CONTEXTWhile acute alcohol and illicit drug use are common in homicide and suicide victims, the role of chronic substance use in violent death is unclear.OBJECTIVETo measure the magnitude of risk of violent death in the home associated with alcohol use or chronic abuse and use of illicit drugs.DATA SOURCESData obtained from a case-control study of risk factors for homicide and suicide in 3 large metropolitan areas of the United States.DESIGNMatched case-control study including 388 homicide cases, 438 suicide cases, and equal numbers of controls matched for age, sex, race, neighborhood, and county. Data were analyzed by means of conditional logistic regressions in which other potential risk factors for violent death were also considered. OUTCOME AND EXPOSURE MEASURES: Homicide and suicide victims were identified from medical examiner reports in Shelby County, Tennessee; King County, Washington; and Cuyahoga County, Ohio. Structured interviews were conducted with proxy respondents close to the decedents to obtain information about alcohol or illicit drug use, and history of alcohol-related hospitalization or trouble at work because of drinking by the subject. Data about alcohol use by others living in the same house as the subject were also obtained.RESULTSThe risks of homicide and suicide associated with alcohol or illicit drug use were elevated, as were the risks of violent death associated with several indicators of chronic alcohol abuse. In addition, nondrinkers living in a home with alcohol users were at increased risk of homicide (odds ratio, 1.7; 95% confidence interval, 0.98-3.0), and non-drug-using individuals residing in homes with illicit drug users were at greatly increased risk of homicide (odds ratio, 11.3; 95% confidence interval, 4.4-28.8).CONCLUSIONSAlcohol and illicit drug use appear to be associated with an increased risk of violent death. The risk of homicide was increased for non-substance-abusing individuals living in households in which other members abused alcohol or drugs. The concept of the individual at risk of homicide should be broadened to include not only the abuser but also those who may be at risk because of their exposure to others.

Background. It is unknown whether keeping a firearm in the home confers protection against crime or, instead, increases the risk of violent crime in the home. To study risk factors for homicide in the home, we identified homicides occurring in the homes of victims in three metropolitan counties.Methods. After each homicide, we obtained data from the police or medical examiner and interviewed a proxy for the victim. The proxies' answers were compared with those of control subjects who were matched to the victims according to neighborhood, sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods.Results. During the study period, 1860 homicides occurred in the three counties, 444 of them (23.9 percent) in the home of the victim. After excluding 24 cases for various reasons, we interviewed proxy respondents for 93 percent of the victims. Controls were identified for 99 percent of these, yielding 388 matched pairs. As compared with the controls, the victims more often lived alone or rented their residence. Also, case households more commonly contained an illicit-drug user, a person with prior arrests, or someone who had been hit or hurt in a fight in the home. After controlling for these characteristics, we found that keeping a gun in the home was strongly and independently associated with an increased risk of homicide (adjusted odds ratio, 2.7; 95 percent confidence interval, 1.6 to 4.4). Virtually all of this risk involved homicide by a family member or intimate acquaintance.Conclusions. The use of illicit drugs and a history of physical fights in the home are important risk factors for homicide in the home. Rather than confer protection, guns kept in the home are associated with an increase in the risk of homicide by a family member or intimate acquaintance.

To the Editor.— The recent SPECIAL COMMUNICATION by Richard B. Drooz, MD (238:43-45, 1977), contains a serious factual error that we wish to correct. In referring to our paper on accidental firearm fatalities,1he writes, "... the number of accidents due to keeping a handgun for selfdefense is obscured and swelled in several ways. Their description is unclear, but apparently theycounted suicides among accidentaldeaths" [italics added]. The "Method" section of our publication states clearly that firearm fatalities are classified as accident, suicide, homicide, or violence of undetermined origin, and the medical and legal methods of classification, which were consistent over the 15 years reported, are described in some detail. We fail to see how anybody could come away with the impression that our accident data include firearm suicides. The paper in question reports 148 fatal firearm accidents (83% of which resulted from mishaps with handguns) in Cuyahoga County,