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. 

Most population data define ‘old’ as persons aged 65 and over to align with the qualifying age for the Age pension. However, this section will generally refer to people aged 50 and over in order to capture people who may be ageing prematurely due to alcohol and other drug use, and to include the ‘Baby Boomer’ cohort (AIHW 2016). The different older age cohorts are specified where relevant.

Key findings

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Tobacco smoking

The Australian burden of disease study 2018 found that tobacco use was one of the leading risk factors contributing to the burden of disease for older Australians. Specifically, tobacco use was the leading risk factor for males aged 65–84 and females aged 45–84 (AIHW 2021b).

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 2020). 

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%) (AIHW 2020, Table S.9). 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% (AIHW 2020, Table 8.9). 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 2020).

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) (AIHW 2020, Table 2.4).
• 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 2020, Table 2.6).

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 2020). 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%) (AIHW 2020, Table 2.46).
• 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 (AIHW 2020, Table 2.48).

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 2020, Table 3.4).

However, people in older age groups who do consume alcohol are more likely to drink in quantities that exceed the lifetime risk guidelines (people in their 50s and 60s) or drink daily (those aged 70 and over) (AIHW 2020).

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%) (AIHW 2020, Table 3.5).
• 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 2020, Table 3.4).

Lifetime risk

The proportion of people in older age groups who exceed the lifetime risk guidelines for alcohol varies according to age (AIHW 2020). 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 (AIHW 2020, Table 3.16). 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 (ABS 2018b, Table 10.3).
• 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) (Figure OLDER1; AIHW 2020, Table 3.16).

Figure OLDER1: Proportion of people exceeding the lifetimeᵃ or single occasionᵇ risk guidelines for alcohol, by sex and age group, 2007 to 2019 (per cent)

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Single occasion risk

Similar to lifetime risk, the proportion of people in older age groups who exceed 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 2020, Table 3.17).

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 2020). 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 (AIHW 2020, Table 3.19).
• 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 2020, Table 3.19).

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 2020).

• 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%) (AIHW 2020, Table 4.4).
• 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%) (AIHW 2020, Table 4.8).
• Recent illicit drug use has also increased among those aged 60 and over, from 3.9% in 2001 to 7.2% in 2019 (AIHW 2020, Table 4.8).
• 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 (AIHW 2020, Table 4.12).
• 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.

Figure OLDER2: People with recent^a use of an illicit drug, by drug type and age group, 2001 to 2019 (per cent)

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Cannabis

People in older age groups continue to be less likely to use cannabis than the general population aged 14 and over (AIHW 2020). 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%) (AIHW 2020, Table 4.43).

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 2020).

Pharmaceuticals

Prescription drug dispensing

Data from the Pharmaceutical Benefits Scheme (PBS) provide information on the number of prescriptions dispensed and the number of patients dispensed supplied at least one script under the PBS within a given financial year. The PBS database includes information medicines that may be used for non-medical purposes, including opioids, benzodiazepines and gabapentinoids. These numbers largely represent medicines being prescribed for and used for their intended purposes, but monitoring dispensing of these drugs is important in the context of harm reduction (see Box PHARMS1). Refer to the Technical notes and Box PHARMS2 for more information.

Data from the PBS indicate that rates of dispensing of opioids, benzodiazepines and gabapentinoids (such as pregabalin) increase with increasing age, and are highest for people in their 60s, 70s and 80 and over (Figure PHARMS2; tables PBS6, PBS8, PBS26, PBS28, PBS50 and PBS52). In 2020–21:

• People aged 80 and over had the highest rates of scripts dispensed and patients of any age group for opioids, benzodiazepines and gabapentinoids. This was followed by people aged 70–79, 60–69 and 50–59.
• Among people aged 80 and over, the rate of scripts dispensed for:
  • Opioids (around 247,000 scripts per 100,000) was between 1.9 and 172 times higher than for people in other age groups (ranging from 1,400 scripts per 100,000 for people aged less than 18 to 127,000 for those aged 70–79).
  • Benzodiazepines (81,500 scripts per 100,000) was between 1.8 and 208 times higher than for people in other age groups (ranging from 390 scripts per 100,000 for people aged less than 18 to 45,300 for those aged 70–79).
  • Gabapentinoids (71,600 scripts per 100,000) was between 1.4 and 398 times higher than for people in other age groups (ranging from 180 scripts per 100,000 for people aged less than 18 to 51,200 for those aged 70–79).

• Females aged 80 and over had the highest dispensing rates of any group for opioids (around 299,000 scripts and 31,900 patients per 100,000 population), benzodiazepines (97,600 scripts and 19,000 patients per 100,000) and gabapentinoids (79,800 scripts and 10,000 patients per 100,000) (Figure PHARMS2; tables PBS6, PBS8, PBS26, PBS28, PBS50 and PBS52).

