Catalano, Paul

Chikritzhs, Tanya

Dietze, P.

Heale, P.

Stockwell, Tim

English

espace@Curtin

NATIONAL ALCOHOL INDICATORS BULLETIN No. 3Funded by the National Drug Strategy November, 2000Patterns of alcohol consumption in Australia, 1998.Prepared by:  Penny Heale*, Tim Stockwell§, Paul Dietze*, Tanya Chikritzhs§, Paul Catalano§.*Turning Point, Alcohol and Drug Centre Inc. Melbourne, Vic; §National Drug Research Institute, Curtin University, WA.Summary Points Estimates from a 1998 national survey were madeof how much alcohol was drunk in Australia atrisky levels for health.  A large proportion (39%) was consumed at levelsthat posed health risks in the long term. Most (51%) of the alcohol consumed in Australia in1998 posed short-term health risks to the drinker.  9% of both male and female drinkers were atmedium or high risk of long-term health problemsdue to alcohol (e.g. liver disease). 46% of male and 32.5% of female drinkers were atrisk of short-term harm from drinking (e.g. injury)at least once a month.  People aged below 25 years had the riskiestdrinking patterns.  These estimates are very conservative since theyaccount for less than half of the alcohol sold inAustralia in 1998.Introduction. In this third Bulletin of the National Alcohol IndicatorsProject (NAIP), we introduce a new way of describing theprevalence of risky drinking. We report an estimate of the proportionof Australia’s alcohol consumption that exceeds levelsrecommended in national drinking guidelines. We also provideestimates of the numbers of people drinking in excess ofrecommended levels. The source of these estimates was the 1998National Drug Strategy Household Survey (AIHW, 1999). In eachcase these estimates are provided separately for drinking patternsknown to cause acute (short-term) and chronic (long-term) harms.Further information about this approach is contained in the“International Guide for Monitoring Alcohol Consumption andRelated Harm” (WHO, 2000).The new (draft) Australian drinking guidelines from the NationalHealth and Medical Research Council (2000) distinguish betweenlevels of daily consumption that pose short-term health risks (e.g.injury and acute pancreatitis) and those that create long-term risksto health (e.g. liver cirrhosis and cardiovascular disease). For thelong-term or ‘chronic’ health problems the draft guidelines areconsistent with earlier guidelines (NHMRC, 1992) in recommendingno more than 14 standard drinks (10g of ethyl alcohol) per week forwomen and no more than 28 standard drinks per week for men. Forshort term or ‘acute’ risks from intoxication, the draft guidelinessuggest that up to 6 drinks for men and 4 for women on any one dayare low risk provided the individual is not operating machinery,driving, working, using medication or suffering from certain physicalconditions. The aim of this Bulletin is to provide estimates of howmuch drinking in Australia is above these levels.According to World Drink Trends (1999) Australia was ranked 19thin the world in terms of per capita consumption with 7.6 litres of purealcohol consumed per person. Underlying this simple statistic is anenormous variation in drinking levels and patterns some of whichare low risk or even of potential benefit to health (NHMRC, 2000).The aim of this Bulletin is to estimate the proportion of Australia’stotal alcohol consumption that presents a medium or high risk tohealth. Ideally, comparisons between the results of the 1998National Drug Strategy Household survey would be made againstprevious surveys. Unfortunately, changes in some of the alcoholquestions in 1998 mean that such comparisons cannot be madewith confidence. However, it is hoped that this Bulletin will provide abenchmark for the prevalence of risky drinking in Australia againstwhich future assessments can be compared. Trends in national andstate per capita alcohol consumption, will be reported in NAIPBulletin 4.61%19%20%Low Medium HighFigure 1: Percentage of alcohol consumed at low, medium andhigh risk levels for long-term (chronic) harm (e.g. liver disease,stroke).49%27%24%Low Medium HighFigure 2: Percentage of alcohol consumed at low, medium andhigh risk levels for short-term (acute) harm (e.g. injury).1NATIONAL ALCOHOL INDICATORS BULLETIN No. 3Funded by the National Drug Strategy November, 2000Method. The raw data for this Bulletin was obtained from the 1998National Drug Strategy Household (NDSH) survey. This survey of10,030 people aged 14 and older includes questions about lifetimeuse of alcohol, use within the last year, quantity and frequency ofusual consumption as well as amount usually consumed on a singledrinking occasion. Responses to these questions were used todetermine the number of people consuming alcohol at the risk levelsdefined below. Some adjustments of the data were made using age,gender and household size weights as determined by the AustralianInstitute