Cannabis is the most commonly used illicit drug among Aboriginal and Torres Strait Islander people [48574], with men more likely to use cannabis than women [39231]. High rates of cannabis use have been found in some remote communities [43145].

Key national surveys containing information on prevalence of cannabis use are: the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and the National Drug Strategy Household Survey (NDSHS) which can be found under publications in this section.

For a regularly updated summary of statistical information on illicit drug use among Aboriginal and Torres Strait Islander people, please see our Latest information and statistics on Illicit drugs.

Cannabis use often begins when people are young, so it is important to provide prevention and education initiatives that reduce the likelihood of people taking up the drug to begin with [23503]. The vulnerability of young people to cannabis use needs to be understood within the context of a commercial cannabis market that targets young people to foster positive attitudes toward cannabis use through social media [43145].

Encouraging young people to engage in programs and activities that keep them connected to their school, family, community and culture can help to protect them from harmful drug use including cannabis use [23508]. If people are already experimenting or using cannabis, it is helpful to provide accurate information in a non-judgemental way [43145]. Parents, caregivers, family members and teachers often have the best opportunity to provide this information.

For Aboriginal and Torres Strait Islander people, it is important that prevention and education initiatives are co-designed, culturally responsive and reflect the broader social, cultural and emotional wellbeing needs of the community [33425].

Resources such as Positive choices provide evidence-based information about alcohol and other drugs, including cannabis, for parents, teachers and individuals. It features a section specifically for Aboriginal and Torres Strait Islander people. The Community Portal on the Alcohol and Other Drugs Knowledge Centre also has resources to support families and community members who want to address drug use.

Cannabis is the third most common drug of concern (after alcohol and amphetamines) reported by Aboriginal and Torres Strait Islander people seeking alcohol or drug treatment [43453] and the second highest cause of hospitalisation due to drug use [42101].

If someone wants to give up cannabis, but they have been using it regularly, they may experience withdrawal symptoms, such as anxiety, irritability, loss of appetite and upset stomach, sweating, chills and tremors, sleeping problems and nightmares [49602][26504]. These symptoms can be managed with the support of health professionals.

Counselling is the main treatment for cannabis dependence [29712]. Some people are referred to counselling through diversion programs (referred from the criminal justice system for a drug related offence). These diversion programs give people a chance to address their cannabis use as a health issue. For more information on diversion programs, see the Alcohol and Other Drugs knowledge Centre’s Justice section.

In 2018-19, amphetamines were the fourth most commonly used illicit drug among Aboriginal and Torres Strait Islander people [39231]. Aboriginal and Torres Strait Islander men were around three times more likely to use amphetamines than women. In 2022-2023, cocaine was the second most common illicit drug used by Aboriginal and Torres Strait Islander people [48574].

In 2023, methamphetamine was the most commonly injected drug reported by attendees of Needle Syringe Programs (NSPs) in Australia [49308]. Of the people attending NSPs in 2023, 22% identified as an Aboriginal or Torres Strait Islander person.

In 2022-23, amphetamines were the second most common drug (after alcohol) that Aboriginal and Torres Strait Islander people sought help for, from alcohol and drug treatment services [43453].

In 2017-19, one quarter of drug-related hospitalisations among Aboriginal and Torres Strait Islander people were due to methamphetamine use [42101].

To prevent harmful drug use, it is important to address risk factors and promote protective factors that influence their use. For Aboriginal and Torres Strait Islander people, this includes emphasis on positive role models and supportive environments, as well as cultural identity, connections and resources [36915][41592].

A number of prevention and education programs have been implemented that aim to prevent the uptake and reduce harms from amphetamines and cocaine use, particularly ice (crystal methamphetamine). These programs seek to help communities work together to address ice use as well as provide evidence-based resources [32287].

Cracks in the ice is an online educational resource that provides trusted, evidence-based information and resources about ice for the community [32896]. It aims to improve help-seeking behaviours by increasing knowledge about ice and decrease stigma around its use [43662]. The website includes a specific section for Aboriginal and Torres Strait Islander Health Workers, families and friends, and communities [32896].

Counselling techniques such as cognitive behavioural therapy or motivational interviewing have been found to be useful strategies to support people who are trying to stop or reduce their amphetamine or cocaine use [23510]. For users needing to recover from amphetamine or cocaine use, it is helpful to sleep, exercise, have good nutrition and allow time to feel well again.

