Last partial update: July 2016 - Please read disclaimer before proceeding
Alcohol use in Australia
Australia has a long history of problems with alcohol abuse, due largely to a culture that accepts alcohol consumption as a social activity in its own right rather than as part of other, healthier activities. Many Australians condone the idea that going out to get drunk after work, after the game etc; seeing it as being Australian. While such traditions also occur in many other countries, there are others where it is considered an insult to be drunk in the company of others; especially when in their homes. Many Australians, on the other hand, do not usually get upset about a person's alcohol consumption until someone gets injured, sexually assaulted or killed; and such alcohol related events are relatively common in Australia. This presents a problem because intoxication and harm can not be dissociated. Once people are drunk their brain functioning changes, causing changes in personality that they can not control and which in some individuals leads to aggression, lack of regard for others, loss of inhibition and increased risk taking.
Adult acceptance of or indifference towards such anti-social drinking behaviour gives a very poor example to children and it should hardly be a surprise to anyone that youth alcohol abuse is such a big problem. Perhaps the best evidence for this disinterest can be seen in the way Australians have allowed the liquor industry to target our teenagers with any number of alcohol-based ‘fruit drinks’; the so-called alcopops.
It is not all bad news, however. Initiatives to try to reduce this problem are starting to emerge in some sporting clubs. People can also help by supporting and encouraging such initiatives in their area wherever possible and by just setting a good example.
Alcohol consumption in Australia
Many Australians still put themselves at risk of harm through alcohol use. Over 45 per cent of men and 33 per cent of women who drink are at increased risk from their drinking with the highest levels occurring in both males and females in the fifteen to twenty-four year age group. About 50 per cent of people over fourteen years of age drink at least once a week, and 80 per cent at least a few times per month. Altogether, 20 per cent of adults regularly drink above recommended levels and roughly five per cent are dependent on alcohol. Alcohol is the cause of most drug related deaths in the young; the 15 to 34 year age group. The cost to the community of alcohol abuse was thought to be about $7.6 billion in 1998 / 1999. (Tobacco use cost the community a staggering figure of about $21 billion in the same year.)
Harmful effects of alcohol
Alcohol is the second largest cause of preventable illness in Australia and is the main drug of abuse. It is responsible for 2.2 per cent of the nation’s total disease burden. This figure is made up of two components; harmful effects (4.9 per cent) due to the conditions stated below and beneficial effects (2.7 per cent), which arise from a reduction in vascular disease. One is subtracted from the other to achieve a net harmful effect of 2.2 per cent. (It should be noted, however, that there is some disagreement about the level of cardiovascular beneficial effect provided by moderate alcohol consumption, with some experts feeling that the benefit mentioned above is greatly overstates the real, much lower figure.)
This subtraction of harmful from beneficial effects simplifies the true situation somewhat because the beneficial and harmful effects occur at completely different ages. Much of the harmful effect occurs in younger people and is the cause of tremendous amounts of death and disability in this age group. Any beneficial effects are due to a reduction in vascular disease (especially heart attacks) that occurs in older, low-risk alcohol consumers.
Alcohol caused an estimated 3,700 deaths in Australia in 1997 and this figure is on the rise. (It is also hard to assess and may be as high as 6,000.) At least 1600 of these deaths are in young men aged between 15 and 29. The main causes of alcohol related deaths are road accidents and liver disease. Alcohol is involved in over 40 per cent of driving fatalities and was responsible for over 5070 cancer cases (2009 figures) and over 1100 cancer deaths (1998 figures) in Australia.
There were 96,000 hospital admissions due to alcohol in 1998 and over 33 per cent of Australians reported being abused, either verbally or physically, by someone under the influence of alcohol. Ten per cent reported being victims of alcohol related property damage or theft.
The significant social disharmony that alcohol causes in many families also imposes a huge cost on society that is frequently underestimated. About 28% of Australians say that their lives are adversely affected by the drinking of a family member or close friend. Even ‘mild’ use may cause regular disharmony in relationships (such as unnecessary arguments) that, over a long period, permanently scar these relationships. (Often such problems are invisible to those outside the home.) All drinkers should regularly question whether their family relationships are being adversely affected by any behavioural changes that accompany their drinking.
The impact of long-term personality changes and changes in brain ‘thinking’ function is also often underestimated by those involved and society at large.
Alcohol's social costs amount to he economic costs, both to the nation and the families involved, of impaired work performance and alcohol related accidents at work are huge; about 15 billion dollars annually. The contribution of the above to the illness burden caused by alcohol is shown in the figure below.
