Heavy Alcohol and Other Substance Use Are Elevated in Mass Violence-Affected Communities

The present study aimed to characterize the prevalence and correlates of legal and illicit substance use, misuse (use of prescription medication other than prescribed), and hazardous use, including alcohol, cannabis, prescription drugs, and illicit drugs, among adults residing in communities that had experienced a mass violence incident (MVI).

Using a household probability sample of adults (N = 5,991; 53.5% female; 70.6% White) from six MVI-affected communities, respondents completed surveys assessing sociodemographic characteristics, MVI-related experiences (i.e., degree of exposure), psychological risk factors (e.g., social support), probable mental health diagnoses, legal and illicit substance use, substance misuse, and hazardous use.

Weighted prevalence estimates indicated that approximately one in five MVI-affected residents reported past-month binge drinking, with nearly one in ten reporting heavy alcohol use. Illicit substance use, substance misuse, and hazardous use were also prevalent. Several factors were consistently associated with increased odds of substance use outcomes, including high MVI exposure (OR = 2.01, 95% CI [1.30-3.10]), low social support (OR = 1.30, 95% CI [1.08-1.56]), and co-occurring PTSD and depression (OR = 3.95, 95% CI [2.87-5.46]). These associations were generally consistent across past-month binge drinking and heavy alcohol use, as well as cannabis use, illicit substance use, and hazardous use since the MVI.

Findings suggest that substance use, particularly heavy alcohol use and hazardous substance use, is prevalent among adults residing in MVI-affected communities. Adults with limited socioeconomic resources, fear of subsequent MVIs, prior criminal victimization, and co-occurring PTSD and depression appear most vulnerable to hazardous substance use and illicit substance use. These results can inform substance use screening and intervention efforts as part of broader community recovery planning.