Experiences of alcohol and other drugs among people with mental health conditions

Introduction

Mental health is fundamental to the wellbeing of individuals, their families, and the population as a whole (ABS 2023). In 2020–2022, around 1 in 5 (21.5% or 4.3 million) people aged 18–65 in Australia had experienced a mental health condition in the past year (ABS 2023). This included anxiety disorders (17.2% or 3.4 million people), affective disorders (7.5% or 1.5 million people) and substance use disorders (3.3% or 647,900 people) (ABS 2023). 

There is a complex relationship between mental health and substance use. People who experience mental health conditions like anxiety or depression may use alcohol and other drugs to provide short-term relief from their symptoms. Conversely, substance use may trigger symptoms of mental illness (AIHW 2024). It is often difficult to determine whether mental illness preceded substance use or vice versa, particularly as self-reported survey data do not establish a causal link between mental health conditions and drug use (AIHW 2024).

This page focuses on alcohol and other drug use, harms and treatment among people with mental health conditions or who are experiencing high levels of psychological distress in Australia. For related content on harms associated with alcohol and other drug use, see Health and harms.

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 people with mental health conditions. These include self-report surveys that ask people about their use of tobacco, alcohol and other drugs and administrative data sets (such as data routinely collected by hospitals and the National Mortality Database). Each data set uses a different methodology, and the language used to describe older people may also differ across sources. 

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

What do we know about alcohol and other drug use among people with mental health conditions in Australia?

Tobacco smoking

The mechanisms linking tobacco smoking with mental health conditions are complex, but it is understood that people may perceive smoking to be helpful in relieving or managing psychiatric symptoms (Minichino et al. 2013). Additionally, 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 et al. 2018).

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 2024). 

In 2022–2023, people with a mental health condition were twice as likely to smoke daily as people who had not been diagnosed or treated for a mental health condition (15.4% compared with 7.4%). People who reported high or very high levels of psychological distress were also twice as likely to report daily smoking as those with low psychological distress (15.3% compared with 6.7%) (AIHW 2024, Tables 10.18 and 10.20; Figure 1).

According to 2022–2023 NDSHS estimates:

• Between 2019 and 2022–2023, there were significant decreases in the proportion of people who smoked daily among those with mental health conditions (from 20% to 15.4%) or high or very high levels of psychological distress (from 21% to 15.3%).
• The proportion of people with high or very high psychological distress who had never smoked increased, from 54% in 2019 to 59% in 2022–2023 (Figure 1).

The 2020–2022 National Study of Mental Health and Wellbeing (NSMHW) showed that of people aged 16–85 whose smoking status was:

• currently smoked:
  • 1 in 3 (31%) had any 12-month mental disorder.
  • 8.7% had substance use disorders. 
  • Males were more likely to have had substance use disorders than their female counterpart (9.0% compared with 7.8%).
• never smoked:
  • 1 in 5 (23%) had any 12-month mental health disorder.
  • 1.8% of people had substance use disorders.
  • Males were more likely to have had substance use disorders than their female counterpart (2.8% compared with 0.9%) (ABS 2023, Table 5.3).

Vaping and e-cigarette use

People with mental health conditions or high or very high psychological distress have higher rates of e-cigarette use than people without mental health conditions (AIHW 2024). Between 2019 and 2022–2023, there were significant increases in the proportion of people who use e-cigarettes among those with mental health conditions (from 4.2% to 12%) or high or very high levels of psychological distress (from 5.6% to 16%).

The increase in e-cigarette use among these populations was greater than for people without mental health conditions (2.3% to 5.8%) or with low psychological distress (from 1.8% to 3.9%) (AIHW 2024, Tables 10.18 and 10.20; Figure 1).

Alcohol use

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 2022–2023 NDSHS findings showed that:

• people with mental health conditions were more likely to drink at risky levels than those without mental health conditions (37% compared with 32%)
• 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 (39% compared with 30%) 
• between 2019 and 2022–2023, the proportion of abstainers/ex-drinkers increased among those with mental health conditions but remained stable among those without mental health conditions (AIHW 2024, Table 10.20; Figure 2).

