Alcohol and other drugs

Priority Area

Health Needs Assessment 2025 - 2028

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The use of alcohol and other drugs are major causes of preventable injury, disease and death in Australia (AIHW, 2024). These behaviours remain highly prevalent across the North Coast region. A range of social, economic and environmental factors influence the ways people use alcohol and other drugs. Mental health issues such as anxiety, depression and trauma, can often drive people to use substances as a form of self-medication. Socioeconomic disadvantage, including unemployment, financial stress and lower educational attainment, can increase vulnerability to substance misuse, as can social isolation and a lack of supportive networks (Alhammad, et al., 2022).

People living on the North Coast experience challenges and barriers to treatment, such as insufficient services to match the demand, long wait times for treatment and cost associated with treatment. This highlights a need to improve access to appropriate alcohol and other drug services across the North Coast region.

Due to the nature of drug and alcohol consumption and misuse there are gaps in data, particularly at local the level. There is a high reliance on data that is self-reported or comes from those already engaged in treatment or in crisis, including emergency department presentations. To increase understanding of the extent of the needs and challenges on the North Coast region, further exploration is required in partnership with service providers and community organisations, along with additional data from outside of the health sector.

Excessive alcohol consumption is a significant health concern in Australia and the fifth overall contributor to the burden of disease and illness nationwide (AIHW, 2024). The National Health and Medical Research Council (NHMRC) recommends that adults consume no more than 10 standard drinks per week and no more than 4 on any single day. In 2023, 1 in 3 adults on the North Coast exceeded the alcohol consumption guidelines, surpassing the NSW average of 27%. Over the 2-year period from 2021 to 2023, there was nearly a 1% increase in people consuming excessive alcohol on the North Coast, in contrast to a 2% decrease across NSW.

People in both local health districts (LHDs) in the region engage in risky drinking more than the NSW average. In 2023, the Northern NSW LHD had higher non-compliance with national guidelines, with 34% of adults exceeding the recommended limits, compared to 31% in the Mid North Coast LHD area. Over the past 2 years, the number of people exceeding the guidelines has reduced by 1% in the Northern NSW, while Mid North Coast experienced a 3% increase.

A total 30% of adults in Northern NSW reported drinking more than 4 standard drinks on any single day in the past 4 weeks, compared to 27% in Mid North Coast and 25% in NSW. Northern NSW had a higher rate of adults drinking more than 10 standard drinks in the past week (17%) than Mid North Coast residents (15%), both higher than the NSW average (10%) (NSW Government, 2022).

These findings indicate that North Coast residents are at greater risk of harm from alcohol-related diseases, injuries or death compared to the average NSW resident. A large portion of the North Coast communities who participated in the survey identified alcohol and other drug use as a serious health concern, highlighting collective recognition of a widespread problem.

The 2022-2023 National Drug Strategy Household Survey (NDSHS) identified concerning trends in illicit drug use across Australia. In the NDSHS illicit drugs refers to illegal drugs and legal drugs and substances used in an illegal manner or in a way not intended. This includes misuse of pharmaceutical and prescription drugs and inhaling substances such as glue and petrol. Of all Australians aged 14 and over:

  • 47% (10.2 million people) had used illicit drugs at some point in their lives
  • 18% (3.9 million) had done so in the past year
  • 44% (9.4 million) of Australians had used illegal drugs, excluding non-medical use of pharmaceuticals, within their lifetime.

These figures show a steady increase in both people having ever used a drug and recent use since 2007 (AIHW, 2024). In relation to the use of specific drugs, the NDSHS shows that:

  • Cannabis remains the most used illegal drug, with 2.5 million Australians reporting recent use, followed by cocaine and hallucinogens. Between 2019 and 2022-2023 recent use of cannabis remained stable while recent use of cocaine increased from 900,000 people (4%) to 1 million (5%).
  •  Between 2019 and 2022-2023 there were large increases in people recently using hallucinogens and ketamine. Recent use of hallucinogens increased from 300,000 (1%) to 500,000 people (2%). Increased use of hallucinogens was mostly due to a large increase in the number of people using mushrooms/psilocybin. Recent ketamine use increased from 200,000 people to 300,000. While recent use was most common among those aged 20-29 but there was also a large increase between 2019 and 2022-2023 in people in their 30’s using ketamine.
  •  These shifts and trends could indicate changing attitudes toward particular substances or evolving generational preferences (AIHW, 2024). 

