Gambling is killing one Australian a day, but it rakes in billions in tax. Who sought help after almost joining the estimated 400 Australians with gambling-related problems who commit suicide.

• Research from Victoria, Australia, estimated that around 2% of suicides between 2010 and 2012 were related to gambling. 16 Broadening our focus beyond problem gambling reveals the true scale of its negative effects and has implications for estimating its economic and social costs.
• Even though Australia is a very small country it is globally number one in per capita gambling-related suicides. $23 billion was gambled away last year (The population is almost 25 million) of this more than half was due to poker machines.

Gambling Related Suicides Australia Wildfires

DEATHS DUE TO HARMFUL ALCOHOL CONSUMPTION IN AUSTRALIA
Alcohol is the most common drug consumed in Australia with the National Drug Strategy Household Survey 2016 (AIHW) finding that 3 in 4 persons (77%) over the age of 14 reported that they had consumed alcohol in a 12 month period prior to the survey. Although the majority of people consume alcohol in a responsible manner, harmful levels of consumption have significant burden on healthcare systems, premature mortality and the crime and justice system. Harmful alcohol use is a leading cause of burden amongst young people in Australia.

Mortality directly attributable to alcohol has declined since the late 1990s recording a death rate of 5.1 per 100,000 persons in 2017, compared with 6.6 per 100,000 capita in 1997. In 2017, males aged between 60 and 64, dying from chronic alcoholic liver disease and living outside of a capital city were those most likely to die from a cause directly attributable to alcohol. This profile is similar to that in the late 1990s except the age of death has increased for both males and females. Although alcohol-induced mortality rates are declining, 2017 still recorded the largest number of deaths in this period, with 1,366 persons dying as a direct result of alcohol, indicating that alcohol consumption still causes significant burden within the Australian health system.

Alcohol related fatalities extend beyond those deaths which are directly attributable to alcohol. In 2017 there were 4,186 deaths where alcohol was mentioned as being a contributing factor to mortality. For deaths of females registered in 2017, a standardised rate of 7.0 deaths per 100,000 persons was recorded and represents the highest mortality rate of alcohol-related deaths for females in twenty years. Deaths due to injury, (including suicide, transport accidents and falls), were the most common underlying causes of death to have alcohol mentioned as a contributory factor. Across the population, younger Australians are more likely to have alcohol as an associated factor to death, often as a result of single occasion risky drinking (e.g. acute alcohol intoxication impaired judgement and influenced the death event), than the older population, who are more likely to have a chronic condition related to long term harmful alcohol consumption.

This article provides further information on alcohol-induced and alcohol-related deaths in Australia in 2017.

Defining an alcohol-induced and alcohol-related death
Alcohol can contribute to mortality in a number of different ways and deaths can be directly attributable or partially attributable to harmful levels of alcohol consumption. Deaths may arise from a chronic condition which is directly related to alcohol use such as alcoholic liver cirrhosis or from an acute condition directly related to harmful consumption such as alcohol poisoning which has led to respiratory depression. In Australia, deaths which are certified as being directly attributable to alcohol are coded as the underlying cause of death (the condition which initiated the train of morbid events). In this report, deaths registered in 2017 which are directly attributable to alcohol are referred to as 'alcohol-induced deaths'.

Alcohol may also play a significant role in a death, yet not be selected as the underlying cause of death. An example of this may be a death due to a motor vehicle accident where a person recorded a high blood alcohol concentration as measured in toxicology, or a death from hepatocellular carcinoma where a person may have demonstrated long term harmful levels of alcohol consumption. In both of these examples, the alcohol use would be referred to as an associated cause of death.

It is useful for understanding a more complete impact of a disease or behaviour to consider both underlying and associated causes of death in tandem. When deaths directly attributable to alcohol and deaths where alcohol were listed as an associated cause of death are considered together, they will be referred to as 'alcohol-related deaths'.

The Causes of Death, Australia report is an analysis of registered deaths and medical conditions listed on the Medical Certificate of Cause of Death (MCCD) in Australia in a given reference period (e.g. 2017). For this report, to be considered an alcohol-induced or alcohol-related death, reference to alcohol must be made on the MCCD by a practitioner for doctor certified deaths or within a police, toxicology, autopsy or coronial finding report for coroner certified deaths. There are many conditions which have strong associations with alcohol misuse and are considered partially attributable alcohol deaths, including mouth and oesophageal cancers, where a certifier may make no reference to alcohol misuse or contribution on the death certificate. These deaths will not be analysed within this report and it is acknowledged that this report is unable to provide a total attribution of fatal burden due to mortality in Australia. Rather, it provides an analysis of deaths where alcohol was certified in Australia for registered deaths in 2017.

