Substance use disorders and homicide death in veterans

The present study examined the association between a diagnosis of an alcohol use disorder or a drug use disorder and death by homicide over the course of 6 years. This was a cohort study that included all patients seen for medical treatment by the Veterans Health Administration during fiscal year (FY) 2001. Treatment records were used to identify all patients with a diagnosis of a substance use disorder in FY01 (n = 3,942,932). The National Death Index data provided information on the timing and cause of death between FY02 and the end of 2007. Analyses examined the association between substance use disorders and the time to homicide, after controlling for age and gender. Veterans Health Administration patients who were diagnosed with an alcohol use disorder were more likely to die by homicide than those without a substance use disorder (hazard ratio [HR] = 3.3, 95% CI [2.6,4.1]). This finding also was true for those with drug use disorders (HR = 4.3, 95% CI [3.4, 5.4]) and for those with both an alcohol use disorder and a drug use disorder (HR = 4.6, 95% CI [3.9, 5.4]), compared with those without a substance use disorder. In this observational study of veterans, a diagnosis of a substance use disorder was significantly associated with death by homicide. Alcohol and drug treatment programs may have an important role to play in reducing the burden of homicide as a public health problem.