8.11 The relationship between tobacco and other drug use in Aboriginal and Torres Strait Islander communities

Last updated: August 2016 
Suggested citation: van der Sterren, A, Greenhalgh, EM, Knoche, D, & Winstanley, MH 8.11 The relationship between tobacco and other drug use in Aboriginal and Torres Strait Islander communities. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from http://www.tobaccoinaustralia.org.au/chapter-8-aptsi/8-11-the-relationship-between-tobacco-and-other-dr

Aboriginal peoples and Torres Strait Islanders are more likely than non-Indigenous Australians not to drink alcohol at all. However, the health and social damage caused by excessive use of alcohol in some communities is immediate and highly visible, and the reason why tobacco use may be regarded as a lesser health issue and of lower urgency than other drug issues—see also Section 8.9.4.1,2 Some Aboriginal peoples and Torres Strait Islanders communities also have high rates of usage of cannabis and other illegal drugs.3 The purpose of this section is to place tobacco in the context of other drug use. 

Data from the latest National Aboriginal and Torres Strait Islander Social Survey show that in 2014–15, 30% of Indigenous people aged 15 and over reported having used substance/s in the past 12 months. Fifteen per cent reported drinking more than 2 standard drinks per day on average over the previous year, exceeding the 2009 national guidelines for lifetime risk (i.e., risk of alcohol-related disease or injury over a lifetime, based on more than two standard drinks on any day). Thirty per cent of Indigenous people reported exceeding the guidelines for single occasion risk (i.e., risk of alcohol-related injury arising from that occasion) by consuming more than 4 standard drinks on a single occasion in the previous year. The proportion of Indigenous people exceeding both types of risk significantly decreased from 2008, from 19% and 38% respectively. The 2008 survey also found that, like non-Indigenous smokers, Indigenous daily smokers were more likely than those who had never smoked to have drunk at chronic risky/high-risk levels and to have engaged in binge drinking (acute risky/high-risk levels) in the past two weeks. Daily smokers were also more likely to have used illicit substances in the previous 12 months.4  

The Australian Aboriginal and Torres Strait Islander Health Survey of  2012–13 found that 22% of Aboriginal peoples and Torres Strait Islanders reported using illicit substances in the 12 months before interview, with marijuana (19%) the most common type of illicit drugs used in the past 12 months (see Table 8.11.1).5 Unfortunately, comparable data on non-Indigenous rates of illicit drug use and trends over time are not available, due to conceptual and methodological differences between the various surveys. Nonetheless, despite only making up 3% of the total population, in 2012–13 Indigenous Australians comprised 14% of those receiving mainstream publicly funded treatment for alcohol and other drug (AOD) use.5 The following sub-sections discuss alcohol and marijuana use in greater detail as these substances are, after tobacco, the most widely used among Aboriginal peoples and Torres Strait Islanders. In addition, tobacco smoking often occurs alongside drinking alcohol and/or smoking marijuana.

Table 8.11.1
Prevalence of substance use among Indigenous persons aged 15 and over, Australia, 2012–13

Other illicit or controlled substances used in the last 12 months     

%

Painkillers or analgesics (used for non-medical purposes)

4

Amphetamines or speed

2

Marijuana, hashish or cannabis

19

Kava

1.3

Used substances but not in the last 12 months

22.7

Had never used illicit substances

51.8

Source: ABS and AIHW 20156

8.11.1 Alcohol

In 2014–15, as mentioned above, 15% of Aboriginal and Torres Strait Islander people exceeded lifetime risk guidelines for alcohol consumption, while 30% exceeded single occasional risk guidelines. People living in remote areas were significantly more likely to report drinking more than 2 standard drinks per day on average over the previous year than those in non-remote areas (18% and 14%, respectively), while proportions of those who exceeded the guidelines for risk of single occasional harm were similar (30% and 32%). Aboriginal and Torres Strait Islander men were almost three times as likely as women to have exceeded the lifetime risk guidelines (22% compared with 8%), and were almost twice as likely to have exceeded the single occasion risk guidelines (39% compared with 21%).7  Figure 8.11.1 shows these patterns by age group. 

