New research shows that Australia's heaviest drinkers are consuming more than they were a decade ago.
The study suggests the top 10% of drinkers are downing up to 5% more - the equivalent of about 140 more standard drinks a year - while lighter drinkers are abstaining more.
Dr Michael Livingston from the National Drug and Alcohol Research Centre says at the heaviest drinking end, it could explain why more people are suffering severe health problems.
He says the changes in drinking may appear small but could tip some from "being healthy to unhealthy, from being in the community to being in hospital."
"At the very heavy drinking end of the population, even an increase of 100 standard drinks a year can be quite important."
Dr Livingston says it is puzzling that heavy drinkers are drinking more, while at the other end of the spectrum lighter drinkers are on average consuming less.
"If one group is drinking more, typically everybody is drinking more," he said. "That's changed in Australia; there is a divergence between the heavy drinkers and the rest of the population."
But he rejects the idea that the anti-alcohol message is not cutting through.
"It certainly seems as though the kind of public health story that has been told for the last 10 years or so is sinking in with most of the population, but not the ones really driving the rates of harm, the top 10 per cent," he said.
Women drinking more
A separate study has found that drinking patterns of men and women have become increasingly similar over the past century.
Dr Cath Chapman from the National Drug and Alcohol Research Centre says in the 1900s, the world's men were three times more likely to drink alcohol.
"If we look at that now and we look at men and women born in the 1990s, men and women are almost as likely to drink alcohol," she said.
"The ratio has converged so that it's almost one. The indications that we have from Australian data are that the trends mirror the global trends."