Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework - 2010

2.20 Risky and high risk alcohol consumption

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Why is it important?:

Excessive consumption of alcohol is associated with health and social problems in all populations. It is a major risk factor for conditions such as liver disease, pancreatitis, diabetes and some types of cancer. Alcohol is also a frequent contributor to motor vehicle accidents, falls, burns, and suicide. It has the potential to evoke anti-social behaviour, domestic violence and family breakdown. Babies may be born with Fetal Alcohol Spectrum Disorders (FASD) where mothers have consumed alcohol during pregnancy. Estimates of the burden of disease and injury for Indigenous Australians attribute 5.4% of the total burden to the net effects of alcohol consumption. For Aboriginal and Torres Strait Islander males aged 15–34 years, alcohol was responsible for the greatest burden of disease and injury among the 11 risk factors considered (Vos et al. 2007) and is a serious public health issue facing Indigenous Australians (Calabria et al. 2010). Reducing alcohol and other substance misuse can significantly reduce levels of assaults and homicides and disability, while improving the overall health and wellbeing of the population (SCRGSP 2009).

Findings:

The 2004–05 NATSIHS collected data on alcohol consumption based on levels of risk associated with short-term (drinking over one day) and long-term risk levels (based on daily consumption over one week) (NHMRC 2001). In 2004–05, 24% of Indigenous Australians aged 18 years and over had abstained from alcohol consumption in the last 12 months and after adjusting for age this was twice the non-Indigenous rate. However, a greater proportion of those who did drink consumed alcohol at levels that posed risks for their health. In 2004–05, 17% of Indigenous Australian adults reported drinking at long-term risky/high risk levels. This was similar to the non-Indigenous rate. An estimated 55% of Indigenous Australians drank at short-term risky/high risk levels at least once in the last 12 months and 19% at least once a week over the 12 month reporting period. After adjusting for the difference in age structure between the two populations, rates of binge drinking among Indigenous adults were twice the non-Indigenous rates. Males were more likely to report drinking at both short-term and long-term risky/high risk levels than females.

The 2008 NATSISS also included a set of questions on chronic alcohol consumption (amount consumed on a usual drinking day in previous 12 months) and binge drinking (largest quantity of alcohol consumed in a single day during the fortnight). Note that these are not the same questions that were asked in the 2004–05 NATSIHS survey and therefore results are not comparable. In 2008, 17% of Indigenous Australians aged 15 years and over reported drinking at chronic risky/high risk levels in the past 12 months, representing no significant change since 2002 (15%). A further 46% of Indigenous Australians were low risk drinkers and 35% had abstained from drinking alcohol in the last 12 months. Indigenous males were more likely than Indigenous females to drink at chronic risky/high risk levels (20% compared with 14%), and this pattern was evident across age groups. Approximately 80% of Indigenous women did not drink during pregnancy.

Chronic risky/high risk drinking was highest among those aged 35–44 years (22%) and lowest among those aged 55 years and over (10%). Rates of risky/high risk drinking ranged from 14% in major cities to 20% in outer regional areas. However, those Indigenous Australians in remote areas were more likely than those in non-remote areas to be abstainers (46% compared with 31%).

In 2008, 37% of Indigenous people aged 15 years and over reported drinking at acute risky/high risk levels (binge drinking) in the two weeks prior to interview. Binge drinking was more common among Indigenous males (46%) than Indigenous females (28%) across age all groups, with men aged 25–44 years reporting the highest rates. Rates of binge drinking were higher in non-remote than remote areas (38% compared with 33%). Alcohol was perceived as a neighbourhood/ community problem by 41% of respondents of the 2008 NATSISS (aged 15 years and over).

Over the period 2004–08, Aboriginal and Torres Strait Islander males died from alcohol-related causes at 6 times the rate of non-Indigenous males. Females died from causes related to alcohol use at 9 times the rate of non-Indigenous females. Most deaths (274 out of 395 deaths) were due to alcoholic liver disease. Indigenous Australians died from mental and behavioural disorders due to alcohol use at 7 times the rate of non-Indigenous Australians; alcoholic liver disease at 6 times the rate of non-Indigenous Australians; and poisoning by alcohol at 6 times the rate.

