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Providing the evidence base to reduce harmful AOD use in
Aboriginal and Torres Strait Islander communities
The term 'alcohol' describes a series of organic chemical compounds, but only one type (ethyl alcohol or ethanol) is found in drinks intended for human consumption. Alcohol is produced by fermentation - the action of yeast on liquids containing sugars and starches. In its pure form alcohol is a clear, colourless liquid with a pungent odour and burning taste. Alcoholic drinks vary in colour and taste because of other ingredients that are added to them .
Alcohol is a psychoactive (mind-altering) drug , and is one of the most widely used drugs worldwide . Classified as a depressant drug, alcohol slows down activity in the central nervous system, affecting concentration and coordination, and slowing down reflexes and the response time to unexpected situations .
From the early colonisation of Australia to the late 19th century, spirits were the most widely consumed alcoholic beverage. The consumption of alcohol fluctuated in the 1900s, before and after the First and Second World Wars. More recently, advances in refrigeration and brewing have resulted in the development of large scale commercial brewing of beer, and a shift away from the consumption of spirits . Over the past century Australia has been depicted as a predominately male, beer drinking culture . While Australia remains a beer drinking country, wine consumption has increased more than threefold since the late 1940s , and there has been a general trend in the brewing industry towards beverages which are perceived to be 'lighter' in terms of colour, calorific content, and alcohol content .
In 2003, Australia was ranked 22nd in the world in terms of per capita consumption of pure alcohol (7.2 litres per person) . In the same year, the consumption of alcohol was a contributing factor in the deaths of 3,430 Australians . Alcohol is second only to tobacco as the major cause of drug-related mortality and hospitalisation in Australia, with more than 31,000 deaths being attributed to risky or high-risk alcohol consumption between 1992 and 2001 . In 2004-05, the social cost of alcohol to the Australian community was almost twice that of illicit drugs ($15.3 billion compared with $8.2 billion .
Findings from the 2010 National drug strategy household survey (NDSHS) showed that 20% of people consumed on average, more than two standard drinks of alcohol per day, putting them at increased risk of harm from alcohol-related injury and disease over their lifetime . The NDSHS also found that 28% of people increased their risk of accident and injury by consuming more than four standard drinks of alcohol in one session, once a month. These statistics remained steady from 2007 to 2010 . According to the NDSHS, the excessive consumption of alcohol in Australia is perceived to be more of a serious concern than other drugs for people in the community .
The last decade has seen an important shift in the public health perspective of drinking, moving from an exclusive focus on the amount consumed (low-risk, risky and high-risk drinking) to incorporating the patterns of consumption (risks of drinking on occasions and over the life-time) . Community attitudes have also changed, as the Australian society is more likely to be aware of irresponsible patterns of drinking .
Alcohol is rapidly absorbed into the bloodstream, and its effects on many organs and systems within the body are evident in minutes . Alcohol works at the cellular and systemic level in the human body, but its most immediate and obvious effects are on the brain . The effects of alcohol vary from person to person. A range of factors determine the effect that alcohol has on the body including: the type and amount of alcohol consumed; the environment; the user's characteristics such as gender, body size, age, food intake, ethnicity, general health and fitness; as well as the expectation of the drug experience .
Alcohol is the most widely used drug in Australia. It is used for many reasons in different social and cultural contexts . Most people consume alcohol at levels that do not place them at harm , and at relatively low levels, alcohol can have a health benefit for some individuals from middle age onwards . However, drinking alcohol even at low or moderate levels can have harmful effects on health through illness or injury . It is well known that the excessive consumption of alcohol in the short-term (binge drinking), or long-term (chronic drinking), has both short-term and long-term health effects resulting in greater costs to a person's health and social wellbeing .
People who regularly drink unsafe levels of alcohol place themselves at an increased risk of chronic ill health and premature death . Alcohol-related problems are a major cause for concern at local, national and international levels and have substantial social and economic implications for the individual, their families and workplaces, and society as a whole ; and can affect any member of society, including the majority who use alcohol in moderation or abstain .
