Source: Houston Chronicle, page 2A
(http://www.chron.com/cgibin/auth/story/content/chronicle/nation/
97/08/20/drugs.20.html)
Contact: viewpoints@chron.com

People who reside with drug abusers face murder perils

By CHRISTOPHER S. WREN, New York Times

People who do not use illegal drugs but live in households where
such drugs are used are 11 times as likely to be killed as those
living in drugfree homes, according to a study reported today in
the Journal of the American Medical Association.

Killings were also 70 percent more likely among nondrinkers in
households where alcoholism exists, according to the study, which
examined the effect of substance abuse on homicides and suicides
in three counties encompassing Seattle, Memphis and Cleveland.

"Our concept of the individual at risk for violent death should
be broadened to include not only the substance abuser, but also
those who may be at risk because of the presence of others within
the household who are substance abusers," the researchers said.

The study, by researchers at the University of Washington, the
University of Tennessee, Case Western Reserve University and
Emory University, found that people who mix alcohol with other
drugs were 16.6 times more at risk for suicide and 12 times more
at risk for homicide than those who abuse neither.

Not only were alcoholism and drug abuse associated with more
frequent suicide, the researchers reported, but homicides also
increased among people who did not consume drugs but lived with
others who did.

Dr. Frederick Rivara, the lead researcher, said the study
underscored the need to confront the abuse of alcohol and other
drugs on many levels, including basic medical care. "Physicians
don't usually screen for substance abuse, and substance abuse has
many implications, including violence," Rivara said in a
telephone interview from Seattle.

Rivara said the study documented that alcohol and drug abusers
posed a risk not just to themselves but to others in their
household.

Alcohol is generally recognized as a factor in killings and
suicides. The researchers alluded to previous studies showing
that 40 percent to 70 percent of homicide victims were found
during autopsies to have had alcohol in their blood.

But the potentially fatal impact of chronic substance abuse on
other household members was often overlooked, the researchers
said.

They studied reports by medical examiners on 438 suicides and 388
homicides occurring at home in Shelby County, Tenn.; King County,
Wash.; and Cuyahoga County, Ohio, during a three to fiveyear
period beginning in August 1987. The victims' proximity to
alcohol or other drugs was compared with that of a control group
of residents of the same or similar neighborhoods.

Alcohol abuse increased the risk of suicide threefold, whether or
not the subject lived alone, the study said, but "nondrinking
individuals who lived with others who drank were not at increased
risk of suicide."

The study said, "Alcohol impairs judgment, possibly causing
individuals to place themselves in situations at high risk of
violence."

But the use of illegal drugs by those younger than 50, the study
found, was associated with a higher incidence of suicide both
among drug users and those who lived with them. Drug use was too
infrequent to be measured in those over 50.

The link between violence and drug use, the researchers
suggested, may result from "drugseeking activities, such as
interaction with drug dealers and theft to obtain resources for
drug purchase."

The study reported that drug abuse in a home increased a woman's
risk of being killed by a spouse, lover or close relative by 28
times.

"That the true risk factor may be the drug culture environment is
supported by our finding that even nondrug users who lived in
households where illicitdrug use occurred were at greatly
increased risk of homicide," it said.

Commenting on the study, Susan Ohanesian of Project Return, an
organization in New York that helps people overcome problems
resulting from substance abuse, said there was a broader pattern
of violence in homes where alcohol and other drugs were used to
excess.

"You see high levels of depression and very low levels of self
esteem as the abused person comes to believe they deserve the
abuse," Ohanesian said. "It's one of the most difficult
challenges to overcome."

Ohanesian, the senior director of substanceabuse services, said
the risk of violence was there whether a domestic partner
abstained from alcohol and other drugs or not.

In addition to Rivara, the authors of the study included Dr. Beth
Mueller and Carmen Mendoza in Seattle; Dr. Grant Somes in
Memphis; Dr. Norman Rushforth in Cleveland; and Dr. Arthur
Kellermann in Atlanta. They cautioned that the study was limited
to homicides and suicides in homes and said that the dynamic of
violent deaths outside might be quite different.

They also acknowledged that alcoholism and drug abuse, rather
than causing killings and suicides, "may play a role solely as
markers for other risk factors" such as antisocial behavior, or
a history of mental illness or depression.