Drug and alcohol use is major cause of disease burden in Australian youth
Alcohol and illicit drug use is well-publicised in media and culture as part of the lives of many adult Australians, but these behaviours are not limited to older adults. Perhaps unsurprisingly, the use and abuse of alcohol and drugs is a common feature in the lives of many young people as well. There is no standard definition to which the descriptor ‘young people’ applies and datasets use different age ranges to represent this category. We can, however, consider the Australian Bureau of Statistics’ (ABS) definition of ‘young people’, and their reporting that in 2017, there were 3.2 million Australians aged between 15-24 (ABS 2018). For Australian males in this age group, alcohol and illicit drug use are the leading cause of total burden of disease, and for females, alcohol and drugs are the second and third leading cause, respectively. The burden of disease is a concept describing the ‘costs’ of a health problem, including physical, social and economic costs. In this case, drug and alcohol use is responsible for the majority of costs to health and reduced quality of life experienced by young people in Australia and is a leading factor in preventable illness and disease. It is thereby a leading public health concern for this demographic.
Data on drug and alcohol use
Drug and alcohol behaviours are monitored and analysed in Australia with data coming from a variety of sources. Several agencies collect this data and provide valuable insight into how these behaviours are trending and changing over time. The Australian Institute of Health and Welfare (AIHW) is one such source of data on these behaviours. Additionally, AIHW create reports on the health and wellbeing of Australians across a range of topics by aggregating different data sources, including ABS data, Australian Burden of Disease Data, Australian Secondary Students’ Alcohol and Drug survey, Alcohol and Other Drug Treatment Services National Minimum Dataset and the National Drug Strategy Household Survey.
Drug use in young people
While rates of illicit drug use by young people are decreasing, with proportion of those aged 18-24 who have experimented dropping from 37% in 2001 to 28% in 2016. the use of pharmaceutical drugs for non-medical reasons remains an increasing public health concern (AIHW 2019b). Cannabis and meth/amphetamines are the most commonly used illicit substances by young people (ibid.). People in their 20s are the age group most likely to use cannabis, with the rate declining to 22% in 2016 from 29% in 2001 (ibid.) and cannabis is the illicit drug most commonly used by those aged 12-17 (Guerin & White 2018).
Alcohol use in young people
The most recent AIHW report on ‘Alcohol, tobacco & other drugs in Australia’ (2019) reports that despite declining rates of tobacco smoking and illicit drug use, young people are still consuming risky levels of alcohol at a high rate. Data from 2016 shows that of those young adults between the ages of 18-24, 42% were reported to have exceeded the single occasion risk guideline by consuming on average more than four standard drinks on one occasion and 15% had consumed more than 11 standard drinks on one occasion (AIHW 2017). In fact, this age group was more likely than any other to exceed the National Health and Medical Research Council (NHMRC) guidelines for single occasion risk on a weekly or monthly basis (ABS 2018). Trends are shifting with the average age of first alcohol consumption, increasing from 14.8 years in 1995 to 16.1 years in 2016 (2016 NDSHS). However, data from the Young Australians Alcohol Reporting System (YAARS) indicates that those who engage in risky drinking behaviours tend to start their drinking about two years earlier than the national average, at just 14 years old (Lam et al. 2017).
Impacts of drug and alcohol use higher in young people
Alcohol and drug use is linked to a range of adverse outcomes in the areas of health, social and economics. Some of these are easy to measure and others can be much more difficult due to the indirect and long-term nature of their effects. In young people, the impacts of alcohol and drug use can be disproportionately high given the early stage of physiological and psychosocial development. Young people are considered a ‘vulnerable’ population given the potential for permanent negative impacts to their health and wellbeing, particularly on their developing brains. This is why guidelines from the NHMRC advise that those aged under 18 are safest avoiding alcohol altogether. A recent study by the National Drug & Alcohol Research Centre published some of the most comprehensive evidence yet of the causal link between adolescent drinking and problems with alcohol later in life (Silins et al. 2018). Alcohol and drug-related harm is a serious issue, with younger people more likely to be victims of alcohol-related incidents involving verbal or physical abuse (AIHW 2017). Of those risky drinkers aged 14-19 in the YAARS data, 83% reported that they were injured as a result of their drinking in the past 12 months, with 7% ending up in the emergency department (Lam et al. 2017). Australians aged 20-24 are more likely than any other group to be charged with driving under the influence of alcohol and/or drugs (ABS 2008) and Transport for NSW reported that in 2018, drivers under 25 were the group with the highest number of drink drivers and the most likely to have fatal crashes in related high blood alcohol levels (Gribbin 2018). Of course, there are a myriad of other impacts of drug and alcohol use in young people, both short and long term. Alcohol and drug use is implicated in mental health problems, criminal behaviour, family and domestic violence and other trauma as victims or perpetrators, injection-related harms, financial costs and premature death. In fact, the World Health Organisation’s ‘Global status report on alcohol and health 2018’ links harmful alcohol use to over 200 different health conditions including cancers, suicide, road injuries, fertility issues, diabetes, liver and cardiovascular diseases (WHO 2018).
Availability and uptake of treatment for drug and alcohol abuse in young people
Australia is fortunate to have a universal health care system that provides publicly-funded services at low costs. However, there is often a higher proportion of service need than service availability. Throughout Australia, there are 952 alcohol and drug treatment services that provide services with public funding to an estimated 130,000 clients annually (AIHW 2019b). The representation of young people in these treatment environments is captured in data from the Alcohol and Other Drugs Treatment Services National Minimum Data Set (AODTS NMDS), which defines young people as those aged 10-29. While there are additional private, for-profit and charitable services available the data reporting requirements for these are not the same as for those government-funded services. In the AODTS NMDS for the year 2017-18, those under 30 made up 38% of the client population with an estimated 76,386 people receiving treatment for their drug and alcohol use. Alcohol was the main concern for 19.9% of clients, with cannabis at 38% and amphetamines at 29% (AIHW 2019b). To better serve young populations, there are specific elements that can contribute to the effectiveness of youth-friendly services. The World Health Organisation (WHO) has recommended that services for young people allow for engagement without parental consent, provide confidentiality, feature promptness in screening and assessment, as well as have short waiting times, ‘drop-in’ services and easy registration. These drug and alcohol treatment services can also be beneficial when linked to other social services, as this provides a more holistic provision of care (WHO 2015). The high social, economic and health-related costs of drug and alcohol use to the individual and society mean that effective and available services are a huge priority for ensuring the health and welfare of young people, who can be amongst the most vulnerable to their damaging effects.
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