Alcohol, tobacco & other drugs in Australia

Experimentation with alcohol and other drugs is a part of the lives of many young people. However, young people (particularly adolescents) are susceptible to permanent damage from alcohol and other drug use as their brains are still developing, which makes them a vulnerable population. Refer to Box YOUNGER1 on how young people are defined in this report. 

Tobacco smoking

Data from multiple sources indicates that the prevalence of tobacco smoking among younger people is decreasing (ABS 2018b, AIHW 2017, Guerin & White 2018; White & Williams 2016). Some key findings from the 2016 NDSHS include:

Daily smoking

• Young adults aged 18–24 are far less likely to smoke daily with smoking rates halving between 2001 and 2016 both among males (24.5% to 12.3%) and females (23.5% to 10.8%) (Table S3.24).
• This trend was similar for young Indigenous people aged 15–24, with the proportion of current daily smokers decreasing from 45% in 2002 to 31% in 2014-15 (AIHW 2018a). More young Indigenous females (61% or 41,600) than males (53% or 36,300) had never smoked and more males than females were current daily smokers (35% or 23,600 and 27% or 18,200, respectively) in 2014–15 (AIHW 2018a).

Age of initiation

• The average age at which young people aged 14–24 smoked their first full cigarette has steadily risen since 1995, for both males and females. Younger people in 2016 who tried smoking their first full cigarette were about 2 years older than those smoking their first full cigarette in 1995 (16.3 years compared with 14.2 years).
• Between 2013 and 2016, the average age of smoking initiation significantly increased from 15.9 years to 16.3 years but the increase was only significant for males, from 16.0 years to 16.6 years.
• Females generally smoked their first full cigarette at a slightly younger average age than males (16.0 years in 2016 compared with 16.6 years for males) (Figure YOUNGER1).

Number of cigarettes

In 2016, smokers aged 18–24 smoked an average of 68 cigarettes per week, a significant decline from 84 in 2013. This age group was the only age group to experience a significant decline in the number of cigarettes smoked over the 3-year period (Table S3.25). Fewer young adult smokers smoked a pack a day in 2016 than in 2013 (21% compared with 36%) (AIHW 2017) (Table S3.26).

Geographic trends

• According to the 2016 NDSHS, 11.6% of young adults aged 18–24 reported daily smoking.
• Tasmania (21%) reported the highest level of daily tobacco smoking by this population, followed by the Northern Territory (17.9%).
• Western Australia (6.4%) reported the lowest level, following a considerable decline from 15.5% in 2013 (Figure YOUNGER2).

The Australian Secondary Students’ Alcohol and Drug (ASSAD) survey in 2017 of 20,000 secondary students aged 12–17 found that:

• 83% of secondary school students had never tried smoking (not even a single puff) in 2017 compared to 76% in 2011.
• 7% of secondary school students aged 12–17 had smoked in the last month, a decrease from 9% in 2011.
• 1 in 20 (5%) of students aged 12–17 were current smokers, that is, smoked on at least one of the past seven days; this is significantly lower than the 7% reported in 2011.
• 2% of secondary school students aged 12–15 and 5% of those aged 16–17 smoked on at least three of the past seven days.
• 23% of current smokers in secondary school aged 16–17 smoked daily.
• Among secondary school students aged 12–17, 29% of past month smokers have used RYO tobacco at least 20 times or more, up from 24% in 2014.   
• 48% of secondary school students who had tried vaping reported in 2017 that they had not previously smoked a cigarette.
• Approximately 13% of secondary school students had tried e-cigarettes, and of these about 32% had vaped at least once in the past month and 13% at least three times in the past month.
• 48% of current smokers stated that their most common source for cigarettes was from friends.
• 48% of the 13% of secondary school students who had ever tried vaping reported in 2017 that they had not previously smoked a cigarette. Of those students who had used e-cigarettes in the past month, 48% had either never smoked a cigarette, had smoked only a few puffs (20%) or had smoked fewer than 10 cigarettes (11%)  (Guerin & White 2018, Table 3.11 to 3.13).

Alcohol consumption

The National Health and Medical Research Council (NHMRC) drinking guidelines advise that for anyone aged under 18, not drinking alcohol is the safest option, with those under 15 at the greatest risk of harm (NHMRC 2009). Drinking alcohol in adolescence can be harmful to young people’s physical and psychosocial development.

Results from the 2016 NDSHS indicate that more younger people are following this advice as the age at which people first tried alcohol has been increasing over time. More specifically:

• the average age at which young people aged 14–24 first tried alcohol has steadily risen since 1995 from 14.8 to 16.1 in 2016
• the average age of initiation was similar for males and females aged 14–24, and between 2013 and 2016, increased for both sexes—from 15.7 to 16.2 for males and from 15.6 to 16.0 for females (AIHW 2017) (Table S3.39).

There were also significant increases in the proportion of males (71% to 83%) and females (73% to 80%) aged 12–17 who abstained from drinking between 2013 and 2016. Overall there are more adolescents abstaining from drinking than previously – rising from 72% in 2013 to 82% in 2016 (AIHW 2017) (Table S3.34).

