Q&A: New policy recommendations aim to address intersection of alcohol use and gun violence

Alcohol use and gun violence are leading causes of preventable injury and death in the U.S., and the issues are most deadly when they intersect. But despite alcohol being a strong risk factor for gun violence, few policy attempts have been made to address this intersection.

Researchers from the Center for Gun Violence Solutions at the Bloomberg School released in May a set of state-based policy recommendations to address the intersection of alcohol use and firearms. Two of the report's authors, Joshua Horwitz, JD, and Silvia Villarreal, MPP, spoke with Public Health On Call host Lindsay Smith Rogers to explain these recommendations, the research behind them, and how they hope their findings will help everyone—from policymakers to everyday Americans—better understand the risks of mixing alcohol and firearms and how to reduce those risks.

Can you explain the concept of a risk-based approach to reducing gun violence?

JH: Risk-based approach is when you identify risk factors for harm to self and harm to others, quantify them as best you can, and then incorporate them into equitable policy. In the field of gun violence prevention, there's long been a focus—and rightfully so—on some of the hardware around firearms. Not enough attention has been paid to who has access to firearms. After the shooting at Sandy Hook, I started looking at how people who seem to be dangerous legally acquire firearms. I learned that federal laws and many state laws did not address real threats of harm to self or others.

What caused you to approach alcohol as a risk factor?

JH: Our first report from this consortium was about extreme risk protection orders—often referred to as red flag laws—and why we need these laws. Through that report, we realized that oftentimes, there's not just one risk factor, but a multiplicity of factors that go into identifying people who are at risk of violence. One factor that came up over and over again was alcohol. As we looked at the literature, we found that there was a lot of general literature about alcohol, but not specifically about its interaction with gun violence.

After a shooting, we often hear about mental illness, which is a really small contributor to interpersonal violence. Alcohol is a much bigger contributor, but nobody talks about it.

Can you give us an overview of the policy recommendations your report proposes?

SR: We analyzed existing state laws that intersect on firearms and alcohol, and made two broad policy recommendations. The first one involves limiting access to firearms by individuals with a record of alcohol misuse. The second involves limiting access to guns when and where alcohol is consumed. For each policy, we also did a racial equity impact assessment (REIA). We use REIAs in all of our recommendations to assess the racial equity and potential unintended consequences of a policy.

The report mentions the 'alcohol harm paradox.' What is that?

SR: The alcohol harm paradox explains that while groups that have been historically marginalized consume less alcohol, they nonetheless experience more alcohol-related problems. We found that the burden of the harms of alcohol consumption disproportionately affects people of color and their communities.

For example, Black and Latino men are more likely to report dependence symptoms and negative social consequences of drinking, even when the rates of alcohol dependence and abuse are roughly the same, and sometimes even greater, among white men. Black and Latino people are also disproportionately impacted by gun violence. The same structural factors that lead to the alcohol harm paradox also contribute to this paradox in gun violence victimization.

What did your research find about alcohol as a predictor of violence?

JH: We learned that:

• An estimated one in three gun homicide perpetrators drank heavily before murdering their victims.
• 30% of gun homicide victims drank heavily before being killed.
• A quarter of gun suicide victims were heavily drinking before they died in suicide.

This tells us that alcohol is one of the largest risk factors in homicide and suicide.

This is not a public attack on alcohol; this is an effort to help people understand the risks of alcohol and violence. Our solutions aren't saying "don't go have a beer"; what we're saying is to not mix firearms into situations in which there's a documented history of abuse or where there is a lot of alcohol consumption. It's a basic rule of firearm safety, but it's surprising how much those two things mix.

There are societal factors at play as well, including where and when alcohol is sold.

SR: Right, we recognize that firearm policy does not work in a vacuum. We made additional policy considerations related to the environments where alcohol is sold and consumed. We found strong research evidence about alcohol outlet density—the number and concentration of places that sell alcohol in a community—and how limiting the days and hours of sale and increasing alcohol taxes help to reduce these environmental risks.

So reducing the number of liquor stores in a given area—through zoning or other other legislative means—can have an impact on gun violence?

SR: Yes, exactly. There's a lot of research evidence that shows how alcohol density impacts gun violence and violent crime.

Can you give some examples of states and jurisdictions that have good policies in place or ones that have been successful?

SR: We couldn't find a state that had everything. Some states already have some of our policy recommendations. Alcohol-related firearm laws vary widely among states, and these laws are very wide in terms of scope. Some are about purchasing, possession, or carrying. Others only address permitting and license to carry. Some laws include carrying provisions where alcohol is served. And some of them include provisions for sellers of firearms.

And we found that for the same reasons that laws are so different in each state, they are hard to enforce. We want to provide a standard that's backed by evidence and that could help fill some of these gaps.

Your report provides these two broad policy recommendations. What do you hope to see happen next?

JH: I hope this raises awareness. In the gun violence prevention movement, we just have not talked about alcohol. The press doesn't talk about alcohol. Across the board, we need to recognize that this is one of the biggest risk factors out there for gun violence. If we look at some of the numbers, 48,000 people died by gun violence in 2021. If you want to make a dent in that, you have to deal with the issue of alcohol. This has to be central to gun violence prevention strategy—but not all of it, of course.

When you think about universal background checks and licensing, what are you looking for? You're looking for those risk-based factors for violence for gun violence, and alcohol must be part of that discussion.

SR: We hope this report was as eye-opening for others as it was for us. We hope it encourages further public health research of this dangerous intersection of alcohol and firearms. We hope it helps policymakers better understand why alcohol misuse is such an important risk factor for gun violence—and become more interested in addressing policy gaps through our recommendations. And we hope that everyday Americans can begin to recognize the risks associated with alcohol misuse and guns—both so they can push for legislation that keeps our communities safe and also so they're aware of the risks of being in a place where alcohol is served and guns are present.

JH: With this information, individuals can also think about what risks they want to put themselves and their families in. I hope this report educates everybody about where the risks are and what they can do to avoid those risks.