Alcohol slows down the messages sent between the brain and the rest of the body. This can make a person feel relaxed and more confident, but may also reduce concentration and slow the reflexes . The initial effects of alcohol may reduce tension or inhibitions. With more alcohol, the effects extend to motor and sensory centres in the brain, causing delayed reaction to stimuli. For example, a person who has been drinking will likely be slower applying the brakes if a car ahead stops suddenly .
With increasing alcohol concentrations in the body, movement and coordination rapidly become more difficult. Confusion, blurred vision and poor muscle control are among some of the immediate effects of alcohol consumption. Excessive alcohol consumption over a short period of time often results in a hangover the next day. Commonly referred to as 'binge drinking', this form of excessive drinking involves drinking heavily over a short period of time, or drinking continuously over a number of days or weeks. Binge drinking is harmful because it results in immediate and severe intoxication . The hangover usually occurs several hours after drinking has stopped and the alcohol has been removed from the body. Symptoms include headaches, dehydration, tremors, dizziness, nausea and vomiting .
Alcohol use over the longer term is a major cause of ill health, increasing the risk of a number of disorders. It is associated with hypertension (high blood pressure) which can affect heart function . Impairment of the brain and liver functions can be permanent, and if the person's diet is also poor, this can further affect their health . The effects of alcohol use are often compounded and exacerbated by other risk factors such as smoking, dietary factors, or the use of other drugs .
For women, drinking alcohol during pregnancy increases the risk of reduced fetal growth which can lead to permanent growth and behavioural problems for babies and children .
In addition to the health problems associated with harmful alcohol use, certain patterns of drinking may have social consequences. These range from minor acts of vandalism or offensive behaviour to far more serious antisocial behaviour, which can result in violence or injury to others . Alcohol use has been shown to be a major contributor to injury through interpersonal violence, particularly assaults, domestic violence and child abuse , and is a factor in some cases of suicide . It can also contribute to absenteeism and reduced productivity in the workplace . Financial problems, legal problems, work problems, sexual problems, accidents and poor personal appearance, are amongst the wide array of social problems associated with harmful alcohol use .
The National Health and Medical Research Council (NHMRC) first published the Australian alcohol guidelines to assist in reducing alcohol-caused deaths and related harm in 2001 (at the request of the National Drug Strategy Committee in 1996) . These guidelines advised that male drinkers should drink no more than an average of 40g of alcohol (four standard drinks) per day, and females no more than an average of 20g of alcohol (two standard drinks) per day, to prevent chronic health problems. The recommendation was also made that, providing there are no other situational or individual risk factors (such as driving or pregnancy), men should drink no more than 60g of alcohol (six standard drinks) on any one day, and woman no more than 40g of alcohol (four standard drinks) per day to prevent acute conditions associated with bouts of intoxication, such as alcohol-related injuries .
|For risk of harm in the short-term:|
|Source: World Health Organization, 2000|
|For risk of harm in the short-term:|
|Males On any one day||up to 6 on any one day,
no more than 3 days per week
|7-10 on any one day||11 or more on any one day|
|Females On any one day||up to 4 on any one day,
no more than 3 days per week
|5-6 on any one day||7 or more on any one day|
|For risk of harm in the long-term:|
|Males per week||up to 28 per week||29 to 42 per week||43 or more per week|
|Females per week||up to 14 per week||15 to 28 per week||29 or more per week|
In 2009, the NHMRC introduced revised guidelines that depart from specifying 'risky' and 'high risk' levels of drinking . The new guidelines seek to estimate the overall risk of alcohol-related harm over a lifetime and to reduce the level of risk to one death for every 100 people. There is no longer any difference in the guidelines based on gender; the guidelines are universal for adults over 18 years (guidelines 1 and 2). Specific guidance is also provided for children and young people (guideline 3), and pregnant and breastfeeding women (guideline 4).
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