Misuse of pharmaceutical drugs is a concern, with 5% of Australians (1.1 million people) using prescription drugs for non-medical purposes in the past year. The misuse of painkillers and opioids has however declined across the country. This is potentially related to changes in 2018 that made codeine-containing medications available only by prescription. Since 2016, the number of people using pain-killers/pain-relievers and opioids, including those containing codeine, for non-medical purposes has decreased from 600,000 to 500,000 people.

While recent use of methamphetamine and amphetamines is relatively low (200,000 people),  the number of people who have ever used remains high at 1.6 million. This suggests that while the immediate problem may not be as widespread, the long-term impact of these drugs still poses serious challenges to community wellbeing and the health system (AIHW, 2024).

Although we do not have specific data for the North Coast region, these national trends provide a picture of use and foundation for local service planning and delivery. Starting from these national findings, we can work with local providers and communities to gain a better understanding and address emerging drug use patterns to ensure targeted prevention efforts and enhance support services that align with regional needs.

On the North Coast during 2022-23, alcohol was the primary substance driving people to seek treatment from alcohol and other drug services, accounting for 47% of cases. Following alcohol, methamphetamines (16%), cannabis (15%) and heroin (8%) were the next drugs of concern. The North Coast had higher rates of both alcohol and heroin as principal drugs of concern compared to national averages. More people are hospitalised due to opioid-related misuse. Hospitalisations in both Northern NSW LHD (142 per 100,000 residents) and Mid North Coast LHD (150 per 100,000) were higher than in NSW (121 per 100,000) (NSW Government, 2023).

Alcohol and other drug treatment services (AODTS) provide a broad range of services and support to people who use alcohol and other drugs. The demographic profile of people using these services on the North Coast in 2022-23 reveals some key characteristics:

  • 59% of service users were male and 39% female. The North Coast region had a higher proportion of female users than the national average of 34%.
  • 23% of service users identified as Aboriginal and/or Torres Strait Islander. This is higher than the Australian average of 18% of AODTS users identifying as Aboriginal peoples
  • 24% of service users were aged 30-39 years. The region had a greater representation of older users, with 15% aged 50-59 and 10% aged 60 years and older, both exceeding Australia wide figures (AIHW, 2024).

These figures highlight the unique demographic patterns of AODTS users on the North Coast region. Local factors such as multiple environmental disasters in recent years, cost of living pressures and housing availability may influence service use. These issues were identified as substantial concerns across all local government areas (LGAs) on the North Coast by survey respondents. Challenges in accessing alcohol and other drugs services were identified, with over 6 in 10 (63%) survey respondents who needed support unable to access it. Among those who did manage to access services, nearly 5 in 10 (48%) found it either somewhat difficult or very difficult. The most common barriers to accessing AODTS reported were lack of services (54%), cost (39%) and difficulty in organising access (37%). Over 4 in 10 respondents found it hard to access rehabilitation services (43%), counselling (42%) and inpatient detox (41%) services. Additionally, 3 in 10 (31%) survey respondents identified drug and alcohol use as a serious health concern in their community. This was most pronounced in Kempsey LGA (45%), followed by Nambucca LGA (36%) and Coffs Harbour LGA (35%). Wait times for AODTS emerged as a prominent theme in community conversations, with participants noting that delays in accessing services are exacerbating the issue within North Coast communities.

The term ‘Aboriginal peoples’ is used to refer to inclusively to individuals who identify as either Aboriginal, Torres Strait Islander, or both Aboriginal and Torres Strait Islander.

Throughout this document ‘survey’ refers to the 2024 Better Health Community survey undertaken as part of the Health Needs Assessment 2025-28 consultation process.

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