It can be hard for some people to stop or reduce their drug use because of the withdrawal symptoms that can occur [32703]. People may experience various mental and physical symptoms such as depression, anxiety, tiredness, headaches and intense drug cravings. Having a strong support network of health professionals, friends and family can increase the likelihood of recovery [49600].

Research indicates that historical trauma, social disadvantage and racism impact the way that Aboriginal and Torres Strait Islander people use methamphetamine (ice), and seek treatment for drug use [32152]. Recommendations for the treatment of ice dependence among Aboriginal and Torres Strait Islander people include:

• provide culturally sensitive, collaborative and family inclusive approaches to treatment
• provide strategies to support families to stay in touch with relatives who use ice
• create after-care services to support people who are returning home from jail or a treatment centre
• use strategies that help people feel less shame about their ice use.

Young people are more susceptible to the harmful effects from drinking alcohol compared to adults [33425]. The young brain is still developing and so it is more easily damaged by alcohol [34702]. Damage to the brain from drinking alcohol can lead to problems with learning and memory. Young people who have been drinking alcohol are also more likely to engage in risky behaviours such as getting in to fights, having accidents and doing things they regret [26162].

Delaying the age at which young people start drinking (preferably until after 18 years of the age) has positive health and social effects [34702].  The later a person starts to drink the less likely they are to have problems with alcohol when they are older.

Health promotion programs to reduce alcohol use are more likely to be successful when they are tailored and culturally appropriate for Aboriginal and Torres Strait Islander young people [26162]. Providing young people with activities that promote health and wellbeing are important strategies in reducing demand and preventing problematic alcohol use.

Controlling the supply of alcohol is a key measure in preventing harms from alcohol use to individuals and the community [20023]. There are a range of approaches to controlling supply of alcohol. Examples of these measures include:

• reducing the number of outlets selling alcohol
• reducing trading hours
• price controls
• alcohol management plans.

Controlling the availability of alcohol – by restricting trading hours and the number of outlets that sell alcohol – directly influences how much alcohol is consumed and the harms associated with alcohol use such as chronic health conditions, hospitalisation and violence [29752]. States and territories have liquor licensing laws that restrict the way alcohol is sold and allow for individuals or communities to object to liquor license applications. However the number and density of liquor outlets continues to increase [33425]. Inadequate resourcing and barriers to accessing legal process can make it difficult for community members to object to license applications [47225].

In regional and remote areas, alcohol management plans that have been initiated and designed by the local community have been shown to have beneficial health and social effects [32884][33620]. Other alcohol restrictions such as enforcement of ‘dry areas’ that are imposed by local government may simply shift drinking out of public view and are not as effective as community based initiatives [28901][23519].

Pricing of drinks based on alcohol content has also been shown to be an effective way of  discouraging people from buying large quantities of drinks with high alcohol content [24410]. Other approaches like income management (such as with a cashless debit card) attempt to control the purchase of alcohol by restricting what can be bought [34140][33819].

Ensuring that Aboriginal and Torres Strait Islander people are involved in influencing policy around alcohol use is important for effective action on reducing harms from alcohol in communities [42837].

Alcohol is the most common drug of concern that both Aboriginal and non-Indigenous people seek help for [43453][37817]. Many alcohol and other drug (AOD) treatment services that are specifically for Aboriginal and Torres Strait Islander people are offered through primary health services or provided by Aboriginal Community Controlled Health Services.

Treatment services for people with alcohol dependence includes brief intervention, withdrawal management, counselling, residential rehabilitation, support groups, case work and other activities to reduce demand. Relapse prevention medicines to reduce cravings may be offered as part of treatment, depending on the physical and mental health needs, patterns of drinking and complexities of daily life for the patient [49439].

Screening for alcohol use problems as part of a routine health check, helps to identify any potential issues with alcohol use that can then be referred for follow up treatment [34063]. For some Aboriginal and Torres Strait Islander people, having access to appropriate residential rehabilitation services provides an opportunity to give up alcohol in a supportive environment [27794][23503].