For the purposes of this report, deaths are categorised as being alcohol-induced or alcohol-related through a tabulation of International Classification of Disease 10th edition (ICD) codes created by the Office of National Statistics in the United Kingdom. The tabulation consists of chronic health conditions, mental and behavioural conditions caused by alcohol abuse (e.g. addiction) and acute toxicity related deaths. Excluded from this article are deaths due to fetal alcohol syndrome (ICD-10 code Q86.0). In 2017 there were no deaths registered as being due to this cause. This article also does not cover types of alcohol consumed (i.e. beer, wine, spirits) which can provide important insights into alcohol consumption, however this information is generally not recorded on the MCCD.

Time series
Following a peak in the late 1990s, rates of alcohol-induced deaths declined during the 2000s, reaching a low of 4.5 deaths per 100,000 persons in 2012 and recording a preliminary rate of 5.1 deaths per 100,000 capita in 2017. Rates of alcohol-induced deaths per 100,000 persons have been stable in the 2013-2017 period. Consumption of alcohol has also decreased over time, with the Apparent Consumption of Alcohol Australia report 2016-2017, recording current rates of alcohol consumption at 9.4 litres per capita compared with 13.4 litres per capita in 1974-1975 (ABS).

Although rates of alcohol-induced deaths have declined significantly when compared with 20 years ago, the number of deaths recorded in 2017 was 1,366, which is the highest in the two decade time series (1,156 deaths in 1997).

The figure below shows a time series from 1997 to 2017 of age standardised death rates for alcohol-induced deaths per 100,000 persons. In addition to demonstrating the higher rates of deaths in the late 1990s, the data shows the consistently higher rates of alcohol-induced deaths in males. On average over the last two decades, the rate of alcohol-induced deaths for males has been 3.5 times higher than that of females. Although the number and rate of deaths is consistently higher in males (1,040 deaths in 2017), the rate of decline in mortality is more marked than that of females over the same period (27% from the peak point for males and 14% from the peak point for females).

The National Drug Strategy Household Survey 2016 (AIHW) found that males were more likely to consume alcohol daily or weekly, when compared with females. Males aged over 18 years were also more likely to be at greater risk for lifetime alcohol related harm and at risk of injury on a single occasion of drinking. However, males also reported a sharper decline in risky alcohol use (both lifetime and single occasion) over a 10 year period, aligning with the decline in mortality rates for alcohol-induced deaths.

Footnote(s): (a) All causes of death data from 2006 onward are subject to a revisions process - once data for a reference year are 'final', they are no longer revised. Affected data in this table are: 2013 and 2014 (final), 2015 (revised), 2016 and 2017 (preliminary). See Explanatory Notes 57-60 in Causes of Death, Australia, 2017 (cat. no. 3303.0). and Causes of Death Revisions, 2014 Final Data (Technical Note) and 2015 Revised Data (Technical Note) in Causes of Death, Australia, 2016 (cat. no. 3303.0). (b) See Explanatory Notes 75-106 for further information on specific issues related to interpreting time-series and 2017 data. (c) Standardised death rates for 2013-2016 presented in this table have been calculated using final re-based estimated resident population based on the 2016 Census. As a result, these rates may differ from those previously published. Age-standardised death rates for 2017 presented in this table have been calculated using preliminary estimated resident population based on the 2016 Census. (d) The data presented for Alcohol-induced deaths is based deaths on an alcohol-induced death tabulation created by the Office of National Statistics in the United Kingdom. See Tabulation of selected causes of death (Appendix) in this publication for further details.

Source(s):Alcohol-induced deaths, standardised death rates, by sex, 1997-2017(a)(b)(c)(d)-Alcohol-induced deaths, standardised death rates, by sex, 1997-2017(a)(b)(c)(d)

Composition
In 2017 approximately two thirds of alcohol-induced deaths were due to alcoholic liver diseases which includes alcoholic cirrhosis, alcoholic hepatitis and alcoholic fatty liver. Harmful alcohol consumption is a major risk factor for liver disease. Alcohol within the blood stream is broken down by the liver. To assist with alcohol digestion the liver produces a toxic substance called acetaldehyde which can destroy liver cells, leading to chronic disease. Deaths which are considered to be alcohol-induced may be certified by a doctor or a coroner depending on the circumstances surrounding the death. In 2017, doctors certified 70% of alcohol-induced deaths and 30% were certified by a coroner.

