The Risk of Firearm-Related Suicide Increases as Alcohol Consumption Increases

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The probability of using a firearm when alcohol is consumed was higher in the male decedents compared to female decedents.

New research suggests suicides via firearms are more likely in individuals with higher alcohol consumption, as well as in male decedents.1

A team, led by Shannon Lange, MPH, PhD, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, evaluated the association between the amount of alcohol consumed and the probability of using a firearm as the method of suicide.

A Growing Concern

While the most common method of suicide in the US involve firearms, acute alcohol use is linked to an increased risk of suicide by firearm. Of the 47,000 individuals who committed suicide in 2021 in the US, more than 50% used firearms.

However, there is not much research on the dose-response association between acute alcohol use and the risk of using a firearm for suicide.

“Research indicates that suicides by firearm are more likely to have been preceded by alcohol use than suicides by other methods and that the alcohol-firearm-suicide connection may be the strongest for individuals who acutely consume high amounts of alcohol,” the authors wrote.

Suicide Statistics

In the cross-sectional study, the investigators used mortality data derived from the US National Violent Death Reporting System on suicide decedents aged 18 years or older with a positive blood concentration (BAC; ie, ≥0.01 g/dL).

The investigators sought main outcomes of the probability of using a firearm as the method of suicide compared to all other methods of suicide.

In the study, there were 45,959 male suicide decedents with a mean age of 42.6 years and 12,136 female suicide decedents with a mean age of 44.2 years. Each individual had a positive BAC and 53.8% (n = 24,720) of male decedents and 29.7% (n = 3599) of female decedents used a firearm for suicide.

The results show the probability of using a firearm when alcohol is consumed was higher in the male group compared to females. The probability started at just below 0.50 BAC and increased to approximately 0.75 for men. For female decedents, the probability began just above 0.30 and rose to approximately 0.55.

The dose-response curves were an inverted U shape in both male and female decedents and the probability of firearm-involved suicide initially increased as BAC increased and then decreased at very high BACs (approximately 0.40 g/dL for male decedents and approximately 0.30 g/dL for female decedents).
The BACs were only present in a small percentage of alcohol-involved suicides, 1.3% (n = 589) of male decedents and 6.2% (n = 754) of female decedents.

“This cross-sectional study of suicide decedents who had consumed alcohol prior to their death suggests that, as alcohol consumption increased, the probability of a firearm-involved suicide increased until a certain BAC, at which point the probability started to decrease,” the authors wrote.


Lange S, Jiang H, Kaplan MS, Kim KV, Rehm J. Association Between Acute Alcohol Use and Firearm-Involved Suicide in the United States. JAMA Netw Open. 2023;6(3):e235248. doi:10.1001/jamanetworkopen.2023.5248