Programs tailored to local needs and culturally safe programs that are flexible and address both individual and community issues have been shown to be effective [30136][33637]. Evidenced based approaches that have been adapted to be culturally relevant to Aboriginal and Torres Strait Islander people have also delivered promising results [34185].

Many Aboriginal and Torres Strait Islander people may not seek help from a specific alcohol and drug treatment service but would benefit from the specialised support that an alcohol and drug treatment service can provide. Developing partnerships between agencies such as justice, health and community services increases the capacity of services to link clients to the help they need and better respond to alcohol and drug dependence. Integrating AOD and mental health services across sectors by different agencies working in partnership is one of the recommendations of the National Aboriginal and Torres Strait Islander Peoples’ Drug Strategy [30136].

There are many reasons why young people use illicit drugs. Some of these are to [23520]:

• relax
• be sociable
• escape boredom
• avoid painful situations.

Young people are less likely to use alcohol and other drugs (AOD) if they can keep busy with activities like school or sport, and if they have a strong support network (family and friends) [23520]. Teaching children about Culture, encouraging them to go to school, yarning with them about drug use and being a good role model reduces the chances of harmful drug use [33943]. Measures that restrict the availability of drugs also have a role [23503].

Education on the harms of drug use is useful but needs to be part of a holistic approach that incorporates other elements. A review of effective programs for young Aboriginal people to address problem AOD use found that a multi-pronged approach that incorporates cultural values and is strength-based is more likely to have successful engagement [33637].

Effective approaches to support people experiencing problem drug use include [45853]:

• counselling
• brief intervention
• peer support
• residential rehabilitation
• medicines or pharmacotherapy (for more information on pharmacotherapies see also the Harm Reduction Portal).

Aboriginal community controlled health services deliver holistic healthcare and have been shown to improve outcomes for individuals and communities [45851]. Mainstream services can be adapted to be more culturally secure by:

• planning and tailoring services in partnership with communities to meet local needs
• employing, listening to and supporting Aboriginal and Torres Strait Islander staff across services
• providing a friendly and flexible approach that allows time for yarning
• building trust and engagement
• providing holistic care that values connecting to Country, culture, family and kin.

There are a range of approaches to regulating the use of illicit drugs. Some legislation aims to reduce supply by disrupting or controlling illicit drugs and their precursors through border control, targeting supply networks and by making it an offence to supply and use illicit drugs (such as ice, heroin, cocaine and cannabis) [30136]. Other strategies aim to control buying of illicit drugs (and alcohol) through controlling where individuals can purchase goods, such as the cashless debit card [31958]. Australian registered general practitioners can prescribe medicinal cannabis after approval from the Therapeutic Goods Administration (TGA). This includes both commercially available and pharmacist compounded products. Accessing medicinal cannabis without a prescription is illegal [45493].

Putting people in jail for offences associated with illicit drug use can have a number of long-term effects which can entrench people in the justice system and make it harder for them to integrate back into the community [30848]. In recognition of this there are a number of strategies identified in the National Aboriginal and Torres Strait Islander Peoples’ Drug Strategy that aim to divert people away from jail when the underlying issue is addiction [30136]. See also our section on Justice System for justice programs including diversion programs and justice reinvestment.

There are a variety of strategies that can be used to prevent the use of illicit drugs and educate people about the potential harms of using them. These strategies include:

• build community knowledge of drug-related harms
• restrict the availability of illicit drugs (see also section on regulation and control)
• develop and promote culturally appropriate resources about illicit drugs for individuals, families and communities, and professionals who have contact with at-risk people
• engage communities and stakeholders in the development of prevention programs [33425].

A strong connection with family, community and culture helps to protect people from harmful illicit drug use [41592].  Encouraging young people to go to school, yarning with them about the harms of substance use, and being a good role model can also reduce the likelihood of young people using illicit drugs [23503]. There are health promotion and education programs run in schools and communities which focus on tackling illicit drug use, such as the  Positive Choices: Aboriginal and Torres Strait Islander resources program. This evidence-based program provides up-to-date information about drug use (including alcohol and tobacco) for parents, teachers and students. Resources on the website have been designed with a focus on education and prevention of harms.

While most Aboriginal and Torres Strait Islander people do not use illicit drugs the most commonly reported illicit drugs used by Aboriginal and Torres Strait Islander people are [48574]:

• cannabis (gunja or yarndi)
• cocaine
• pain-killers/pain-relievers and opioids for non-medical purposes
• hallucinogens
• methamphetamine and amphetamine (ice or speed).

