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

Seventeen per cent of Aboriginal peoples and Torres Strait Islanders aged 15 years and over reported drinking alcohol at chronic risky/high-risk levels, while 37% reported risky/high-risk levels of binge drinking in the fortnight prior to interview.⁴ Twenty per cent of Aboriginal peoples and Torres Strait Islanders reported using illicit substances in the 12 months before interview, with marijuana (16%) and amphetamines (10%) the most common type of illicit drugs used in the past 12 months.⁴ The 2008 National Aboriginal and Torres Strait Islander Social 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

Unfortunately, conceptual and methodological differences means that the National Aboriginal and Torres Strait Islander Social Survey data are not directly comparable to data from the 2004–05 National Aboriginal and Torres Strait Islander Health Survey⁵ or the 2004–05 National Health Survey,⁶ although for alcohol use these two data sets can be compared to each otherⁱ. Comparisons with non-Indigenous illicit substance use cannot be made as the relevant survey (the National Drug Strategy Household Survey) used different questions, reported on different groupings, and was conducted at different times from the 2004–05 national Aboriginal and Torres Strait Islander social and health surveys.¹ Although the 2007 National Drug Strategy Household Survey found that Indigenous people were almost twice as likely as other Australians to be recent users of illicit substances, the small sample size of Indigenous people in the survey means that this finding should be interpreted with caution (see footnote i in Section 8.3).⁷

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. Data is drawn from the 2008 National Aboriginal and Torres Strait Islander Social Survey, and where comparisons are made with the non-Indigenous population, from the 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey.

8.11.1 Alcohol

A smaller proportion of Aboriginal peoples and Torres Strait Islanders consume alcohol regularly than the overall Australian population, but of those who do drink alcohol, a higher proportion consumes it at risky or high-risk levels.¹ When comparing age-standardised data from the 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey, nearly twice as many Indigenous people did not consume alcohol in the 12 months prior to the survey than non-Indigenous people (29% compared with 15%). Non-Indigenous people were also 1.5 times more likely to have drunk alcohol in the week before the survey. There was no significant difference between the proportions of Indigenous and non-Indigenous people who drank at long-term risky or high-risk levels (15% and 14%). However, Indigenous people were 1.2 times more likely to have been binge drinking in the 12 months prior to the survey, and twice as likely to have been binge drinking at least once a week in the previous 12 months (17% compared to 8%).¹

As noted earlier, the 2008 National Aboriginal and Torres Strait Islander Social Survey reports that 17% of Aboriginal peoples and Torres Strait Islanders aged 15 years and over have used alcohol at chronic risky/high-risk levels in the last 12 months. Proportions of chronic risky/high-risk drinking was higher among men than women (20% compared with 14%), and highest among those aged 35–44 years (22%). Rates of risky/high-risk drinking were similar for residents in remote and non-remote areas, but Indigenous people in remote areas were more likely than those in non-remote areas to have abstained from alcohol in the past 12 months (46% compared with 31%).⁴ Binge drinking (drinking at acute risky/high-risk levels in the two weeks prior to interview) was reported by 37% of Aboriginal peoples and Torres Strait Islanders aged 15 years and over, and was also more common among males than females (46% compared with 28%), and higher among those living in non-remote than remote areas (38% compared with 33%).⁴

Aboriginal peoples and Torres Strait Islanders 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 larynx⁸ (see Section 8.7.3.2).

Studies comparing alcohol use between Indigenous and non-Indigenous teenagers have shown various results. Data from the 2009 Victorian Adolescent Health and Wellbeing Survey (a school-based survey in years 7, 9 and 11) show 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, the 2008 National Aboriginal and Torres Strait Islander Social Survey shows that one-third of Aboriginal peoples and Torres Strait Islanders had ever tried marijuana, and 16% had used it in the last 12 months. 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 As stated above, there is no data available that enables comparison of marijuana use between Indigenous and non-Indigenous populations.

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 ekes out 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

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).^13,16 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.² 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.²

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.² The health consequences of cannabis use are discussed in Chapter 3, Section 3.32.2.