Elsevier

Preventive Medicine

Volume 79, October 2015, Pages 15-21
Preventive Medicine

Alcohol misuse, firearm violence perpetration, and public policy in the United States

https://doi.org/10.1016/j.ypmed.2015.04.015Get rights and content

Highlights

  • Alcohol misuse and firearm access are common and associated with one another.

  • In an average month, 8.9 to 11.7 million firearm owners binge drink.

  • Alcohol misuse and firearm access increase risk of committing homicide and suicide.

  • Enforceable restrictions on firearm access because of alcohol misuse are uncommon.

  • Restrictions based on other risk factors appear to be effective.

Abstract

Objective

Firearm violence is a significant public health problem in the United States, and alcohol is frequently involved. This article reviews existing research on the relationships between alcohol misuse; ownership, access to, and use of firearms; and the commission of firearm violence, and discusses the policy implications of these findings.

Method

Narrative review augmented by new tabulations of publicly-available data.

Results

Acute and chronic alcohol misuse is positively associated with firearm ownership, risk behaviors involving firearms, and risk for perpetrating both interpersonal and self-directed firearm violence. In an average month, an estimated 8.9 to 11.7 million firearm owners binge drink. For men, deaths from alcohol-related firearm violence equal those from alcohol-related motor vehicle crashes. Enforceable policies restricting access to firearms for persons who misuse alcohol are uncommon. Policies that restrict access on the basis of other risk factors have been shown to reduce risk for subsequent violence.

Conclusion

The evidence suggests that restricting access to firearms for persons with a documented history of alcohol misuse would be an effective violence prevention measure. Restrictions should rely on unambiguous definitions of alcohol misuse to facilitate enforcement and should be rigorously evaluated.

Section snippets

Firearms

Exposure to firearms is very common in the United States. Roughly 300 million firearms are in civilian possession in this country—about 45% of all civilian-owned firearms worldwide, though the United States accounts for only about 4.5% of the world's population (Graduate Institute of International Studies, 2007). General Social Survey (GSS) data for 2010 suggest that there are approximately 50 million firearm owners in the United States, including about 35% of men and 11% of women (General

Alcohol misuse, firearms, and violence

In prevalence studies, to the extent that the questions have been asked, persons with alcohol or other substance abuse disorders, other forms of serious mental illness, impulsive anger, and suicidal ideation have reported the presence of firearms in the home (as distinct from personal firearm ownership), gun carrying outside the home, and storing firearms both loaded and not locked away at frequencies that approximate those in the general population (Swanson et al., 2015) (Ilgen et al., 2008,

Federal and State policies on firearms and alcohol

Policies intended to prevent firearm violence often focus on individuals believed to be at high risk for committing such violence. Federal statutes, for example, prohibit the purchase and possession of firearms by persons who have been convicted of any felony or domestic violence misdemeanor, who are subject to a domestic violence restraining order, have been found to be “an unlawful user of or addicted to any controlled substance,” have been “adjudicated as a mental defective” or “committed to

Effectiveness of regulation

Efforts to prevent firearm violence by regulating access to firearms are based on the means reduction approach to violence prevention (Johnson and Coyne-Beasley, 2009, Sarchiapone et al., 2011). Many general population studies, only a few of which are cited here, have established an association between the prevalence of access to firearms and risk of firearm violence (Killias, 1993, Miller et al., 2007a, Miller et al., 2007b, Wintemute et al., 1999). The means reduction approach holds that if

Acting on the evidence

The available evidence is that acute alcohol intoxication and a history of alcohol misuse are independent risk factors for firearm violence. Policies that restrict firearm access by persons with other risk factors for have been shown to be effective. Properly-crafted policies addressing firearm access for persons who misuse alcohol are likely to be effective as well.

The critical flaw in most existing alcohol-related restrictions on firearm access is the vague and subjective definitions that

Conclusion

Firearm access, including personal firearm ownership, and alcohol misuse are both common in the United States. They appear to be associated with one another, and both are associated with an increase in risk for committing firearm violence. Restricting access to firearms by persons who misuse alcohol would likely prevent violence, if restrictions were well-designed and enforced. States enacting such restrictions would be acting in accord with a large body of empirical evidence. To add to that

Conflict of Interest

The author declares that there are no conflicts of interests.

Acknowledgments

The author is grateful to Vanessa McHenry of the Violence Prevention Research Program for assistance with manuscript preparation.

This research was supported in part by The California Wellness Foundation (grant no. 2013–159), which played no role in study design or conceptualization; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

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