Mental and behavioural disorders due to alcohol abuse, including alcohol addiction, accounted for a further 20% (approximate) of alcohol-induced deaths in 2017. Acute alcohol toxicity, alcoholic cardiomyopathy and other chronic conditions (e.g. alcoholic pancreatitis) comprised the remaining deaths.

The graph below highlights the similar compositions of alcohol-induced deaths for both males and females. Females had a slightly higher proportion of alcohol-induced deaths which were due to acute alcohol toxicity (7.5% of deaths compared with 5.8% of deaths for males).

Alcohol-induced deaths, by composition, by sex, 2017(a)(b)(c)
(a) Causes of death data for 2017 are preliminary and subject to a revisions process. See Explanatory Notes 57-60.
(b)The data presented for Alcohol-induced deaths is based deaths on an alcohol-induced death tabulation created by the Office of National Statistics in the United Kingdom. See Tabulation of selected causes of death (Appendix) in this publication for further details.
(c) Data presented in 'Other' includes ICD-10 codes E24.4, G31.2, G62.1, G72.1, K29.2, K85.2, K86.0 and R78.0. See Tabulation of selected causes of death (Appendix) in this publication for further details.
Age profile of alcohol-induced deaths
Males and females differ in their peak ages of death directly attributable to alcohol. The highest rate of death for males in 2017 was in the 80-84 year old age group (see below table), with a rate of 27.2 deaths per 100,000 population. The highest number of deaths for males was in the 55-59 year group with 168 deaths occurring in 2017. This is in comparison to females who recorded the highest number and rate of deaths in the 50-54 year old age group with 62 deaths and a mortality rate of 8.1 deaths per 100,000 persons. For both males and females deaths directly attributable to alcohol are rare before the age of 30.

Alcohol-induced deaths are a significant cause of premature mortality, with 26,205 years of life lost in 2017. On average, males lost 20.3 years from their life and females lost 22.7 years. The median age at death for males in 2017 was 60.1 years for males and 55.6 years for females. This is a slightly older profile than those who died from alcohol-induced deaths in 1997, when the median age at death was 58.3 years for males and 53.9 years for females. Premature mortality directly related to alcohol is perpetuated in many ways: harmful alcohol use is associated with adverse physical outcomes, including liver disease and alcohol poisoning leading to respiratory depression. Alcohol abuse is also linked to other effects such as the development of mental health conditions including anxiety and depression, and poor nutritional intake, which may in turn create new, or exacerbate, existing health issues.

Footnote(s): (a) All causes of death data from 2006 onward are subject to a revisions process - once data for a reference year are 'final', they are no longer revised. Affected data in this table are: 2013 and 2014 (final), 2015 (revised), 2016 and 2017 (preliminary). See Explanatory Notes 57-60 in Causes of Death, Australia, 2017 (cat. no. 3303.0). and Causes of Death Revisions, 2014 Final Data (Technical Note) and 2015 Revised Data (Technical Note) in Causes of Death, Australia, 2016 (cat. no. 3303.0). (b) See Explanatory Notes 75-106 for further information on specific issues related to interpreting time-series and 2017 data. (c) Age-specific death rates. Deaths per 100,000 of estimated resident population as at 30 June (mid year). See Glossary for further information. (d) The data presented for Alcohol-induced deaths is based deaths on an alcohol-induced death tabulation created by the Office of National Statistics in the United Kingdom. See Tabulation of selected causes of death (Appendix) in this publication for further details.

Source(s):Alcohol-induced deaths, age-specific death rates, by sex, 2017(a)(b)(c)(d)-Alcohol-induced deaths, age-specific death rates, by sex, 2017(a)(b)(c)(d)

Alcohol-induced deaths by region
New South Wales recorded the highest number of alcohol-induced mortality in 2017 with 458 deaths, however the highest rate was in the Northern Territory with 16.7 deaths per 100,000 persons. Victoria recorded the lowest rate of deaths directly attributable to alcohol at 4.0 deaths per 100,000 population. Higher rates of alcohol-induced deaths were recorded in all regions outside of capital cities, with on average, rates being 1.5 times higher in the 'rest of state or territory' regions. The exception to this was the Northern Territory rest of state region, which had a rate of alcohol-induced death of 28.5 per 100,000 persons, which was over three times higher than that recorded in Greater Darwin.
Harmful alcohol use in regional and remote Australia has been well documented. The National Drug Strategy Household Survey 2016 found that there were a higher proportion of risky alcohol consumers (both lifetime and single occasion risk) living outside of capital cities in Australia. Importantly, the survey also found that persons living outside of capital cities also had a higher proportion of non-drinkers or abstainers.