Sadly, the above figures are all getting worse.
*The main cancers caused by alcohol and breast, colorectal cancers and cancer of the mouth, pharynx and larynx. Source – Adapted from Australian Institute of Health and Welfare: Mathers 1999. |
Physical effects of alcohol on the body
The National Health and Medical Research Council states that only small amounts of alcohol are beneficial to health. One to two standard drinks a day is optimal (10 to 20 grams of alcohol) and any intake above two standard drinks per day (20 grams) has no overall beneficial affect, either physically and mentally.
This does not mean that non-drinkers should be encouraged to take up drinking as alcohol is associated with numerous health problems and there is no guarantee that the ‘new drinker’ will be able to avoid these problems.
Alcohol and liver disease:
Drinking large amounts of alcohol over a prolonged period progressively destroys liver cells and can lead to liver cirrhosis and death. It is especially a problem in people with other chronic liver disease, such as that caused by hepatitis B or C. The incidence of liver cancer is also significantly increased in those consuming large quantities of alcohol.
Alcohol and gastrointestinal tract cancer:
As well as liver cancer, alcohol is responsible for a significant increase in cancers of other areas in the gastrointestinal tract, including the lips, mouth, throat, larynx, and oesophagus, and may increase the risk of bowel cancer. (It is not thought to be related to bladder, pancreas or prostate cancer.) People who consume both alcohol and cigarettes increase their risk of cancer of the oropharynx, larynx and oesophagus by about 75 per cent.
Alcohol and breast cancer:
Alcohol also causes an increase in breast cancer, with the risk increasing linearly with increasing alcohol consumption. The risk of breast cancer increases about seven per cent for each additional 10 grams of alcohol consumed per day (i.e. for each additional standard drink consumed per day).
In one comprehensive review paper, women who drank three to four glasses a day were calculated to have a rate of breast cancer 35 per cent greater than women who do not drink and this figure rose to 67 per cent with the consumption of more than four drinks per day (NHMRC 2001). Reducing alcohol intake in middle (and later) life is likely to reduce this effect. The rise in breast cancer is thought to be due to alcohol increasing the production of oestrogen, which is known to cause an incidence in breast cancer incidence. The rise in body acetaldehyde levels that accompanies alcohol consumption may also have a causal effect.
Cancer attributable to alcohol consumption in Australia |
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Type of cancer |
Proportion of cancer attributable to alcohol |
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Males |
Females |
Breast cancer |
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12% |
Larynx |
51% |
46% |
Liver |
39% |
35% |
Oesophagus |
46% |
40% |
Mouth and pharynx (throat) |
40% |
31% |
Source: Ridolfo and Stevenson 2001: AIHW
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Alcohol and vascular disease:
At present it is generally accepted that low level alcohol consumption has mild beneficial affects with respect to reducing cardiovascular disease in males over the age of 40. (There is no female benefit.) However the evidence for this is not conclusive and there is increasing debate about the level of this protection, if any. The reason is that the benefits identified are being questioned is that some of the research indicating such benefits is to some extent flawed. (When assessing the no alcohol group, some studies have failed to differentiate between people who choose not to drink and people who do not drink because of medical problems or who have given up because of medical problems caused by alcohol. Including such people obviously makes health outcomes of the ‘no alcohol’ group appear worse.) Certainly nobody should consider commencing alcohol consumption in an attempt to reduce their risk of cardiovascular disease.
The possible explanations for a beneficial cardiovascular effect are that alcohol increases HDL cholesterol, perhaps decreases LDL cholesterol, and produces a slight reduction in blood pressure when taken in small amounts (20 grams per day or less), all of which help reduce vascular disease. Higher intake levels increase blood pressure and the incidence of strokes. Red wine has the added benefit of possessing anti-oxidants (polyphenols and anthocyanins). These antioxidants are the red pigments from the grape skins and may play a role in helping reduce vascular disease by preventing the oxidation of LDL cholesterol. One negative factor with regard to vascular disease that concerns all alcoholic products is that they exacerbate obesity. This occurs because alcohol provides the body with large amounts of energy.
