Key trends nationally and locally in relation to alcohol consumption and alcohol-related harm

Key trends nationally and locally in relation to alcohol consumption and alcohol-related harm November 2013 1

Executive Summary... 3 National trends in alcohol consumption and alcohol-related harm... 5 ACT trends in alcohol consumption and alcohol-related harm... 5 The social costs of alcohol abuse... 7 ACT hospitals data... 8 Alcohol-related Emergency Department data... 8 Alcohol-related hospital admissions... 9 ACT sobering-up shelter data... 16 National and ACT drug treatment data... 16 Summary... 17 2

Executive Summary This paper has been prepared by ACT Health to provide an overview of trends nationally and locally in relation to alcohol consumption and alcohol-related harm. Key findings include: Australians aged 15 and over were estimated to have consumed 10.1 litres of pure alcohol per person in 2011-12, the equivalent of 2.2 standard drinks per day per person 1, (noting that this figure is an average and does not reflect the 12.1% of people aged 14 and over who report never having consumed a serve of alcohol 2 ). The average age of initiation of use of alcohol in Australia reduced from 17.1 years in 1995 to 14.8 years in 2010 3. In the ACT, overall drinking prevalence, defined as recent use of alcohol by people aged 14 and older, is higher than the national figure (86.5% for the ACT versus 80.5% nationally) 4. A higher proportion of males than females in the ACT drink at levels that put them at risk of long-term harm; this is similar to the national average (29.9% of ACT males versus 29% nationally, and 9.4% of ACT females versus 11.3% nationally) 5. Overall, the proportion of ACT residents aged 14 years and older drinking at such levels is 19.5% versus 20.1% nationally 6. (Risk of long-term harm as defined by the NHMRC Guidelines 7 is drinking more than 2 standard drinks a day.) The proportion of males and females who report being recent drinkers and drinking to risky levels on a single occasion was higher in the ACT compared to the national average (55.6% of ACT males versus 50% nationally, and 33.5% of ACT females versus 29.8% nationally) 8. (Risky drinking on a single occasion is defined as drinking more than 4 drinks on a single occasion). 31% of ACT secondary students (aged 12-17) who identified as current drinkers were drinking to risky levels on a single occasion the week before they were surveyed 9 versus 37% nationally 10. 22.6% of ACT males reported driving a motor vehicle under the influence of alcohol while 13.0% of ACT females reported driving under the influence 11. These were higher than the national averages of 17.1% of males and 8.8% of females reporting driving a motor vehicle under the influence of alcohol 12. Emergency Department presentations at The Canberra Hospital and Calvary Hospital for the toxic effects of alcohol, including acute alcohol intoxication, increased by 34.7% over the period 2009-10 to 1 http://www.abs.gov.au/ausstats/abs@.nsf/lookup/4307.0.55.001main+features12011-12?opendocument Australian Bureau of Statistics 4307.0.55.001 - Apparent Consumption of Alcohol, Australia, 2011-12. 2 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 3 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 4 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 5 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 6 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 7 NHMRC Australian Guidelines to reduce health risks from drinking alcohol (2009), Commonwealth of Australia. 8 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 9 additional (unpublished) data analysis, ACT Health (2013). Substance use and other health-related behaviours among ACT secondary students: results of the 2011 ACT Secondary Students Alcohol and Drug Survey, ACT Government, Canberra ACT 10 Australian secondary school students use of tobacco, alcohol, and over-the-counter and illicit substances in 2011 (December 2012), prepared for the Drug Strategy Branch, Australian Government Department of Health and Ageing, Cancer Council Victoria. 11 McDonald, D 2012, The extent and nature of alcohol, tobacco and other drug use, and related harms, in the Australian Capital Territory, 4th edition, ACT Government Health Directorate, Canberra. 12 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 3

