Experts have sounded the alarm over the rising toll of deaths related to alcohol. They are calling for stronger advertising regulation and more specialist services to meet demand.

Alcohol is deeply ingrained in Australia’s culture. In 2022, the rate of alcohol-induced deaths reached its highest point in more than 20 years: 6.2 deaths for every 100,000 people. There were 1765 alcohol-induced deaths in Australia in 2024, a significant increase from the 1362 in 2015. Most alcohol-induced deaths result from chronic conditions such as liver cirrhosis and occur among men. The median age of death is 58.4 years.

The recent increase in alcohol-induced deaths is related to generational differences in drinking, Michael Livingston, PhD, associate professor of alcohol research at the National Drug Research Institute (NDRI) at Curtin University in Melbourne, Victoria, Australia, told Medscape News Australia.

“Generation X Australians have been a heavy drinking generation across their life course (on average), and these groups are now reaching the ages where alcohol-induced mortality is most likely. These deaths are predominantly chronic disease such as liver disease, so they peak in later life. We’ve now got a cohort at high risk hitting their peak risk ages,” he said.

“These deaths are all unnecessary and preventable,” Livingston continued. “They impact families, friends, and communities in all kinds of ways. People shouldn’t be dying at 60 from alcohol-related liver cirrhosis. Every death is a tragedy.”

Alcohol Advertising Regulations

Men aged 55-64 years are at highest risk for alcohol-induced deaths, Danielle McMullen, MBBS, president of the Australian Medical Association (AMA) and a general practitioner (GP) in Brisbane, Queensland, Australia, told Medscape News Australia. Youths, on the other hand, are more likely to experience acute trauma and harm resulting from alcohol intake and associated risky behavior.

“We know that both chronic moderate and high rates of drinking are harmful to health, as is binge drinking or short-term high alcoholism,” she said. “But as people get older, it’s that cumulative effect of alcohol-related harm, either repeated binge drinking or chronic drinking, and you’re more likely to have liver disease, heart disease, neurologic complications, and more chronic impact on health, so it’s not surprising that it’s older people or middle-aged-to-older people who are more affected.”

It’s, therefore, important to prevent harm “by getting to people when they’re young,” McMullen emphasized.

That’s one of the reasons why the AMA, in its recent submission to the Australian Communications and Media Authority (ACMA) review of alcohol advertising restrictions in the Free TV Code, called for the removal of alcohol advertising exemptions for sports. These exemptions allow alcohol advertising during sports events from Friday evening to Sunday night, when alcohol harms peak. The AMA also called for further restrictions on advertising hours.

“We want to reduce the impact of advertising that talks up the benefits of drinking and makes alcohol use look attractive to younger people, who are really susceptible to advertising at a time when their habits are being set up,” said McMullen.

The AMA wants ACMA to step in and replace weak advertising regulations with a mandatory program standard, which would allow it to have more power to enforce and regulate alcohol advertising on television. The AMA would also like to ensure that the standard includes zero-alcohol products and that rules are applied across broadcaster steaming services (which allow alcohol ads during children’s programs), too.

“We also have to recognize that video on-demand services are now how a lot of people seek entertainment, and sometimes the standards that are applied to free-to-air TV aren’t being carried across to other services,” McMullen added. “We think they should also be covered by the same code of practice around volumes of advertising. Often, consumers report that it’s the same ad they’re watching over and over when they’re using a streaming service. This is real reinforcement, and we’re concerned about the amplification of risk.”

The GP’s Role

Experts agree that GPs are perfectly positioned to support patients in reducing their alcohol use. They can refer patients to specialists as needed. But experts also stress that more resources to support patients are urgently required.

Michala Kowalski, PhD, a postdoctoral research fellow at the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney, New South Wales, Australia, has researched how to better engage GPs in alcohol treatment. All the GPs she interviewed stressed a need to improve their knowledge of alcohol disorders and screening practices. Many reported a lack of time, lack of education, and stigma as challenges, she said.

“Ideally, GPs would receive better training on identifying substance use disorders throughout their careers, along with the confidence to destigmatize substance use disorder, and confidence to provide patients with adequate referrals if they are on board with treatment,” she said.

GPs could improve their screening practices by asking questions about alcohol use when a patient presents with clinically relevant symptoms or complications that could be induced or worsened by alcohol use, Kowalski added.

“These screenings would be quite simple, straightforward questions about a patient’s alcohol use, and if the GP were to judge that intake as clinically relevant, [he or she would] discuss the issue with the patient, explain the harms and problems, and offer an intervention,” she said.

Shortage of Specialist Services

But specialist services are insufficient for patients who require additional support, and some GPs faced referral challenges, according to the experts who spoke with Medscape News Australia.

“It has been raised time and time again that we don’t have enough public or private resources for alcohol and other drug [AOD] use and that wait lists are long,” McMullen said. “We need more investment in drug and alcohol services and a bigger workforce, including doctors, nurses, social workers, and other allied health staff that work on those teams.”

Livingston agreed. “There are real gaps between primary care, [AOD] treatment, and specialist healthcare, such as liver clinics,” he said. “Screening and brief interventions for alcohol in GP consults is pretty well established as an effective way to reduce people’s consumption, but better referral pathways to treatment services, early liver function testing to catch damage before it progresses too far, and more widespread use of pharmacotherapy for alcohol are all relatively easy steps that could produce real reductions in these deaths fairly quickly.”

The shortage of specialist services is particularly acute in regional areas, and GPs often lack knowledge about where to refer their patients, said Kowalski. “There is a shortage of publicly funded, affordable specialist services, leading to long wait lists, long travel times to see the specialists, and out-of-pocket costs. Moreover, many GPs are not well acquainted or connected with AOD specialists and, thus, do not have a good starting point for a specialist to refer patients to,” she said.

If Australia is to reduce deaths, then it must implement stronger policies to control the sale of alcohol across the country, Nic Taylor, PhD, a research fellow at the NDRI at Curtin University, told Medscape News Australia.

“We know that alcohol affordability is a key driver of alcohol consumption and harms. Wine consumption has grown considerably in Australia. It is not taxed based on its alcohol content, which has allowed for cheap strong wine to grow in the market,” he said.

“In recent years, the Australian government has also given tax incentives to beer and spirits distillers, introducing new sources of cheap alcohol into the market.”

Health institutions could take on data sharing approaches that allow for targeted interventions, said Taylor. One such example is at Royal Perth Hospital, which records where alcohol-related attendances purchase the bulk of their alcohol. Regulators could use these data to penalize retailers who act irresponsibly.

“Reform is needed to ensure that the appropriate pricing policies are in place to reverse these trends,” Taylor added.

Livingston, McMullen, Kowalski, and Taylor reported having no relevant financial relationships.