Alcohol and the mind:
Alcohol is a sedative drug that decreases alertness /increases sleepiness, slows reflexes and impairs coordination, resulting in an increased risk of falls and accidents. It alters mood, making some people more aggressive and argumentative, and decreases inhibitions resulting in increased risk taking. It also depresses mood, which can worsen existing depression. (Depression and alcohol abuse commonly coexist.) This combined with an increase in aggressive behaviour and a reduction in the ability to use coping behaviours can increase the risk of self-harm and suicide. These effects are worsened with the use of other drugs that depress brain activity, the main ones being cannabis and heroine.
Alcohol and learning in adolescents:
There is growing evidence that the developing adolescent brain is far more susceptible to the damaging effects of alcohol than the adult brain and that excess alcohol consumption in teenagers is causing significant brain impairment.
Alcohol and the risk of fractures:
Excessive alcohol intake increases bone loss and the risk of osteoporosis developing. Also, any alcohol consumption reduces coordination and thus increases the risk of falls. All this makes fractures more likely, especially in older people.
What is a standard drink?
A standard drink is one that contains 10 grams of alcohol. Unfortunately, the alcohol content shown on bottles is not expressed in weight (i.e. grams) but in percentage by volume. The weight of alcohol contained in a glass varies depending on the percentage alcohol content of the drink and the volume in the glass.
A very important observation that can be made from the table below is that common Australian servings of beer, wine or spirits usually contain more than one standard drink (i.e. 10g of alcohol). As an example, when drinking a full bodied Australian red wine with an alcohol content of 14 per cent (quite common these days), one standard drink would equal about 90mls of wine. This is a small glass of wine!All alcohol products should state the number of standard drinks that they contain.
Alcohol content of typical Australian drinks
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Beverage |
% alcohol content |
Volume of a normal serving |
Alcohol content of serving (in g) |
Number of standard drinks in normal serving |
What volume of this drink would contain one standard drink? (i.e. 10 g of alcohol) |
Beer (normal strength) |
4.5% |
350mL (a stubbie or can) |
12.4g |
1.24 |
280ml |
Beer (light) |
2.8% |
350mL |
7.4g |
0.74 |
450ml |
Beer (extra light) |
0.9% |
350mL |
2.4g |
0.24 |
1,410ml |
Wine |
11% |
150mL |
13.0g |
1.30 |
115ml |
Wine |
13% |
150mL |
15g |
1.50 |
98ml |
Wine |
15% |
150ml |
18g |
1.80 |
85ml |
Spirits |
40% |
30mL (a ‘nip’) |
10.0g |
1.00 |
30ml |
Safe and problem drinking in Australia
Unfortunately, many Australians do not drink at safe levels. Nine per cent of both males and females are at risk from long-term harmful drinking and about 46 per cent of males and 33 per cent of females are at risk from short-term drinking. And females are catching up!! Each year about 7.3 million Australians consume alcohol that puts them at risk of short term harm from alcohol, while 3.7 million consume levels that put them at risk of long term harm.
| Guidelines for assessing / reducing drinking risk level | ||
| Risk of harm in the short term for adults | ||
Low risk (standard drinks per day) |
High risk (standard drinks per day) |
|
Healthy males and females (On any one day) |
Up to 4 drinks Not drinking is the safest option when involved in or supervising risky activities such as driving, operating machinery or water sports Not drinking is the safest option when supervising children. |
Over 4 drinks (Having four drinks on a single occasion doubles the risk of injury in the next six hours & this risk increases 1.3 times for each additional drink) |
| Risk of harm in the long term for adults | ||
Low risk (standard drinks) |
High risk (standard drinks) |
|
Healthy males and females (On an average day) |
Up to 2 drinks per day This level keeps lifetime risk of death from an alcohol related cause to below 1 in 100 It is also wise to have at least two alcohol free days per week. |
Over 2 drinks per day Consuming over 2 drinks per day increases risk of death from an alcohol related cause by over 5 times for men and 6 times for women |
Other issues relating to alcohol consumption for adults to consider(See additional notes below for further information)
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| Reducing risk of harm for people under the age of 18 years | ||
| Males and females | Not drinking is the safest option as young people are more likely to drink excessively and partake in more dangerous behaviour. Their developing brains are also more susceptable to long term damage from alcohol. Children under the age of 15 years are at greatest risk and it is especially important for them not to consume alcohol. Young people should delay having their first drink as long as possible as the earlier a person starts to drink the more likely he or she is to have long term problems with alcohol use. |
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| Reducing risk of harm during pregnancy / breatfeeding | ||
| Pregnant women | Not drinking is the safest option as alcohol can:
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| Women breast feeding | Not drinking is the safest option as alcohol consumption reduces breast milk production. Alcohol also enters the breast milk and its subsequent consupmtion by the baby disturbs sleeping and feeding patterns and can affect the baby's psychomotor development. | |
| Source – Adapted from NHMRC Australian Alcohol Guidelines 2009 | ||
Further information regarding alcohol consumption recommendations
Young adults (18 to 25 years): This group is the most likely to be harmed by alcohol and should keep strictly to (or drink below) the low-risk levels. In particular, they should not drink at all before undertaking risky activities, such as driving or swimming. Alcohol should not be mixed with other mood altering drugs.