2012-13. Emergency Department presentations at The Canberra Hospital and Calvary Hospital for alcohol-attributable injuries increased by 23.7% over the same period. Saturday and Sunday mornings from 12:00am 8:59am received the majority of the Emergency Department presentations for the toxic effects of alcohol, including acute alcohol intoxication. The majority of these presentations arrived by ambulance. Stricter penalties for drink driving, and stricter enforcement and laws against serving drunk customers, were the most supported policy measures to reduce problems associated with alcohol in the ACT (84.8% and 83.8%, respectively) and nationally (85.7% and 83.2%, respectively) 13. The number of treatment episodes in Australia for people engaging in drug treatment where alcohol was the primary drug of concern increased by 45.8%, from 46,747 treatment episodes in 2002-03 to 68,167 in 2010-11 14. In the ACT, for people engaging in drug treatment where alcohol was the primary drug of concern treatment episodes increased by 40.3%, from 1,191 episodes in 2002-03 to 1,671 in 2010-11 15. In 2011-12 there were 1,934 treatment episodes where alcohol was the primary drug of concern 16. 13 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 14 Australian Institute of Health and Welfare Alcohol and other drugs (AODT-NMDS) data cubes, 2002-03 to 2010-11. 15 Australian Institute of Health and Welfare Alcohol and other drugs (AODT-NMDS) data cubes, 2002-03 to 2010-11. 16 ACT Minimum Data Set, Alcohol and Other Drug Treatment Services, 2011-12. 4

National trends in alcohol consumption and alcohol-related harm The Australian Bureau of Statistics (ABS) state that the most recent estimate for per capita consumption, rounded to 10.1 litres of pure alcohol per person in 2011-12, is equivalent to an average of 2.2 standard drinks per day, per person aged 15 years and over 17. The current National Health and Medical Research Council (NHMRC) Alcohol Guidelines state that drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury and for young people aged 15-17 years, the safest option is to delay the initiation of drinking for as long as possible 18. It is important to note that the consumption figure of 2.2 standard drinks per day per person is an average and does not reflect the 12.1% of people aged 14 and over, surveyed across Australia in the Australian Institute of Health and Welfare s (AIHW) National Drug Strategy Household Survey 2010, who reported never having consumed a serve of alcohol 19. The AIHW National Drug Strategy Household Survey 2010 also reported that about 1 in 5 people aged 14 years or older, (19.5% in the ACT and 20.1% Australia-wide), consumed alcohol at a level that put them at risk of harm from alcohol-related disease or injury over their lifetime 20. This was reported to have remained stable between 2007 and 2010. The survey reported that more than 1 in 4 people (28.4%) who considered themselves recent drinkers drank alcohol in quantities on a single occasion at least once a month that placed them at risk of accident or injury (12.5% at least monthly; 12.9% at least weekly, totalling 28.4%). The AIHW also stated that the proportion of the Australian population consuming alcohol at a level that puts them at risk of harm from alcohol-related disease or injury over their lifetime equated to 3.7 million people, based on their reported pattern of drinking in 2010, including approximately 87,466 ACT residents aged 15 and over. The average age of initiation of use of alcohol reduced from 17.1 years in 1995 to 14.8 years in 2010, for people aged 14-24 years 21. An analysis by the National Drug and Alcohol Research Centre (NDARC), of four successive National Drug Strategy Household Surveys conducted since 2001, showed that the top 10% of drinkers in Australia are drinking between 4-5% more than they were a decade ago while at the other end of the scale more people were abstaining altogether and lighter drinkers were drinking less 22. It was argued that while overall alcohol consumption has declined, harms associated with alcohol use appear to have increased, including increased alcohol-related hospitalisations, increased Emergency Department presentations due to intoxication, late night alcohol-related assaults, and domestic violence involving alcohol 23. ACT trends in alcohol consumption and alcohol-related harm In the ACT, overall drinking prevalence as defined as recent use of alcohol by people aged 14 and older (daily, weekly or less than weekly) is higher than the national figure (86.5% for the ACT versus 80.5% nationally) 24. The proportion of ACT residents drinking at a level that puts them at risk of long-term harm (that is, drinking more than 2 standard drinks a day 25 ) is 19.5% versus 20.1% nationally, of those aged 14 years and older 26. A 17 Australian Bureau of Statistics 4307.0.55.001 - Apparent Consumption of Alcohol, Australia, 2011-12 18 NHMRC Australian Guidelines to reduce health risks from drinking alcohol (2009), Commonwealth of Australia. 19 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 20 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 21 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 22 http://ndarc.med.unsw.edu.au/news/increase-heavy-drinkers-leading-more-harm-new-australian-analysis-shows 23 http://ndarc.med.unsw.edu.au/blog/alcohol-fuelled-violence-rise-despite-falling-consumption 24 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 25 NHMRC Australian Guidelines to reduce health risks from drinking alcohol (2009), Commonwealth of Australia. 5

