2.16 Risky alcohol consumption
Why is it important?
Excessive consumption of alcohol is associated with health and social problems in all populations. Long-term excessive alcohol consumption is a major risk factor for conditions such as liver disease, pancreatitis, heart disease, stroke, diabetes, obesity and cancer. It is also linked to social and emotional wellbeing, mental health and other drug issues (NHMRC 2009). Where mothers have consumed alcohol during pregnancy, babies may be born with Foetal Alcohol Spectrum Disorders (FASD) (Telethon 2009).
Binge drinking contributes to injuries and death due to suicide, transport accidents, violence, burns and falls. For the general population, one-third of suicides for men and women and one-third of motor vehicle deaths for men have been linked to alcohol consumption (NHMRC 2009). Alcohol abuse can also affect families and communities. It has the potential to lead to anti-social behaviour, violence, assault, imprisonment and family breakdown (NHMRC 2009).
The 2003 Burden of Disease study estimated that alcohol harm accounts for 5.4% of the total burden of disease and injury for Indigenous Australians. For Indigenous males aged 15–34 years, alcohol was responsible for the greatest burden of disease and injury among the risk factors considered and was the second leading cause for females in this age group (Vos et al. 2007).
The National Health and Medical Research Council (NHMRC) state that 'drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury' and that 'drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion' (NHMRC 2009).
The 2012–13 Health Survey collected data on those who exceeded the NHMRC lifetime and single occasion risk guidelines. Based on the survey, 26% of Indigenous Australians aged 15 years and over abstained from alcohol in the previous 12 months. After adjusting for differences in the age structure of the two populations, this was 1.6 times the non-Indigenous rate.
In 2012–13, 54% of Indigenous Australians exceeded the single occasion guidelines (binge drinking) at least once in the last twelve months (19% weekly and 35% less than weekly). After adjusting for differences in the age structures of the two populations, this was 1.1 times the non-Indigenous rate. Rates of binge drinking were higher for Indigenous males (64%) than females (44%). Those living in non-remote areas were more likely to binge drink at least once in the last 12 months than those living in remote areas (55% compared with 48%); while rates for binge drinking at least once per week were 20% in remote areas and 18% in non-remote areas. Comparable data for Indigenous Australians aged 18 years and over from 2004–05 show no change in binge drinking over time.
In 2012–13, 18% of Indigenous Australians drank at rates that exceeded the NHMRC lifetime risk guideline, a rate similar to non-Indigenous Australians. Comparable data for Indigenous Australians aged 18 years and over show no significant change in lifetime risky drinking between 2001 and 2012–13.
Excess alcohol consumption has significant impacts on communities. In 2012–13, 14% of Indigenous Australians reported experiencing a family stressor related to alcohol problems. After adjusting for differences in the age structure of the two populations Indigenous Australians were 3.6 times more likely to report a stressor relating to alcohol or drug-related problems than non-Indigenous Australians. Numerous studies show that alcohol increases the risk of violence among people pre-disposed to aggression (Exum 2006; Fergusson et al. 2000). One study in NSW found that, after controlling for social and demographic variables, rates of offensive behavior and property damage tended to be higher in areas with higher levels of alcohol sales (Stevenson et al. 1999). There is a clear link between alcohol, violence and imprisonment (see measure 2.11).
Survey data provides an indication of the prevalence of alcohol consumption, but under-estimates actual consumption. Furthermore, it cannot be assumed that patterns of consumption are uniform across geographic regions (Stockwell et al. 2004). After considering a range of evidence, a review by Wilson and colleagues estimated the prevalence of harmful alcohol use in the Aboriginal and Torres Strait Islander population at twice that of the non-Indigenous population (Wilson et al. 2010).
Over the period 2008–12, in NSW, Qld, WA, SA and the NT combined, Indigenous males died from alcohol-related causes at 5 times the rate of non-Indigenous males, and Indigenous females at 6 times the non-Indigenous rate. Most deaths (245 out of 365 deaths) were due to alcoholic liver disease. Indigenous Australians died from mental and behavioural disorders due to alcohol use at 6 times the rate of non-Indigenous Australians and alcoholic liver disease and poisoning by alcohol at 4 times the rate of non-Indigenous Australians. The Overcoming Indigenous Disadvantage Report (SCRGSP 2014a), found that the age-standardised alcohol-related death rate among Indigenous Australians fell from 28 deaths per 100,000 in 2003–07 to 22 deaths per 100,000 in 2008–12 and that the gap between Indigenous Australians and non-Indigenous Australians narrowed.