of Health and Welfare (AIHW, 1999) to ensure that theresults were nationally representative.Definition of a ‘drinker’ and a ‘drink’The use of the term ‘drinker’ or ‘current drinker’ in this Bulletinmeans someone who had at least one drink of alcohol in theprevious 12 months. A ‘standard drink’ or ‘drink’ here refers to onecontaining 10g of ethyl alcohol.Definitions of risk levelsThe definitions of low risk alcohol consumption for acute and chronicharms were made as consistent as possible with the new draftNHMRC guidelines for responsible drinking (NHMRC, 2000).However, in order to provide a distinction between medium and highrisk drinking (not mentioned in the new draft guidelines) we havealso drawn upon other sources (NHMRC, 1992; WHO, 2000). Thedefinitions of low, medium and high risk drinking used in this Bulletinare summarised in Tables 1 (chronic) and 2 (acute).‘Chronic’ health problems are those resulting mainly from long termexcessive alcohol consumption. Low risk consumption for chronichealth problems is defined by NHMRC (1992, 2000) as up to 14drinks per week for females and up to 28 drinks per week for males.Additionally, for the purposes of this document, consumption of 15to 28 drinks per week for women and 29 to 42 drinks per week formen was classified as ‘medium’ risk and higher weekly intake as‘high’ risk (see Table 1) in accordance with the 1992 NHMRCGuidelines.Table 1: Weekly intake of standard drinks (=10g of ethyl alcohol)defined as low, medium and high risk to chronic (long-term) healthproblems.RISK* Males Females    Low 1-28 1-14    Medium 29-42 15-28    High 43+ 29+* Consistent with NHMRC (1992, 2000) and WHO (2000)The new (draft) NHMRC guidelines define low risk consumption foracute harm as up to 4 drinks on any one day for females and up to 6drinks on any one day for males (NHMRC, 2000). However, theseguidelines provide no definition of medium as opposed to high riskdrinking. For the purposes of this Bulletin high risk drinking wasdefined as 9 or more drinks in a day for males and 7 or more forfemales, in keeping with available response options in the NDSHsurvey.Table 2: Daily intake of standard drinks (=10g) designated low,medium and high risk for acute (short-term) health problemsRISK Males Females    Low* 1-6 1-4    Medium✝ 7-8 5-6    High✝ 9+ 7+*Consistent with NHMRC (2000) and WHO (2000)✝The distinction between ‘medium’ and ‘high’ is based only on categoriesavailable in the 1998 NDSH surveyProportion of alcohol consumed at risk levels for chronic harmTo calculate the proportion of all alcohol consumed which placeddrinkers at risk of chronic harm, items concerning the quantity andfrequency of alcohol consumption were combined to determineaverage numbers of drinks per day for males and femalesseparately. This amount was summed for all respondents whoseaverage consumption exceeded low risk levels. The resulting total ofall medium and high risk consumption was divided by the totalamount of alcohol consumed by all respondents.Proportion of alcohol consumed at risk for acute harmThe proportion of alcohol consumed causing medium risk of acuteharm was calculated by multiplying the frequency of medium riskdrinking days by the average number of drinks consumed on suchdays. This figure was then divided by the total number of drinksconsumed by all men or women (as appropriate) on an average day.For the proportion of all alcohol consumed at high risk of acute harmthis process was repeated using the higher risk levels defined inTable 2.Proportion of Australian drinkers at risk of chronic harmThe number of drinkers at low, medium and high risk levels wascalculated from (i) the frequency of drinking in terms of days perweek, month or year and (ii) the number of drinks a person reportedthey usually had on a day when they drank. The totals resulting frommultiplying answers to these two questions were used to classifydrinkers into the low, medium and high risk drinking categoriesProportion of Australian drinkers at risk of acute harmThe number of people consuming alcohol at a medium risk level foracute harm was calculated on the basis of responses to thequestion: “In the past 12 months how often have you had more than6 (4 drinks if female) standard drinks in a day?”. There was noequivalent question in the 1998 NDSH survey for high risk drinking.An estimate was made, however, on the basis of those people whoanswered positively to the above question and also reporteddrinking at least 8 drinks (males) or 6 drinks (females) to anotherquestion: “When you drink more than 4 drinks in a day (males, 2 forfemales), how many standard drinks do you usually have?”