Alcohol, tobacco & other drugs in Australia

Experimentation with alcohol and other drugs is a part of the lives of many young people, though use of tobacco, alcohol, and illicit drugs is less common among young people in 2019 than their same-age peers in 2001. Drug use among young people remains concerning as these age groups (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.

Key findings

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Tobacco smoking

Data from multiple sources indicates that the prevalence of tobacco smoking among people in younger age groups is decreasing (ABS 2018b, AIHW 2020, Guerin & White 2020). This appears to be driven by a higher proportion of young adults not taking up smoking. According to the NDSHS estimates, in 2019:

• 97% of people aged 14–17 had never smoked, increasing from 82% in 2001.
• 4 in 5 (80%) people aged 18–24 had never smoked, up from 58% in 2001 (AIHW 2020) (Table S2.15).

These increases are supported by the 2017 Australian Secondary Students’ Alcohol and Drug (ASSAD) survey, which found that the proportion of secondary school students aged 12–17 who had never tried smoking (not even a single puff) increased from 77% in 2011 to 82% in 2017.

The proportion of younger people who smoke appears to rise with increasing age. Estimates from the 2019 NDSHS indicate that people aged 18–24 (14.9%) are slightly more likely to be current smokers than the general population aged 14 and over (14.0%), while people aged 14–17 are much less likely to be current smokers (3.2%) (AIHW 2020) (Table S2.15).

Additionally, the 2017 ASSAD survey of 20,000 secondary students aged 12–17 found that:

• 1 in 20 (5%) students aged 12–17 were current smokers, that is, smoked on at least 1 of the past 7 days; this is significantly lower than the 7% reported in 2011.
• 7% of secondary school students aged 12–17 had smoked in the last month, a decrease from 9% in 2011.
• 2% of secondary school students aged 12–15 and 5% of those aged 16–17 smoked on at least 3 of the past 7 days.
• 48% of current smokers stated that their most common source for cigarettes was from friends.

Daily smoking

The proportion of young adults who smoke daily has been declining since 2001 (AIHW 2020). Estimates from the NDSHS showed, in 2019:

• Just under 1 in 10 (9.2%) people aged 18–24 smoked daily, down from 24% in 2001. This was consistent for both males (from 24.5% in 2001 to 10.0% in 2019) and females (23.5% to 8.5%) (Table S2.15).
• Among people aged 14–17, daily smoking decreased from 11.2% in 2001 to 1.9% in 2019. Notably, the 2019 estimate has a relative standard error of 25% to 50% and should be interpreted with caution (AIHW 2020b). This is consistent with the 2017 ASSAD survey where, of the total 5% of students aged 12–17 who currently smoked, only 22% smoked daily (Guerin & White 2020).

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 younger people aged 14–24 smoked their first full cigarette has steadily risen since 2001, for both males and females (AIHW 2020). According to NDSHS estimates:

• In 2019, the age at which younger people tried smoking their first full cigarette (16.6 years) was about 2 years older than in 2001 (14.3 years).
• Between 2016 and 2019, the average age of smoking initiation among females increased from 16.0% to 16.6%. For males, it remained stable (16.6% in both years) (Figure YOUNGER1).
• Females generally smoked their first full cigarette at a slightly younger average age than males. However, in 2019, for the first time, the age of smoking initiation was the same for both males and females (both 16.6%) (Figure YOUNGER1).

Figure YOUNGER1: Age of initiationᵃ of tobacco use, people aged 14–24 who have ever smoked a full cigarette, by sex, 2001 to 2019 (years)

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Number of cigarettes

In 2019, the number of cigarettes smoked per day by those in the 18–24 age group continued to decline. In 2001, smokers aged 18–24 smoked an average of 11.1 cigarettes per day, declining to 9.7 cigarettes per day in 2016 and a further decline to 8.1 cigarettes per day in 2019 (Table S3.25). The proportion of people aged 18–24 who smoked a pack a day remained stable from 2016 (21%) to 2019 (19.4%) (AIHW 2020) (Table S3.26).

