohol varies by age. Estimates from the NDSHS showed that, in 2019:

• people aged 70 and over (8.8%) were the least likely age group to exceed single occasion risk guidelines at least monthly, though this figure had increased since 2016 (7.2%) (Figure OLDER1).
• people in their 60s (17.4%) were also less likely to consume alcohol in excess of single occasion risk guidelines compared with those aged 14 and older (25%), but people in their 50s (27%) were slightly more likely to do so (Figure OLDER1)
• compared with people aged 14 and over (4.4%), people in their 50s (6.8%) were more likely to exceed this guideline most days or every day. This suggests that older people who engage in risky levels of alcohol consumption may do so more regularly (AIHW 2020b) (Table S3.35).

High risk alcohol consumption

People in older age groups (50 and over) are less likely to consume 11 or more standard drinks on a single drinking occasion at least once in the past 12 months than the general population (AIHW 2020b). Estimates from the NDSHS show that, in 2019:

• people in their 60s (5.3%) and aged 70 and over (2.8%) were the least likely to have consumed 11 or more standard drinks at least once a year (Table S3.36)
• the proportion of people in older age groups (50 and over) who consumed alcohol at these levels at least yearly and at least monthly has remained stable from 2016 to 2019 (AIHW 2020b) (Table S3.36).

Illicit drugs

Data from the 2019 NDSHS showed that a greater proportion of older Australians reported illicit drug use than in previous years, indicating that there is an ageing cohort of people who use illicit drugs (AIHW 2020b).

• The proportion of people aged 60 or older who had used illicit drugs in their lifetime increased significantly between 2016 (26%) to 2019 (29%). There were significant increases for both males (from 30% to 34%) and females (22% to 24%) (Table S3.41).
• Between 2001 and 2019, recent use of any illicit drug has nearly doubled among people in their 50s (from 6.7% to 13.1%), with similar increases among both males (from 8.1% to 16.0%) and females (5.2% and 10.3%) (Table S3.42).
• Recent illicit drug use has also increased among those aged 60 and over, from 3.9% in 2001 to 7.2% in 2019 (Table S3.42).
• The age distribution of people who have recently used illicit drugs has shifted over time, reflecting an ageing cohort of people who use drugs. In 2001, 6.1% of people who had recently used an illicit drug were in their 50s and 4.4% were aged 60 and over. In 2019, this increased to 11.8% and 11.2%, respectively (Table S3.43).
• The difference in the proportion of recent illicit drug use between people in older age groups (50 and over) and the general population (14 and over) continues to decrease (Figure OLDER2).

The 2 most commonly used drugs by older people are cannabis and pharmaceutical drugs when used for non-medical purposes.

Cannabis

People in older age groups continue to be less likely to use cannabis than the general population aged 14 and over (AIHW 2020b). However, the proportion of older people who have recently used cannabis has increased over time. Specifically, the 2019 NDSHS showed that:

• recent use of cannabis has been increasing since 2001 among people in their 50s and those aged 60 and over, reaching its highest level in 18 years in 2019 (Figure OLDER2)
• between 2016 and 2019, recent use of cannabis significantly increased among people in their 50s (from 7.2% to 9.2%) and those aged 60 and over (1.9% to 2.9%). This rise was driven by increased cannabis use among females, both in their 50s (up from 4.7% to 6.7%) and aged 60 and over (1.0% to 2.1%) (Table S3.45).

Data from the NDSHS suggest that older people are also more likely to use cannabis for medical purposes than people in younger age groups. In 2019, 43% of people who had recently used cannabis for medical purposes only were aged 50 and over, while 16% of people who used cannabis for non-medical reasons were aged 50 and over (AIHW 2020b).

Non-medical use of pharmaceutical drugs

Similar to cannabis, non-medical use of pharmaceutical drugs is generally lower among older age groups than the general population aged 14 and over. However, pharmaceuticals are the second most common drug used by older people.

• In 2019, 3.4% of people in their 50s and 3.7% of those aged 60 and over reported recent use of a pharmaceutical for non-medical purposes, compared with 4.2% of all people aged 14 and over.
• From 2016 to 2019, recent non-medical use of pharmaceutical drugs fell slightly for people in their 50s (from 4.1% to 3.4%) and significantly decreased for those aged 60 and over (from 4.5% to 3.7%) (AIHW 2020b) (Table S3.46).

Health and harms

Treatment

Data from AIHW’s Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) and the National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) indicates that in the last 10 years, an ageing cohort of Australians receiving drug and alcohol treatment has emerged. Specifically, NOPSAD data indicate that the proportion of clients receiving pharmacotherapy treatment on a snapshot day that were aged 40 and over increased from 42% in 2010 to 64% in 2019 (AIHW 2020c). AODTS NMDS data show that the proportion of closed treatment episodes for all clients aged 40 and over (including clients who sought treatment for their own drug use and others seeking support for someone else’s drug use) has increased from 30% in 2009–10 to 36% in 2018–19 (AIHW 2020a). In 2018–19:

• Principal drug of concern: where treatment was for their own drug use, 60% of clients aged 50–59 sought treatment for alcohol as their principal drug of concern and 12.3% sought treatment for amphetamines. In those clients aged 60 and over, 76% sought treatment for alcohol as their principal drug of concern, followed by cannabis (4.5%) (Table S3.49).

• Treatment type: The most common treatment type for clients aged 50–59 who sought treatment for their own drug use was counselling (42%), followed by assessment only (19.6%). Counselling was also the main treatment type for those clients aged 60 and over (39%), followed by assessment only (24%) (Table S3.50).

The AODTS data were matched with the Specialist Homelessness Services (SHS) collection to identify clients who use both services (matched clients) and compared characteristics between the groups (AIHW 2016). Older clients were identified as 1 of 4 vulnerable cohorts in the analysis (along with clients with a current mental health issue, clients who experienced family and domestic violence and young clients aged 15–24). The analysis found that matched clients aged 50 and over (when compared to the other vulnerable cohorts) were more likely to be:

• male (68%) and living alone (69%)
• receiving treatment for alcohol (68%)
• Indigenous (17%).

Older clients had similar patterns of treatment type, regardless of whether they were in the matched group or AODT-only group, with counselling being the most commonly provided treatment type for all older clients (AIHW 2016).

Drug-related deaths

Data on cause of deaths in Australia shows that the age profile of people with drug-induced deaths has changed over the last 2 decades. While the rate of drug-related deaths among younger people has decreased significantly since 1999, among older age groups the rate of drug-induced deaths is now much higher. This is especially the case among people aged 45–64 (ABS 2017).

• From age 55, males are more likely to have opiate-based painkillers present on toxicology than other substances.
• Benzodiazepines are the most common substance in drug deaths for women from aged 20 to their mid-60s (ABS 2017).