That said, alcohol use among adolescents in Australia was prevalent in 2016, with 9.1% of males and 6.8% of females aged 12–17 exceeding the adult guidelines for single occasion risk. However, these proportions were lower than in 2013, when 13.5% of males and 11.3% of females aged 12–17 exceeded these guidelines (Table S3.35).

Findings from the Australian Secondary Students’ Alcohol and Drug Survey (ASSAD) showed that:

• almost half (46%) of those aged 12–17 had tried alcohol in the past year and 27% in the past month
• one-third (34%) reported that they had never consumed alcohol
• 43% of students who were current drinkers obtained alcohol from their parents (Guerin & White 2018).

Lifetime risk

Between 2001 and 2010, people in their late teens and 20s were more likely to exceed the lifetime risk guidelines by consuming more than 2 standard drinks per day on average than other age groups. However, since 2010, the proportion of people aged 18–24 drinking at risky levels declined significantly from 31% in 2010 to 18.5% in 2016 (AIHW 2017) (Table S3.34).

In 2016, the Northern Territory (28.9%) and Tasmania (28.8%) recorded the highest proportion of young adults (aged 18–24) exceeding lifetime risk guidelines, while the ACT (11.6%) and South Australia (15.2%) recorded the lowest (AIHW 2017) (Table S3.37). However, since 2010, the proportion of young adults aged 18–24 exceeding the lifetime risk guidelines has decreased overall in every jurisdiction (Figure YOUNGER3).

Single occasion risk

Younger people are more likely than any other age groups to consume alcohol that exceeds the NHMRC single occasion risk guidelines by consuming on average more than four standard drinks on one occasion. Specifically:

• Young people aged 18–24 were the most likely of all age groups to exceed single occasion risk guidelines weekly or monthly (42%) (Figure YOUNG4). This is consistent with data from the National Health Survey (ABS 2018b).
• However, there has been an overall reduction in the proportion of young people aged 18–24 years exceeding single occasion risk guidelines (at least monthly).
• This appears to be due to the proportion of people under 30 reducing their alcohol use. For example, from 2013 to 2016, the proportion of young people aged 12–17 (8.7% to 5.4%) and 18–24 (47% to 42%) drinking quantities of alcohol on a single occasion that exceeded single occasion risk guidelines significantly fell (AIHW 2017).
• Young people between 18–24 in the Northern Territory and Tasmania (both 51%) were the most likely to exceed single occasion risk guidelines in 2016, while those in Western Australia (39%) and the ACT (40%) were the least likely to exceed these guidelines (Table S3.38).

The 2016–17 Young Australians Alcohol Reporting System (YAARS) examines risky drinking behaviours of the top 25% of drinkers aged between 14 and 19 years in more detail. The general trends from the YAARS data are similar to that of the NDSHS but also show that:

• Risky drinkers started their drinking around two years earlier (14 years) than the national average from the 2016 NDSHS (16 years)
• Around half were consuming 11+ standard drinks on one occasion at least once a month and their average drinking duration was 6.4 hours (Lam et al. 2017).

Alcohol-related harm

Alcohol consumption at very high levels was more common among young people. Specifically, people aged 18–24 (15.3%) were more likely to consume 11 or more standard drinks at least monthly than people in other age groups, thus placing themselves at high risk of alcohol-related harm (Table S3.36).

Younger people are also more likely to be victims of alcohol-related incidents. Specifically, people aged 20–24 were the most likely age group to experience verbal abuse, physical abuse or put in fear in the previous 12 months (AIHW 2017) (Table S3.40).

Furthermore, 83% of risky drinkers aged 14–19 years reported that they were injured as a result of their drinking in the past 12 months and 7% attended the emergency for an alcohol related injury (Lam et al. 2017).

Illicit drug use

Since 2001, there has been a reduction in the proportion of people aged 12–24 who have experimented with drugs. While people aged 18–24 are the most likely age group to have used illicit drugs in the last 12 months (28% in 2016), this has declined from 37% in 2001 (Table S3.42).

Age of initiation

The average age at which people aged 14 and over used their first illicit drug has fluctuated between 18.9 and 19.7 since 1995. However, in 2016, the age at which people first tried an illicit drug was older, increasing (slightly but significantly) from 19.3 in 2013 to 19.7 in 2016 and was the oldest average age of initiation since 1995 (Table S3.48).

Cannabis use

Since 2001, recent cannabis use has generally declined among the younger age groups (those aged 14–24), but either increased or remained stable for the older age groups (40 or older) (Figure YOUNG5). Compared with those in other age groups, people in their 20s continue to be the most likely to use cannabis but this declined from 29% in 2001 to 22% in 2016 (AIHW 2017) (Table S3.45).

Among adolescents aged 12–17, cannabis is the most commonly used illicit substance (Guerin & White 2018). Lifetime cannabis use was slightly higher in 2017 (31%) compared to 2011 (27%) for students aged 16–17 (Guerin & White 2018).

