Alcohol, tobacco & other drugs in Australia

Mental health is fundamental to the wellbeing of individuals, their families and the population as a whole [1]. According to the 2016 National Drug Strategy Household Survey (NDSHS) estimates, 16% of the general population aged 14 and over had been diagnosed or treated for a mental illness in the previous 12 months, a significant increase from 14% in 2013. The proportion of adults also experiencing high or very high levels of psychological distress also increased from 10% in 2013 to 12% in 2016 [2].

Increasing literacy and awareness around mental illness in Australia may partially explain these reported increases [3], 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 [2]. It is often difficult to determine whether mental illness preceded substance use or vice versa.

Tobacco smoking

According to the 2016 NDSHS estimates, people who reported daily tobacco smoking were:

• more than twice as likely to have high/very high levels of psychological distress compared with people who had never smoked (22% compared with 9.7%), and
• nearly two and a half times as likely to have been diagnosed with, or treated for, a mental health condition as those who had never smoked (29% compared with 12.4%) (Figure MENTAL1).

Between 2013 and 2016, there was a statistically significant increase in the proportion of smokers reporting:

• high levels of psychological distress (from 11.1% to 14.0%)
• very high levels of psychological distress (from 6.2% to 7.9%)
• mental illness (from 20.7% to 27.7%) [2].

The mechanisms linking tobacco smoking with mental health problems 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 [4]. 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 [5].

Alcohol consumption

The association between alcohol use and psychological distress and the diagnosis or treatment of a mental health condition is less marked than for tobacco and illicit drugs. The 2016 NDSHS findings showed that:

• people who exceeded the single occasion risk guidelines at least weekly were more likely to have high or very high levels of psychological distress (16.0%) than people drinking at low-risk levels for a single occasion (9.3%) (Table S2.72)
• the diagnosis or treatment for a mental health condition was about 1.2–1.3 times higher among drinking at risky levels (for both lifetime and single occasion risk) than those drinking at low-risk levels or abstaining from alcohol (Figure MENTAL2).

Illicit drug use

There is a strong association between illicit drug use and mental health problems.

Estimates for the 2016 NDSHS indicate that the proportion of people self-identifying as being diagnosed with, or treated for, a mental illness significantly increased among recent users of cannabis, ecstasy, meth/amphetamines and cocaine between 2013 and 2016.

• The most noticeable increase was among recent users of ecstasy (from 18% to 27%), followed by recent users of meth/amphetamines (from 29% to 42%).
• People using meth/amphetamines in the past 12 months were more likely than any other drug users to report being diagnosed with or treated for a mental illness and their rate was 3 times as high as the non-illicit drug using population (42% compared with 14%) (Figure MENTAL3).

The Ecstasy and Related Drugs Reporting System (EDRS) which surveys regular psychostimulant users also reported a significant increase in self-reported mental health problems between 2008 and 2018 (from 24% to 47%) [6].

The proportion of recent drug users experiencing high or very high levels of psychological distress increased across drugs shown in Figure MENTAL3. Overall, there was an increase in the proportion of adults in the population experiencing high or very high levels of psychological distress between 2016 and 2013 (11.6% compared with 10.0%), and this can be seen even among the non-illicit drug using population. High or very high levels of psychological distress increased from 8.6% to 9.7% among people who had not used illicit drugs in the last 12 months.

The increase in psychological distress levels was most noticeably seen among people who had used ecstasy in the last 12 months—high or very high levels of psychological distress increased by 48% between 2013 and 2016 (from 18% to 27%). High or very high distress levels also significantly increased among people who had used meth/amphetamines in the previous 12 months—from 27% to 37%—and was 3.3 times as high as people who had not used meth/amphetamines in the previous 12 months (Table S2.74).

References

1.  Australian Bureau of Statistics (ABS) 2018. National health survey: first results, 2017–18. Cat. no. 4364.0.55.001. Canberra: ABS. Viewed 12 December 2018.
2. Australian Institute of Health and Welfare (AIHW) 2017. National drug strategy household survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. Viewed 14 December 2017.
3. National Mental Health Commission of NSW 2015. National Surveys of Mental Health Literacy and Stigma and National Survey of Discrimination and Positive Treatment: A report for the Mental Health Commission of NSW. Sydney: Mental Health Commission of NSW.
4. Minichino A, Bersani FS, Calo WK, Spagnoli F, Francesconi M, et al. Smoking behaviour and mental health disorders--mutual influences and implications for therapy. International Journal of Environmental Research and Public Health, 2013; 10(10):4790–811.
5. Greenhalgh, EM., Stillman, S., & Ford, C 2016. 7.12 Smoking and mental health. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria. Viewed 12 January 2018.
6. Peacock A, Gibbs D, Karlsson A, Uporova J, Sutherland R, Bruno R, Dietze P, Lenton S, Alati R, Degenhardt L & Farrell M 2018. Australian Drug Trends 2018. Key findings from the National Ecstasy and Related Drugs Reporting System (EDRS) Interviews. Sydney, National Drug and Alcohol Research Centre, UNSW Australia.