Alcohol, tobacco & other drugs in Australia

Mental health is fundamental to the wellbeing of individuals, their families and the population as a whole (ABS 2018). According to the 2019 National Drug Strategy Household Survey (NDSHS) estimates, 16.9% of the general population aged 14 and over had been diagnosed or treated for a mental health condition in the previous 12 months. This increased from 15.9% in 2016 (AIHW 2020). The proportion of people aged 18 and over experiencing high or very high levels of psychological distress also increased, from 11.7% in 2016 to 14.0% in 2019 (AIHW 2020).

Increasing literacy and awareness around mental illness in Australia may partially explain these reported increases (National Mental Health Commission of NSW 2015), however, there are likely to be other factors involved including changing trends and patterns in alcohol and other drugs use. 

There is a complex relationship between mental health and alcohol and other drug use. A mental illness may make a person more likely to use drugs to provide short-term relief from their symptoms, while other people have drug problems that may trigger the first symptoms of mental illness (AIHW 2020). It is often difficult to determine whether mental illness preceded substance use or vice versa. In particular, self-reported survey data (such as that reported in the NDSHS) do not establish a causal link between mental health conditions and drug use (AIHW 2020).

Tobacco smoking

Tobacco smoking has declined among people with mental health conditions or high or very high psychological distress, but remains higher among these groups than people without mental health conditions (AIHW 2020). According to 2019 NDSHS estimates:

• between 2016 and 2019, there were significant decreases in the proportion of people who smoked daily among those with mental health conditions (from 24% to 20%) or high or very high levels of psychological distress (from 24% to 21%)
• the proportion of people with high or very high psychological distress who had never smoked increased, from 50% in 2016 to 54% in 2019
• however, in 2019, people with mental health conditions were still twice as likely to smoke daily as people who had not been diagnosed or treated for mental health conditions (20% compared with 9.9%)
• people who reported high or very high levels of psychological distress were also twice as likely to report daily smoking as those who reported low psychological distress (21% compared with 9.5%) (Table 2.72; Figure MENTALHEALTH1).

The mechanisms linking tobacco smoking with mental health conditions are complex; however it is understood that people may perceive smoking to be helpful in relieving or managing the psychiatric symptoms associated with their disorder (Minichino et al. 2013). It has also been shown that people with mental health conditions may find smoking cessation difficult. However, upon quitting, they are likely to experience improvements in their mood, general wellbeing, mental health and quality of life (Greenhalgh, Stillman & Ford 2018).

Alcohol consumption

People with mental health conditions or high or very high levels of psychological distress are more likely to drink at risky levels than people without these conditions. The 2019 NDSHS findings showed that:

• people with mental health conditions were more likely to drink at risky levels than those without mental health conditions (21% compared with 17.1% for lifetime risky drinking, and 31% compared with 25% for single occasion risky drinking at least monthly)
• people with high or very high levels of psychological distress were more likely to report drinking at risky levels than those who reported low psychological distress (22% compared with 16.4% for lifetime risky drinking, and 36% compared with 22% for single occasion risky drinking)
• the proportion of abstainers/ex-drinkers increased among those with low psychological distress and without mental health conditions, but remained stable among those with high distress and mental health conditions (AIHW 2020) (Table 2.72; Figure MENTALHEALTH2).

Illicit drugs

The NDSHS found that, in 2019, compared with people without mental health conditions, people with a mental health condition were:

• 1.7 times as likely to have recently used any illicit drug (26% compared with 15.2%)
• 1.8 times as likely to have used cannabis (19.4% compared with 10.7%)
• about 2.2 times as likely to have used meth/amphetamine (2.6% compared with 1.2%)
• 1.4 times as likely to have used ecstasy (4.1% compared with 3.0%) or cocaine (6.2% compared with 4.3%)
• 2.1 times as likely to use pharmaceuticals for non-medical purposes (7.6% compared with 3.6%) (Figure MENTALHEALTH3; Table S2.74) (AIHW 2020).

Use of specific illicit drugs among people with mental health conditions and high psychological distress has varied across time and by drug type. Between 2016 and 2019:

• there was a significant increase in the proportion of people with mental health conditions that reported recent use of cocaine (from 4.3% in 2016 to 6.2% in 2019)
• conversely, there were significant decreases in recent use of meth/amphetamines (from 4.1% to 2.6%) and pain-killers/pain-relievers and opioids (from 6.5% to 4.9%) among people with mental health conditions (Table S2.74)
• among people with high or very high levels of psychological distress, recent use of cocaine increased from 5.1% to 8.0%
• recent use of pain-killers/pain-relievers and opioids (excluding over-the-counter) for non-medical purposes decreased from 7.5% to 5.9% among people with high or very high levels of distress (Table S2.73) (AIHW 2020).

People who inject drugs

Estimates from the 2020 IDRS showed that 47% of participants self-reported that they had experienced a mental health problem in the previous 6 months, stable from 2019 (Peaock et al. 2021). The most commonly reported mental health problems were depression (70%) and anxiety (55%). Over half (53%) of these people had seen a mental health professional in the previous 6 months, down from 67% in 2019 (Peacock et al. 2021).