Figure 8.11.1. Proportion of Aboriginal and Torres Strait Islander people who exceeded the lifetime and single occasion risk guidelines for alcohol consumption, by age and sex, 2014–15.

Source: National Aboriginal and Torres Strait Islander Social Survey, Australia, 2014–157 

The 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey showed that Indigenous people who had completed year ten or lower were significantly less likely to report binge drinking in the prior year than those who complete year 12 (54% and 61%, respectively), while proportions were similar for lifetime risk (21% and 18%). Indigenous Australians who reported not participating in the labour force were significantly less likely to drink at occasional or lifetime risky levels than those who were currently either employed or unemployed.6    

The 2008 National Aboriginal and Torres Strait Islander Social Survey showed that those who reported risky/high-risk binge drinking were more likely to be current daily smokers compared to those who drank at low risk levels (59% compared to 33%). Similarly, those who drank at chronic risky/high-risk levels were also more likely to be current daily smokers than those drinking at low risk levels (63% compared with 46%).4 A higher prevalence of smoking, combined with greater incidence of risky drinking levels, leads to an increased risk of developing cancers of the oral cavity oesophagus and larynx.8 (see Section 8.7.3.2). 

In 2012–13, Indigenous Australians were significantly less likely than non-Indigenous people to report having consumed alcohol in the previous 12 months, and significantly more likely to report they had never consumed alcohol. Adjusting for age, rates of lifetime risky alcohol consumption were not significantly different from rates for non-Indigenous people (18% vs 19%). Indigenous people were significantly more likely (1.1 times as likely) to have exceeded the guidelines for single occasion risk; however, this difference only remained true for women, with Indigenous women 1.2 times as likely as non-Indigenous women to report drinking at this level. For men, the difference was non-significant.5   

Studies comparing alcohol use between Indigenous and non-Indigenous teenagers have shown varying results. Data from the 2009 Victorian Adolescent Health and Wellbeing Survey (a school-based survey in years 7, 9 and 11) showed that while similar levels of Aboriginal and non-Aboriginal young people had ever drunk alcohol (71.3% and 61.9% respectively), Aboriginal young people were more likely to have had five or more alcoholic drinks in a row in the last two weeks (37.8% compared with 18.3%).9  Similarly, a 1996 survey of New South Wales Indigenous students aged 12–17 found that they were about as likely as non-Indigenous students to report weekly drinking of alcohol, but were twice as likely to report hazardous drinking.10 Other studies among youth, however, show that Indigenous young people are either less likely or about as likely to have experimented with alcohol or to have drunk frequently/to excess as non-Indigenous young people.11–13 The findings of two of these surveys of Indigenous young people have been compared to non-Indigenous surveys that are not directly comparable (due to timing of their administration, methodology or the questions asked), although they do give a broad indication.11,13 The Western Australian Aboriginal Child Health Survey reported that those young people who drank alcohol but not to excess were four times more likely to smoke regularly than young people who did not drink at all, and young people who drank to excess were 4.5 times more likely to smoke than those who did not drink.13 

8.11.2 Cannabis (marijuana, hashish, 'ganja' or 'yarndi')

As reported above, marijuana was the most common type of illicit drugs used in 2012–13  by Indigenous Australians, with use in non-remote areas slightly higher (19%) than in remote areas (17%).5 Cannabis use among smokers was reported in older surveys; in 2008, of current daily smokers aged 15 years and over, 26% reported using marijuana in the last 12 months, compared with 9% of ex-smokers and 5% of those who had never smoked.4 The National Aboriginal and Torres Strait Islander Health Survey 2004?05 found that 46% of Indigenous smokers in non-remote regions aged between 18 and 34 had used marijuana, hashish or cannabis resin in the past year, compared with 16% of Indigenous non-smokers.14  

