Firearms were used to commit 16 883 suicides and 12 791 homicides in the USA in 2006.1 One of the most common and possibly least controversial objectives of firearm policies in the USA is to keep firearms from people deemed to be at elevated risk of injuring others or themselves. Firearms laws in the USA commonly disqualify individuals if they are too young, have been convicted of a serious crime, are subject to certain domestic violence restraining orders, have been adjudicated to be “mentally defective,” or because they abuse illegal drugs or alcohol.

Here we discuss the potential of well-crafted firearms prohibitions for persons who abuse alcohol or controlled substances to reduce violence and injuries. There is a large body of scientific evidence indicating that people who abuse alcohol or illicit drugs are at increased risk of committing acts of violence and self-harm. Drug and alcohol abuse has been strongly linked with the perpetration of fatal and non-fatal domestic violence,2 3 4 5 6 youth violence,7 8 incarceration for violent crimes,9 and suicide and suicide attempts.4 10 Although there is some debate about whether these associations are causal or are due to other underlying determinants, there is little doubt that drug and alcohol abusers represent a high-risk group. For example, in one case–control study of risk factors for homicides and suicides within the home, the prevalence of prior alcohol abuse and illicit drug use among homicide perpetrators was 17 and 4.6 times higher, respectively, than among controls. For suicide victims, the prevalence of alcohol abuse was nearly 7 times higher, and the prevalence of illicit drug use 6 times higher, than for controls.4

There has been a long and contentious debate about the risks and benefits associated with gun ownership among the general population. While we …