Alcohol, tobacco & other drugs in Australia

Older people make up a considerable proportion of Australia’s population. In 2017, over 1 in 7 people were aged 65 and over and the number and proportion of older Australians is expected to continue to grow (AIHW 2018). Older people have unique health circumstances including pain, co-morbidities, and social circumstances such as isolation DoH 2017). These contextual factors are important to consider in the context of alcohol and other drug use. Refer to Box OLDER1 for how ‘older people’ are defined in this report.                                      

Tobacco smoking

Tobacco is one of the leading risk factors contributing to the burden of disease for older Australians. Specifically, tobacco is the leading risk factor for males aged 45-84 and females aged 65–84 (AIHW 2019c).

Data from the 2016 National Drug Strategy Household Survey (NDSHS) showed that the smoking rate for older age groups is not declining at the same rate as that for younger age groups (AIHW 2017). 

Daily smoking

• In 2001, daily smokers were more likely to be aged under 40 than aged 40 and over (56% compared with 44%). But as these cohorts have aged over time and as more young people are not taking up smoking, the majority of daily smokers in 2016 consisted of people aged 40 and over (57% compared with 43% for people under 40) (Table S3.24).

Number of cigarettes

• In 2016, people in their 50s (109 cigarettes), 60s (117 cigarettes) and over 70 (111 cigarettes) smoked a greater number of cigarettes per week on average, than younger people aged 14–19 (58 cigarettes) and 20–29 (70 cigarettes) (Table S3.25).
• In 2016, over one-third (37%) of daily smokers were smoking a pack-a-day. This was highest among smokers in their 50s with almost 1 in 2 (48%) smoking 20 or more cigarettes per day (Table S3.26).

Intentions to quit

• In 2016, 1 in 3 (33%) daily smokers and 1 in 4 (26%) occasional smokers were not planning to quit smoking (Table S3.27)—and these intentions were highest among smokers aged 70 and over (49%) (Table S3.28).
• Among those older smokers who do not plan to quit, the main reason was because they enjoy smoking (ranging from 52% for those aged 40–49 to 69% for those aged 70 and over not planning to quit) (Table S3.29).

Alcohol consumption

Data from the 2016 NDSHS indicated that older people drink more regularly than those in younger age groups. However, people from younger age groups were more likely to consume alcohol in excess of single occasion risk guidelines and to consume alcohol heavily (11 or more standard drinks on a single occasion) (AIHW 2017).

Daily drinking

• Between 2013 and 2016, people aged 60–69 experienced a significant decline in daily drinking from 12.3% to 10.2%, while for most other age groups there were slight but insignificant declines (Table S3.32).
• Those aged 70 and over continue to be the age group most likely to drink daily, for both males (19.5%) and females (8.7%) (AIHW 2017) (Table S3.33).

Lifetime risk

• Among females, those aged in their 50s (13.0%) are now the most likely to drink at levels that exceed the National Health and Medical Research Council (NHMRC) lifetime risk guidelines by drinking on average more than two standard drinks per day. This age cohort has replaced females aged 18–24 (12.8%) who were previously the most likely to drink at risky levels.
• Among males, those aged 55–64 (28.8%) were the most likely age cohort to drink at levels exceeding guidelines for lifetime risk (AIHW 2017). This is consistent with data from the National Health Survey (Table S2.27).

Single occasion risk

• People aged 70 and over were the least likely to exceed the NHMRC single occasion risk guidelines, with only 1 in 10 (11.0%) consuming more than 4 standard drinks on a single occasion in the past year (Figure OLDER1). This is consistent with data from the National Health Survey (ABS 2018).
• However, people in their 60s were most likely to exceed this guideline on at least 5 days per week (7.0% in 2016 up from 5.7% in 2013), suggesting that older people engage in risky levels of alcohol consumption more regularly (AIHW 2017) (Table S3.35).

High risk alcohol consumption

• The proportion of people in their 50s (from 9.1% to 11.9%) and 60s (from 4.7% to 6.1%) consuming 11 or more standard drinks on a single drinking occasion in the past 12 months significantly increased between 2013 and 2016, thus placing them at a high risk of alcohol-related harm. This was also the case for people in their 50s in the last month (from 4.1% in 2013 to 5.8% in 2016) (AIHW 2017) (Table S3.36).

Illicit drug use

Data from the 2016 NDSHS showed that a greater proportion of older Australians reported illicit drug use than previously, indicating that there is an ageing cohort of drug users (AIHW 2017).

