A nation-wide study into head-punching, or "king-hit" deaths in Australia found alcohol was a major contributing factor to the violent fatalities, and not necessarily in combination with the use of other drugs.
Detailed in the journal Drug and Alcohol Dependence, researchers from Monash University and the Victorian Institute of Forensic Medicine reviewed 90 king-hit cases resulting in death, cited in coroners' reports over a 12-year period to December 2012.
Toxicological reports for 63 of the cases revealed that alcohol was involved in the majority (49) with the victims' blood-alcohol reading registering at up to four times the legal driving limit in Australia. Illicit drugs were detected in 10 cases of which most involved cannabis. Pharmaceutical drugs were detected in three other cases.
Lead author Dr Jennifer Pilgrim, a Research Fellow at Monash University's Department of Forensic Medicine, said alcohol intoxication also increased the risk of victimisation, not just aggressive offending.
"Assaults are an ongoing problem in Australian society and king hits form a large part of these substance-related and often unprovoked attacks," Dr Pilgrim said.
"It was surprising to find that alcohol was involved in the majority of cases. We expected the use of drugs other than alcohol to be a major factor in this cohort but it was not the case.
"Although it is commonly accepted that people under the influence of alcohol are more likely to become aggressive and violently offend, this study indicates that alcohol also increases the risk of becoming a victim of a violent act."
Cases reviewed in the study were aged between 15 and 78, with an average age of 33 years. Four of the 90 victims were women. Of the 90 cases cited, 28 occurred in New South Wales, followed by Victoria and Queensland (24).
Dr Pilgrim said a significant number of young men were victims of these tragic premature deaths and there was more to be done to curb alcohol-fuelled violence on the streets.
"Alcohol and drug misuse are significant problems among the community, but this study shows that in the case of violent assaults, alcohol consumption is the more urgent contributing issue," Dr Pilgrim said
"To curb alcohol-fuelled violence, we need to alter the drinking culture in Australia - particularly among young people. Education campaigns, limitations on sponsorship and advertising of alcohol, and more research to support and guide prevention campaigns are key to a healthier future for Australia."
The study did not include cases still in criminal courts or under investigation by the coroner, or non-fatal cases where victims were left with permanent disability.
Dr Dimitri Gerostamoulos and Professor Olaf Drummer of Monash and the Victorian Institute of Forensic Medicine collaborated on the research.
Explore further: Study quantifies direct effect of alcohol misuse on 20-somethings