. Thismethod slightly underestimates the true number.Throughout this Bulletin the highest category for the number ofdrinks consumed was “13 or more drinks” which in every case, wascoded as 13. This produces a conservative estimate of theproportion of all alcohol that was consumed above low and mediumrisk levels as some people will have consumed more than 13 drinks.2NATIONAL ALCOHOL INDICATORS BULLETIN No. 3Funded by the National Drug Strategy November, 2000FindingsCoverage of total alcohol consumptionRespondents to the NDSH survey reported drinking on average357.5 standard drinks in the previous 12 months – or one drink perday. This translated to 4.47 litres of pure alcohol per person. Bycomparison, World Drink Trends (1999) estimated Australia’s percapita consumption to be 7.6 litres in 1997/1998, based on nationalsales data. When adjusted for the population aged 14 or over, percapita consumption for 14+ year olds becomes 9.61 litres perperson. Thus the percentage coverage of actual alcoholconsumption accounted by this national survey was only 46.5%.Clearly the figures reported here significantly under-estimate thetrue amount of alcohol consumed that year in Australia. This is ausual finding for surveys of alcohol use (WHO, 2000).Proportion of alcohol consumed at risk levels for chronic harmAn average of 9,897,675 standard drinks was consumed each dayin 1998 by males and 3,763,686 standard drinks consumed eachday by females. While most were consumed at low risk levels forlong term health problems, as many as 39% (see Fig 1) wereconsumed by people who regularly exceeded these levels (45% forwomen, 36% for men). The total proportions of all men and womenwho drank at high risk levels were 21% and 17% respectively.728849 526859 664868 65239121912 28 21328356 33929 2112 13 20 240102030405060708090100male fem male fem male fem male fem male fem%Low Medium High 14-17yrs 18-24yrs 25-39 yrs 40-64yrs 65+yrsFigure 3: Proportion of alcohol consumed at low, medium and highrisk levels for chronic harm by age and sex.Proportion of alcohol consumed at risk levels for acute harmAn average of 5,259,248 drinks per day were consumed by males indrinking sessions exceeding 6 standard drinks i.e. above low risklevels. This represented 53% of all drinks consumed by Australianmales each day. There was an average of 1,769,928 standarddrinks consumed by women on drinking occasions exceeding 4standard drinks in a day, accounting for 47% of female alcoholconsumption. It is striking that the 14 to 17 year age group had thehighest proportion of alcohol consumed in a risky fashion(medium/high) for acute harm at 71%. The 18 to 24 year olds werenext highest with 66%. See Fig 4. for proportions by sex.Using the higher cut-offs designated here as high risk for acuteharm, 27% of all alcohol consumed by men and 17% of the alcoholconsumed by women was high risk. For all respondents this was24%.27 32 3143 4452 51 53728323251725 2730 3436141750 43 5132 3018 16 11 140102030405060708090100male fem male fem male fem male fem male fem%Low Medium High 14-17yrs 18-24yrs 25-39 yrs 40-64yrs 65+yrsFigure 4: Proportion of alcohol consumed at low, medium and highrisk levels for acute harm by age and sex.Proportion of the population that drinks alcoholOne in five persons aged 14 or over reported abstaining fromalcohol: half of these (9.6%) were life-time abstainers and half hadnot had a drink for at least 12 months (10.3%). Males were slightlymore likely to be current drinkers (84.2%) than were females (76%).Persons aged 18 to 24 were also most likely to be current drinkers(87.5%), while persons aged 65 or over (66%) and those aged 14 to17 (62%) were least likely to be current drinkers.Proportion of drinkers at risk of chronic harmAlcohol was consumed at low risk levels for chronic harm by 91.2%of current drinkers, at medium risk levels by 5.7% and at high risklevels by 3.1% (see Table 3). Drinkers aged 18 to 24 were mostlikely to be high risk drinkers (8.7% of males; 4.9% of females).When comparing male and female consumption, it needs to beborne in mind that medium and high risk consumption are defineddifferently for each sex.Table 3: Proportion of current drinkers consuming at low, mediumand high risk levels for chronic harm by age and sex.%14-17 18-24 25-39 40-64 65+ TOTALMalesLow risk 95.7 86.4 92.8 90.1 93.6 91.1Medium risk 3.8 4.9 3.5 7.0 2.4 4.9High risk 0.5 8.7 3.7 2.9 4.0 4.0FemalesLow risk 98.4 90.0 92.2 89.6 91.7 91.2Medium risk 1.3 5.2 6.5 7.8 8.3 6.7High risk 0.3 4.9 1.3 2.6 0.0 2.1TotalLow risk 97.1 88.1 92.5 89.9 92.8 91.2Medium risk 2.5 5.0 4.9 7.4 5.0 5.7High risk 0.4 6.8 2.5 2.8 2.2 3.13NATIONAL ALCOHOL INDICATORS BULLETIN No. 3Funded by the National Drug Strategy November, 2000Proportion of drinkers at risk of acute harmPersons at risk of acute harm were taken to be males who drank inexcess of 6 drinks on a single occasion (4 drinks for females) atleast once a month in the past year. When only current drinkerswere considered 46% of men and 32.5% of women indicated highrisk consumption at least once a month, with the highest proportionevident amongst 18-24 year olds (see Fig 5). It was also