Drinking too much alcohol, both on single drinking occasions (binge drinking) and over a person’s lifetime can lead to harms including chronic diseases, injury and transport accidents, mental health disorders, intergenerational trauma and violence [33425][48572]. This affects individuals, families and the wider community. Many factors influence why people may drink too much alcohol, for example, socioeconomic disadvantage, stress and negative early life experiences [39347][39351]. With regard to Aboriginal and Torres Strait Islander people, as noted elsewhere in the Overview, it is important to understand the historical and social contexts of colonisation, the ongoing effects of dispossession of land and culture, economic exclusion and how these factors influence alcohol use [33425][34063]. Extent of alcohol use among Aboriginal and Torres Strait Islander people Aboriginal and Torres Strait Islander people are less likely to drink alcohol than non-Indigenous people, but those who do drink are more likely to at levels that cause harm [48572][42101]. Assessing risks from use of alcohol The 2020 National Health and Medical Research Council (NHMRC) Australian guidelines to reduce health risks from drinking alcohol provide recommendations on reducing the risk of alcohol-related harm for adults, children and people under 18 years of age, and women who are pregnant or breastfeeding [42089]: Guideline 1 recommends that to reduce the risk from alcohol-related disease or injury, men and women should drink no more than 10 standard drinks a week and no more than four standard drinks on any one day. Drinking less, lowers the risk of harm from alcohol. Guideline 2 recommends that to reduce the risk of alcohol-related harm and injury, children and people aged under 18 years should not drink alcohol. Guideline 3 recommends that to prevent alcohol-related harm to an unborn child, women who are planning a pregnancy, or who are pregnant, should not drink alcohol. For women who are breastfeeding, not drinking alcohol is the safest option for their baby. Abstinence or no consumption of alcohol in the last 12 months The 2022-23 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) found that one in four (25%) Aboriginal and Torres Strait Islander adults reported they had either never consumed alcohol (7.3%) or had not done so for more than 12 months (18%) (Derived from [50170]). The proportion was higher for females (29%) than males (21%). The proportion was lowest among people aged 25-34 years (18%) and 35-44 years (20%), and highest in people aged 55 years and over (37%). For the different Australian jurisdictions (excluding the ACT), the proportion of respondents aged 18 years and over who had consumed alcohol 12 or more months ago was highest in the NT (27%), followed by WA (23%), Tas (19%), Qld (18%), SA (17%), NSW (16%), and Vic (12%). A greater proportion of people aged 15 years and over living in remote areas (44%) than non-remote areas (27%) reported that they had never consumed alcohol or had not done so for more than 12 months. Did not exceed guideline In the 2022-23 NATSIHS, 62% of people aged 18 years and over reported that they did not exceed the 2020 Australian adult alcohol guideline (see box above, Guideline 1) [50170]. A greater proportion of females (73%) did not exceed the guideline than males (51%). The age-group with the highest proportion of people who did not exceed the guideline was 55 years and over (70%), followed by those aged 45-54 years (63%). The proportion of respondents who did not exceed the guideline was similar in both remote and non-remote areas (63% and 65% respectively). Exceeded guideline In the 2022-23 NATSIHS, 36% of people aged 18 years and over reported exceeding the 2020 Australian adult alcohol guideline (see box above, Guideline 1) [50170]. This included those who had consumed more than 10 standard drinks in the week prior to the survey (22%) and/or had consumed 5 or more standard drinks on a single day at least 12 times in the last 12 months (32%). The proportion of males (48%) who exceeded the guideline was higher than that for females (25%). By jurisdiction (excluding the ACT), NSW had the highest proportion of respondents who had exceeded the guideline (40%), followed by WA (38%), Vic and Qld (both 34%), SA (31%), and Tas and the NT) (both 30%). The proportion of respondents who exceeded the guideline was similar in both remote and non-remote areas (35% and 34% respectively). Alcohol and pregnancy In 2022, 88% of pregnant Aboriginal and Torres Strait Islander women self-reported not consuming alcohol during the first 20 weeks of pregnancy (excluding NSW) [43321]. After 20 weeks of pregnancy, this increased to 