higher proportion of males than females in the ACT drink at such levels; this is similar to the national average (29.9% of ACT males versus 29% nationally, and 9.4% of ACT females versus 11.3% nationally) 27. The proportion of males and females who reported being recent drinkers and reported drinking to risky levels on a single occasion was higher in the ACT compared to the national average (55.6% of ACT males versus 50% nationally, and 33.5% of ACT females versus 29.8% nationally) 28. Activities undertaken while under the influence of alcohol were higher amongst males than females in the ACT. For example, 22.6% of ACT males reported driving a motor vehicle under the influence of alcohol while 13.0% of ACT females drove under the influence 29. These were higher than the national averages of 17.1% of males and 8.8% of females reporting driving a motor vehicle under the influence of alcohol 30. When surveyed in 2011, 14% of ACT secondary students (aged between 12 and 17) reported having an alcoholic drink at least once in the last 7 days 31 compared with 17.4% of secondary students nationally 32. Significantly fewer ACT secondary students (4.3%) reported engaging in single-occasion risky drinking (defined as consuming more than 4 drinks) in the week before the 2011 survey 33 compared to the national rate (6.4%) 34. It is important to note that these proportions reflect the number of respondents reporting this type of drinking behaviour across the entire population sampled, including those reporting not ever drinking. Further analysis revealed that 31% of ACT secondary students identifying as current drinkers were drinking to risky levels on a single occasion the week before they were surveyed 35 versus 37% nationally 36. Breaking down these data for the ACT, 14.6% of all students aged 16-17 reported drinking 1-5 drinks in the preceding 7 days, 3.8% reported drinking 6-10 drinks, and 5.0% reported drinking 11 or more drinks in the last 7 days, while 21.6% of students in this age group described themselves as party drinkers 37. These proportions are reflective of respondents reporting this type of drinking behaviour across the entire population sampled, not just those identifying as current drinks. 26 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 27 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 28 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 29 McDonald, D 2012, The extent and nature of alcohol, tobacco and other drug use, and related harms, in the Australian Capital Territory, 4th edition, ACT Government Health Directorate, Canberra. 30 Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug 31 ACT Health (2013). Substance use and other health-related behaviours among ACT secondary students: results of the 2011 ACT Secondary Students Alcohol and Drug Survey, ACT Government, Canberra ACT. 32 Australian secondary school students use of tobacco, alcohol, and over-the-counter and illicit substances in 2011 (December 2012), prepared for the Drug Strategy Branch, Australian Government Department of Health and Ageing, Cancer Council Victoria. 33 ACT Health (2013). Substance use and other health-related behaviours among ACT secondary students: results of the 2011 ACT Secondary Students Alcohol and Drug Survey, ACT Government, Canberra ACT. 34 Australian secondary school students use of tobacco, alcohol, and over-the-counter and illicit substances in 2011 (December 2012), prepared for the Drug Strategy Branch, Australian Government Department of Health and Ageing, Cancer Council Victoria. 35 additional (unpublished) data analysis, ACT Health (2013). Substance use and other health-related behaviours among ACT secondary students: results of the 2011 ACT Secondary Students Alcohol and Drug Survey, ACT Government, Canberra ACT 36 Australian secondary school students use of tobacco, alcohol, and over-the-counter and illicit substances in 2011 (December 2012), prepared for the Drug Strategy Branch, Australian Government Department of Health and Ageing, Cancer Council Victoria. 37 ACT Health (2013). Substance use and other health-related behaviours among ACT secondary students: results of the 2011 ACT Secondary Students Alcohol and Drug Survey, ACT Government, Canberra ACT. 6

