- Health impacts of alcohol and other drugs: an overview
- Drawing on data published by research institutions around Australia, this chapter explores both the established and emerging health impacts of alcohol and other drugs (AOD). While alcohol remains a major source of substance-related harm in the community, new psychoactive substances present increasingly complex challenges. In considering the impact of AOD, this chapter also places focus on populations who face heightened risks of experiencing AOD-related harm.
Health impacts of alcohol and other drugs
2.2AOD use is associated with a range of adverse health outcomes, including substance use disorder and heightened rates of mental illness, suicide, infectious diseases, injuries, overdoses, and cardiovascular and liver disease. Harmful use of alcohol and other drugs encompasses the consumption of alcohol outside the National Medical and Health Research Council (NMHRC) alcohol guidelines, the non-prescribed use of prescription drugs, and the use of illicit substances.
2.3Substance use disorder—a condition defined by uncontrolled use of a substance despite harmful consequences—is a primary health impact of AOD consumption. In its submission to the inquiry, the Matilda Centre for Research in Mental Health and Substance Use (the Matilda Centre) highlighted that AOD use disorders are common health conditions in Australia and have remained so for over a decade. Drawing on the 2020-21 Australian National Study of Mental Health and Wellbeing (NSMHWB), the Matilda Centre submitted that 19.6 per cent of Australians had experienced an AOD disorder in their lifetime, and 3.3 per cent in the past 12 months. This represents a minimal decrease in AOD disorder prevalence from the previous iteration of the NSMHWB conducted in 2007.
2.4Drug Policy Modelling Program at the University of New South Wales submitted that approximately 10 per cent of alcohol users, 23 per cent for heroin users, and 17 per cent of cocaine users develop a substance use disorder. The use of AOD, however, can develop a broad spectrum of other health harms, which vary by type of substance. This was emphasised by Dr Elizabeth Moore, President of the Royal Australian and New Zealand College of Psychiatrists, who said:
The health impacts of alcohol, nicotine and other drugs in Australia are profound. We recognise their impact not only on the individual but on families, carers and communities.
2.5Throughout the inquiry, alcohol was identified as the main driver of AOD-related health harm. The World Health Organization’s International Agency for Research on Cancer classifies alcohol as a Group 1 carcinogen (in the same category, for example, as tobacco and asbestos), which means that, as the George Institute for Global Health noted, its use is not safe in any quantity. In January 2025, the Office of the U.S. Surgeon General published a report that identified alcohol as a risk factor for several types of cancer, including breast (in women), colorectum, oesophagus, voice box, liver, mouth and throat.
2.6AOD use is also associated with pregnancy complications, including a risk of the development of Fetal Alcohol Spectrum Disorder (FASD) in infants. FASD is a term that describes a range of neuro-developmental impairments. It is a lifelong disability, which impacts the brain and body of individuals who were prenatally exposed to alcohol. People living with FASD experience ‘challenges in their daily living and need support with motor skills, physical health, learning, memory, attention, communication, emotional regulation, and social skills to reach their full potential’.
2.7Evidence to the inquiry reveals a broad spectrum of AOD health impacts. Dementia Australia, for example, submitted that alcohol and tobacco use is a modifiable risk factor for dementia. Excessive alcohol use is associated with reduced brain volume; furthermore, alcohol use can result in alcohol-related brain injury (ARBI). Both conditions present significant health impairments.
2.8Multiple witnesses also drew attention to the link between AOD and oral health, noting that people with substance use disorders have higher risk of tooth decay, periodontal disease, and oral cancer than the general population. This cohort is less likely to receive dental care. As witnesses noted, poor oral health further adds to the stigma associated with AOD use and contributes to poor general health.
2.9Beyond the immediate health impacts, AOD use is a factor associated with a range of other risks to health and wellbeing, including increased family, domestic and sexual violence, and engagement in risky behaviour that can cause traffic collisions, swimming accidents, workplace harms and broader community safety issues.
2.10The Foundation for Alcohol Research and Education (FARE) noted that alcohol is a significant contributor to gendered violence in Australia, with alcohol present in 34per cent of intimate partner violence incidents and over 29 per cent of family violence incidents. Harms to children, FARE further explained, are significantly greater in households where a person drinks alcohol at higher risk levels.
The level of AOD use in Australia
2.11In its submission to the inquiry, the Department of Health and Aged Care noted that ‘alcohol and illicit drug use remain public health challenges in Australia’. In 2022-2023, more than 30 per cent of people in Australia consumed levels of alcohol that put their health at risk. At the same time, almost 18 per cent had acknowledged using an illegal drug in the past 12 months, with cannabis being the most common. Australia also has a higher rate of opioid and cocaine use compared to other countries within the Organisation for Economic Co-operation and Development (OECD).
Alcohol consumption in Australia
2.12According to data from the Australian Institute of Health and Welfare (AIHW), the use of alcohol is more common than the use of tobacco, e-cigarettes, illicit drugs and non-medical use of pharmaceuticals. Alcohol presents one of the leading contributors to the overall burden of disease and it also accounts for a larger number of ambulance attendances, hospitalisation and deaths than illicit drugs.
