"I drink to have fun with friends … it helps the conversation move and to get along," the 23-year-old said.

Nicolette Barbas got her first drink – a Vodka Cruiser – from her mum when she was 16. These days the 21-year-old sips three to six during a night out.

"I know I'm sensible and I won't go overboard ... [but] everyone sort of does silly things when they're drunk. It's part of the fun," she said.

Kahli Gifford's mum also bought her first drink when she was 16. She averages about six drinks twice a week.

When young people drink they tend to go pretty hard, judged against national health recommendations.

But the latest NSW Chief Health Officer's report shows 16 to 24-year-olds are the least likely to drink daily.

The biggest daily drinkers in the state are overwhelmingly over 65.

It's a stark generational disparity often overlooked in Australia, where the short-term harms of alcohol can often take precedence over the health effects of long-term drinking.

It's the difference between an intoxicated teen falling over and hitting their head, and a budding retiree with liver failure.

Less than 1 per cent of people aged 16 to 24 drank daily compared to roughly one in seven people (14 per cent) over 65, the report released on Thursday found.

Over-65s also had two times the rate of hospitalisations for alcohol-related problems compared to the 15-24-year age group.

Alcohol risk awareness campaigns had predominantly targeted youth drinking, addiction specialist Adrian Dunlop said.

"But we're trying to have a more meaningful dialogue about alcohol-related harms," he said.

The findings among older Australians showed a "worrying trend", especially when this group exceeded four drinks a day, he said.

"We need to think about the older populations a lot more and how alcohol is contributing to chronic disease [including] cirrhosis damage and alcohol-related brain injury," he said.

The younger crowd still out-binged drink their elders, the report showed.

More than one in three 16-24-year-olds drank at levels that increased their long-term health risks compared to one in eight over-65s. Almost one in five 12-17-year-olds who drank reported doing so to get drunk.

Roughly one-third had been given their first drink by their parents and about three in five had their last drink under adult supervision, the report showed.

Excessive alcohol consumption is the leading contributor to illness and deaths in Australia for people up to 44 years old, costing the NSW economy more than $3.87 billion a year.

One in four adults drink at levels that put their long-term health at risk, a decline of 5.5 per cent over the past decade, the report showed.

It also found Aboriginal people were equally likely to abstain from drinking alcohol as non-Aboriginal people, though Aboriginal people who did drink were more likely to do so at risky levels.

But Australians' attitudes and behaviours towards alcohol were clearly shifting.

Young people were delaying their first drink, and drinking at less hazardous levels than they used to, the report showed.

High school students who reported drinking in the past 12 months dropped from three in five in 2005 to two in five in 2014, and binge drinking was down from one in 10 to one in 20 over the same period.

The rate of 15 to 24-year-olds presenting at emergency departments with acute alcohol problems also declined from more than 3500 in 2007 to about 3000 in 2015.

"There are benefits to drinking aside from health. It's part of Australian culture for many people. It's how we celebrate birthdays and Christmases and socialise generally," Dr Dunlop said.

Older generations needed to shed the misinformed belief that a glass of wine a day had any health benefit.

"That theory has been blown out of the water," he said.

The tipping point between acceptable and risky drinking was also unclear for many people, Dr Dunlop suspected.

National guidelines recommend men and women drink no more than two standard drinks on any day to reduce their lifetime risk of alcohol-related harms.

To reduce short-term risk of injury men and women should stick to no more than four standard drinks on any occasion.

NSW's Chief Health Officer Kerry Chant said it was encouraging to see decreasing numbers of adults drinking at levels that increase long-term risk of harm, but more needed to be done.

"[Excessive drinking] not only affects the drinker but can also contribute to relationship and family problems, public intoxication, and other criminal offences", and increased the likelihood of aggressive behaviour, she said.

With Cassandra Morgan