People with mental health conditions
Mental health is fundamental to the wellbeing of individuals, their families and the population as a whole (ABS 2018). According to the 2019 National Drug Strategy Household Survey (NDSHS) estimates, 16.9% of the general population aged 14 and over had been diagnosed or treated for a mental health condition in the previous 12 months. This increased from 15.9% in 2016 (AIHW 2020). The proportion of people aged 18 and over experiencing high or very high levels of psychological distress also increased, from 11.7% in 2016 to 14.0% in 2019 (AIHW 2020).
Increasing literacy and awareness around mental illness in Australia may partially explain these reported increases (National Mental Health Commission of NSW 2015), however, there are likely to be other factors involved including changing trends and patterns in alcohol and other drugs use.
There is a complex relationship between mental health and alcohol and other drug use. A mental illness may make a person more likely to use drugs to provide short-term relief from their symptoms, while other people have drug problems that may trigger the first symptoms of mental illness (AIHW 2020). It is often difficult to determine whether mental illness preceded substance use or vice versa. In particular, self-reported survey data (such as that reported in the NDSHS) do not establish a causal link between mental health conditions and drug use (AIHW 2020).
Tobacco smoking has declined among people with mental health conditions or high or very high psychological distress, but remains higher among these groups than people without mental health conditions (AIHW 2020). According to 2019 NDSHS estimates:
- between 2016 and 2019, there were significant decreases in the proportion of people who smoked daily among those with mental health conditions (from 24% to 20%) or high or very high levels of psychological distress (from 24% to 21%)
- the proportion of people with high or very high psychological distress who had never smoked increased, from 50% in 2016 to 54% in 2019
- however, in 2019, people with mental health conditions were still twice as likely to smoke daily as people who had not been diagnosed or treated for mental health conditions (20% compared with 9.9%)
- people who reported high or very high levels of psychological distress were also twice as likely to report daily smoking as those who reported low psychological distress (21% compared with 9.5%) (AIHW 2020, tables 8.7 and 8.9; Figure MENTALHEALTH1).
The mechanisms linking tobacco smoking with mental health conditions are complex; however it is understood that people may perceive smoking to be helpful in relieving or managing the psychiatric symptoms associated with their disorder (Minichino et al. 2013). It has also been shown that people with mental health conditions may find smoking cessation difficult. However, upon quitting, they are likely to experience improvements in their mood, general wellbeing, mental health and quality of life (Greenhalgh et al. 2018).
Figure MENTALHEALTH1: Smoking status, by self-reported mental health conditiona or psychological distressb, people aged 18 and over, 2010 to 2019 (percent)
The figure shows that, between 2010 and 2019, the proportion of daily smokers who reported having a mental health condition steadily decreased from 26.5% in 2010 to 20.2% in 2019. Among people who had never smoked, the proportion of people with a self-reported mental health condition changed from 42.3% in 2010 to 49.1% in 2019.
New Australian guidelines to reduce health risks from drinking alcohol were released in December 2020. Data for alcohol risk in this report are measured against the 2009 guidelines (see Box ALCOHOL1). National Drug Strategy Household Survey data relating to the updated guidelines are available in the Measuring risky drinking according to the Australian alcohol guidelines report.
People with mental health conditions or high or very high levels of psychological distress are more likely to drink at risky levels than people without these conditions. The 2019 NDSHS findings showed that:
- people with mental health conditions were more likely to drink at risky levels than those without mental health conditions (21% compared with 17.1% for lifetime risky drinking, and 31% compared with 25% for single occasion risky drinking at least monthly)
- people with high or very high levels of psychological distress were more likely to report drinking at risky levels than those who reported low psychological distress (22% compared with 16.4% for lifetime risky drinking, and 36% compared with 22% for single occasion risky drinking)
- the proportion of abstainers/ex-drinkers increased among those with low psychological distress and without mental health conditions, but remained stable among those with high distress and mental health conditions (AIHW 2020, tables 8.7 and 8.9; Figure MENTALHEALTH2).
Figure MENTALHEALTH2: Drinking status, by self-reported mental health conditionᵃ or psychological distressᵇ, people aged 18 and over, 2010 to 2019 (percent)
The figure shows that the proportion of people with a self-reported mental health condition was highest among those who exceeded single occasion risky drinking levels (30.9%) or exceeded lifetime risk (21.3%).