2.13The National Drug Research Institute (NDRI) at Curtin University provided further details on the impact of alcohol use, noting that in 2017-2018, nearly half a million Australians were dependent on alcohol, with alcohol accounting for more than 5,200 deaths over that 12-month period. NDRI further calculated that the tangible cost of alcohol use (to health care, workplace, and areas such as family violence) amounted to $18.2 billion, and the intangible cost (including, for example, premature death and lost quality of life) to $48.6 billion.
2.14The Department of Health and Aged Care noted some positive trends in alcohol consumption, highlighting that in the last 15 years there has been a steady (although modest) decline in the proportion of the population that drinks alcohol. Australia has also seen a reduction in high-risk drinking behaviours across all age cohorts. At the same time, the percentage of people who abstained from alcohol increased from 19.9to 23.5 per cent. Risky consumption of alcohol for males between 2010 and 2023 has decreased across all aged groups, with 14-19 years and 60-69 years age groups exhibiting the most significant reductions. While the consumption of alcohol by males aged 20-29 years is trending downwards, this age cohort was most likely to engage in risky consumption.
2.15Alcohol consumption by women in the same period reveals a different trajectory. Risky consumption of alcohol trended downward from 2010 until 2019 but subsequently increased between 2019 and 2023 for females aged 20-29, 40-49, 60-69 and those above the age of 70. The Department of Health and Aged Care noted that females are more likely than males to consume alcohol at risky levels.
2.16This trend was also highlighted by Dr Paul Clark, Professor of Medicine at the University of Queensland and Director of the Alcohol and Drug Assessment Unit at Princess Alexandra Hospital, who told the Committee:
In terms of the changes in the distribution, I do think there's an increase in younger women presenting with advanced liver disease early and also alcohol related hepatitis … That's something that's definitely been observed in the last five years, particularly post-COVID. Alcohol related hepatitis is a very morbid presentation too, so it's important. We have increased representation of women in alcoholic hepatitis, and alcoholic hepatitis in that subgroup is a very morbid presentation.
2.17While Australian data points to the fact that attitudes towards alcohol are shifting as the population is becoming more aware of the health harms associated with alcohol abuse, alcohol consumption remains deeply embedded in Australian culture. Alcohol is often seen as an integral element of social gatherings and celebrations, and this normalisation of alcohol consumption, according to the Department of Health and Aged Care, inhibits efforts to reduce its harmful effects.
2.18In Australia, the NHMRC provides guidelines on the health effects of drinking alcohol. According to the NHMRC guidelines, a healthy adult should consume no more than 10 standard drinks each week, and no more than four standard drinks in any one day. A standard drink contains 10 grams of pure alcohol; in most contexts, a serving of beer or wine contains more than one standard drink.
2.19Guidelines for alcohol consumption in other countries differ from Australia. In 2023, the Canadian Centre on Substance Use and Addiction recommended limiting alcohol consumption to two drinks per week and warned that seemingly even moderate drinking poses a serious health risk, including cancer, heart disease and stroke. In the United States, official guidelines recommend no more than two drinks per day for men, and one drink per day for women.
2.20Multiple submissions insisted that the level of understanding of the impact of alcohol consumption remains low in Australia. A significant portion of the population is not familiar with the NHMRC guidelines, and while recognition of the link between, for example, alcohol and liver damage is high, Australians are not fully aware of the spectrum of health conditions triggered by alcohol use.
2.21In her submission, Ms Narella Coleman-Flood shared her experience with alcohol consumption and observed that current health messaging on alcohol use had limited reach, highlighting that:
We need more targeted messaging around the link between alcohol and breast cancer, which remains largely under-communicated. Public health campaigns and interventions should focus on educating women and targeting young women about these risks and address drinking behaviours before they escalate into “alcohol use disorder”.
2.22The National Organisation for Fetal Alcohol Spectrum Disorders (NOFASD) similarly noted that, despite ongoing efforts to raise awareness about the risks of alcohol consumption during pregnancy, there are still significant gaps in public knowledge:
The Australian Institute of Health and Welfare (AIHW) reported that 77% of Australians aged 14 and over consumed alcohol in 2022-23, and approximately 25% of women continued drinking after learning they were pregnant. A 2021 poll by the Foundation for Alcohol Research and Education (FARE) found 30% of Australians are unaware that alcohol use during pregnancy can cause FASD. Awareness is particularly low amongst men (63%) compared to women (77%), and nearly 23% of Australians mistakenly believe that some alcohol consumption during pregnancy is safe.
