Strategic areas for action



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  1. Substance use and misuse

Strategic areas for action


















































Early child development and growth (prenatal to age 3)




Early school engagement and performance (preschool to year 3)




Positive childhood and transition to adulthood




Substance use and misuse




Functional and resilient families and communities




Effective environmental health systems




Economic participation and development


























































- Alcohol consumption and harm

- Tobacco consumption and harm

- Drug and other substance use and harm
























































Substance use and misuse has the potential to affect all the headline indicators discussed in this Report. Reducing substance misuse can significantly reduce the level of assaults and homicides and the level of disability, while improving the overall health and wellbeing of a population. A reduction in substance use might also increase children’s educational attainment, household and individual income levels, and reduce crime and imprisonment rates.

Health risk behaviours, such as smoking, excessive alcohol consumption and illicit drug use, are strongly associated with many aspects of socioeconomic disadvantage. Health risk behaviours are particularly prevalent in lower socioeconomic groups. The 2002 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) showed that reported rates of substance use among Indigenous people aged 15 years and over in non-remote areas were significantly higher for those without employment. The Survey also showed an increased rate of tobacco use for those over 15 years with lower household income, lower levels of education and who were unemployed (ABS and AIHW 2005).

Poor economic and social conditions can lead to alcohol dependence, drug use and cigarette smoking, In turn, use and misuse of these substances intensifies the factors that first led to their use. Risk factors for problem drug use include family disruption and dependence problems in the family, poor performance at school, social deprivation, young age of onset of substance use, and depression and suicidal behaviour during adolescence (Lloyd 1998). Richard and Payne (2005) also found that risk factors, including childhood abuse and neglect, drug and alcohol abuse among family members, and troubled school education, were all highly interrelated and important correlates of criminal offending and high frequency substance abuse among 371 juvenile offenders.

A study by Loxley, Toumbourou and Stockwell (2004) found that:



  • Social disadvantage particularly as reflected in factors such as unemployment, homelessness or insecure housing and poverty — is clearly linked to health-damaging behaviours, including the misuse of alcohol and other drugs. (p.14)

  • Drug use, both licit and illicit, is associated with high health, legal and social costs to communities and families, as well as to users. It is associated with crime and violence, sexual assault and domestic violence. Crime is strongly associated with alcohol and drug use, particularly alcohol with violence and heroin with property crime. Drug use has impacts on families, the workforce and road trauma; and it affects public safety and amenity, not only through perceived threat, but through disturbances such as noise, litter and public intoxication. (p.3)

The relative socioeconomic disadvantage experienced by Indigenous Australians compared with other Australians may place them at greater risk of ill health, which in turn can exacerbate their already disadvantaged socioeconomic positions. Indigenous people generally experience high levels of harm as a result of alcohol, tobacco and other drug use. According to AIHW (2006), which provided data collected from 635 alcohol and other drug treatment agencies across Australia, Indigenous people accounted for almost 10 per cent of total clients who sought treatment for drug and alcohol use in 2004 05.1 This was almost five times the proportion of Indigenous people in the Australia population 2, Compared with non-Indigenous clients, Indigenous clients were more likely to be in the youngest group (10–19 years), and more likely to nominate alcohol as the principle reason for seeking treatment.

A study by Ridolfo and Stevenson (2001) estimated that in 1998 the use of tobacco, alcohol and other (illicit) drugs caused about 25 per cent (7 000) of the deaths of Australians under 65 years old, among which over 2 000 deaths were related to alcohol (which include alcohol related road injuries), about 4 200 related to smoking and 1 000 related to illicit drug use. However, there is no information available regarding Indigenous status in this study.

This chapter examines patterns in, and harms related to, the use and misuse of alcohol, tobacco and other drugs among Indigenous and non-Indigenous people.

Following feedback and comments from consultation on the 2005 Report, this chapter has been restructured. In the 2003 and 2005 Reports patterns in alcohol and tobacco consumption were reported in one section, and alcohol and tobacco related harms in another. This chapter now reports three indicators by type of substance, covering patterns in use and related harms for each type of substance. The three indicators are:



  • 8.1 Alcohol consumption and harm

  • 8.2 Tobacco consumption and harm

  • 8.3 Drug and other substance use and harm.

New data on hospitalisations related to tobacco use and drug influenced homicides are included for the first time in this Report.

Attachment tables


Attachment tables for this chapter are identified in references throughout this chapter by an ‘A’ suffix (for example, table 8A.1.1). A list of attachment tables is in section 8.5. These tables can be found on the Review web page (www.pc.gov.au/gsp). Users can also contact the Secretariat to obtain the attachment tables.




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