Figure 2: Drinking status, by self-reported mental health condition^a or psychological distress^b, people aged 18 and over, 2010 to 2022–2023

The 2020–2022 NSMHW showed that of people aged 16–85 whose alcohol consumption was:

• nearly every day:
  • Just over 1 in 5 (23%) of people had any 12-month mental disorder.
  • 8.5% of people had substance use disorders.
  • Males and females had similar proportions of substance use disorders (8.4% and 8.7%, respectively).
• 1–3 days a month:
  • Just over 1 in 4 (23%) of people had any 12-month mental disorders.
  • 3.1% of people had substance use disorders.

Males were more likely to have had substance use disorders than their female counterpart (4.5% compared with 0.8%) (ABS 2023, Table 5.3).

Illicit drug use

The NDSHS found that, in 2022–2023, compared with people without mental health conditions, people with a mental health condition were: 

• 1.8 times as likely to have recently used any illicit drug (29% compared with 15.9%) 
• 2.0 times as likely to have used cannabis (19.8% compared with 10.0%)
• about 3.9 times as likely to have used methamphetamine or amphetamines (2.7% compared with 0.7%) 
• 1.5 times as likely to have used ecstasy (3.0% compared with 2.0%) 
• 1.6 times as likely to have used cocaine (6.9% compared with 4.4%)
• 2.5 times as likely to use ketamine (3.0% compared with 1.2%) (AIHW 2024, Table 10.20; Figure 3).

Between 2019 and 2022–2023, there was an increase in the proportion of people who had used an illicit drug in the past 12 months experiencing high or very high levels of psychological distress (from 26% to 30%) (AIHW 2024, Table 10.17). The proportion of people who recently used an illicit drug and had been diagnosed with or treated for a mental health condition in the previous 12 months remained stable from 26% in 2019 to 29% in 2022–2023 (AIHW 2024, Table 10.19; Figure 3).

Use of specific illicit drugs among people with mental health conditions and high psychological distress has varied across time and by drug type. Between 2019 and 2022–2023:

• there were significant increases in the proportion of people with mental health conditions that reported recent use of hallucinogens (from 2.4% in 2019 to 4.0% in 2022–2023) and ketamine (from 1.9% in 2019 to 3.0% in 2022–2023) (AIHW 2024, Table 10.20)
• recent use of ecstasy decreased from 6.1% to 4.6% among people with high or very high levels of distress (AIHW 2024, Table 10.18).

Mental health conditions also appear to be more common among people who use drugs more regularly. The 2020–2022 NSMHW showed that of people aged 16–85 whose use of drugs was:

• At least once a week:
  • 3 in 5 (58%) of people had any 12-month mental disorders.
  • Over 1 in 4 (29%) of people had substance use disorders.
  • Males were more likely to have had substance use disorders than their female counterparts (29% compared with 26%).
• Less than once a month:
  • Over 2 in 5 (44%) of people had any 12-month mental disorders.
  • 13% of people had substance use disorders.
  • Similar proportions of males and females had substance use disorders (13% and 14%, respectively) (ABS 2023, Table 5.3).

What do we know about health and harms for people with mental health conditions?

Deaths involving alcohol and other drugs

There is currently limited data available relating to deaths involving alcohol and other drugs among people with mental health conditions. However, AIHW analysis of the National Mortality Database includes information on mental and behavioural disorders and psychosocial risk factors as associated causes of death. 

In 2024, among the total 1,948 drug-induced deaths:

• the most commonly recorded psychosocial risk factor was personal history of self-harm (12% of all drug-induced deaths) (Table NMD10)
• mental and behavioural disorders due to psychoactive substance use were mentioned as associated causes of death in 1,754 drug-induced deaths, while mood disorders were mentioned in 546 deaths (Table NMD14).

Detailed information about psychosocial risk factors recorded in alcohol and drug-related deaths is presented in Deaths involving alcohol and other drugs.

How many people with mental health conditions receive treatment for alcohol and other drug use?

There is currently no available national, general population data on alcohol and other drug treatment service use among people with mental health conditions. 

For general information about alcohol and other drug treatment services in this report, see Treatment.

Where do I go for more information?

• Mental health and use of alcohol, tobacco, e-cigarettes and other drugs
• National Study of Mental Health and Wellbeing