In terms of alcoholic drink preferences, most ACT secondary students aged 16-17 reported that premixed spirits was their preferred drink (40.6%), followed by spirits (27.5%), ordinary beer (29.1%), and wine (17.3%) 38. While Australian students aged 16-17 expressed similar preferences for premixed drinks and spirits, fewer reported preferences for ordinary beer (19.4%) and wine (6.4%) 39 compared to the ACT students in this age range. Twice as many male ACT secondary students (6.8%) than female secondary students (3.4%) reported intending to get drunk every time they drank, and male ACT secondary students were at least twice as likely as female secondary students to report creating a public disturbance or nuisance, hit someone or have a fight, cause damage to property, physically threaten someone, drive a motor vehicle, or be taken home by police, after drinking alcohol 40. Again these proportions are reflective of respondents reporting this type of drinking behaviour across the entire population sampled, including those reporting not ever drinking. The social costs of alcohol abuse The total costs to society of alcohol-related problems in Australia were estimated at $14.35 billion in 2010 41. Included in this estimate were costs to the criminal justice system (e.g police, courts and prisons), the health system (e.g. hospitals and emergency services), worker productivity (e.g. reduced workforce participation, absenteeism) and other alcohol-related problems (e.g. alcohol-related road incidents), but not included in this estimate were the negative impacts on others associated with someone else s drinking. The authors noted that "...the societal costs of alcohol (e.g. in this case direct costs) outweigh the revenue generated from alcohol taxation by a ratio of 2:1" 42. On 6 August 2013 the NSW Auditor-General reported to NSW Parliament on the cost of alcohol abuse to the NSW Government. In the report, the term alcohol abuse was used to mean drinking at levels that are likely to cause significant injury or ill health, and where drinking has led to a government intervention or response 43. The report estimated that the social costs associated with alcohol abuse cost the NSW Government $3.87 billion a year, or about $1,565 per NSW household per year. Costs to the NSW health system were estimated at $575.7 million for 2010 and this estimate included costs associated with hospitalisation, non-inpatient hospital costs, nursing homes, pharmaceuticals and ambulance services 44. An estimated 48% of the social costs of alcohol are argued to be avoidable 45. Australian and international research has demonstrated that of all the measures that decrease harmful alcohol consumption, supply 38 ACT Health (2013). Substance use and other health-related behaviours among ACT secondary students: results of the 2011 ACT Secondary Students Alcohol and Drug Survey, ACT Government, Canberra ACT. 39 Australian secondary school students use of tobacco, alcohol, and over-the-counter and illicit substances in 2011 (December 2012), prepared for the Drug Strategy Branch, Australian Government Department of Health and Ageing, Cancer Council Victoria. 40 ACT Health (2013). Substance use and other health-related behaviours among ACT secondary students: results of the 2011 ACT Secondary Students Alcohol and Drug Survey, ACT Government, Canberra ACT. 41 Manning, M. et al. (2013) The societal costs of alcohol misuse in Australia. Australian Institute of Criminology, Trends and Issues in Crime and Criminal Justice No. 454 April 2013, Australian Government. 42 Manning, M. et al. (2013) The societal costs of alcohol misuse in Australia. Australian Institute of Criminology, Trends and Issues in Crime and Criminal Justice No. 454 April 2013, Australian Government. 43 New South Wales Auditor-General s Report Performance Audit: Cost of alcohol abuse to the NSW Government, 6 August 2013. 44 New South Wales Auditor-General s Report Performance Audit: Cost of alcohol abuse to the NSW Government, 6 August 2013. 45 Collins, D.J. and Lapsley, H.M. (2008). The avoidable costs of alcohol abuse in Australia and the potential benefits of effective policies to reduce the social costs of alcohol. Commonwealth of Australia. 7

