Australia's legal drinking age should be raised to 21, according to an expert who says there is mounting evidence the move would dramatically reduce alcohol-related harm among young people.
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Professor John Toumbourou, from Deakin University's School of Psychology and Centre for Mental Health and Wellbeing Research, says the time is right for a reignited debate on increasing Australia's legal drinking age, with alcohol-related harm in teenagers and young adults "a very real public health issue".
In an online essay published on Monday for the Medical Journal of Australia, Dr Toumbourou says there is growing evidence and support for the move.
"We are very concerned that there are rising and very high rates of youth alcohol-related problems in the young adult age group in Australia," he said.
"We've had a number of surgeons telling us about the horrors they face over the weekends in Australia, having to treat young people who've been injured as a result of alcohol-related violence."
He also warned that Australia was at risk of having "an epidemic of foetal alcohol problems in the next generation of children ... because young Australian women are drinking at such high levels now.
''So this is an issue that we've got to really get on top of because in addition to the alcohol-related violence, the heavy patterns of use that we see with the pre-loading and the absolute disregard for public health guidelines in alcohol, this is going to set us up so that we are likely to have problems when this generation has children," he said.
Dr Toumbourou also points to "less challenging policy options" such as restricting purchasing rights until the age of 19 or 20, restricting the amount and type of alcoholic products young people can purchase and laws limiting the "secondary supply" of alcohol to minors.
"The price of alcohol is too cheap – we need to look at doing what we did with tobacco and make it more expensive. The availability [of alcohol] is too easy and we do need to restrict the hours that alcohol is sold but the drinking age is an important one within the mix," he said.
He said there needed to be a cultural shift around attitudes towards alcohol in Australia, much like what has occurred with smoking.
"We used to have a very unhealthy relationship with cigarettes and we've managed to get a divorce there gradually and I think the same things need to happen now with alcohol," he said.
"We think this next generation are ready for a change where we would see the drinking age raised and less normalisation of the idea that you need to get drunk to have a good time."
Australian Medical Association ACT president Andrew Miller said the data on lifting the drinking age was "very mixed".
"If we're trying to reduce harm associated with excessive alcohol consumption, the real big issue in younger people is binge drinking," he said.
"I think it's a really complex issue – whilst there's some data to show that raising the drinking age may have some benefits to it, by itself, it's not going to work. What we've really got to do is change people's attitudes towards alcohol consumption."
University students James Addinsall, 24, and Jack Hamill, 20, did not believe lifting the drinking age was necessary.
"Kids are going to drink anyway whether it's 18 or 21," Mr Addinsall said. "I think they'll be more likely to drink if it is lifted to 21. You get your licence at 17 and you're not allowed to drink until you're 18 so there's still that year if that's an issue."
Mr Hamill believed underage drinking would become an even bigger problem if the drinking age was raised.
"Especially since the age of 18, you're technically an adult, everyone is finishing school, leaving home, doing gap years, going to uni, getting jobs, earning money. People our age want to have a good time so whether it's legal or illegal, it's going to happen one way or another so I think raising it is going to be unnecessary," he said.
"I wouldn't be keen on it even though I don't consider myself a huge drinker."
In the Perspective piece, Dr Toumbourou said evidence from the US, Canada, New Zealand and Australia suggested increasing the drinking age reduced youth alcohol use and harm.
He said evaluations of US states where the drinking age was lifted to 21 in the late 1970s and early '80s found crashes involving alcohol dropped, while Canadian data found a higher minimum drinking age reduced youth hospitalisation rates for alcohol use disorder, alcohol poisoning, suicidal behaviour and traffic crash injury.
He said young people were not "neurologically full adults" at 18 and were more vulnerable to alcohol harm.
Dr Toumbourou said public support for increasing the legal drinking age had grown.
"People want there to be tougher government action around alcohol and in the end politicians will be seen in a good light because, just like tobacco, we look back at those politicians who took action and we actually respect them," he said.