People in older age groups consistently had the highest rates of dispensing for opioids, benzodiazepines and gabapentinoids between 2012–13 and 2020–21. However, rates of dispensing of benzodiazepines and opioids declined over time for these age groups. Conversely, gabapentinoid dispensing rates increased across the period, but have stabilised since 2017–18 (Figure PHARMS2; tables PBS6, PBS8, PBS26, PBS28, PBS50 and PBS52).

Non-medical use of pharmaceuticals

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 2020, Table 5.3).

Health and harms

Drug-related hospitalisations

National Drug and Alcohol Research Centre (NDARC) analysis of the National Hospital Morbidity Database of drug-related hospitalisations (excluding alcohol) showed that, in 2018–19, people aged 20–29 and 30–39 had the highest rates of drug-related hospitalisations of any age group. However, this rate has been increasing among older age groups. From 1999–2000 to 2018–19:

• The rate of drug-related hospitalisations increased for people aged 50–59 (from 94.3 to 183.7 hospitalisations per 100,000 population), 60–69 (from 51.3 to 98 per 100,000) and people aged 70 and over (from 52.7 to 73.5 per 100,000).
• Males aged 40–49 and 50–59 had the greatest increase in the rate of hospitalisations of any group (Man et al. 2021).

Deaths due to harmful alcohol consumption

Alcohol-induced deaths are defined as those that can be directly attributable to alcohol use, 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 2018).

Australian Institute of Health and Welfare (AIHW) analysis of the AIHW National Mortality Database showed that of the reported 1,452 alcohol-induced deaths in 2020, the highest age-specific rates for alcohol-induced deaths were for older people:

• 16.0 per 100,000 population for those aged 60–64 years
• 13.2 per 100,000 population for those 55–59
• 12.3 per 100,000 population for those aged 50–54 (Table S1.5).

In comparison, the lowest rates of alcohol-induced deaths were for young people aged 15–24 years—there were no alcohol-induced deaths for people aged 15–19 and the rate was 0.1 per 100,000 population for those aged 20–24 years.

Higher rates of alcohol-related deaths were also recorded for the older age groups (ranging from 32.2 deaths per 100,000 population for those aged 50–54 to 37.1 per 100,000 population for those aged 60–64) (Table S1.5). This compares with the lowest rate of 1.0 per 100,000 population for people aged 15–19 years.

 ABS Causes of Death data 2020 reported:

• The highest age-specific rates for males were for those aged 55–64 years (22.4 per 100,000 population), followed by those 65 and over (16.9 per 100,000 population).
• The highest age-specific rates for females were also those aged 55–64 years, (7.1 per 100,000 population), followed by those 45–54 years (6.8 per 100,000).
• The median age at death was higher for males than females (59.3 and 56.7 years, respectively) (ABS 2021).

Drug-induced deaths

Drug-induced deaths are defined as those that can be directly attributable to drug use and includes both those due to acute toxicity for example, drug overdose) and chronic use (for example, drug-induced cardiac conditions) as determined by toxicology and pathology reports (ABS 2021).

In 2020, ABS Causes of Death data reported 1,842 drug-induced deaths. Of these deaths, 28% were in people aged 55 years and over (512 deaths). Overall, the highest rates were in the 35–44 and 45–54 year age groups, both with an age-specific rate of 13.5 deaths per 100,000 population. For the older age groups:

• Males aged 55–64 years reported an age-specific death rate of 11.7 per 100,000 population (170 deaths), while males aged 65 and over reported a lower age-specific death rate of 5.8 per 100,000 population (113 deaths).
• Females aged 55–64 years reported an age-specific death rate of 8.0 per 100,000 population (123 deaths), while females aged 65 and over reported a lower age-specific death rate of 4.8 per 100,000 population (106 deaths).
• Almost half (46%, or 198 deaths) of intentional drug-induced deaths were for those aged 55 and over (ABS 2021).

AIHW analysis of the National Mortality database shows that in 2020, people aged 65 years and over were the only age group to not have personal history of self-harm as the most frequently occurring psychosocial risk factor. Personal history of self-harm was second most frequently occurring risk factor, behind limitation of activities due to disability (17.4% of drug-induced deaths in this age group) (Table 2.71b).

Data analysis on causes of death in Australia by the National Drug and Alcohol Research Centre (NDARC) show that the age profile of people with drug-induced deaths has changed over the last 2 decades:

• Between 1997 and 2005, the highest rate of drug-induced deaths was recorded for people aged 25–34 years. However, the rate decreased substantially from a peak of 22.0 per 100,000 population in 1999 to 7.1 per 100,000 in 2006. The rate has fluctuated since the beginning of the reporting in 1997, with 8.0 deaths per 100,000 population in 2020.
• Conversely, the rate for people aged 45–54 years increased from 5.6 deaths per 100,000 population in 1997 to 13.0 in 2020 – the equal highest rate recorded across all age groups for 2020.
• The rate for people aged 55–64 years also increased between 1997 (3.2 per 100,000 population) and 2020 (9.8 per 100,000 population) – the third highest rate recorded in 2020 (Chrzanowska et al. 2022).

