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

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8.0 Introductory note

8.1 Overview

8.2 History of tobacco use among Aboriginal peoples and Torres Strait Islanders

8.3 Prevalence of tobacco use among Aboriginal peoples and Torres Strait Islanders

8.4 Smoking among Aboriginal and Torres Strait Islander children and teenagers

8.5 Types of tobacco used by and levels of consumption among Aboriginal peoples and Torres Strait Islanders

8.6 Cessation

8.7 Morbidity and mortality caused by smoking among Aboriginal peoples and Torres Strait Islanders

8.8 Economic and social issues relating to tobacco use among Aboriginal peoples and Torres Straits Islanders

8.9 Attitudes to and beliefs about smoking

8.10 Interventions targeting Aboriginal peoples and Torres Straits Islanders

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

8.12 The tobacco industry and Indigenous communities

8.13 Policy recommendations for advancing tobacco control programs among Aboriginal peoples and Torres Strait Islanders

Acknowledgments

References

Aboriginal peoples and Torres Strait Islanders have a higher prevalence of experimentation and usage of most other drugs compared with the non-Indigenous population.124 The damage caused by alcohol and other drug misuse 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 8.9.3.6, 36

As discussed in Section 8.7, tobacco use is a causal, contributing or complicating factor to four out of five of the disease processes which claim most Aboriginal and Torres Strait Islander lives. However the purpose of this section is not to understate the extent of the misery and damage caused by other substance misuse in Indigenous communities, which is rightly an area for priority action, but to place tobacco in the context of other drug use.

Table 8.10 shows the prevalence of smoking, alcohol and other drug use in the Indigenous population aged 18 and over, as reported by the National Aboriginal and Torres Strait Islander Health Survey of 2004–05.35 A similar data set has been reported by the NATSISS of 2002, reporting for individuals aged 15 and over.34 The data from these surveys are broadly similar, the major point of difference occurring in the statistics related to alcohol consumption, which is likely to reflect the larger age range sampled for the NATSISS. Indigenous Australians are about twice as likely to be regular tobacco smokers, and to have used illicit substances in the last 12 months compared with the overall Australian population.35, 41[19] [20][21][22]

As in the non-Indigenous population, Indigenous smokers are more likely to use alcohol and other drugs than Indigenous non-smokers. In 2004–05, non-remote dwelling Indigenous smokers were twice as likely to have used illicit substances[23] in the previous year than non-smokers.46

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.125 According to the NHS 2004–05, 62% of the total Australian population aged 18 and over reported having had at least one drink in the week prior to the survey, and of those who drank, about one in five consumed alcohol at risky or high risk levels. In contrast, the NATSIHS of 2004–05 found that 49% of Indigenous Australians aged 18 and over had consumed alcohol in the previous week, but that of these, about one third had drunk at risky or high risk levels.125 Taking the populations as a whole (both drinkers and non-drinkers), about 15% of adult Indigenous Australians drink at risky or high risk levels, similar to the age-adjusted level for the non-Indigenous adult population.125

Smoking and drinking often occur together. In 2004–05, Indigenous smokers were twice as likely to drink at risky or high-risk levels than Indigenous non-smokers.46 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 larynx73 (See Section 8.7.2 above).

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

The National Aboriginal and Torres Strait Islander Health Survey 2004–05 found that 23% of respondents reported having used cannabis in the last year,41 compared to 11% of non-Indigenous people.35[24]

Cannabis use is far more prevalent among tobacco-smokers, with 46% of Indigenous smokers in non-remote regions aged between 18–34 having used marijuana, hashish or cannabis resin in the last year, compared with 16% of Indigenous non-smokers.46

Other research suggests that level of usage may be higher still in some communities. A 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.126 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 used both cannabis and tobacco began using the substances at or near the same time. Most users (88%) combined their cannabis with tobacco, the mixture commonly being smoked via a bucket bong, allowing a number of users to share. Some communities may be spending between 31–60% 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 tobacco and cannabis in combination could have serious health consequences, and that joint dependence on these substances provided a major challenge to those working in public health.126

The National Aboriginal and Torres Strait Islander Tobacco Control Project (NATSITCP) 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.6 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.6

There may also be widespread misconceptions about the health effects of cannabis use. The NATSITCP study found that many respondents perceived cannabis as more 'natural' and hence less harmful than manufactured tobacco products.6 The health consequences of cannabis use are discussed in Chapter 3, Section 3.32.2.