Other research suggests that level of usage may be higher still in some communities. A 2000–01 study from eastern Arnhem Land (in the ‘Top End’ of the Northern Territory) found that 70% of Indigenous males and 59% of females were current users of cannabis.15 Of those who were current users, 61% used it weekly or more often, and few who had ever used cannabis had quit (7%). Cannabis use was strongly associated with tobacco use. Current tobacco smokers were about three times as likely to use cannabis as were non-smokers, and a third of those who had ever used both cannabis and tobacco began using the substances at or near the same time. Most current cannabis users (84%) were also using tobacco; the favoured method of cannabis use was to combine it with tobacco, the mixture commonly being smoked via a bucket bong, allowing a number of users to share. Some communities may be spending between 31% and 60% of their weekly income on cannabis; combining it with less expensive tobacco prolongs the supply. This study concluded that cannabis use helped reinforce continued tobacco use, that widespread adoption of using cannabis in combination with tobacco could have serious health consequences, and that joint dependence on these substances provided a major challenge to communities and to those working in public health.15 Longitudinal research in Arnhem Land (from 2001 to 2005–06) found that most of those who reported cannabis use at baseline again reported current use at follow up. However, tobacco use did not predict cannabis use.16 The Cape York Cannabis Project found that in 2010–11, 66% of males and 30% of females interviewed were current users, 12% of males and 31% of females were former users and 22% of males and 39% of females had never used cannabis. Almost all current cannabis users (97%) were also users of tobacco.17   

Studies of illicit drug use among Indigenous teenagers show varied results. The Victorian Adolescent Health and Wellbeing Survey (2009) found no significant difference between the proportions of Aboriginal and non-Aboriginal young people who had ever used illicit drugs.9 Likewise, a comparison of data from the 2000–02 Western Australian Aboriginal Child Health Survey and the 2002 Australian Secondary Students’ Alcohol and Drug Survey found that similar proportions of Indigenous and non-Indigenous young people in Western Australia had used marijuana at some time (30% and 31% respectively), and in the previous week (11.9% and 9% respectively).13,18 On the other hand, a 1996 survey of school students aged 12–17 in NSW found that Aboriginal students were 1.6 times more likely to have ever tried cannabis than non-Aboriginal students.10 The Western Australian Aboriginal Child Health Survey found that young people who used marijuana weekly or more often were 11 times more likely to smoke than those who did not use marijuana.13 

The National Aboriginal and Torres Strait Islander Tobacco Control Project also found that cannabis was widely used among various Aboriginal and Torres Strait Islander communities, and that its use was closely connected with tobacco use. It was commonly reported that cannabis was mixed with tobacco, and that even if the primary aim was to use cannabis, tobacco addiction would result.1 While some communities felt that the relationship between tobacco and cannabis was so interconnected that one could not properly be addressed without the other, other communities expressed the view that the importance of cannabis use and its illicit status meant that it was best dealt with as a separate issue. These matters are clearly for individual communities to decide.1  

There may also be widespread misconceptions about the health effects of cannabis use. The National Aboriginal and Torres Strait Islander Tobacco Control Project study found that many respondents perceived cannabis as more ‘natural’ and hence less harmful than manufactured tobacco products.1 The health consequences of cannabis use are discussed in Chapter 3, Section 3.32.2.

References

1. Lindorff KJ. Tobacco time for action: National Aboriginal and Torres Strait Islander tobacco control project final report. Canberra, Australia: National Aboriginal Community Controlled Organisations, 2002.

2. Murphy M and Mee V. Chapter 6: The impact of the national tobacco campaign on Indigenous communities: A study in Victoria, in Australia’s national tobacco campaign: Evaluation report vol.1. Hassard K, Editor Canberra: Department of Health and Aged Care; 1999. Available from:  http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-publicat-document-metadata-tobccamp.htm/$FILE/tobccamp_g.pdf .