Meth/amphetamine use

Meth/amphetamine use has been declining since it peaked at 13.2% for 18–24 year olds in 2001 and significantly declined between 2013 and 2016. This decline was mainly driven by a substantial decline among people in their 20s—recent use of meth/amphetamines halved among this age group between 2013 and 2016 (from 5.7% to 2.8%) for both males (6.7% to 3.3%) and females (4.8% to 2.2%) (AIHW 2017) (Table S3.47).

Drug-induced deaths

For both males and females, drug induced deaths were lowest for those aged 15–19.

Males aged 20–24 are the only age group to have an illicit drug (rather than a pharmaceutical drug) as the most common substance present in drug induced deaths, with heroin being present in 1.6 deaths per 100,00 males (ABS 2017).

Geographic trends

In 2016, the proportion of young people aged 18–24 who reported recent use of illicit drugs was highest in Tasmania (40%), followed by Queensland (32%), the Northern Territory (30%), Western Australia and South Australia (both 29%). Those in NSW (25%) were the least likely to report illicit drug use (Figure YOUNGER6).  However, the proportion of 18–24 year olds who reported recent illicit drug has fluctuated over time and within jurisdictions.  

Health and harms

Burden of disease

In young people (aged 15–24):

• Alcohol and illicit drug use were the leading causes of the total burden of disease in males.
• Alcohol and illicit drug use were the second and third leading causes (respectively) of disease burden in females.
• Males experienced nearly two times the burden from alcohol use and nearly two times the burden from illicit drug use, compared with females (AIHW 2019a).

Mental health

• The ASSAD showed that in 2017, both male and female students who reported a mental health condition were more likely to report higher use of tobacco, alcohol and illicit substances than those that had not been diagnosed with a mental health condition (Guerin & White 2018).
• The Australian Child and Adolescent Survey of Mental Health and Wellbeing showed that in 2013–14, 45% of young people with major depressive disorder had used cannabis or other drugs (Lawrence et al. 2015).

Treatment

Data from the Alcohol and Other Drugs Treatment Services National Minimum Data Set (AODTS NMDS) provides information of the representation of young people in drug and alcohol treatment in Australia (AIHW 2019b). For the purposes of the AODTS NMDS, young people are defined as those aged between 10 and 29 years.

• In 2017–18, there were around 76,386 clients aged under 30, representing 38% of all clients (Table S3.52).
• Principal drug of concern: People aged under 30 were most likely to present to treatment where cannabis was the principal drug of concern (38%), followed by amphetamines (29%). Compared with older people, young people were less likely to present to treatment where alcohol was the principal drug of concern (68% for people aged over 50 compared with 19.9% for people aged under 30) (Table S3.49).
• Source of referral: Self/family (32%) was the most common source of referral for people aged under 30, followed by health service (25%) and a diversion program (23%) (Table S3.50).
• Treatment type: People aged under 30 were most likely to receive counselling (42%), support and case management only (14.5%) and assessment only (14.3%) (Table S3.51).

A study of the overlap between youth justice supervision and alcohol and other drug (AOD) treatment services from 1 July 2012 to 30 June 2016 showed that young people aged 10–17 who received an alcohol and other drug treatment service were 30 times as likely as the Australian population to be under youth justice supervision (21% compared with 0.7%) (AIHW 2018b).

Dual service clients of AOD treatment service and youth justice supervision were more likely than those who only received AOD treatment services to have multiple treatment episodes (47% compared with 19%) and principal drugs of concern (20% compared with 4%) (AIHW 2018b).

References

ABS (Australian Bureau of Statistics) 2017. Causes of death, Australia, 2016. ABS cat. no. 3303.0. Canberra: ABS. Viewed 4 January 2018

ABS 2018a. Australian Demographic Statistics, Sep 2017. ABS cat no. 3101.0. Canberra: ABS. Viewed 9 May 2018 

ABS 2018b. National health survey: first results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS. Viewed 12 December 2018

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

AIHW 2018a. Aboriginal and Torres Strait Islander adolescent and youth health and wellbeing. Cat. no. IHW 202. Canberra:AIHW 

AIHW 2018b. Overlap between youth justice supervision and alcohol and other drug treatment services: 1 July 2012 to 30 June 2016. Cat. no. JUV 126. Canberra: AIHW. Viewed 16 October 2018

AIHW 2019a. Australian burden of disease study: Impact and causes of illness and death in Australia 2015. Series no.19. BOD 22. Canberra: AIHW. Viewed 13 June 2019.

AIHW 2019b. Alcohol and other drug treatment services in Australia 2017-18: key findings. Web Report. Viewed 17 April 2019.

Guerin N & White V 2018. Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2017. Victoria: Centre for Behavioural Research in Cancer. Viewed 11 March 2019.

Lam T, Lenton S, Chikritzhs T, Gilmore W, Liang W, Pandzic et al. 2017. Young Australians’ Alcohol Reporting System (YAARS): National Report 2016/17. National Drug Research Institute, Curtin University, Perth, Western Australia.

Lawrence D, Johnson S, Hafekost J, Boterhove de Haan K, Sawyer M, Ainley J & Zubrick SR 2015. The mental health of children and adolescents: Report on the secondary Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra: Department of Health.

National Health and Medical Research Council (NHMRC) 2009. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC. Viewed 12 October 2017