Gambling Related Suicides Australia Fires

Gambling Related Suicides Australian

Alcohol-induced deaths by region of usual residence, 2017 (a)(b)(c)

Region of Usual Residence	rate
New South Wales	458	100.0
Greater Sydney	4.3
Rest of NSW	223	48.7
Victoria	4.0
Greater Melbourne	175	64.8
Rest of VIC	5.2
Queensland	271	100.0
Greater Brisbane	4.6
Rest of QLD	152	56.1
South Australia	6.1
Greater Adelaide	77	65.3
Rest of SA	8.6
Western Australia	113	100.0
Greater Perth	3.8
Rest of WA	30	26.5
Tasmania	8.9
Greater Hobart	22	36.1
Rest of TAS	9.7
Northern Territory	39	100.0
Greater Darwin	9.0
Rest of NT	24	61.5
Australian Capital Territory	9.0
Capital Cities	759	55.8
Remainder of States	8.0
Australia	1366	100.0

(a) Causes of death data for 2017 are preliminary and subject to a revisions process. See Explanatory Notes 57-60.
(b)The data presented for Alcohol-induced deaths is based deaths on an alcohol-induced death tabulation created by the Office of National Statistics in the United Kingdom. See Tabulation of selected causes of death (Appendix) in this publication for further details.
(c) Standardised death rates. Deaths per 100,000 of estimated mid-year population. See Glossary for further information.
Aboriginal and Torres Strait Islander persons - alcohol-induced deaths
Aboriginal and Torres Strait Islander people recorded rates of mortality directly attributable to alcohol five times higher than that of the Non-Indigenous population over the 2013 to 2017 period. The annual average per 100,000 capita for this time frame was 23.8. Non-Indigenous Australians recorded a rate of 4.7 alcohol-induced deaths per 100,000 persons over the same period.

Aboriginal and Torres Strait Islander males died from alcohol-induced conditions at five times the rate of Non-Indigenous males with a rate of 36.5 deaths per 100,000 persons (7.4 per 100,000 persons for non-Indigenous males). Indigenous females had a rate six times higher than that of Non-Indigenous females, and 1.7 times higher than that of Non-Indigenous males. The majority of Aboriginal and Torres Strait Islander alcohol-induced deaths were due to alcoholic liver diseases.

The prevalence of harmful alcohol use has been estimated to be at twice the level of that of Non-Indigenous persons (Wilson et al, 2010). Acknowledging the disproportionate harm experienced by Aboriginal and Torres Strait Islander persons due to drug and alcohol use, the Intergovernmental Committee on Drugs developed the National Aboriginal and Torres Strait Islander Peoples' Drug Strategy (a sub-strategy of the National Drug Strategy) with the aim of minimising harm associated with alcohol across communities and individuals. The Strategy outlines four priority areas to achieve harm reduction, focusing on building capability and capacity for alcohol and drug workforce's within communities, improving service accessibility, strengthening partnerships between government and Indigenous persons and developing meaningful measures. Risky alcohol consumption is a key health determinant measure detailed in the Health Performance Framework Report (PM&C).

Gambling Related Suicides Australia Since

Footnote(s): (a) All causes of death data from 2006 onward are subject to a revisions process - once data for a reference year are 'final', they are no longer revised. Affected data in this table are: 2013 and 2014 (final), 2015 (revised), 2016 and 2017 (preliminary). See Explanatory Notes 57-60 in Causes of Death, Australia, 2017 (cat. no. 3303.0). and Causes of Death Revisions, 2014 Final Data (Technical Note) and 2015 Revised Data (Technical Note) in Causes of Death, Australia, 2016 (cat. no. 3303.0). (b) See Explanatory Notes 75-106 for further information on specific issues related to interpreting time-series and 2017 data. (c) The age standardised death rates for Aboriginal and Torres Strait Islander people presented in this table use Aboriginal and Torres Strait Islander population projections based on the 2011 Census. See Explanatory Note 69 for further information. (d) The data presented for Alcohol-induced deaths is based deaths on an alcohol-induced death tabulation created by the Office of National Statistics in the United Kingdom. See Tabulation of selected causes of death (Appendix) in this publication for further details. (e) Data are reported by jurisdiction of usual residence for NSW, Qld, WA, SA and the NT only. Data for Victoria, Tasmania and the Australian Capital Territory have been excluded in line with national reporting guidelines. For information on issues with Aboriginal and Torres Strait Islander identification, see Explanatory Notes 61-73.

