Alcohol remains deadliest drug in the U.S., by far

CHICAGO — Which intoxicating substance is associated with the most lethal violence?

The correct answer, by far, is alcohol. It’s involved in more homicides than pretty much every other substance, combined. Alcohol’s relative importance has grown over the past 15 years, as aging populations of cocaine users account for a declining proportion of violent crime.

Surveys of people incarcerated for violent crimes indicate that about 40 percent had been drinking at the time they committed these offenses. Among those who had been drinking, average blood-alcohol levels were estimated to exceed three times the legal limit. Drinking is especially common among perpetrators of specific crimes, including murder, sexual assault, and intimate partner violence.

Correlation does not equal causation, of course. If offenders all stopped drinking, we wouldn’t see a 100 percent reduction in their crimes. Yet alcohol does play a distinctive role. It lowers inhibitions and, among some people, fosters aggressive behavior that ratchets up the risk that violence will somehow occur.

Aside from its role among perpetrators of violence, alcohol use is widespread among victims, too. If alcohol makes you more likely to be a perpetrator of violence, almost by definition it makes you more likely to be a victim in the same incident. Downing some liquid courage may impair your judgment, which makes you a little less wary or a little more vulnerable in obvious ways. It may narrow your options and thus create other risks, too. You’re less likely to leave that cutting remark unanswered. If you’re unfit to drive, you’re more willing to accept that ride home from a helpful stranger.

Recent data from the Illinois Violent Death Reporting System bear out these trends. At my request, researchers at the Stanley Manne Children’s Research Institute analyzed 3,016 homicides occurring in five Illinois counties between 2005 and 2009.

Many of the Illinois findings are depressingly familiar to anyone who reads a newspaper. Two-thirds of the victims were African-American; only 11 percent were non-Hispanic white. Eighty-six percent were men. Seventy-seven percent were victims of gun violence.

Almost 40 percent of the homicide victims tested had some blood alcohol in their systems when they were killed. These data do not indicate actual blood-alcohol levels. Our previous work indicates that many homicide victims have alcohol in their systems above the legal limits for driving.

Other intoxicating substances were far less prevalent. About 10 percent of homicide victims had cocaine in their systems. (And roughly half of this group had also been drinking.) Opiates, in contrast, were only present in about 3 percent of homicide victims and appears to be a very small part of the story.

Disparities by age are especially pronounced. Homicides among adolescents and young adults are a special problem in Chicago.

Alcohol is the only substance that frequently appears among young homicide victims. Cocaine (and, to a lesser extent, heroin) is a much more important part of the story among victims age 35 or older.

What to do?

Treatment matters, too. In 2011, about 4 million Americans were both uninsured and satisfied criteria for alcohol disorders. The Affordable Care Act should improve treatment access to many within this group. ACA’s Medicaid expansion.