2.23NOFASD also advocated for more public education about the impact of drinking before a pregnancy is confirmed. As Interim Chief Operating Officer Mrs Sophie Harrington explained:
It's important to consider, when we talk about prenatal alcohol exposure, that the onset of pregnancy symptoms is commonly experienced at around five to six weeks and that at least 40 per cent of pregnancies in Australia are unplanned or unintended. With this in mind, and when we take into consideration Australia's drinking culture, we can start to create a picture of what the actual prevalence of FASD in Australia could look like … Mainstream education is needed. We must have courageous conversations and address the elephant in the room, which is alcohol.
Drug use in Australia
2.24With respect to illicit drug use, the Department of Health and Aged Care noted that there had been an increase in the prevalence of all illicit drug use since 2010, with the rise of hallucinogens and ketamine use particularly notable. The use of marijuana, heroin, methamphetamine and amphetamine, and cocaine have remained unchanged in this period, while the use of ecstasy, non-medical pain killers and opioids has declined.
2.25According to NDRI data, more than two million Australians use cannabis, with 152,000 individuals dependent on the drug. The use of cannabis is also attributable to over 3,400 adult prison sentences. The tangible cost of cannabis use amounts to $4.4 billion, while intangible costs are estimated at $106 million.
2.26NDRI further revealed that over 645,000 Australians use extra-medical opioids, which include the illegal use of heroin and the misuse of pharmaceutical opioids. Approximately 104,000 Australians are dependent on extra-medical opioids, and 2,203 Australian deaths are attributable to this use. The tangible costs of extra medical opioid use amount to $5.63 billion, while intangible costs are estimated at $10.13 billion.
2.27In analysing illicit drug use by age and gender, the Department of Health and Aged Care highlighted that aside from males aged 14-19, for which the use of illicit drugs decreased, all other age groups experienced a small increase between 2010 and 2023. The use of illicit drugs has significantly increased for females aged 14-19,20-29 and 30-39. For both males and females, recent illicit drug use was highest among those aged 20-29, which echoes the findings for alcohol use.
2.28Use of both alcohol and other drugs among women of all ages continues to rise, and this fact was raised by multiple witnesses as matter of emerging concern. The Alcohol and Drug Foundation (ADF), for example, noted in its submission the rise of illicit drug use among women and that the gap between young men and women drinking at risky levels was narrowing.
2.29The Committee was deeply concerned not only by the evidence pertaining to the increase of illicit drug use, but also by the expanding range of available drugs. Yarra Drug and Health Forum noted, for example, that many drugs have become cheaper to produce and easier to transport, lowering consumer prices and making them accessible to more people than ever before. Its submission further emphasised that:
New drug types, including synthetic opioids, New Psychoactive Substances (NPS) and amphetamine-type stimulants present greater dangers compared to those from 10 or 20 years ago. Not only do these drugs pose significantly higher risks, but they are also often consumed in riskier ways, exacerbating both the acute and chronic risks associated with drug use.
2.30Multiple submissions raised concerns regarding the use of adulterants in the drug supply, particularly potent synthetic opioids like fentanyl and nitazenes. ADF reported that, over the past three years, nitazenes have been detected across Australia and have been linked to several overdose deaths in Victoria, New South Wales and South Australia.
2.31Throughout the course of the inquiry, various witnesses informed the Committee that most people using AOD will experience minimal or even no harm. According to AIHW, an estimated 18 per cent of the population use an illicit substance each year, while 77 per cent of people consume alcohol each year in Australia. It is estimated that 3.3 to 5 per cent of people experience an AOD use problem. These findings are largely in line with international evidence, with the Global Commission on Drug Policy noting that the use of drugs encompasses a wide spectrum of behaviours, ranging from non-problematic to profoundly harmful, with 10 per cent of people who use drugs globally considered ‘problem users’. Those who are affected by their AOD use will, however, face serious health challenges, and will likely encounter a range of difficulties in accessing the right type of services in a timely manner.
2.32Moreover, the Committee acknowledges that AOD-related harm disproportionally affects Australia’s most vulnerable populations. As MrJoseph Coyte, Executive Director of Ngaimpe Aboriginal Corporation (The Glen Group) emphasised:
… humans have consumed drugs, including alcohol, for thousands of years, perhaps more, and this is not likely to change any time soon. Some drug consumers, probably most, don't suffer significant, immediate adverse consequences or create significant societal problems from their usage, although all drug use does cause some longer-term harm. In regard to problematic drug use, the use itself is often only a symptom of the real problem. The people who are more likely to be involved in problematic drug use are the people who don't score well on the basic social determinants of health. Sadly, the most vulnerable people in our community are over-represented in all problematic drug related statistics.
Committee comments
2.33The Committee acknowledges that the health impacts of AOD use are extensive, and that they present a major burden to individuals, their families, and communities. While recognising some positive trends in alcohol consumption across Australia, the Committee notes with concern that alcohol remains a significant contributor to AOD-related harm, with particularly troubling trajectories of increased consumption among certain population cohorts. The emergence of new and potent illegal substances presents additional challenges that warrant careful attention. The Committee emphasises that detailed monitoring of changes in AOD patterns and types of use is essential for shaping effective responses in this domain and informing the direction of any future policy in this domain.