Source(s):Alcohol-induced deaths, Indigenous status, SDRs, 2013-2017 (a)(b)(c)(d)(e)-Alcohol-induced deaths, Indigenous status, SDRs, 2013-2017 (a)(b)(c)(d)(e)

ALCOHOL-RELATED DEATHS
In 2017 there were an additional 2,820 deaths where alcohol was mentioned as a contributory cause to death. This indicates that people were twice as likely to have alcohol certified at death as a contributory factor than to have died from an alcohol-induced death.

Taking into account deaths directly attributable to alcohol, there were a total of 4,186 deaths in 2017 were certified by a doctor or mentioned in a coronial report as being alcohol-related. When looking at rates for alcohol-related deaths over the last 20 years (see graph below), the rate of death for all persons in 2017 is 15.9 deaths per 100,000 persons, the second highest in a twenty year time period. For females the rate of alcohol-related deaths is the highest in the time series. Alcohol was related to 2.6% of all deaths in Australia in 2017.

Footnote(s): (a) All causes of death data from 2006 onward are subject to a revisions process - once data for a reference year are 'final', they are no longer revised. Affected data in this table are: 2013 and 2014 (final), 2015 (revised), 2016 and 2017 (preliminary). See Explanatory Notes 57-60 in Causes of Death, Australia, 2017 (cat. no. 3303.0). and Causes of Death Revisions, 2014 Final Data (Technical Note) and 2015 Revised Data (Technical Note) in Causes of Death, Australia, 2016 (cat. no. 3303.0). (b) See Explanatory Notes 75-106 for further information on specific issues related to interpreting time-series and 2017 data. (c) Standardised death rates for 2013-2016 presented in this table have been calculated using final re-based estimated resident population based on the 2016 Census. As a result, these rates may differ from those previously published. Age-standardised death rates for 2017 presented in this table have been calculated using preliminary estimated resident population based on the 2016 Census. (d) The data presented for Alcohol-induced deaths is based deaths on an alcohol-induced death tabulation created by the Office of National Statistics in the United Kingdom. See Tabulation of selected causes of death (Appendix) in this publication for further details.

Source(s):Alcohol-related deaths, SDRs by Sex, 1997-2017 (a)(b)(c)(d)-Alcohol-related deaths, SDRs by Sex, 1997-2017 (a)(b)(c)(d)

Composition of alcohol-related deaths
When looking at all alcohol-related deaths, the composition of disease contribution is markedly different from deaths which were directly attributable to harmful alcohol use. While alcoholic liver disease was the most common cause of alcohol-induced death, mental and behavioural conditions due to alcohol use is the most common contributor to alcohol-related deaths. Abuse and addiction of alcohol were the most conditions certified by a doctor or coroner, with 2,131 deaths having these conditions certified in 2017. Acute alcohol intoxication, where the toxicity did not lead to death, but instead one's perception and judgement may have been affected by alcohol, was mentioned in 622 deaths in 2017. Patterns were similar for alcohol-related conditions in both males and females.
The difference in causal composition is reflected in certifier type. In 2017, 58.3% of alcohol-related deaths were certified by a coroner and 41.7% of deaths were certified by a doctor.
Composition of Alcohol-related deaths, by selected groupings, 2017 (a)(b)(c)
(a) Causes of death data for 2017 are preliminary and subject to a revisions process. See Explanatory Notes 57-60.
(b)The data presented for Alcohol-induced deaths is based deaths on an alcohol-induced death tabulation created by the Office of National Statistics in the United Kingdom. See Tabulation of selected causes of death (Appendix) in this publication for further details.
(c) Data presented in 'Other' includes ICD-10 codes E24.4, G31.2, G62.1, G72.1, K29.2, K85.2, K86.0 and R78.0. See Tabulation of selected causes of death (Appendix) in this publication for further details.
Age composition of alcohol-related deaths
The age composition of alcohol-related deaths differs to that of alcohol-induced deaths. The graph below shows that whilst the proportion of alcohol-induced deaths peak between the ages of 55 to 69 the number of deaths before the age of 35 is minimal. A steep incline in the proportion of deaths is seen between the ages of 44 and 49. This correlates with the high number of deaths due to chronic alcoholic liver diseases which take a number of years to develop and lead to death.

In contrast the proportion of alcohol-related deaths has a slower incline to the peak of 55 to 59, with a larger proportion of younger people likely to have an acute condition such as alcohol intoxication or harmful alcohol use certified at death. The median age for alcohol-related deaths is lower than that for deaths directly attributable to alcohol, at 56.0 years (compared to 59.1 for alcohol-induced) and on average, people lose 28.0 years from their life.