Types of tobacco products consumed

Use of roll-your-own (RYO) cigarettes and e-cigarettes has been increasing among younger people since 2001. Estimates from the 2019 NDSHS showed that:

• People aged 18–24 were the most likely age group to currently use RYO cigarettes or to have used an e-cigarette in their lifetime.
• Almost two-thirds (63%) of smokers aged 18–24 currently used RYO cigarettes, a significant increase from 2016 (50%). This is similar to the findings for people aged 14 and over where there was a significant increase from 36% in 2016 to 45% in 2019 (Table S2.17).
• Of people aged 18–24, more than one-quarter (26%) had used an e-cigarette in their lifetime, the largest proportion of any age group, and 64% of current smokers in this age group had used an e-cigarette. This has increased significantly since 2016, when 19.2% of people and 49% of current smokers aged 18–24 had ever used an e-cigarette (Table S2.18).
• Almost two-thirds (65%) of people aged 14–17 and 39% of those aged 18–24 who had ever smoked an e-cigarette reported that they were a ‘never smoker’ the first time they tried an e-cigarette (AIHW 2020).

Additionally, the 2017 ASSAD survey found that:

• 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.
• Approximately 14% 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 3 times in the past month.
• In 2017, 48% of secondary school students who had ever tried vaping reported that they had not previously smoked a cigarette. One in 5 (20%) had smoked only a few puffs and around 1 in 10 (11%) had smoked fewer than 10 cigarettes (Guerin & White 2020).

Geographic trends

According to the 2019 NDSHS, 9.2% of young adults aged 18–24 reported daily smoking, a decrease from 11.6% in 2016. Most states and territories reported a decrease in young adults aged 18–24 who reported daily smoking, however, the decrease was only significant in New South Wales (from 13.1% in 2016 to 7.8% in 2019) (AIHW 2020).

Alcohol consumption

The Australian guidelines to reduce health risks from drinking alcohol 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 2019 NDSHS indicate that younger people are increasingly following this advice, with the age at which people first tried alcohol rising over time. Specifically:

• The average age at which young people aged 14–24 first tried alcohol has steadily risen from 14.7 years in 2001 to 16.2 in 2019.
• The average age of initiation was similar for males and females aged 14–24, and increased from 16.0 in 2016 to 16.3 in 2019 for females (AIHW 2020) (Table S3.39).

There has also been a long-term increase in the proportion of young people who abstain from alcohol. From 2007 to 2019, the proportion of people aged 14–17 who abstained increased from 39% to 73%, while for people aged 18–24 it rose from 13.1% to 21%. These proportions remained stable from 2016 to 2019 (Table S3.34).

Similarly, findings from the ASSAD survey showed that one-third (34%) of students aged 14–17 reported that they had never consumed alcohol (Guerin & White 2020). However, in 2017:

• Almost half (46%) of those aged 12–17 drank alcohol in the past year, and 27% had done so in the past month.
• 43% of students who were current drinkers obtained alcohol from their parents (Guerin & White 2020).

Lifetime risk

While the proportion of young people aged 18–24 who exceed the lifetime risk guidelines has increased slightly between 2016 and 2019 (18.6% in 2016 to 18.8% in 2019), this proportion has declined substantially since 2007 (30%) AIHW 2020). Data from the 2019 NDSHS shows:

• The proportion of males who exceeded the risk guidelines increased from 23% in 2016 to 27% in 2019.
• The proportion of females exceeding the risk guidelines decreased from 12.9% in 2016 to 9.7% in 2019 (Table S3.34).

