Australian Indigenous HealthReviews
From the Australian Indigenous HealthInfoNet
Background information of the harmful use
of alcohol amongst Indigenous Australians
Introduction
Contents
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 [1].
Introduction�������������������������������������������������������������������������������������������� 1
Alcohol is a psychoactive (mind-altering) drug [2][3], and
is one of the most widely used drugs worldwide [4][5].
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 [1][6].
Drinking guidelines�������������������������������������������������������������������������� 3
Alcohol use in Australia���������������������������������������������������������������� 1
Effects of alcohol use���������������������������������������������������������������������� 2
Short-term health effects������������������������������������������������������������ 2
Long-term health effects������������������������������������������������������������� 3
Social consequences associated with alcohol use 3
References������������������������������������������������������������������������������������������������ 5
Alcohol use in Australia
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 [7]. Over the past century Australia has been
depicted as a predominately male, beer drinking culture [7]
[8]. While Australia remains a beer drinking country, wine
consumption has increased more than threefold since the
late 1940s [9][10], and there has been a general trend in the
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brewing industry towards beverages which are perceived to
be ‘lighter’ in terms of colour, calorific content, and alcohol
content [10].
In 2003, Australia was ranked 22nd in the world in terms
of per capita consumption of pure alcohol (7.2 litres per
person) [7]. In the same year, the consumption of alcohol
was a contributing factor in the deaths of 3,430 Australians
[9]. 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 [11]
[12]. 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 [4][13].
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 [14]. 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 [14]. 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 [14].
Alcohol is the most widely used drug in Australia. It is used
for many reasons in different social and cultural contexts
[2][9][11][15]. Most people consume alcohol at levels that
do not place them at harm [4], and at relatively low levels,
alcohol can have a health benefit for some individuals from
middle age onwards [2][3][4][10]. However, drinking alcohol
even at low or moderate levels can have harmful effects on
health through illness or injury [11]. It is well known that the
excessive consumption of alcohol in the short-term (binge
drinking), or long-term (chronic drinking), has both shortterm and long-term health effects resulting in greater costs
to a person’s health and social wellbeing [6][10][11].
People who regularly drink unsafe levels of alcohol place
themselves at an increased risk of chronic ill health and
premature death [10]. 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 [6][10][11]; and can affect any member of society,
including the majority who use alcohol in moderation or
abstain [16].
Short-term health effects
There are several short-term physical effects associated with
the consumption of one to three standard drinks per hour.
These include [6][17]:
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) [11].
Community attitudes have also changed, as the Australian
society is more likely to be aware of irresponsible patterns
of drinking [10].
•
a change in heart rate
•
a reduction in body temperature
•
dilation of the small blood vessels producing a warm
flushing
•
stimulation of appetite
•
increased urination
•
reduced muscle coordination.
Effects of alcohol use
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 [6][11]. 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 [10].
Alcohol is rapidly absorbed into the bloodstream, and
its effects on many organs and systems within the body
are evident in minutes [3][10][11]. Alcohol works at the
cellular and systemic level in the human body, but its most
immediate and obvious effects are on the brain [3][6][11].
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 [6][11].
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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 [1]. 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 [17].
Long-term health effects
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 [1]. 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 [1]. 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 [10].
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
[18].
Long-term health consequences associated with harmful
alcohol include [6][11][17]:
•
Alcohol dependence - once a person has become
dependent on alcohol it is much more likely that
drinking will continue in a manner that could harm both
the drinker and others.
•
Cancer - alcohol is a carcinogen and chronic heavy
drinking has been shown to cause cancers of the
mouth, throat and oesophagus, as well as liver, bowel
and breast. Smoking in conjunction with heavy drinking
hugely increases the risk.
•
Cardiovascular disease - harmful alcohol use is
associated with cardiomyopathy (reduced heart muscle
strength), and is a causal factor in high blood pressure,
haemorrhagic stroke and heart failure.
•
Cirrhosis of the liver - the most common cause of illness
and death associated with chronic harmful alcohol use.
•
Cognitive problems and dementia - high levels of
alcohol use affect the brain and continued levels of
chronic drinking over time can lead to cell damage and
cell death. This affects cognitive skills, memory, and
reasoning skills.
•
Mental health conditions - mental health conditions
including depression, anxiety, bi-polar disorder and
schizophrenia can be affected by drinking alcohol,
which can lead to poorer health outcomes for people
with mental health conditions.
•
Pancreatitis - pancreatitis is inflammation of the
pancreas, which can occur suddenly and severely (acute)
or be ongoing (chronic). Alcohol consumption is the
most common cause and people who drink excessive
amounts of alcohol are most at risk of developing
pancreatitis.
Social consequences associated
with alcohol use
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 [7][10][11].
Alcohol use has been shown to be a major contributor to
injury through interpersonal violence, particularly assaults,
domestic violence and child abuse [7], and is a factor
in some cases of suicide [11]. It can also contribute to
absenteeism and reduced productivity in the workplace [2]
[7][19]. 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 [6].