The NDSHS found that, in 2019, compared with people without mental health conditions, people with a mental health condition were:
- 1.7 times as likely to have recently used any illicit drug (26% compared with 15.2%)
- 1.8 times as likely to have used cannabis (19.4% compared with 10.7%)
- about 2.2 times as likely to have used meth/amphetamine (2.6% compared with 1.2%)
- 1.4 times as likely to have used ecstasy (4.1% compared with 3.0%) or cocaine (6.2% compared with 4.3%)
- 2.1 times as likely to use pharmaceuticals for non-medical purposes (7.6% compared with 3.6%) (Figure MENTALHEALTH3; AIHW 2020, Table 8.9).
Figure MENTALHEALTH3: Recentᵃ illicit drug use, by self-reported mental health conditionᵇ or psychological distressᶜ and drug type, people aged 18 and over, 2010 to 2019 (percent)
Figure MENTALHEALTH3: Recent illicit drug use, by self-reported mental health condition and psychological distress and drug type, people aged 18 and over, 2010 to 2019 (per cent)
The figure shows that the proportion of people who had recently used any illicit drug and experienced psychological distress increased between 2010 and 2016 (from 25.2% to 30.8%). This pattern was true for cannabis, cocaine and ecstasy.
Use of specific illicit drugs among people with mental health conditions and high psychological distress has varied across time and by drug type. Between 2016 and 2019:
- there was a significant increase in the proportion of people with mental health conditions that reported recent use of cocaine (from 4.3% in 2016 to 6.2% in 2019)
- conversely, there were significant decreases in recent use of meth/amphetamines (from 4.1% to 2.6%) and pain-killers/pain-relievers and opioids (from 6.5% to 4.9%) among people with mental health conditions (AIHW 2020, Table 8.9)
- among people with high or very high levels of psychological distress, recent use of cocaine increased from 5.1% to 8.0%
- recent use of pain-killers/pain-relievers and opioids (excluding over-the-counter) for non-medical purposes decreased from 7.5% to 5.9% among people with high or very high levels of distress (AIHW 2020, Table 8.7).
Injecting drug use
For related content on injecting drug use, see also:
Results from the 2022 Illicit Drug Reporting System (IDRS) showed that 47% of participants self-reported that they had experienced a mental health problem in the previous 6 months, stable from 2021 (47%). The most commonly reported mental health problems were depression (64%) and anxiety (55%). Fifty-five per cent of these people had seen a mental health professional in the previous 6 months, down from 58% in 2021 (Sutherland et al. 2022).
ABS (Australian Bureau of Statistics) 2018. National Health Survey: First Results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS. Viewed 12 December 2018.
AIHW (Australian Institute of Health and Welfare) 2020. National Drug Strategy Household Survey 2019. Drug statistics series no. 32. Cat. no. PHE 270. Canberra: AIHW. Viewed 31 July 2020.
Greenhalgh EM, Stillman S, & Ford C 2018. 9A.3 People with substance use and mental disorders. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria. Viewed 30 January 2023.
Minichino A, Bersani FS, Calo WK, Spagnoli F, Francesconi M, et al. 2013. Smoking behaviour and mental health disorders--mutual influences and implications for therapy. International Journal of Environmental Research and Public Health, 10(10):4790–811.
National Mental Health Commission of NSW 2015. National Surveys of Mental Health Literacy and Stigma and National Survey of Discrimination and Positive Treatment: A report for the Mental Health Commission of NSW. Sydney: Mental Health Commission of NSW.
Sutherland R, Uporova J, King C, Jones F, Karlsson A, Gibbs D, Price O, Bruno R, Dietze P, Lenton S, Salom C, Daly C, Thomas N, Juckel J, Agramunt S, Wilson Y, Que Noy W, Wilson J, Degenhardt L, Farrell M and Peacock A. 2022. Australian Drug Trends 2022: Key Findings from the National Illicit Drug Reporting System (IDRS) Interviews. Sydney: National Drug and Alcohol Research Centre, UNSW Sydney. Viewed 13 October 2022.