93% of women. Treatment In 2022-23, 18% of people aged 10 years and over who accessed publicly funded AOD treatment services for their own substance use identified as being Aboriginal and/or Torres Strait Islander [43453]. Alcohol was the main drug of concern for 37% of Aboriginal and Torres Strait Islander clients who sought treatment for their own AOD use. A study conducted in 2019 among 775 Aboriginal and Torres Strait Islander people in SA (aged 16 years and over) found that 2.2% were likely dependent on alcohol (self-reported two or more dependence symptoms via the Grog Survey App) [42836]. Hospitalisation In 2017-19, the crude rate of alcohol-related hospitalisations for Aboriginal and Torres Strait Islander people was 7.0 per 1,000 [42101]. The rate was higher for males than females (8.1 per 1,000 and 5.8 per 1,000 respectively). The highest crude rate of hospitalisations related to alcohol use for Aboriginal and Torres Strait Islander people was for mental and behavioural disorders at 6.3 per 1,000 (males: 7.3 per 1,000 and females: 5.3 per 1,000). Acute intoxication was the leading mental and behavioural disorder, with a crude hospitalisation rate of 4.2 per 1,000. Across age ranges, the highest age-specific alcohol-related hospitalisation rates among Aboriginal and Torres Strait Islander people in 2017-19 were for the 45-54 years age-group (22 per 1,000), followed by the 35-44 years age-group (17 per 1,000), 55-64 years age-group (15 per 1,000), 25-34 years age-group (7.3 per 1,000), 65 years and over age-group (4.6 per 1,000), 15-24 years age-group (3.0 per 1,000) and 0-14 years age-group (0.2 per 1,000) [42101]. The rankings by age-group were the same among females and males, except males in the 55-64 years age-group who had a higher hospitalisation rate than males in the 35-44 years age-group (20 per 1,000 and 19 per 1,000 respectively). By jurisdiction, crude rates of alcohol-related hospitalisations in 2017-19 for Aboriginal and Torres Strait Islander people were highest in the NT (16 per 1,000), followed by SA (9.1 per 1,000), WA (8.6 per 1,000), Qld (7.6 per 1,000), the ACT (4.8 per 1,000), NSW (4.0 per 1,000), Vic (3.7 per 1,000) and Tas (2.8 per 1,000) [42101]. Males had higher crude rates of alcohol-related hospitalisation than females across all states and territories, except the NT (males: 15 per 1,000 and females: 17 per 1,000). Hospitalisation rates related to alcohol use in 2017-19 varied by level of remoteness [42101]. Aboriginal and Torres Strait Islander people living in remote areas (excluding remote Vic) had the highest crude rates of hospitalisation related to alcohol use (15 per 1,000), followed by those in very remote areas (11 per 1,000). People in inner regional areas (3.1 per 1,000) and major cities (5.3 per 1,000) had the lowest crude rates of hospitalisation related to alcohol use. Mortality In 2018, 350 deaths among Aboriginal and Torres Strait Islander people (9.7% of all deaths) were attributable to alcohol use [44827]. For 2015-2019 in NSW, Qld, WA, SA and the NT, the crude rate for Aboriginal and Torres Strait Islander deaths related to alcohol use was 13 per 100,000 [42101]. The alcohol-related death rate for Aboriginal and Torres Strait Islander males was 2.1 times higher compared with females (17 per 100,000 and 8.1 per 100,000 respectively). The main cause of alcohol-related deaths was from alcoholic liver disease with a crude rate of 8.0 per 100,000. Burden of disease In 2018, alcohol use was the second leading risk factor contributing to the total burden of disease among Aboriginal and Torres Strait Islander people, accounting for 11% of the burden [44827]. For non-fatal burden of disease among Aboriginal and Torres Strait Islander people, 9.2% was attributable to alcohol use, the most of any risk factor. Alcohol use disorders were the fourth leading group of diseases causing burden among Aboriginal and Torres Strait Islander people in 2018 (4.4% of total DALY) [44827]. Alcohol was a key contributor to burden of disease among males in particular, with alcohol use disorders ranked as the third leading cause of total burden, accounting for 6.2% of total DALY. Alcohol use was the leading risk factor contributing to the burden of disease for males in both the 15-24 years and 25-44 years age-groups, accounting for 26% and 23% of total disease burden respectively. For females, alcohol use disorders ranked 10th among the causes of total burden (2.4% of total DALY). Alcohol use disorders were the leading cause of total burden among Aboriginal and Torres Strait Islander people aged 25-44 years (8.4% of total DALY) and the second leading cause among those aged 15-24 years (9.9% of total DALY). References