Single occasion risk

Younger people are more likely than any other age group to consume alcohol that exceeds the single occasion risk guidelines by consuming on average more than 4 standard drinks on one occasion. Estimates from the 2019 NDSHS indicate that:

• Young adults aged 18–24 were the most likely of all age groups to exceed single occasion risk guidelines at least monthly (41%), compared with 25% of people aged 14 and over (Figure YOUNGER2). This is consistent with data from the National Health Survey (ABS 2018b).
• The proportion of young adults aged 18–24 years exceeding single occasion risk guidelines fell slightly between 2016 and 2019 (42% in 2016 to 41% in 2019).
• There has been an overall reduction in the proportion of young people aged 18–24 years exceeding single occasion risk guidelines, from 54% in 2007 to 41% in 2019.
• The proportion of young people aged 14–17 exceeding the adult single occasion risk guidelines showed a small increase between 2016 and 2019 (8.0% to 8.9%) (Table S3.35; AIHW 2020).

Data from the ASSAD survey also showed a significant decrease in the proportion of single occasion risky drinkers aged 16–17 (from 16% in 2011 to 11% in 2017) (Guerin & White 2020).

• Young adults aged 18–24 drinking quantities of alcohol on a single occasion that exceeded single occasion risk guidelines also fell slightly between 2016 and 2019 (42% in 2016 to 41% in 2019) (AIHW 2020).

Figure YOUNGER2: Proportion of people exceeding the lifetimeᵃ or single occasionᵇ risk guidelines, by sex and age group, 2007 to 2019 (per cent)

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High-risk alcohol consumption

In the 2019 NDSHS, alcohol consumption at very high levels was more common among younger people than the general population. Specifically, people aged 18–24 (14.6%) were more likely to consume 11 or more standard drinks at least monthly than people in other age groups (Table S3.36).

The 2016–17 Young Australians Alcohol Reporting System (YAARS) examines risky drinking behaviours of the top 25% of drinkers aged 14–19 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 2 years earlier (14 years) than the national average for recent and ex-drinkers from the 2019 NDSHS (16.2 years).
• Around half were consuming 11 or more standard drinks on one occasion at least once a month, and their average drinking duration was 6.4 hours (Lam et al. 2017).

Geographic trends

Overall, since 2007, the proportion of young adults aged 18–24 exceeding the lifetime risk guidelines has decreased in every jurisdiction, with the exception of the Northern Territory. Between 2016 and 2019, there was a significant increase in the Northern Territory in the proportion of young adults aged 18–24 who exceeded the single occasion risk guideline at least monthly (from 51% to 69%). In all other jurisdictions, the proportion of young adults who exceeded the single occasion risk guideline in 2019 was lower than the level reported in 2007 (Table S3.38).

Illicit drugs

Since 2001, there has been an overall reduction in the proportion of people in younger age groups reporting recent use of illicit drugs. Estimates from the 2019 NDSHS showed that almost 1 in 3 (31%) people aged 18–24 had used illicit drugs in the last 12 months, a higher proportion than for any other age group and an increase from 28% in 2016.

Just under 1 in 10 (9.7%) people aged 14–17 had recently used an illicit drug, a decrease from 10.9% in 2016 (Table S3.42). These figures have declined since 2001, when 37% of people aged 18–24 and 23% of people aged 14–17 had recently used an illicit drug. Cannabis, cocaine, and ecstasy are the drugs that are most commonly used by people aged 18–24 (AIHW 2020; Table S3.42; Figure YOUNGER3).

Figure YOUNGER3: Proportion of people with recentᵃ use of illicit drugs, by drug type and age group, 2001 to 2019 (per cent)

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Age of initiation

In 2019, the average age at which people first tried any illicit drug was 19.9 years, the oldest it has been in 18 years. This figure remained relatively stable since 2016 (19.8 years), but has increased overall since 2001 (18.6 years) (Table S3.48) (AIHW 2020). The average age of initiation has increased since 2001 for a range of drugs including cannabis, cocaine, and inhalants (AIHW 2020).

Cannabis

Estimates from the NDSHS show that people aged 18–24 continue to be the most likely age group to use cannabis, and cannabis is the most widely used drug among this age group (AIHW 2020). In 2019, one-quarter (25%) of people in this age group had used cannabis in the past 12 months, compared with 11.6% of people aged 14 and over (Table S3.45). However, recent use of cannabis has been declining among this cohort since 2001 (32%), but remained stable from 2016 (24%) to 2019 (AIHW 2020).