Between 2019 and 2020, the rate of opioid-induced deaths continued to decrease for people aged 55-64 (5.9 per 100,000 population to 5.3), and people aged 75–84 (1.5 per 100,000 population to 1.4). There was an increase in opioid-induced deaths for people aged 65–74 (1.9 per 100,000 in 2019 to 2.3 in 2020) (Chrzanowska et al. 2022).

Treatment

The 2020–21 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) Early Insights report shows that 11% of clients receiving treatment were aged 50–59 and 5.1% were aged 60 and over (AIHW 2022a).

Data collected for the AODTS NMDS are released twice each year—a key findings report in April and a detailed report mid-year.

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 AIHW’s AODTS NMDS and National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collections indicate that, in the last 11 years, an ageing cohort of Australians receiving drug and alcohol treatment has emerged.

NOPSAD data indicate that:

• On a snapshot day in 2021, 22% of clients who received opioid pharmacotherapy treatment were aged 50–59 (excluding data for Queensland). This has increased from 15% in 2011.
• The median age of clients who received opioid pharmacotherapy treatment has increased from 38 years in 2011 to 44 in 2021 (AIHW 2022b).

Data from the AODTS NMDS show that 16% of clients who received treatment for their own or someone else’s alcohol or other drug use in 2020–21 were aged 50 and over. This has increased from 13% in 2014–15 (AIHW 2022a).

In 2020–21, among clients who sought treatment for their own AOD use:

• The most common principal drug of concern among clients aged 50–59 was alcohol (59% of clients), followed by amphetamines (12%).
• Alcohol was also the most common principal drug of concern for those aged 60 and over (74% of clients), followed by cannabis (6%) (AIHW 2022a, Table SC.10).

• Counselling was the most common treatment type for clients aged 50–59 (43% of clients) and those aged 60 and over (40%), followed by assessment only (21% of clients aged 50–59 and 27% of those aged 60 and over) (AIHW 2022a, Table SC.19).

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 one 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 alcohol and other drug treatment types, 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).

Smoking and alcohol cessation medicines

Data from the Pharmaceutical Benefits Scheme (PBS) provide information on the number of prescriptions dispensed and the number of patients supplied at least one script under the PBS within a given financial year. The PBS database includes information about medicines that are used to help people stop their smoking or alcohol consumption (smoking and alcohol cessation medicines).

Some smoking cessation medicines, such as Nicotine Replacement Therapies (NRT; for example, nicotine patches and gums), are available over-the-counter (OTC) as well as via a prescription. OTC NRT data are not captured in the PBS data as OTC medicines are not subsidised under the PBS. Refer to the Technical notes and Box PHARMS2 for more information.

Data from the PBS indicate that rates of dispensing of smoking and alcohol cessation medicines are consistently highest for people aged in their 40s, 50s and 60s (tables PBS66, PBS68, PBS82 and PBS84). In 2020–21:

• People aged 50–59 had the highest rates of smoking cessation medicine scripts dispensed and patient rates of any age group. This was followed by people aged 40–49 (scripts dispensed) or 60–69 (patient rate per 100,000 population).
• Males aged 50–59 had the highest rate of smoking cessation medicine scripts dispensed and patient rates of any group (around 4,500 scripts and 2,100 patients per 100,000 population).
• People aged 40–49 had the highest rates of alcohol cessation scripts dispensed and patient rates of any age group, followed by people aged 50–59.
• Males aged 40–49 had the highest rate of alcohol cessation medicine scripts dispensed and patient rates of any age group (around 970 scripts and 385 patients per 100,000 population) (tables PBS66, PBS68, PBS82 and PBS84).

Between 2012–13 and 2020–21, people in their 40s, 50s and 60s consistently had the highest dispensing rates for smoking and alcohol cessation medicines of any age group.

• Rates of smoking cessation medicine scripts dispensed fluctuated over time, but overall increased among people in their 50s and over. However, the rate of patients remained stable or declined for all age groups, apart from those in their 70s and those aged 80 and over where rates increased. This indicates that people in their 50s and 60s may be receiving an increasing number of scripts per patient across time.
• Rates of alcohol cessation medicine scripts dispensed and patients who received a supply of an alcohol cessation medicine increased across the period for people in their 40s and over (tables PBS66, PBS68, PBS82 and PBS84).