Footnote(s): (a) Causes of death data for 2017 are preliminary and subject to a revisions process. See Explanatory Notes 57-60. (b) The data presented for Alcohol-induced deaths is based deaths on an alcohol-induced death tabulation created by the Office of National Statistics in the United Kingdom. See Tabulation of selected causes of death (Appendix) in this publication for further details.

Source(s):Proportion of total alcohol-induced and alcohol-related deaths by age, 2017(a)(b)-Proportion of total alcohol-induced and alcohol-related deaths by age, 2017(a)(b)

Most common conditions certified for alcohol-related deaths
Approximately one third of alcohol-related deaths are comprised of deaths directly attributable to alcohol as outlined in the section above (1,366 deaths in 2017). The remaining two-thirds of alcohol-related deaths have alcohol assigned as a contributing factor to chronic health conditions or external cause events. Injury related deaths collectively formed the largest proportion of deaths where alcohol was mentioned as an associated factor, with 1,646 deaths recorded in 2017. Approximately 15% of all external cause deaths in 2017 had alcohol listed as a factor to death.
The table below shows the top ten most common underlying conditions and external events for deaths where alcohol was listed as an associated cause (as opposed to a death directly attributable to alcohol) by selected age groups. Intentional self-harm was the most common underlying cause to have alcohol recorded as a contributory factor, with 18.1% of alcohol-related deaths (759 deaths) being certified as due to suicide in 2017. This number is exacerbated in the younger age groups, with over one third of alcohol-related deaths in the 15-44 year old age group being to intentional self-harm. Harmful alcohol use has been shown to be a risk factor in both suicide attempts and deaths by suicide and alcohol intoxication has been shown to be consistently associated with suicidal behaviour both in Australia and internationally (Esang and Ahmed, 2018).
Alcohol-related deaths, top 10 underlying causes, proportion of total alcohol-related deaths, by age group, 2017 (a)(b)

Cause of death and ICD code	44-74 years	All ages
Alcohol-related deaths total	100.0	100.0
Intentional self-harm (X60-X64-X66-X84,Y870)	11.8	18.1
Accidental poisoning (X40-X44,X46-X49)	6.0	7.8
Ischaemic heart diseases (I20-I25)	8.6	7.0
Land transport accidents (V01-V89,Y85)	2.2	5.2
Accidental falls (W00-W19)	3.6	3.2
Chronic lower respiratory diseases (J40-J47)	4.1	3.1
Malignant neoplasms of liver and intrahepatic bile ducts (C22)	2.8	2.1
Cerebrovascular diseases (I60-I69)	1.9	1.6
Diabetes (E10-E14)	1.5	1.3
Influenza and pneumonia (J09-J18)	1.0	0.9

(a) Causes of death data for 2017 are preliminary and subject to a revisions process. See Explanatory Notes 57-60.
(b)The data presented for Alcohol-induced deaths is based deaths on an alcohol-induced death tabulation created by the Office of National Statistics in the United Kingdom. See Tabulation of selected causes of death (Appendix) in this publication for further details.
Accidental drug overdoses, land transport accidents and accidental falls were the second, fourth and fifth most common causes of alcohol-related deaths in 2017 accounting for 492 deaths collectively. Accidental poisoning and land transport alcohol-related deaths were most common in those aged 15-44 years and alcohol-related fall deaths were most common in those aged over 75 years. Alcohol and its involvement in both non-fatal and fatal drug overdoses has been well researched. Alcohol is a depressant, and when taken in a polypharmacy setting can exacerbate the effects of other drugs leading to respiratory depression. Likewise the connection of alcohol to transport accidents is well established with roadside testing for alcohol intoxication being introduced in Australia in 1985 and has been accompanied by large scale public health campaigns to promote the dangers of driving whilst under the influence of a harmful amount of alcohol.

For those aged 75 years and over, ischaemic heart disease accounted for the underlying cause of approximately 10% of all alcohol-related deaths in 2017. Harmful consumption of alcohol can lead to lead to a raised level of triglycerides, a type of fat in the blood which are associated with high cholesterol and subsequently raise the risk of development of coronary artery disease. Cerebrovascular diseases such as stroke and diabetes, which share similar risk factors to coronary artery disease also had alcohol certified as a contributing factor in 1.6% and 1.3% of alcohol-related deaths respectively in 2017.

