ALCOHOL AND ILLICIT DRUG-ABUSE AND THE RISK OF VIOLENT DEATH IN THE HOME

Context.-While acute alcohol and illicit drug use are common in homici de and suicide victims, the role of chronic substance use in violent d eath is unclear.Objective.-To measure the magnitude of risk of violent death in the home associated with alcohol use or chronic abuse and us e of illicit drugs. Data Sources.-Data obtained from a case-control st udy of risk factors for homicide and suicide in 3 large metropolitan a reas of the United States. Design.-Matched case-control study includin g 388 homicide cases, 438 suicide cases, and equal numbers of controls matched for age, sex, race, neighborhood, and county. Data were analy zed by means of conditional logistic regressions in which other potent ial risk factors for violent death were also considered. Outcome and E xposure Measures.-Homicide and suicide victims were identified from me dical examiner reports in Shelby County, Tennessee; King County, Washi ngton; and Cuyahoga County, Ohio. Structured interviews were conducted with proxy respondents close to the decedents to obtain information a bout alcohol or illicit drug use, and history of alcohol-related hospi talization or trouble at work because of drinking by the subject. Data about alcohol use by others living in the same house as the subject w ere also obtained. Results.-The risks of homicide and suicide associat ed with alcohol or illicit drug use were elevated, as were the risks o f violent death associated with several indicators of chronic alcohol abuse. In addition, nondrinkers living in a home with alcohol users we re at increased risk of homicide (odds ratio, 1.7; 95% confidence inte rval, 0.98-3.0), and non-drug-using individuals residing in homes with illicit drug users were at greatly increased risk of homicide (odds r atio, 11.3, 95% confidence interval, 4.4-28.8). Conclusions.-Alcohol a nd illicit drug use appear to be associated with an increased risk of violent death. The risk of homicide was increased for non-substance-ab using individuals living in households in which other members abused a lcohol or drugs. The concept of the individual at risk of homicide sho uld be broadened to include not only the abuser but also those who may be at risk because of their exposure to others.