3. Australian Institute of Health and Welfare. Substance use among Aboriginal and Torres Strait Islander people. cat. no. IHW 40 Canberra: AIHW, 2011. Available from: http://www.aihw.gov.au/publications/ihw/40/11503.pdf.

4. Australian Bureau of Statistics and Australian Institute of Health and Welfare. 4704.0. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples, 2010 Canberra: ABS, 2010. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4704.0.

5. Australian Institute of Health and Welfare, The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Cat. no. IHW 147. Canberra: AIHW; 2015. Available from:http://www.aihw.gov.au/publication-detail/?id=60129550168 .

6. Australian Institute of Health and Welfare, The health and welfare of australia’s Aboriginal and Torres Strait Islander peoples 2015: Supplementary tables. Cat. No. Ihw 147. Canberra: AIHW; 2015. Available from: http://www.aihw.gov.au/publication-detail/?id=60129550168&tab=2 .

7. Australian Bureau of Statistics. 4714.0 - National Aboriginal and Torres Strait Islander Social Survey, 2014–15. 2016. Available from:http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4714.02014-15?OpenDocument

8. US Department of Health and Human Services. The health consequences of smoking. A report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2004. Available from: http://www.surgeongeneral.gov/library/smokingconsequences/.

9. Department of Education and Early Childhood Development. The state of Victoria’s children 2009: Aboriginal children and young people in Victoria. Melbourne, Australia: Department of Education and Early Childhood Development, 2010. Available from: http://www.education.vic.gov.au/about/directions/children/vcams/vcamsreports.htm.

10. Forero R, Bauman A, Chen J, and Flaherty B. Substance use and socio-demographic factors among Aboriginal and Torres Strait Islander school students in New South Wales. Australian and New Zealand Journal of Public Health, 1999; 23:295–300. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10388175

11. Gray D, Morfitt B, Ryan K, and Williams S. The use of alcohol and other drugs by young Aboriginal people in Albany, Western Australia. Australian and New Zealand Journal of Public Health, 1997; 221:71–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9141733

12. Dunne M, Yeo M, Keane J, and Elkins D. Substance use by Indigenous and non-Indigenous primary school students. Australian and New Zealand Journal of Public Health, 2000; 24:546–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11109696

13. Zubrick S, Lawrence D, Silburn S, Blair E, Milroy H, et al. The Western Australian Aboriginal child health survey: The health of Aboriginal children and young people. Perth, Australia: Telethon Institute for Child Health Research, 2004. Last update: Viewed Available from: http://www.ichr.uwa.edu.au/waachs.

14. Australian Bureau of Statistics, 4722.0.55.004—tobacco smoking—Aboriginal and Torres Strait Islander people: A snapshot, 2004–05 Canberra: ABS; 2007. Available from:http://www.abs.gov.au/AUSSTATS/abs@.nsf/productsbyCatalogue/D030A9BD9BF14B08CA25730E0021BCE1?OpenDocument .

15. Clough R. Associations between tobacco and cannabis use in remote Indigenous populations in northern Australia. Addiction, 2005; 100(3):345–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15733248

16. Lee KSK, Conigrave KM, Clough AR, Dobbins TA, Jaragba MJ, et al. Five-year longitudinal study of cannabis users in three remote Aboriginal communities in Arnhem Land, Northern Territory, Australia. Drug & Alcohol Review, 2009; 28(6):623–30. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=51399127&site=ehost-live

17. Bohanna I and Clough AR. Cannabis use in Cape York Indigenous communities: High prevalence, mental health impacts and the desire to quit. Drug & Alcohol Review, 2012; 31(4):580–4. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=76330278&site=ehost-live

18. Zubrick S, Silburn S, Garton A, Burton P, Dalby R, et al. Western Australian child health survey: Developing health and well-being in the nineties. Perth, Australia: Australian Bureau of Statistics and the Institute for Child Health Research, 1995. Available from: http://www.ichr.uwa.edu.au/files/user20/ichr%204303_5.pdf . 

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