Surveys show that illicit drug use is more common among younger age groups, and men are more likely than women to have recently used an illicit drug [31278][39231].

For a summary of statistical information updated yearly on the prevalence of illicit drug use among Aboriginal and Torres Strait Islander people, see also the illicit drugs section in our latest Overview of Aboriginal and Torres Strait Islander health status.

According to national surveys the proportion of Aboriginal and Torres Strait Islander people reporting risky drinking has declined overall since 2010 (from 48% in 2010 to 33% in 2022-23) [48574][40728]. However, alcohol use continues to cause a heavy burden of harm to individuals and community health and wellbeing [46914].

While drinking patterns can vary greatly [39570], information from large national surveys [48752][40728][39231] indicate that:

• Aboriginal and Torres Strait Islander people are more likely to abstain from drinking alcohol than non-Indigenous people
• Aboriginal and Torres Strait Islander people who drink, are more likely to do so at levels that cause harm to their health than non-Indigenous people
• Aboriginal and Torres Strait Islander males are more likely than females to consume alcohol at levels that pose lifetime risk to their health.

Key surveys containing information on prevalence of alcohol use are: the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and the National Drug Strategy Household Survey (NDSHS) which can be found under publications in this section. For a summary of statistical information updated yearly on alcohol use among Aboriginal and Torres Strait Islander people, see also our latest Overview of Aboriginal and Torres Strait Islander health status.

There are multiple treatment options available for Aboriginal and Torres Strait Islander people who want to quit smoking. Many of these treatment options can be used in conjunction with each other. When supporting someone who wants to quit smoking, it’s important to focus on what works for each individual [23503].

Some of these options include:

• nicotine replacement therapy (NRT)
• brief intervention
• counselling
• using physical activity to support quit attempts
• quitting unaided (going cold turkey)[34634].

NRT combined with ongoing support has been shown to be an effective approach to quitting smoking [29583].  NRT aims to help the transition between smoking and quitting by providing the body with smaller and more controlled doses of nicotine. NRT in the form of nicotine patches is a common medication used by Aboriginal and Torres Strait islander people to help quit smoking. A subsidy is available for some NRT products under the Pharmaceutical Benefits Scheme (PBS) [39952]. Varenicline (Champix) and Bupropion (Zyban) are also forms of medication which can help people to quit.

Brief intervention uses counselling skills such as motivational interviewing and goal setting to raise awareness, share knowledge, and get someone to think about making changes to improve their health and behaviours  [23503]. When discussing smoking cessation with Health professionals, strategies such as brief intervention have been shown to be a significant motivating reason for people to quit smoking [36654].

Free, confidential telephone counselling is available via Quitline which offers an Australia-wide service for people who want to give up smoking. There is an Aboriginal and Torres Strait Islander specific Quitline in some states and territories. For those states with only mainstream Quitline services, there will still be an opportunity to speak to an Aboriginal and Torres Strait Islander advisor.

Physical activity has been shown to aid quit attempts. Exercise can reduce withdrawal and cravings for cigarettes and helps to prevent relapse by boosting self-esteem and feelings of wellbeing [34633].

Quitting unaided, or ‘going cold turkey’ is another way of giving up smoking. Quitting unaided is usually more successful when someone quits all at once, rather than tapering down. Planning ahead to know when a person is more vulnerable to cravings (triggers) will help support the effort to quit [34634].

Research has shown that the most common reasons for wanting to give up smoking for Aboriginal and Torres Strait Islander people are health, price of cigarettes and concern for children [36654]. The factor most likely to predict sustained quit attempts was the capacity for self-empowerment.

Australia is considered to be at the forefront of tobacco regulation and control, particularly with the introduction of plain packaging laws in 2012 [34325]. In addition to plain packaging, there are also laws which prohibit smoking in public places, such as restaurants and pubs, government buildings, public transport, and some outdoor areas like swimming pools or other venues. These laws also apply to the same areas in Aboriginal and Torres Strait Islander communities.

There are also laws banning any kind of tobacco promotion and advertising (with some small exceptions) [34325]. In some Australian states and territories, tobacco companies are banned from sponsoring sporting or other cultural events.

