According to the CDC, excessive drinking includes binge drinking — defined as five or more drinks on a single occasion for men and four or more for women — and heavy drinking — defined as 15 or more drinks a week for men and eight or more for women.
Excessive drinking is indisputably bad for your health. Yet, because alcohol consumption is also income-dependent — the CDC reports households earning at least $75,000 a year are more likely to drink excessively — the heaviest drinking cities tend to be healthier and more prosperous than the driest cities. In all of the 20 heaviest drinking cities a smaller share of adults report being in fair or poor health than the 15.0% national share. Similarly, 18 of the 20 heaviest drinking cities have a lower premature death rate than the nationwide rate. The opposite is generally true in cities with the lowest excessive drinking rates.
In an interview with 24/7 Wall St., Aaron White, Senior Scientific Advisor to the Director of the National Institute of Alcohol Abuse and Alcoholism, explained the apparent contradiction.
“Alcohol is just one of many health related variables,” White said. Understanding that excessive alcohol consumption is more common in higher-income areas, the same people who can afford to drink excessively can also afford otherwise healthy lifestyles. “We know that people that have more money have better access to health care and they have better access to healthier food,” White said.
Bars are more accessible in cities with high excessive drinking rates. Nationwide, there are about 1.3 bars for every 10,000 people. In 15 of the 20 heaviest drinking cities, the concentration of bars is at least double the national ratio. Conversely, 16 of the driest U.S. cities have a lower concentration of bars than the U.S. as a whole. “You have to have access to alcohol to consume it, and essentially wherever there are more outlets for alcohol, there is more alcohol consumption,” White said.
Binge drinking is the most common form of excessive drinking, and younger adults are more likely than older adults to binge drink. Of the 20 heaviest drinking cities, in 13 the median age is lower than the 37.8 year national median. On the other end of the spectrum, 15 of the 20 driest cities are older than the nation as a whole. “We know that age is associated with alcohol consumption,” White confirmed.
Similarly, heavy drinking cities are more likely to have a disproportionately high share of college or graduate students than drier cities. While the gap in excessive drinking rates between colleges and non-college areas has closed in recent years, “there is more alcohol use at colleges than in the towns surrounding them,” White said.