Though alcohol is enjoyed responsibly by millions of Americans every day, it is also misused by many — and over consumption can have serious consequences. Excessive drinking is the third leading preventable cause of death in the United States.
About a fifth of American adults regularly consumed unhealthy amounts of alcohol in 2018, the latest year for which data is available.
Appleton in the state of Wisconsin is the metro area with the highest share of adults who drink excessively in the U.S., at 30.8%.
Excessive drinking includes both binge and heavy drinking. Heavy drinking is defined as consuming at least 15 drinks a week or averaging two or more drinks a day for men, according to the CDC. For women, it’s eight drinks or more per week or more than one drink on average a day. Binge drinking is defined as a pattern of alcohol consumption that brings a person’s blood alcohol concentration level to 0.08% or higher — estimated to take about five or more drinks within two hours for men and four or more drinks for women.
Excessive alcohol consumption rates appear associated with some economic factors. Alcohol can be expensive, and people’s ability to drink to excess can be limited by their income. In Appleton, the median household income is $68,335 a year, or $2,623 more than the annual national median of $65,712.
Fatal car accidents that involve alcohol appear to be more common in the cities with the highest excessive drinking rates. Nationwide, 27.0% of all driving deaths involve alcohol. In Appleton, 31.1% of fatal car accidents are alcohol related.
To identify the U.S. metro areas with the highest excessive drinking rates, 24/7 Wall St. reviewed the percentage of adults 18 and older who report binge or heavy drinking within a 30-day period across all 382 metro areas in the country. Data came from the 2021 County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. These are the 50 drunkest cities in America.
| Metro area | State | Excessive drinking rate | Pct. alcohol-related driving deaths | Median household income |
|---|---|---|---|---|
| Appleton | Wisconsin | 30.8% | 31.1% | $68,335 |
| Dubuque | Iowa | 28.1% | 15.6% | $62,178 |
| Sheboygan | Wisconsin | 27.9% | 31.5% | $60,706 |
| Green Bay | Wisconsin | 27.8% | 42.9% | $65,026 |
| Oshkosh-Neenah | Wisconsin | 27.6% | 31.4% | $58,347 |
| Madison | Wisconsin | 27.6% | 31.7% | $75,545 |
| Fond du Lac | Wisconsin | 26.5% | 31.6% | $65,329 |
| Barnstable Town | Massachusetts | 26.5% | 37.3% | $85,042 |
| La Crosse-Onalaska | Wisconsin | 26.4% | 26.0% | $59,608 |
| Waterloo-Cedar Falls | Iowa | 26.4% | 18.2% | $63,131 |
| Pittsfield | Massachusetts | 26.4% | 27.7% | $58,895 |
| Wausau-Weston | Wisconsin | 26.1% | 17.2% | $65,094 |
| Eau Claire | Wisconsin | 25.9% | 37.7% | $63,460 |
| Milwaukee-Waukesha | Wisconsin | 25.4% | 30.5% | $65,845 |
| Lincoln | Nebraska | 25.3% | 29.4% | $61,539 |
| Duluth | Minnesota | 25.2% | 34.5% | $60,316 |
| Racine | Wisconsin | 25.2% | 36.4% | $60,779 |
| Janesville-Beloit | Wisconsin | 25.1% | 42.1% | $61,243 |
| Des Moines-West Des Moines | Iowa | 24.7% | 35.0% | $71,164 |
| San Luis Obispo-Paso Robles | California | 24.4% | 40.5% | $77,265 |
| North Port-Sarasota-Bradenton | Florida | 24.4% | 26.4% | $65,526 |
| Portland-South Portland | Maine | 24.2% | 30.4% | $71,913 |
| Hilton Head Island-Bluffton | South Carolina | 24.1% | 26.7% | $71,252 |
| Omaha-Council Bluffs | Nebraska | 23.9% | 32.9% | $70,373 |
| Ames | Iowa | 23.7% | 20.0% | $62,181 |
| Santa Rosa-Petaluma | California | 23.6% | 32.7% | $87,828 |
| St. Cloud | Minnesota | 23.5% | 28.6% | $66,076 |
| Missoula | Montana | 23.5% | 36.2% | $57,347 |
| Cedar Rapids | Iowa | 23.4% | 18.3% | $64,088 |
| Boston-Cambridge-Newton | Massachusetts | 23.3% | 29.7% | $94,430 |
| Iowa City | Iowa | 23.3% | 25.9% | $63,761 |
| Cape Coral-Fort Myers | Florida | 23.2% | 24.4% | $62,240 |
| Fort Collins | Colorado | 23.2% | 32.6% | $75,186 |
| The Villages | Florida | 23.1% | 13.1% | $60,287 |
| Sioux Falls | South Dakota | 23.1% | 27.4% | $65,566 |
| Kahului-Wailuku-Lahaina | Hawaii | 23.0% | 49.0% | $80,754 |
| Rapid City | South Dakota | 23.0% | 34.3% | $58,361 |
| Minneapolis-St. Paul-Bloomington | Minnesota | 22.9% | 31.4% | $83,698 |
| Springfield | Massachusetts | 22.8% | 31.1% | $62,346 |
| Monroe | Michigan | 22.8% | 40.6% | $62,839 |
| Albany-Schenectady-Troy | New York | 22.7% | 24.1% | $73,398 |
| Billings | Montana | 22.7% | 37.0% | $60,962 |
| Napa | California | 22.6% | 39.7% | $92,769 |
| Deltona-Daytona Beach-Ormond Beach | Florida | 22.5% | 22.2% | $54,533 |
| Fargo | North Dakota | 22.5% | 36.5% | $62,820 |
| Norwich-New London | Connecticut | 22.4% | 35.2% | $75,633 |
| Bay City | Michigan | 22.4% | 34.0% | $49,610 |
| Scranton–Wilkes-Barre | Pennsylvania | 22.4% | 27.2% | $54,304 |
| Buffalo-Cheektowaga | New York | 22.4% | 17.5% | $60,105 |
| Reno | Nevada | 22.3% | 38.9% | $72,132 |
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