Over the period July 2011 to June 2013, there were 9,995 hospitalisations of Indigenous Australians with a principal diagnosis related to alcohol use. This represented 2% of all hospitalizations of Indigenous Australians (excluding dialysis). Rates were highest in remote areas (17 per 1,000) and lowest in inner regional areas (5 per 1,000). Indigenous males were hospitalised for diagnoses related to alcohol use at 5 times the rate of non-Indigenous males, and Indigenous females at 4 times the rate of non-Indigenous females. Acute intoxication was the most common reason Indigenous Australians were hospitalised for alcohol use (56%), followed by dependence syndrome (13%), alcoholic liver disease (11%), and withdrawal (11%). Indigenous Australians were hospitalised for acute intoxication at 11 times the rate of non-Indigenous Australians and for alcoholic liver disease at 5 times the rate. Between 2004–05 and 2012–13 hospitalisation rates relating to alcohol use increased for Indigenous females (4.8 to 7.5 per 1,000 population) and Indigenous males (9.8 to 12.8 per 1,000 population).
The health effects of excess alcohol consumption are evident in both mortality and morbidity statistics. Reducing alcohol abuse can reduce levels of assaults and disability and improve the health and wellbeing of the population.
Interventions that reduce the supply of alcohol are effective (Gray et al. 2010). Internationally, price controls have been found to be the most effective method. A study in Central Australia attributed the decline in alcohol consumption and related harm over the period 2000–10 to a suite of alcohol control measures, finding that the biggest contribution was from measures that indirectly increased the price of alcohol (Symons et al. 2012).
Evidence from trials in Newcastle demonstrates a reduction in assaults as a result of trading hour restrictions (Jones et al. 2009). Reducing the number of alcohol sales outlets may also be effective, with a halving in assaults in Aurukun attributed to the phased closure of the Aurukun tavern (FaHCSIA 2012). Community alcohol restrictions that are supported by residents, leaders and businesses can also be effective. Margolis et al. (2011) reported that the rate of serious injury in four remote Indigenous communities in Queensland, as measured by Royal Flying Doctor Service injury retrieval data, dropped from 30 per 1,000 in 2008 to 14 per 1,000 in 2010, coinciding with the tightening of alcohol restrictions.
The National Drug Strategy 2010–2015 provides the framework for an integrated and coordinated approach across all levels of government that aims to reduce drug-related harm and drug use in Australia. Under the strategy, the National Aboriginal and Torres Strait Islander peoples Drug Strategy (NATSIPDS) is being developed. The NATSIPDS will act as a guide for governments, communities, service providers and individuals to identify key issues and priority areas for action. The goal of the strategy is to improve the health and wellbeing of Indigenous Australians by preventing and reducing the harmful effects of alcohol and drugs on individuals, families, and their communities. The strategy has been informed by community and stakeholder consultation.
The Indigenous Advancement Strategy—Safety and Wellbeing Programme and the Indigenous Australians' Health Programme provide funding for combatting alcohol and other substance misuse (see measure 3.11).
On 25 June 2014, the Australian Government announced funding of $9.2 million for the National Fetal Alcohol Spectrum Disorders (FASD) Action Plan, which includes funding for Indigenous-specific prevention and promotion activities. The FASD Action Plan is directed at the frontline of dealing with risky alcohol consumption—providing better diagnosis and management, developing best practice interventions, and services to support high-risk women. A review of 22 programmes in the US has found that pre-natal health screening followed by empathetic interventions by health professionals was effective in reducing alcohol use during pregnancy (AIHW and AIFS 2015).
Figure 2.16-1 shows the age-standardised proportion of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians aged 15 years and over who consumed alcohol at different risk levels in 2012–13. Data is presented for abstainers; people who exceeded the single occasion guideline; and people who exceeded the lifetime risk guideline. Refer to the findings section of this measure for a description of key results found in this figure.
Source: ABS and AIHW analysis of 2012–13 AATSIHS
Figure 2.16-2 shows the age-specific proportions of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians aged 15 years and over who exceeded the single occasion risk guidelines in 2012–13. Data is presented separately for males and females. Refer to the findings section of this measure for a description of key results found in this figure.
a) Percentages are age-standardised
Source: ABS and AIHW analysis of 2012–13 AATSIHS
Figure 2.16-3 shows the proportion of Aboriginal and Torres Strait Islander peoples aged 15 years and over who exceeded the single occasion risk guidelines in 2012–13. Data is presented separately for each jurisdiction, and Australia as a whole. Refer to the findings section of this measure for a description of key results found in this figure.
Source: ABS and AIHW analysis of 2012–13 AATSIHS
Figure 2.16-4 shows the age-standardised rate (rate per 100,000) for deaths related to alcohol use among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians in NSW, Qld, WA, SA and NT in 2008–2012. Data is presented separately for the following causes of death: alcoholic liver disease; mental and behavioural disorders due to alcohol use; and poisoning by alcohol. Refer to the findings section of this measure for a description of key results found in this figure.
Source: ABS and AIHW analysis of National Mortality Database