reduction measures most effectively do so. It has also been shown that the supply reduction measures that optimally decrease harms are increases in the prices, and restrictions in the physical availability, of alcohol 46. ACT hospitals data Alcohol-related Emergency Department data Hospital Emergency Department data analysed in 2010-11 showed that 77% of all substance use Emergency Department presentations were for alcohol-related conditions 47. At this time around 56% of all alcohol-related conditions presenting to ACT Emergency Departments were for acute alcohol intoxication 48. Defining alcohol-related harm has been the subject of previous Australian studies. For example, because the primary diagnosis rather than the cause of injury is recorded in Emergency Departments data collection systems, it is difficult to attribute Emergency Department presentations to being alcohol-related. Previous studies have defined that community-acquired injuries presenting to Emergency Departments can be used to estimate alcohol-attributable injuries. This should be considered when analysing the results presented in this paper. Applying this type of analysis, as well as examining recorded cases of acute alcohol intoxication, hospital separations for acute alcohol-related harm and hospital separations for chronic alcohol-related harm, various data were examined to attempt to identify alcohol-related harm in the ACT community. The results of this analysis are presented on the following pages. The number of injuries being treated in ACT hospital Emergency Departments for those aged 15 and over has increased steadily from around 17,000 in 2009-10 to around 22,500 in 2012-13 (Table 1). In 2012-13 an estimated 6,700 of these injuries were attributable to alcohol, or 18.4 a day. When adjusted for population aged 15 and above, the number presenting to ACT Emergency Departments to be treated for alcoholattributable injuries rose from 17.7 per 1,000 population 2009-10, to 21.9 per 1,000 population in 2012-13, a 23.7% increase (Table 2). The number of presentations for the toxic effects of alcohol being treated in ACT hospital Emergency Departments increased from 506 in 2009-10 to 729 in 2012-13, or 2 a day (Table 3). When analysed by month, 85 people were treated for the toxic effects of alcohol in March 2013, compared with 36 in March 2012, 52 in March 2011, and 50 in March 2010 (Figure 1). When adjusted for population (all age groups), the number presenting to ACT Emergency Departments to be treated for the toxic effects of alcohol rose from 1.44 per 1,000 population in 2009-10 to 1.94 in 2012-13, a 34.7% increase (Table 3). As noted previously, Emergency Department data systems are only able to capture the primary diagnosis for a person presenting. It is important to note that changing practices in the Emergency Department could result in changes to the proportion of patients who present with alcohol diagnoses who are reported with these diagnoses as their primary diagnosis. The majority of presentations to ACT Emergency Departments for the toxic effects of alcohol were for acute alcohol intoxication, ranging from 56% of presentations for the toxic effects of alcohol in 2011-12 (lowest) to 70.2% in 2012-13 (highest) (Table 4). 46 See, generally, for example, Babor, T. et al., Alcohol : no ordinary commodity : research and public policy, 2 nd edition, Oxford University Press, Oxford, 2010; Loxley, W., et al. The Prevention of Substance Use, Risk and Harm in Australia: A review of the Evidence, National Drug Research Institute and the Centre for Adolescent Health, Commonwealth of Australia, 2004. 47 McDonald, D 2012, The extent and nature of alcohol, tobacco and other drug use, and related harms, in the Australian Capital Territory, 4th edition, ACT Government Health Directorate, Canberra. 48 McDonald, D 2012, The extent and nature of alcohol, tobacco and other drug use, and related harms, in the Australian Capital Territory, 4th edition, ACT Government Health Directorate, Canberra. 8

A more detailed analysis of the pattern of hospital Emergency Department presentations for the toxic effects of alcohol shows that the majority of presentations occurred between 12:00am and 8:59am on Sunday morning, followed by 12:00am and 8:59am on Saturday morning (Figure 2A). When Sunday was analysed to determine the average number of presentations over the year for the toxic effects of alcohol per hour, the 12:00am to 8:59am period had on average 0.19 presentations per hour, versus 0.07 per hour for the preceding period of 5:00pm to 11:59pm (Table 5). These calculations were averaged over the entire (2009-10 2012-13) period and assumed 52 Sundays in a year. Further investigation of these data showed that a high proportion of the presentations arrived by ambulance and that the proportion arriving by ambulance increased over time (Figure 3). There were 93 Emergency Department presentations for the toxic effects of alcohol who arrived by ambulance on a Sunday between 12:00am and 8:59am in the most recent period, 2012-13, while 42 arrived by other means. Alcohol-related hospital admissions A hospital separation is defined as being an event where a patient is discharged from hospital, after having been formally admitted and treated. When assessing the number of acute and chronic alcohol-related hospital separations for those aged 15 and above, it was observed that both the number of acute alcoholrelated hospital separations (Table 6) and the number of chronic alcohol-related hospital separations (Table 7) increased slightly over time. However, when adjusted for the population aged 15, there was a minimum of 4.34 acute alcohol-related hospital separations per 1,000 population in 2010-11 and a maximum of 4.71 per 1,000 population in 2011-12 (Table 6). The same pattern followed for chronic alcohol-related hospital separations a minimum of 18.24 chronic alcohol-related hospital separations per 1,000 population in 2010-11 and a maximum of 18.76 per 1,000 population in 2011-12 (Table 7). 9