Government initiatives
Australia has implemented the seventh iteration of the National Drug Strategy (NDS), with the framework in place from 2017-2026. The strategy aims to minimise the harms associated with alcohol, tobacco and other drugs through demand reduction (delaying or preventing uptake of alcohol and drug use), supply reduction (e.g. preventing sale of alcohol to underage recipients) and harm reduction (e.g. reducing adverse health consequences for alcohol users). The strategy cites the importance of collaboration and partnerships both nationally and by jurisdiction to address alcohol and drug harm in Australia. The National Alcohol Strategy 2018-2026, a sub-strategy of the NDS is currently undergoing a consultation process. The aim of the National Alcohol Strategy will be to 'provide a national framework to prevent and minimise alcohol-related harms among individuals, families and communities'.
To reduce the risks related to drinking the National Health and Medical Research Council has created guidelines to reduce the risks from and help define, harmful drinking levels. The guidelines are as follows:

Guideline 1: Reducing the risk of alcohol-related harm over a lifetime
The lifetime risk of harm from drinking alcohol increases with the amount consumed.
For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.

Guideline 2: Reducing the risk of injury on a single occasion of drinking
On a single occasion of drinking, the risk of alcohol-related injury increases with the amount consumed.
For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.

Guideline 3: Children and young people under 18 years of age
For children and young people under 18 years of age, not drinking alcohol is the safest option.
A. Parents and carers should be advised that children under 15 years of age are at the greatest risk of harm from drinking and that for this age group, not drinking alcohol is especially important.
B. For young people aged 15−17 years, the safest option is to delay the initiation of drinking for as long as possible.

Guideline 4: Pregnancy and breastfeeding
Maternal alcohol consumption can harm the developing fetus or breastfeeding baby.
A. For women who are pregnant or planning a pregnancy, not drinking is the safest option.
B. For women who are breastfeeding, not drinking is the safest option.
For a complete outline of Australian Alcohol Guidelines and guidance to standard drink definitions in Australia please see the NHMRC Australian guidelines site.
For free and confidential advice about alcohol and other drugs, call the National Alcohol and Other Drug hotline on 1800 250 015. It will automatically direct you to the Alcohol and Drug Information Service in your state or territory. These local alcohol and other drug telephone services offer support, information, counselling and referral to services.
References
Australian Bureau of Statistics (ABS) 2018, Apparent Consumption of Alcohol, 2016-2017. Cat no. 4307.0.55.001.
Australian Institute of Health and Welfare (AIHW) 2017. National Drug Strategy Household Survey 2016.
Department of Health. National Drug Strategy 2017-2026.
Department of Health. National Aboriginal and Torres Strait Islander Peoples' Drug Strategy 2014-2019.
Department of Health. Consultation Draft. National Alcohol Strategy 2018-2026.
Department of the Prime Minister and Cabinet 2017. The Aboriginal and Torres Strait Islander Health Performance Framework (HPF).
Esang, M., & Ahmed, S. (2018). A closer look at substance use and suicide. American Journal of Psychiatry, 13(6), pp 6-8.
National Health and Medical Research Council 2009. Australian Guidelines to Reduce Health Risks from Drinking Alcohol.
Wilson, M., et al. (2010). The Harmful Use of Alcohol Amongst Indigenous Australians. Australian Indigenous Health Bulletin, 10(3), July-September.

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Gambling Addiction Causes Another Suicide
By Peter D Mack

Man kills himself due to a gambling addiction he couldn’t control.

The names have been changed to protect the family and friends of this person.

A man living on the northern beaches area of Sydney was found dead in suburban bushland on June 1st. It was not an assault or murder but in a strange way, his suicide may have brought some form of macabre peace to his family, his parents and friends.

Where is Robert?

When Robert Fellows mother found out that her son hadn’t come home again one night she went to seek him out at one of the local RSL (Returned Servicemen’s League clubs, an institution in Australia). She went immediately to his local club and started to look for him in the poker machine area. She couldn’t find him and knew immediately what the problem was. She demanded some assistance from the club management by asking them for possibly the twentieth time to ban him when next he turned up. Robert had thrown hundreds of thousands of dollars at those machines over the last few years but time was running out.

The police believed that he had left the club around 2 am after a thirteen-hour session. He had been at two other clubs and two visits to his usual club during that time.

The last person to see Robert alive was a taxi driver who had dropped him near the bushland area. A search and rescue team found his body five days later. He was forty-five.

His wife Jenny and mother Ruth had been to every similar club over the recent years trying to get him banned. The only way this could have been done was to get him to ban himself from any club, pub or location that had poker machines. He was the only person who could do it. Jenny and Ruth had tried to get him to do this time after time.