Use of cannabis is relatively less common among 14–17 year olds, with 8.2% of people in this age group having recently used cannabis in 2019 (AIHW 2020) (Table S3.45). This represents a decrease from 21% in 2001, and a slight increase from 7.9% in 2016.

The ASSAD survey reported that:

• In 2017, 8% of students aged 12–17 had used cannabis in the month before the survey and 16% reported using cannabis in their lifetime, making cannabis the most commonly used drug in this cohort (Table S2.41).
• There were no significant differences between 2011 and 2017 in the proportion of students aged 12–17 who reported lifetime and past month use of cannabis.
• However, there was a significant increase in the proportion of females aged 16–17 who had used cannabis in the past month (10% in 2011 compared with 14% in 2017) (Table S2.40).

Meth/amphetamine and other stimulants

Use of meth/amphetamine among younger people has declined over time. Estimates from the 2019 NDSHS showed that:

• Recent use of meth/amphetamine among young adults aged 18–24 has declined from 13.2% in 2001 to 2.3% in 2019. This pattern was consistent for both males (15.0% to 3.5%) and females (11.3% to 0.8%), although the 2019 estimates for both males and females have a relative standard error of 25% to 50% and should be interpreted with caution.
• The proportion of people aged 18–24 who have recently used meth/amphetamine remained stable from 2016 (2.3%) to 2019 (AIHW 2020) (Table S3.47).

By contrast, recent use of cocaine and ecstasy has increased since 2016, though this has fluctuated over time. NDSHS estimates suggest that among people aged 18–24:

• Use of cocaine increased from 2016 (5.1%) to 2019 (10.8%), with significant increases for both males (from 5.7% to 13.1%) and females (4.5% to 8.0%) (Table S2.47).
• Use of ecstasy has been fluctuating since 2001 (11.7%), but significantly increased from 2016 (8.0%) to 2019 (10.8%). This was driven by an increase in recent use among males (from 7.4% in 2016 to 12.6% in 2019) (AIHW 2020) (Table S2.46).

The use of stimulants among younger people aged 17 and under appears to be less common, with findings from the ASSAD survey revealing that most secondary school students aged 12–17 had never tried amphetamines (98%), cocaine (98%) or ecstasy (95%) (Guerin & White 2020).

Other drugs

Other drugs that are used by young people include inhalants, hallucinogens, ketamine, new and emerging psychoactive substances, and tranquilisers and other pharmaceuticals for non-medical purposes (AIHW 2020, Guerin & White 2020). The 2017 ASSAD survey showed that, among students aged 12–17:

• Around 1 in 5 (19%) students had ever used tranquilisers for a non-medical reason, but only 5% had used them in the past month (Table 2.53) (Guerin & White 2020).  This is higher than 2019 NDSHS estimates (1.3% for lifetime use among people aged 14–17, and 0.7% for use in the past 12 months), though these estimates have relative standard errors of 25% to 50% and should be used with caution (AIHW 2020).
• 18% of students had deliberately sniffed inhalants at least once in their lifetime, with 7% reporting doing so in the past month (Table 2.53). 13% had used inhalants in the past year—of those, most (43%) had tried them once or twice however almost 1 in 5 (19%) had done so more than 10 times in the past year (Guerin & White 2020).
• The majority of students (97%) reported they had never used synthetic cannabis or any new synthetic drug in the last 12 months (Guerin & White 2020) (Table S2.57). This is supported by findings from the 2019 NDSHS (AIHW 2020).