Table 1: Estimated number of alcohol-attributable injuries (from any level of drinking) for those aged 15 and above being treated in ACT hospital Emergency Departments (TCH and Calvary) Year Total number of ED presentations for those aged 15+ Number of ED presentations for injuries for those aged 15+ Number of ED presentations for alcohol-attributable injuries for those aged 15+ Lower 95% CI Upper 95% CI 2009-10 84,991 17,062 5,084 2,871 7,456 2010-11 89,271 17,090 5,093 2,876 7,468 2011-12 95,283 18,706 5,574 3,049 8,175 2012-13 95,243 22,490 6,702 3,666 9,828 Table note: The estimated number of alcohol-attributable injuries uses abstainers as the reference group and the 2007 drinking prevalence 49 Table 2: Estimated number of alcohol-attributable injury presentations per 1,000 population aged 15 and above being treated in ACT hospital Emergency Departments Year Population of the ACT aged 15+ 50 Number of ED presentations for alcoholattributable injuries for those aged 15+ Number of ED presentations for alcoholattributable injuries per 1,000 population aged 15+ 2009-10 287,329 5,084 17.7 2010-11 292,529 5,093 17.4 2011-12 301,300 5,574 18.5 2012-13 306,361 6,702 21.9 Table note: The estimated number of alcohol-attributable injuries uses abstainers as the reference group and the 2007 drinking prevalence 51 Table 3: Number of toxic effects of alcohol presentations per 1,000 population (all age groups) being treated in ACT hospital Emergency Departments Year Population of the ACT 52 Number of ED presentations for toxic effects of alcohol Number of ED presentations for toxic effects of alcohol per 1,000 population 2009-10 352,200 506 1.44 2010-11 358,600 533 1.49 2011-12 367,800 502 1.36 2012-13 374,912 729 1.94 Table note: toxic effects of alcohol includes T51.0 toxic effects of alcohol (ethanol); T51.9 alcohol unspecified; F10.0 mental disorders due to alcohol use (acute intoxication); F10.1 mental disorders due to alcohol use (harmful use); Z72.1 alcohol use 49 Chikritzhs T. et al. (2011) Australian Alcohol Aetiologic Fractions for Injuries Treated in Emergency Departments. Perth, National Drug Research Institute, Curtin University. 50 Australian Bureau of Statistics 3235.0 Population by Age and Sex, Regions of Australia, 2009, 2010, 2011, 2012 51 Chikritzhs T. et al. (2011) Australian Alcohol Aetiologic Fractions for Injuries Treated in Emergency Departments. Perth, National Drug Research Institute, Curtin University. 52 Australian Bureau of Statistics 3235.0 Population by Age and Sex, Regions of Australia, 2009, 2010, 2011, 2012 10

Table 4: Proportion of presentations for the toxic effects of alcohol that are for acute alcohol intoxication, being treated in ACT hospital Emergency Departments (TCH and Calvary) (all age groups) Year Number of ED presentations for toxic effects of alcohol Number of ED presentations for acute alcohol intoxication Proportion of ED presentations for the toxic effects of alcohol that are due to acute intoxication 2009-10 506 353 69.8% 2010-11 533 361 67.7% 2011-12 502 282 56.2% 2012-13 729 512 70.2% Table note: toxic effects of alcohol includes T51.0 toxic effects of alcohol (ethanol); T51.9 alcohol unspecified; F10.0 mental disorders due to alcohol use (acute intoxication); F10.1 mental disorders due to alcohol use (harmful use); Z72.1 alcohol use Table 5: The average number of Emergency Department presentations for the toxic effects of alcohol, per hour, averaged over the period 2009-10 2012-13 Time of day Day of week Average number of ED presentations for toxic effects of alcohol 9:00am 4:59pm Sunday 0.04 per hour 5:00pm 11:59pm Sunday 0.07 per hour 12:00am 8:50am Sunday 0.19 per hour Table note: toxic effects of alcohol includes T51.0 toxic effects of alcohol (ethanol); T51.9 alcohol unspecified; F10.0 mental disorders due to alcohol use (acute intoxication); F10.1 mental disorders due to alcohol use (harmful use); Z72.1 alcohol use Table 6: Number of hospital separations for those hospitalised for acute alcohol-related conditions (TCH and Calvary) and aged 15 and above Year Number of acute alcoholrelated hospital separations Population of the ACT aged 15+ 53 Number of acute alcoholrelated hospital separations per 1,000 population aged 15+ 2009-10 1,324 287,329 4.61 2010-11 1,270 292,529 4.34 2011-12 1,419 301,300 4.71 2012-13 1,337 306,361 4.36 Table note: as derived by principal diagnosis, according to the ICD-10 codes in Table 26 54 53 Australian Bureau of Statistics 3235.0 Population by Age and Sex, Regions of Australia, 2009, 2010, 2011, 2012 54 Chikritzhs, T. et al. (2003) Australian Alcohol Indicators 1990-2001: Patterns of alcohol use and related harms for Australian states and territories, National Drug Research Institute. 11