Winning the Big One

Two years ago Robert had two major wins and won $60,000. He soon lost it and then went back to try to get “The big one,” as he kept saying. A year ago he approached his parents for another substantial loan for his business which was severely suffering. They agreed to it on condition that he went to Gamblers Anonymous. After the first visit with his mother to a meeting, she followed quietly in her car to ensure that he went to the second. He walked away telling her that “I am not like all those other yobbos.” “You are exactly like them,” she told him “You just haven’t lost everything yet. ”He did not make a third visit.

Robert lost more and more including family, friends and worst of all Jenny and his family. She told him that she needed access and total control over the family and business finances and then she would consider coming back home. After agreeing she went through the accounts and discovered that he had spent the deposits of three new jobs for his business.

Ambassador program for high rollers

Another $60,000 had been poured into the machines. After more complaints to the clubs management seeking some form of response and responsibility Jenny and Ruth found out that his main club had made him a member of their ‘Ambassador’ program for high rollers. He was given access to a special car park and red carpet access without having to sign in at the entrance. He was given points that he could spend in the club on drinks and when he ran out of cigarettes a staff member left the building to get his favourite brand for him. His Ambassador card allowed Robert to set his own maximum limits.

No remorse

Finally when all was lost Ruth went one more time to the management to ask if they would help pay for his funeral as his family were deeply in debt. The management declined and gave her some information for community groups who may be able to assist. All she and Jenny wanted was some minuscule sense of sorrow, recognition and acceptance of what they had assisted in causing.

Those two poor women received nothing: absolutely nothing at all. You would think that with his history with his club the management would have made an exception in his case. Funeral costs were a grain of sand on the beach compared to their $56.2 million revenue. Maybe they said no because they would have to then do the same for the next person to fall foul of the situation. This simply tells me that there are many more than just Robert Fellows with the same or heaven forbid worse symptoms. How could they simply ignore what they were seeing?

Gambling is a real addiction

A spokesman for ClubsNSW stated that self-exclusion was a satisfactory way to curb uncontrolled gambling. There is no real system in place to stop this happening again. They also stated that this is not an unusual story. There are hundreds of Roberts out there and tomorrow some of them will also be dead but nobody appears to care. Why don’t the authorities do something about it? Forget about the tax revenue just put a stop to it.

FYI…According to last year’s annual report, Robert’s favourite club took in $13.2 million from catering and drinks. They gave away $1.9 million in community support. They took in $43 million from its poker machines.

Casino owners refuse to listen

Poker machines appear to have very little restrictions with regard to placement. They are found in casinos, clubs even golf clubs, pubs, bars and hotels. It beggars belief that after so many requests from an obviously very distraught wife and mother the clubs did absolutely nothing to help. His home club was more concerned in making him an Ambassador member with benefits. This just upped his expectations and he spent more and more time and money at the club. They refused to listen to the problems and then made the problems a whole lot worse.

Even though Australia is a very small country it is globally number one in per capita gambling-related suicides. $23 billion was gambled away last year (The population is almost 25 million) of this more than half was due to poker machines. Accounting for less than 0.5 per cent of the world’s population, the nation is home to a fifth of the world’s slot machines.

Last time I was in the USA I visited Pittsburgh and apart from catching up with friends I wanted to visit the Andy Warhol Museum. After the visit, I strolled through the city and came across the Rivers Casino. It was close to lunchtime so I went in and had a coffee and a sandwich. I decided to put twenty dollars in a machine so that I could at least say ‘Yeah bin there dun that.’ The twenty yielded me sixty eight dollars so I took the ticket out of the machine and already well ahead I popped in another twenty.

Out came a sixty-four dollars and a few cents ticket. It wasn’t a hard decision. I then presented the two tickets and walked out with one hundred and thirty-two dollars and a few cents. Forty dollars expenditure, ninety-two dollars profit.

Not a bad result for about thirty minutes work and a nice lunch.

I found it very easy to walk away with my winnings. I also found it very difficult to place myself in Robert’s shoes. We don’t ‘get it’ mentally and emotionally but if you are caught in this roller coaster ride back to oblivion it must be difficult to see your problem. But as he said to his mom after the second meeting. “I am not like all those other yobbos.” Strange because he was the only one who couldn’t see it.

There must be a way to make these clubs and casinos see the problem and report it immediately. Then placing a ban on the person concerned. The places that have poker machines in their premises must surely belong to some type of association. They can then ban these poor people from their premises in the whole state. You need to step up to the plate New South Wales, Australia and fix this abomination.

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