Young people (up to 18 years): Health authorities recommend that people under the age of 18 years should not drink at all. All young people who have access to alcohol should keep drinking to a minimum and should never drink to become intoxicated. Adolescents under 18 who have the opportunity to drink alcohol should be supervised by a responsible adult and adults organising a party for young people need to monitor carefully or exclude alcohol depending on the age group.
Performing activities requiring skill or involving risk: People should not drink any alcohol before or while doing an activity that requires skill or involves risk, such as flying, driving a motor vehicle or boat, any water sports, ski-ing or operating machinery.
Problems with alcohol already: People with a health or social problem that is made worse by alcohol should preferentially stop drinking for good (especially if they have developed severe alcohol dependence or have a severe health problem worsened by alcohol). Stopping for at least several months, and then perhaps reintroducing alcohol gradually under medical supervision is an option for those with minor alcohol related problems. (They should ensure that they drink only at low levels.)
Pregnant women (or women that might soon become pregnant): Women having a baby should consider not drinking at all. If they choose to drink, they should keep drinking levels to a maximum of seven standard drinks per week, have no more that two drinks in any one day, and never become intoxicated. The risk to the foetus is highest in the early stages of pregnancy. Some authorities are suggesting that even lower levels should be adhered to; namely two standard drinks per week.
Family history of alcohol problems: People who have a first- or second-degree relative with alcohol-related problems are at a significantly increased risk of developing similar problems and should be especially careful about how much they drink. They should ensure they have at least two alcohol-free days each week to reduce the likelihood of dependence developing. Stopping drinking completely is also an option that should seriously be considered.
Mental-health problems: People who have a mental health problem also need to watch their drinking carefully and keep to the low-risk guidelines. An even wiser option is to give up altogether, especially if alcohol has already exacerbated their mental illness.
Older people: Older people should drink less as they will attain higher blood alcohol levels than a younger people. An increased risk of falls and associated fractures is a problem faced by any older person that consumes any amount of alcohol.
Taking medications: Many medications interact with alcohol and may require a reduction in alcohol intake.
People who choose not to drink: People should support those who choose not to drink. They often have a good reason for their decision and are will be healthier for it.
Avoiding the cycle of regular drinking - An import part of reducing risk of harm from alcohol consumption
Preventing developing regular drinking or breaking the cycle of regular drinking is an important part of reducing risk from alcohol consumption. This can be achieved in two ways
- Having two alcohol free days per week
- Having at least one month per year where no alcohol is consumed. This can be achieved by taking part in community events such as 'Dry July'in NSW or 'FebFast' or Sober October or 'Hello Sunday Morning'.
Drinking and driving
It is an unfortunate fact that many people, especially young adults, drive while under the influence of alcohol. Thirty-seven per cent of male road injuries and 18 per cent of female road injuries are attributable to alcohol. The best way to stay below the 0.05 per cent blood alcohol limit is as follows.
For males: A maximum of two standard drinks in the first hour and then one drink per hour after this.
For females: A maximum of one standard drink in the first hour and then one drink per hour after this.
The time it takes the body to break down alcohol is solely determined by the speed that the liver can process the ingested alcohol and nothing will quicken this process. The reason that females should drink less initially is that they have relatively less water content in their bodies for the ingested alcohol to ‘dissolve in’. (Women have a higher body fat content and alcohol does not dissolve in fat). Because of this, their blood alcohol level is raised more quickly, even though their liver is still able to break down alcohol as quickly as a male’s liver; a rate of 10 grams per hour.
The following groups may need to consume less alcohol than stated above to stay under 0.05; people with a small build (due to relatively less body water), people in poor health (due to poorer liver function), and people who are overweight (due to relatively more body fat and less body water)
'P' plate and learner drivers are not allowed to have any alcohol in their blood when driving and thus blood should not drink at all prior to driving. People who ride a bicycle need to refrain from drinking alcohol completely as just one drink raises the risk of a fatal or serious injury five fold. This is because riding a bike requires alertness and considerable co-ordination skills.