• There was a greater proportion of people aged 60 or older who had used illicit drugs in their lifetime in 2016 than in 2013—significantly increased from 25% to 30% for males and from 18% to 22% for females (Table S3.41).
• Between 2001 and 2016, recent use of any illicit drug has nearly doubled among males in their 50s (from 8.1% to 15.0% in 2016) and males aged 60 and over (from 4.0% to 7.9%) (Table S3.42).
• People in their 50s and aged 60 and over constitute a much greater proportion of illicit drug users in 2016 than in 2001 (increased from 6.1% to 11.5% for people in their 50s and from 4.4% and 10.9% for people aged 60 and over).
• The difference in the proportion of recent illicit drug use between people aged 40 years and older and people aged under 40 years continues to get smaller (Figure OLDER2).

The two most commonly used drugs by older people are cannabis and pharmaceutical drugs when used for non-medical purposes.

Cannabis

• Cannabis use is increasing among older people. Between 2013 and 2016 there was a slight but significant increase among people aged 60 and over using cannabis in the last 12 months (from 1.2% to 1.9%).
• In comparison to 2013 there were more males aged 60 and over using cannabis in 2016 (significantly increased from 1.8% to 2.9%).
• Recent use of cannabis among males in their 40s and 50s, and those aged 60 and over is at the highest rate recorded in the last 15 years (Table S3.45).

Non-medical use of pharmaceutical drugs

• In 2016, 8.6% of people aged 50 and over reported misusing a pharmaceutical drug (Table S3.46).
• Data on cause of deaths in Australia shows that the age profile of those dying from drug-induced deaths has changed over the last two decades. While the rate of drug-related deaths among younger people has decreased significantly since 1999, among older age groups the rate of drug-induced deaths is now much higher. This is especially the case among people between 45 and 64 (ABS 2017).
  • From age 55, males are more likely to have opiate based painkillers present on toxicology than other substances.
  • The age at which women experience the highest rate of drug induced deaths is in their mid to late-40s.
  • Benzodiazepines are the most common substance in drug deaths for women from aged 20 to their mid-60s (ABS 2017).

Health and harms

Treatment

Data from AIHW’s Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) and the National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) indicates that in the last 10 years, an ageing cohort of Australians receiving drug and alcohol treatment has emerged. Specifically, NOPSAD data indicate that the proportion of clients receiving pharmacotherapy treatment on a snapshot day that were aged 40 and over increased from 38% in 2008 to 63% in 2018 (AIHW 2019a). AODTS NMDS data show that the proportion of closed treatment episodes for clients aged 40 and over has increased from 28% in 2008–09 to 34% in 2017–18 (AIHW 2019b).

• Principal drug of concern: In 2017–18, 68% of closed treatment episodes for clients over 50 years old were for alcohol as the principal drug of concern, 8.1% were for cannabis, 7.9% for amphetamines and 4.6% for heroin (Table S3.49).
• Source of referral: For clients over 50, 46% of referrals to treatment came from self/family and 37% from a health service (Table S3.50).
• Treatment type: The most common treatment type for clients over 50 was counselling (46%), followed by assessment only (16.5%) and withdrawal management (14.9%) (Table S3.51).

The AODTS data were matched with the Specialist Homelessness Services (SHS) collection to identify clients who use both services (matched clients) and compared characteristics between the groups (AIHW 2016). Older clients were identified as one of four vulnerable cohorts in the analysis (along with clients with a current mental health issue, clients who experienced family and domestic violence and young clients aged 15–24). The analysis found that matched clients aged 50 and over (when compared to the other vulnerable cohorts) were more likely to be:

• male (68%) and living alone (69%)
• receiving treatment for alcohol (68%)
• Indigenous (17%).

Older clients had similar patterns of treatment type, regardless of whether they were in the matched group or AODT-only group, with counselling being the most commonly provided treatment type for all older clients (AIHW 2016).

References

ABS (Australian Bureau of Statistics) 2017. Causes of death, Australia, 2016. ABS cat. no. 3303.0. Canberra: ABS. Viewed 4 January 2018.

ABS 2018. National health survey, first results, 2017-18. ABS cat. no. 4364.0.55.001. Canberra: ABS. Viewed 21 December 2018.

AIHW (Australian Institute of Health and Welfare) 2016. Exploring drug treatment and homelessness in Australia. Cat. No. CSI 23. Canberra: AIHW. Viewed 10 January 2018.

AIHW 2017. National drug strategy household survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. Viewed 14 December 2017.

AIHW 2018. Older Australia at a glance. Canberra: AIHW. Viewed 14 November 2018

AIHW 2019a. National opioid pharmacotherapy statistics (NOPSAD) 2018. Web Report. Viewed 3 April 2019.

AIHW 2019b. Alcohol and other drug treatment services in Australia 2017-18: key findings. Web Report. Viewed 17 April 2019.

AIHW 2019c. Australian burden of disease study: Impact and causes of illness and death in Australia 2015. Series no.19. BOD 22. Canberra: AIHW. Viewed 13 June 2019.

DoH (Department of Health) 2017. National Drug Strategy 2017-2026. Canberra: Australian Government. Viewed 12 January 2018.