Additionally, the NDSHS has showed that use of certain drugs among younger people aged 18–24 has fluctuated or increased over time (AIHW 2020). Specifically:

• Non-medical use of pharmaceuticals in the past 12 months increased from 4.6% in 2007 to 6.3% in 2019, while use of ketamine rose from 1.6% in 2016 to 4.1% in 2019.
• The proportion of people who have recently used hallucinogens has fluctuated over time, with 5.2% of those aged 18–24 reporting recent use in 2019 (AIHW 2020).

Geographic trends

Data from the 2019 NDSHS showed that the proportion of 18–24 year olds who reported recent illicit drug use has fluctuated over time and within jurisdictions (Table S3.44).

Health and harms

Burden of disease

The Australian burden of disease study 2018 found that in young people (aged 15–24):

• Alcohol use and illicit drug use were the leading causes of the total burden of disease in males.
• Alcohol use and illicit drug use were the second and third leading causes (respectively) of disease burden in females (AIHW 2021b).

Alcohol-related harm

Younger people are also more likely to be victims of alcohol-related incidents. In 2019, 1 in 3 (34%) people aged 18–24 had been the victim of any alcohol-related incident (including physical and verbal abuse and being put in fear) in the previous 12 months (AIHW 2020). This was higher than for any other age group (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 department for an alcohol related injury (Lam et al. 2017).

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). See also Health impacts: Deaths due to harmful alcohol consumption.

In 2020, ABS Causes of Death data reported 1,452 alcohol-induced deaths. Of these deaths, 2.6% (or 38 deaths) were in people aged 15–34 years, with those in this age group experiencing the lowest rate of death at 0.5 deaths per 100,000 population:

• Overall, the lowest age-specific rate for both females and males were for those aged 15–34 years (0.4 and 0.6 per 100,000 population respectively) (ABS 2021).

Australian Institute of Health and Welfare (AIHW) analysis of the AIHW National Mortality Database showed that young people aged 15–24 years had the lowest rates of alcohol-induced and alcohol-related deaths in 2019:

• There were no alcohol-induced deaths for people aged 15–19 and the rate was 0.3 per 100,000 population for those aged 20–24 years. This compares with the highest rate of 13.4 per 100,000 population for people aged 60–64 years.
• For alcohol-related deaths, the rate for people aged 15–19 years was 4.2 per 100,000 population and for those aged 20–24 years it was more than double, 9.5 per 100,000 population. These rates compare with the highest rate of alcohol-related death of 37.7 per 100,000 people for those aged 60–64 years (Table S1.1e).

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, 6.5% (or 120 deaths) were in people aged 15–24 years. This age group had the lowest age-specific rate of death, 3.7 deaths per 100,000 population:

• Overall, the lowest age-specific rate for both females and males was for those aged 15–24 years (2.0 and 5.4 per 100,000 population, respectively) (ABS 2021).

In 2019, low rates of opioid-induced deaths were recorded for those aged 15–24 (2.1 per 100,000 population compared with the highest rate of 9.7 per 100,000 population for those aged 45–54) (Chrzanowska et al. 2021).

Mental health

• The Australian Secondary Students' Alcohol and Drug (ASSAD) survey 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 2020).
• 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

The AODTS NMDS provides information on treatment provided to clients by publicly funded AOD treatment services, including government and non-government organisations. Data from the AODTS NMDS showed that almost 2 in 5 (38%) clients were aged between 10 and 29 years in 2019–20, down from 43% in 2014–15. Over 9 in 10 clients aged 10–19 (93%) or 20–29 (95%) sought treatment for their own drug use (AIHW 2021a).

In 2019–20, among clients who sought treatment for their own alcohol or other drug use:

• The most common principal drug of concern for clients aged 10–19 was cannabis (59% of clients), followed by alcohol (14%).
• The most common principal drug of concern for clients aged 20–29 was amphetamines (31%), followed by cannabis (29%) (Table S3.49).
• Counselling was the most common main treatment type for clients aged 10–19 (37% of clients) and those aged 20–29 (42%). For clients aged 10–19, the second most common main treatment type was information and education (19%); for those aged 20–29 it was assessment only (21%) (Table S3.50).

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).