Alcohol Use and Firearms

Alcohol misuse is widespread in the US and can have fatal consequences.

“Misuse,” for the purposes of this page, collectively refers to excessive use of, abuse of, and dependence on alcohol¹ as well as alcohol use disorder. Excessive alcohol use accounts for more than 140,000 deaths each year.² Additionally, alcohol misuse increases the risk of firearm injury and death through homicide, suicide, and unintentional injury. When firearms are introduced to situations involving alcohol misuse, they increase the risk of a serious injury or death.

The Numbers

Alcohol consumption is common in the US. In 2022, 48.7% (or 137.4 million people) of those ages 12 and older reported any alcohol consumption and 21.7% (or 61.2 million people) reported binge drinking in the past month.³ While most adults who drink do not engage in firearm violence, alcohol consumption increases the risk of such violence as well as the risk for suicide. This may be partly due to increased heavy drinking among firearm owners; one analysis found that gun owners are more likely than non-gun owners to drink heavily or binge drink.⁴

Who’s at Risk

Alcohol misuse increases the risk of all forms of gun violence,^4–6 including interpersonal, domestic and intimate partner, and self-directed violence.^7,8

Risky firearm behaviors. Alcohol misuse appears to be associated with risky firearm behaviors, such as carrying a concealed firearm for protection against other people and keeping a firearm at home that is both loaded and not locked away.⁴ One study also showed that individuals with alcohol use disorder were more than twice as likely to report impulsive angry behavior and carry their guns in public.⁹

Homicide, assault, and firearm-related crime. Alcohol misuse and firearm access increase the risk of both committing and being a victim of homicide, with an estimated 1 in 3 firearm homicide perpetrators drinking alcohol before killing their victims and 1 in 3 gun homicide victims drinking heavily before being killed.^8,10 Heavy drinkers are more than twice as likely to be shot during an assault when compared with non-drinkers.⁶

A growing body of evidence demonstrates an association between alcohol-related legal problems and firearm violence.¹¹ Among legal gun owners, having driving under the influence (DUI) or other alcohol-related convictions is associated with a four- to fivefold increase in the risk of incident arrest for a violent or firearm-related crime.¹² Among California handgun purchasers, having a prior DUI conviction was associated with a three times higher risk of subsequent arrest for violent crimes, including violent crimes using firearms and intimate partner violence.^13,14

This association between alcohol and guns holds true not just at the individual level, but also for communities: one study with urban adolescents found that adolescents who had personal history of alcohol use or lived in neighborhoods with high densities of alcohol outlets had a significantly higher risk of firearm homicide.¹⁵

Suicide and firearm suicide. Alcohol misuse is highly prevalent among people who die by suicide, especially among those who use firearms. One large multi-state study showed that people who used a firearm versus other means were more likely to have been intoxicated at the time of death.¹⁶ Among male handgun purchasers in California, those with recent alcohol charges at the time of purchase had double the risk of firearm suicide when compared with those who had no alcohol or drug charges, demonstrating that firearm owners with alcohol offenses may benefit from prevention efforts to reduce firearm access and alcohol use.¹⁷

Social and structural determinants. People of color are disproportionately affected by both gun violence and alcohol misuse. Though their consumption of alcohol is comparable to and often less than that of white individuals, Black and Hispanic or Latino and American Indian and Alaska Native people experience greater harms from alcohol misuse.¹ Black and Hispanic drinkers are more likely to report social consequences of drinking such as arguments or fights, accidents, as well as workplace, legal, and health problems.¹⁸ Additionally, people of color are more likely to live in areas with more liquor stores and bars. Higher alcohol outlet density is associated with higher rates of community violence and community disadvantage, both of which are associated with lower life expectancies.¹⁹

What you can do

By recognizing the relationship between alcohol misuse, firearm use, and violence and suicide, clinicians can tailor their conversations to reduce the risk of firearm-related harm in their patients.

The US Preventive Services Task Force (USPSTF) recommends screening for unhealthy alcohol use in adults in primary care settings and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce their risk of negative health outcomes from alcohol.²⁰

Firearm-related harm should also be considered a potential negative health outcome from alcohol misuse, especially in situations where intoxication can exacerbate other risk factors. Alcohol’s disinhibitory and depressant properties can be especially dangerous in patients at risk for suicide, intimate partner or domestic violence, or other interpersonal violence.

When clinicians identify a patient who is misusing alcohol, they can apply the 3A’s Framework to determine if other risk factors are present and if firearm access is clinically relevant. Depending on the level and type of risk present, clinicians can explore different interventions to reduce risk in their patients:

• Lethal means safety
• Safe storage
• Temporary firearm transfers
• Civil protective orders
• Substance use treatment