Table 7: Number of hospital separations for those hospitalised for chronic alcohol-related conditions (TCH and Calvary) and aged 15 and above Year Number of chronic alcohol-related hospital separations Population of the ACT aged 15+ 55 Number of chronic alcohol-related hospital separations per 1,000 population aged 15+ 2009-10 5,343 287,329 18.60 2010-11 5,337 292,529 18.24 2011-12 5,653 301,300 18.76 2012-13 5,541 306,361 18.09 Table note: as derived by principal diagnosis, according to the ICD-10 codes in Table 26 56 55 Australian Bureau of Statistics 3235.0 Population by Age and Sex, Regions of Australia, 2009, 2010, 2011, 2012 56 Chikritzhs, T. et al. (2003) Australian Alcohol Indicators 1990-2001: Patterns of alcohol use and related harms for Australian states and territories, National Drug Research Institute. 12

Number of emergency department presentations Figure 1: The number of presentations for the toxic effects of alcohol being treated in ACT hospital Emergency Departments (TCH and Calvary) from July 2009 to June 2013 90 80 70 60 50 40 30 20 10 0 Note: toxic effects of alcohol includes T51.0 toxic effects of alcohol (ethanol); T51.9 alcohol unspecified; F10.0 mental disorders due to alcohol use (acute intoxication); F10.1 mental disorders due to alcohol use (harmful use); Z72.1 alcohol use 13

Figure 2: The number of presentations for the toxic effects of alcohol being treated in ACT hospital Emergency Departments (TCH and Calvary) by time of day and day of week Note: toxic effects of alcohol includes T51.0 toxic effects of alcohol (ethanol); T51.9 alcohol unspecified; F10.0 mental disorders due to alcohol use (acute intoxication); F10.1 mental disorders due to alcohol use (harmful use); Z72.1 alcohol use 14

Figure 3: The number of presentations in the early morning (12:00am to 8:59am) for the toxic effects of alcohol being treated in ACT hospital Emergency Departments (TCH and Calvary) arriving by ambulance (dark bar) or arriving by other (light bar) Note: toxic effects of alcohol includes T51.0 toxic effects of alcohol (ethanol); T51.9 alcohol unspecified; F10.0 mental disorders due to alcohol use (acute intoxication); F10.1 mental disorders due to alcohol use (harmful use); Z72.1 alcohol use 15