Over the period July 2006 to June 2008, there were 7,354 hospitalisations of Indigenous Australians (excluding Tasmania and the ACT) that had a principal diagnosis related to alcohol use, representing 2.4% of all hospitalisations of Indigenous Australians. Indigenous males were hospitalised for diagnoses related to alcohol use at 5 times the rate of other males, and Indigenous females at 3 times the rate of other females. Eighty-two per cent of all hospital episodes of Indigenous Australians related to alcohol use had a principal diagnosis of mental and behavioural disorders due to alcohol use, including acute intoxication, withdrawal state and psychotic disorder. Indigenous Australians were hospitalised for alcoholic liver disease at 5 times the rate of other Australians.

Implications:

The health effects of risky/high risk alcohol consumption are evident in both mortality and morbidity statistics. Alcohol misuse is closely related to social and emotional wellbeing, mental health and other drug and alcohol co-morbidities. The National Alcohol Strategy 2006–2011: Towards Safer Drinking Cultures aims to prevent and minimise alcohol-related harm to individuals, families and communities through the development of a safer drinking culture in Australia. Various local, regional and national strategies have been implemented with the aim of reducing risky and high risk alcohol consumption, including some which restrict supply. The National Drug Strategy 2010–2015 is currently being developed, including a review of the Aboriginal and Torres Strait Islander Peoples Complementary Action Plan to address the use of alcohol, tobacco and other drugs to promote health and wellbeing.

In 2009–10, more than 130 organisations across Australia were funded by OATSIH to provide, or support, alcohol and other drug treatment and rehabilitation services. Services provide a variety of treatment models including rehabilitation in a residential setting and drug and alcohol workers in Indigenous primary care services. At COAG in July 2006 and again in December 2007, the Australian Government announced additional funding for drug and alcohol treatment and rehabilitation services in regional and remote areas. In 2009–10, the Australian Government continued to support successful elements of the drug and alcohol services component of the Northern Territory Emergency Response by increasing alcohol and other drug (AOD) workers across remote NT communities, and investing in AOD treatment and rehabilitation organisations to provide increased service delivery.

Alcohol Treatment Guidelines for Indigenous Australians have been developed to provide an evidence-based, user-friendly resource to assist health professionals understand and manage alcohol-related issues experienced by their Indigenous clients. Community involvement in local actions to alleviate the problems of alcohol misuse is vital. In the Fitzroy Valley, Western Australia, a community-driven project is underway to determine the prevalence of FASD in the area and to support the community through education, diagnosis and support.

Figure 118 – Alcohol risk levels by Indigenous status, persons aged 18 years and over, age-standardised, Australia 2004–05


Figure 118 – Alcohol risk levels by Indigenous status, persons aged 18 years and over, age-standardised, Australia 2004–05
Source: ABS & AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey
Text description of figure 118 (TXT 1KB)

Figure 119 –Persons aged 18 years and over who drank at short-term risky/high risk levels at least once a week, age-standardised, 2004–05


Figure 119 –Persons aged 18 years and over who drank at short-term risky/high risk levels at least once a week, age-standardised, 2004–05
Source: ABS & AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey
Text description of figure 119 (TXT 1KB)

Figure 120 – Aboriginal and Torres Strait Islander adults who drank at short-term risky/high risk levels at least once a week, by jurisdiction, 2004–05


Figure 120 – Aboriginal and Torres Strait Islander adults who drank at short-term risky/high risk levels at least once a week, by jurisdiction, 2004–05
Source: ABS & AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey
Text description of figure 120 (TXT 1KB)

Figure 121 – Age-standardised rates for deaths related to alcohol use, NSW, Qld, WA, SA and NT, 2004–2008


Figure 121 – Age-standardised rates for deaths related to alcohol use, NSW, Qld, WA, SA and NT, 2004–2008
Source: AIHW analysis of National Mortality Database
Text description of figure 121 (TXT 1KB)

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