estimatedthat at least 7.8% of drinkers were at high risk of acute harm (11.5%of males, 4% of females).59 563148 4965 5774 818527 344239 36313725 171514 102713 154 60102030405060708090100male fem male fem male fem male fem male fem%Low Medium High 14-17yrs 18-24yrs 25-39 yrs 40-64yrs 65+yrs1 2Figure 5: Proportion of current drinkers at low, medium and highrisk levels for acute harm at least once a month, by age and sex.Conclusions. The above results suggest that at least two-thirds ofthe alcohol consumed by people under 25 years of age poses a riskof short-term or acute health consequences – as does around half ofall the alcohol consumed by all Australians aged 14 or over. Asignificant but smaller amount of this consumption also poses a riskof long-term health problems (e.g. liver cirrhosis, stroke and cancer).There has been debate about whether prevention policies should betargeted at the whole population of drinkers or just some high riskgroups (e.g. Kreitman, 1986). These results suggest that preventionof alcohol-related harm is an issue for most drinkers and not just asmall minority. Prevention policies which impact upon the wholepopulation such as limiting the general physical and economicavailability of alcohol need to be given serious consideration.It is known that estimates of alcohol use made from householdsurveys underestimate true consumption due to factors such aspoor recall, under-reporting and sample bias (WHO, 2000). In thiscase less than half the alcohol known to have been sold in thefinancial year 1997/8 was accounted for by the levels ofconsumption reported in the NDSH survey. This suggests that theactual prevalences of medium and high risk alcohol consumption inAustralia are substantially higher than the estimates presented here.This Bulletin clearly indicates the extent of risky alcoholconsumption in Australia. The methods used and the resultspresented provide a useful benchmark against which future patternsof high risk alcohol consumption and compliance with nationaldrinking guidelines may be compared. It will, however, be necessaryto modify the next NDSH survey so that the alcohol questionscorrespond more closely to the new national drinking guidelines.Acknowledgments.  Faye Soupourmas, Database ManagerHouseholds Research Database, University of Melbourne forsupplying survey data files. Mark Cooper-Stanbury, AustralianInstitute of Health and Welfare for providing advice regarding NDHSdata. The National Drug Strategy of the Commonwealth Departmentof Health and Aged Care for funding the National Alcohol IndicatorsProject. Joanne Cronin (formerly NDRI) and Paul Williams (formerlyAIHW) for work on incorporating new questions on alcohol in the1998 NDSH survey. Paul Jones of NDRI for assistance withformatting the bulletin.Citation Details.  Heale, P., Stockwell, T., Dietze, P. Chikritzhs,T., & Catalano, P. (2000) Patterns of alcohol consumption inAustralia, 1998. National Alcohol Indicators Project, Bulletin No. 3.National Drug Research Institute, Curtin University of Technology,Perth, WA.Correspondence. For copies of the Technical Report contact theNational Drug Research Institute at GPO Box U1987, Perth,Western Australia, 6845. Send e-mail requests to:enquiries@ndri.curtin.edu.auReferences.Australian Institute of Health and Welfare (1999) National DrugStrategy Household Survey Technical Report 1998. Canberra:Department of Health and Aged Care.Chikritzhs, T., Jonas, H., Heale, P., Dietze, P. Hanlin, K. &Stockwell, T. (1999) Alcohol caused deaths and hospitalisations inAustralia, 1990-1997. National Alcohol Indicators Project, BulletinNo. 1. National Drug Research Institute, Curtin University ofTechnology.Chikritzhs, T., Stockwell, T., Heale, P., Dietze, P. & Webb, M. (1999)Trends in Alcohol-Related Road Injury in Australia, 1990-1997.National Alcohol Indicators Project, Bulletin No. 2. National DrugResearch Institute, Curtin University of Technology.Kreitman, N. (1986) Alcohol consumption and the preventiveparadox, British Journal of Addiction, 81, 353-363.National Health and Medical Research Council (1992) Is there asafe level of daily consumption of alcohol for men and women.Canberra: Australian Government Publishing Service.National Health and Medical Research Council (2000) Nationaldrinking guidelines: draft for consultation. NHMRC, Canberra. Seeweb site http://www.nhmrc.health.gov.au/advice/alc-comp.htmWorld Drink Trends (1999) International Beverage Consumption andProduction Trends. Henley-on-Thames: NTC Publications Limited.World Health Organization (2000) International guide for monitoringalcohol consumption and alcohol related harm. World HealthOrganization,Geneva.WHO/MSD/MSB/00.54

Patterns of alcohol consumption in Australia, 1998.

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Patterns of alcohol consumption in Australia, 1998.

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