Reducing smoking among Aboriginal and Torres Strait Islander communities is a critical element of closing the gap in health outcomes between Aboriginal and Torres Strait Islander and non-Indigenous people [43959].

An important way of reducing the harms from tobacco smoking among Aboriginal and Torres Strait Islander people is to provide education about the risks of smoking, and to reduce the proportion of people who take up smoking in the first place [29610].

There have been a number of education campaigns running recently in schools with high Aboriginal and Torres Strait Islander populations. These campaigns focus on healthy lifestyles, which include information about smoking. One example of a successful education campaign is the Queensland

program, which is run through the Institute of Urban Indigenous Health (IUIH) [30104].

Health promotion activities and community education programs have been found to be most effective when they use a multi-level approach to support tobacco control [30424]. These may be culturally sensitive social media campaigns or promoting services that help individuals to quit. It is important that as well as providing education about tobacco harms, organisations providing health promotion activities are able to refer people who want to quit to smoking cessation support services. Fostering partnerships between organisations helps to ensure people are part of a network of care that links services to together.

Smoking prevalence among Aboriginal and Torres Strait Islander people has historically been high due to the lasting effects of colonisation and targeted tobacco industry marketing [42338]. However, initiatives such as the Tackling Indigenous Smoking program are helping to reduce smoking prevalence among Aboriginal and Torres Strait Islander people.

Information from recent surveys indicates that:

• there is a strong downward trend in smoking prevalence among Aboriginal and Torres Strait Islander people [39231]
• the proportion of young Aboriginal and Torres Strait Islander people (18-24 years) who smoke has decreased, which will lead to improved health outcomes over time
• a similar proportion of Aboriginal and Torres Strait Islander men and women smoke
• the proportion of Aboriginal and Torres Strait Islander people living in rural and remote areas who smoke is higher than for those living in urban areas
• the proportion of Aboriginal and Torres Strait Islander secondary school students who smoke has continued to decrease and the proportion of those who have never smoked has increased significantly [40944].

For a summary of statistical information updated yearly on tobacco use and vaping among Aboriginal and Torres Strait Islander people, see also our latest Overview of Aboriginal and Torres Strait Islander health status.

The risk of smoking during pregnancy is an issue for both Aboriginal and Torres Strait Islander and non-Indigenous women. However, while declining over time, there are particular concerns about the high rates of smoking reported for Aboriginal and Torres Strait Islander mothers [43321]. Data shows that there are high rates of quit attempts by pregnant Aboriginal and Torres Strait Islander women however these quit attempts are often not sustained [44080][37437].

Smoking in pregnancy is a concern because of the poisons contained in cigarettes, which can pass on to the unborn baby [42101]. Women who smoke may have more problems during pregnancy and labour than those who do not smoke, and are at higher risk of:

• miscarriage
• ectopic pregnancy (when a fertilised egg is implanted outside the uterus, usually in the fallopian tubes)
• complications of pregnancy relating to the placenta and membranes, many of which can lead to preterm delivery (when the baby is born too early) [29610].

Smoking in pregnancy also means the baby may:

• be born too early (premature/preterm birth)
• be born too small (low birthweight)
• be at higher risk of Sudden Infant Death Syndrome (SIDS)
• have an increased risk of deformities [43321][29610].

Smoking is one of the most important preventable risk factors for complications in pregnancy and poor health outcomes for babies [43321]. It is best if mothers can stop smoking before getting pregnant, but the earlier they stop during pregnancy the better. It is also important for pregnant women to try to avoid being around second-hand smoke [42101].

Pregnancy is a good time to encourage Aboriginal and Torres Strait Islander women to quit smoking as they have strong protective feelings for their unborn babies and a desire to quit  [44080][37437]. As well as having positive health outcomes for the child, this can have a longer-term preventative effect; children who live in smoke-free homes are less likely to smoke [39058].

Programs such as

have been developed specifically to improve health provider’s skills when offering smoking cessation care to pregnant Aboriginal and Torres Strait Islander women [46156]. This program offers free online smoking and vaping cessation training for health professionals in both Aboriginal and mainstream health services to support pregnant Aboriginal and Torres Strait Islander women in quitting smoking and vaping, ultimately improving maternal and infant health outcomes.