Alcohol poisoning and alcohol-related liver diseases are major contributors to the recently identified spike in mortality among middle aged, white Americans. Alcohol is the fourth leading cause of preventable death in the United States, claiming nearly 88,000 lives a year, according to the Centers for Disease Control and Prevention (CDC).

Across the country, the share of adults who drink to excess varies widely. While nationwide, 18% of adults drink unhealthy amounts of alcohol on average, only 9.2% do in Provo-Orem, Utah, and as many as 26.8% do in Appleton, Wisconsin. To identify the drunkest and least drunk cities in the United States, 24/7 Wall St. reviewed self-reported binge and heavy drinking rates among adults in U.S. metro areas from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.

Excessive drinking can take the form of binge drinking or heavy drinking. The CDC defines binge drinking as consuming four or more drinks for women and five or more drinks for men during a single sitting. Heavy drinking is defined as some 15 or more drinks consumed per week for men and eight or more drinks for women.

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Excessive alcohol consumption can lead to serious and often fatal health consequences. According to the CDC, negative health outcomes associated with heavy drinking include liver disease, neurological damage, and cardiovascular diseases.

Excessive alcohol consumption is only one aspect of a less healthy lifestyle, and it alone may not lead to poorer health. In fact, many of the cities with a relatively high share of binge and heavy drinkers actually rank better than most U.S. cities in certain health measures, reporting less frequent physically and mentally unhealthy days and lower premature death rates. This is likely because cities with the highest binge drinking rates also tend to have higher incomes, higher insurance coverage rates, more physically active populations, and lower smoking rates than the cities with the lowest binge drinking rates, which may help to offset or mitigate the harms from alcohol abuse.

While excessive drinking rates may not lead to overall poorer health, it can lead to riskier behavior. Drunk driving accounts for 31.0% of roadway fatalities nationwide. In many of the cities with the highest excessive drinking rates, the share of deadly car accidents attributable to alcohol is far higher. In Green Bay, Wisconsin, for example, a city where over a quarter of adults drink excessively, 47.5% of fatal car accidents involve alcohol, the seventh highest share in the country. Meanwhile, only a quarter of the cities with the lowest excessive drinking rates have a higher than average share of alcohol-related roadway fatalities.

While a recent report published by the CDC found that alcohol consumption takes a tremendous $249 billion toll on the economy, alcohol can also be a boon for certain local businesses. There are an average of 1.6 bars for every 10,000 residents across the metro areas examined. With the exception of Corvallis, Oregon, each of the 20 cities with the highest excessive drinking rates has at least that many bars per capita. The Lacrosse-Onalaska metro area, parts of which are in Wisconsin and Minnesota, is the city with the sixth highest excessive drinking rate. The region has 6.9 bars for every 10,000 residents, more than any other U.S. metro area. Perhaps not surprisingly, the vast majority of the 20 cities with the lowest drinking rates have fewer than one bar for every 10,000 residents.

Alcohol is expensive, and the CDC reports that binge drinking is more common in households that earn at least $75,000 a year. While the median household income in the majority of cities with the highest excessive drinking rates is roughly in line with the $53,657 national median, the cities with the lowest excessive drinking rates tend to be relatively poor. Three-quarters of the cities with the lowest excessive drinking rates have a higher poverty rate than the nation as a whole.

To identify the U.S. cities with the highest and lowest excessive drinking rates, 24/7 Wall St. reviewed the percentage of adults who report binge or heavy drinking across 381 metro areas. Metro level data were aggregated from county level data provided by County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. All data are as of the most recent available year. Median household income and poverty data came from the U.S. Census Bureau’s American Community Survey. The number of bars per capita came from the Bureau of Labor Statistics. Health outcomes, including the number of potential lives lost per 100,000 people due to premature death annually and the percentage of adults who report fair or poor health were also aggregated from county-level data obtained from County Health Rankings & Roadmaps.

These are the drunkest and driest cities in America.