ACT sobering-up shelter data CatholicCare have operated the ACT s Sobering Up Shelter located on the same grounds as Ainslie Village since 2004. The shelter works with people under the influence of alcohol and/or other drugs. The program runs from 11pm to 11am Thursday, Friday and Saturday each week, with the last intake at 6am. The majority of referrals to the facility are from ACT Policing, and are for alcohol intoxication (Table 8). The total number of referrals of those people who were intoxicated in public, and were either brought to the Sobering Up Shelter by police, ambulance, themselves, a friend etc. increased from 328 referrals in 2008-09 to 492 referrals in 2012-13, an increase of 50% (Table 8). The number of those occupying a bed increased from 303 in 2008-09 to 447 in 2012-13, an increase of 48%. Table 8: Activity data ACT Sobering Up Shelter Financial period Total number of referrals to the Sobering Up Shelter Percent of referrals involving alcohol intoxication Percent of referrals made by police Number of people referred who occupied a bed 2008-09 328 96% 90% 303 2009-10 284 96% 86% 262 2010-11 244 97% 86% 223 2011-12 352 94% 87% 331 2012-13 492 96% 93% 447 Source: CatholicCare ACT Minimum Data Set National and ACT drug treatment data The number of closed (ceased) treatment episodes in Australia for people engaging in drug treatment, where alcohol was the primary drug of concern, increased from 46,747 ceased treatment episodes in 2002-03 to 68,167 in 2010-11 57, an increase of 45.8% (Table 9). By contrast, the Australian population aged 15-64 increased from 13.4 million people in 2002 58 to 15.0 million people in 2011 59, an increase of 11.9%. Total population increased from 19.6 million people in 2002 60 to 22.3 million people in 2011 61, an increase of 13.8%. In the ACT, the number of closed treatment episodes in Australia for people engaging in drug treatment, where alcohol was the primary drug of concern, increased from 1,191 closed treatment 57 Australian Institute of Health and Welfare Alcohol and other drugs (AODTS-NMDS) data cubes, 2002-03 to 2010-11. 58 Australian Bureau of Statistics 3222.0 - Population Projections, Australia, 2002 to 2101 http://www.abs.gov.au/ausstats/abs@.nsf/mediareleasesbytitle/f4a2f9dd7183ee99ca256d9500046e75?op endocument 59 Australian Bureau of Statistics 3235.0 - Population by Age and Sex, Regions of Australia, 2011 http://www.abs.gov.au/ausstats/abs@.nsf/products/3235.0~2011~main+features~main+features#paralink 3 60 Australian Bureau of Statistics 3222.0 - Population Projections, Australia, 2002 to 2101 http://www.abs.gov.au/ausstats/abs@.nsf/mediareleasesbytitle/f4a2f9dd7183ee99ca256d9500046e75?op endocument 61 Australian Bureau of Statistics 3235.0 - Population by Age and Sex, Regions of Australia, 2011 http://www.abs.gov.au/ausstats/abs@.nsf/products/3235.0~2011~main+features~main+features#paralink 3 16

episodes in 2002-03 to 1,671 closed treatment episodes in 2010-11, an increase of 40.3% (Table 9). The number of closed treatment episodes where alcohol was the primary drug of concern increased in 2011-12, to 1,934 episodes 62. ACT-specific alcohol-related closed treatment episodes as a proportion of all Australian episodes did not increase over time, with the proportion varying from 2.45% in 2010-11 to 4.03% in 2006-07. Table 9: The number of alcohol-related ceased treatment episodes in the ACT versus Australia-wide Financial period ACT: Alcohol-related ceased treatment episodes Australia: Alcoholrelated ceased treatment episodes ACT alcohol-related episodes as a proportion of all alcohol-related episodes 2002-03 1,191 46,747 2.55% 2003-04 295* 48,500 0.61% 2004-05 1,797 50,324 3.57% 2005-06 2,056 56,076 3.67% 2006-07 2,399 59,480 4.03% 2007-08 1,792 65,702 2.73% 2008-09 1,962 63,272 3.10% 2009-10 1,876 67,450 2.78% 2010-11 1,671 68,167 2.45% Source: Australian Institute of Health and Welfare Alcohol and other drugs (AODTS-NMDS) data cubes, 2002-03 to 2010-11. *The number of closed treatment episodes for the ACT in 2003-04 is an undercount due to data collection issues. Summary The ACT Health analysis of hospital data shows: increasing presentations to ACT Emergency Departments for toxic effects of alcohol, including acute alcohol intoxication, over time; increasing ambulance presentations to ACT Emergency Departments for the toxic effects of alcohol, including acute alcohol intoxication, over time; and increasing presentations to ACT Emergency Departments for alcohol-attributable injuries over time. Additional data analysis, including analysis of ACT Ambulance Service data (for example, call outs for alcohol overdose or alcohol-related injuries by time of day/day of week, and location) and ACT Policing data (for example, analysis of alcohol-related assaults and other alcohol-related incidents by time of day/day of week, and location, etc.) would be helpful in determining if similar trends are being observed in these data sets. Further research to understand the association between alcohol outlet density and alcohol-related harm, and models to apply this research in a local context, could be informative, as well as data relating to where a person had their last drink before being detected for drink driving, and where a person had their last drink before committing offences such as assaults. 62 ACT Minimum Data Set, Alcohol and Other Drug Treatment Services, 2011-12. 17