Drinking guidelines
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) [10]. 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 [20].
3
Table 1.
Summary of guidelines for low risk drinking
For risk of harm in the short-term:
Low risk
Risky
High risk
(standard
drinks)
(standard
drinks)
(standard
drinks)
For risk of harm in the short-term:
Males On any
up to 6 on any
7-10 on any one
11 or more on
one day
one day,
day
any one day
no more than 3
days per week
Females On any
up to 4 on any
5-6 on any one
7 or more on
one day
one day,
day
any one day
no more than 3
days per week
For risk of harm in the long-term:
Males per week
Low risk
Risky
High risk
(standard
drinks)
(standard
drinks)
(standard
drinks)
up to 28 per
29 to 42 per
43 or more per
week
week
week
Females per
up to 14 per
15 to 28 per
29 or more per
week
week
week
week
Source: World Health Organization, 2000
In 2009, the NHMRC introduced revised guidelines that
depart from specifying ‘risky’ and ‘high risk’ levels of drinking
[11]. 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).
•
Guideline one: to reduce the lifetime risk of harm from
alcohol-related disease or injury, no more than two
standard drinks should be consumed on any day;
•
Guideline two: to reduce the risk of injury on a single
occasion of drinking, no more than four standard drinks
should be consumed;
•
Guideline three: recommends avoiding alcohol for those
under 15 years, and delaying the initiation of drinking
for those aged 15 to 17 years for as long as possible;
•
Guideline four: recommends pregnant and breast
feeding women avoid drinking alcohol [11].
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Copyright © 2010 Australian Indigenous HealthInfoNet
References
1.
Alcohol facts (2011) Australian Drug Foundation
2.
Intergovernmental Committee on Drugs Australia (2006) National
Alcohol Strategy 2006 - 2011. Canberra: Ministerial Council on Drug
Strategy, Australia
3.
Alcohol and other drugs: a handbook for professionals (2004)
National Centre for Education and Training on Addiction (NCETA)
Consortium
4.
Australian Institute of Health and Welfare (2011) Drugs in Australia
2010: tobacco, alcohol and other drugs. Canberra: Australian
Institute of Health and Welfare
5.
Alcohol Advisory Council of New Zealand & Ministry of Health (2001)
National alcohol strategy 2000-2003. Wellington: Alcohol Advisory
Council of New Zealand & Ministry of Health
6.
Alcohol: drug facts (2011) NSW Health
7.
Ministerial Council on Drug Strategy (2001) Alcohol in Australia.
Issues and strategies. Canberra: Commonwealth of Australia
8.
National Drug Research Institute (2007) Restrictions on the sale and
supply of alcohol: evidence and outcomes. Perth: National Drug
Research Institute, Curtin University of Technology
9.
Australian Institute of Health and Welfare (2007) Statistics on drug
use in Australia 2006. Canberra: Australian Institute of Health and
Welfare
10.
National Health and Medical Research Council (2001) Australian
alcohol guidelines. Health risks and benefits. Canberra: National
Health and Medical Research Council
11.
National Health and Medical Research Council (2009) Australian
guidelines to reduce health risks from drinking alcohol. Canberra:
National Health and Medical Research Council
12.
Ridolfo B, Stevenson C (2001) The quantification of drug-caused
mortality and morbidity in Australia, 1998. Canberra: Australian
Institute of Health and Welfare
13.
Collins DJ, Lapsley HM (2008) The costs of tobacco, alcohol and illicit
drug abuse to Australian society in 2004/05. Canberra: Department
of Health and Ageing
14.
Australian Institute of Health and Welfare (2011) 2010 National Drug
Strategy Household Survey report. Canberra: Australian Institute of
Health and Welfare
15.
Tai Y, Saunders JB, Celermajer DS (1998) Collateral damage from
alcohol abuse: the enormous cost to Australia. Medical Journal of
Australia; 168(6-7):
16.
Health Department of Western Australia (1999) The effects of alcohol
on the body: alcohol fact sheets for health professionals. Perth:
Health Department of Western Australia
17.
Alcohol and pregnancy and fetal alcohol spectrum disorder
resources for health professionals (2009) Telethon Institute for Child
Health Research
18.
Pidd K, Berry JG, Harrison JE, Roche AM, Driscoll TR, Newson RS
(2006) Alcohol and work: patterns of use, workplace culture and
safety. Adelaide: Australian Institute of Health and Welfare
19.
Stockwell T, Heale P, Chikritzhs T, Dietze P, Catalano P (2002) How
much alcohol is drunk in Australia in excess of the new Australian
alcohol guidelines? [Letter]. Medical Journal of Australia; 176: 91-92
20.
World Health Organization (2000) International guide for monitoring
alcohol consumption and related harm. Geneva: Department of
Mental Health and Substance Dependence, Noncommunicable
Diseases and Mental Health Cluster, World Health Organization.
5
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F e a t u r e d A r t wo r k
The Balga Bush
by Donna Lei Rioli
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