Alcohol and the young
Adolescents get confusing messages about alcohol in Australia. Many adults do not consider alcohol as a ‘drug’ or feel that it is less harmful than illicit drugs. This of course is not true. Many young people, despite being under the legal age to consume alcohol, frequently report that they have been provided with alcohol by their parents, and that they have consumed excess alcohol when they were under adult supervision.
Alcohol use in Australia is encouraged in young people by sophisticated marketing, that has includes:
- the development of sweet fruit soft-drink-like alcohol products that appeal directly to this age group (especially girls)
- the labeling of these products to attract young drinkers
- associating these products with other adolescent goods such as clothing and adolescent events such as concerts.
As a result, chronic alcohol use disorders are common in the young, with a prevalence estimated at 11 per cent of Australians aged between 18 and 34 years. A fifth of young people aged 16 to 24 years drink to intoxication most times they drink, and 42 per cent of drinkers report memory loss after drinking. Further, between 20 per cent and 40 per cent of young people report alcohol-related violence, and around 30 per cent report alcohol-related sexual risk taking. Even in the 14 to 18 year olds, 10 to 20 per cent of females and almost 30 per cent of males consume alcohol in a harmful manner at least once a month. Altogether, about 66 per cent of adolescent alcohol use poses a short-term risk of harm, with both males and females being heavily involved.
Adolescents who start consuming alcohol before the age of 13 are of great concern as they are significantly more likely to experience alcohol related problems both in adolescence and later life. Such problems include dropping out of school, unemployment and social isolation. The use of alcohol (and cigarettes) in the young also increases their risk of using illicit substances; a common combination.
The fact that 52 per cent of alcohol-related serious road accidents occur in the 15 to 24 year age group (and 75 per cent in the 15 to 34 year age group) is a potent reminder of the consequences of this behaviour. In the ten years from 1993 to 2002 about 500 teenagers below the driving age died as a direct effect of alcohol use, mostly related to motor vehicle deaths.
Self-harm and suicide in young people are also increased with alcohol use.
This topic is dealt with in detail in the section ‘Teenage alcohol use’; a must read for parents.
Source – Adapted from Australian Institute of Health and Welfare: Mathers 1999. |
Drinking alcohol in the presence of children
As well as avoiding hazardous and excessive drinking, it is important to adjust drinking habits according to the occasion, especially when children are present. People should not drink at all if they are in charge of the safety of young children (especially if swimming is at all likely) and they should also moderate their drinking if they will be interacting with children or teenagers. Young people can tell when an adult has drunk too much and will appreciate their company less. Drinking habits are often learnt at home and parent drinking habits should provide a good model for children. If children wish to start drinking when they are old enough, allowing them to drink responsibly at home is an excellent way to learn responsible drinking habits.
Risk factors for problem alcohol consumptionIn General
In the young
In older people
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Further reading
Teenagers, Alcohol and Drugs What your kids really want and need to know about alcohol and drugs. by Paul Dillon. Published by Allen & Unwin, 2009
Further information
Alcohol and Drug Information Service in your state.
This service will provide information and/or advice regarding problems. They can also refer you to health professionals that can help you personally regarding alcohol and other drug problems.
ACT Ph 6205 4545; NSW Ph 9361 8000 or 1800 422 599: NT 8981 8030 or 1800422 599; Qld Ph 3236 2414 or 1800 177 833; SA Ph 1300 131 340; Tas 1800 811 994; Vic Ph 9416 1818 or 1800 136 385; WA Ph 9442 5000 or 1800 198 024) Check directory assistance if these numbers have changed.
Australian Drug Information Network www.adin.com.au
Information about alcohol, tobacco and other drugs.
Australian Drug Foundation
www.adf.org.au
Another good general site regarding drug use; easy to access information about most types of drugs.
Family Drug Support 24 hour hotline www.fds.org.au
Ph 1300 368 186 (throughout Australia)
National Health and Medical research Council National Guidelines on Responsible Drinking https://www.nhmrc.gov.au/health-topics/alcohol-guidelines
Brief Intervention: the Drink-less package (University of Sydney) http://sydney.edu.au/medicine/addiction/drinkless/index.php
This site the very helpful and commonly used alcohol reduction program ‘Drink-less’. It can be downloaded free or orders can be taken from the site.