America’s Drunkest States

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50. Tennessee
> Adults drinking excessively: 11.2%
> Alcohol-related driving deaths: 28.0% (11th lowest)
> Adults in fair or poor health: 19.9% (9th highest)
> Drunkest metro area: Nashville-Davidson–Murfreesboro–Franklin

Binge or heavy drinking is less of a problem in Tennessee than in any other state. However, it is not a rarity either as 11.2% of the adult population drinks excessively. Nationwide, a much higher percentage of adults report excessive drinking, at 18.0%.

Excessive drinking over time can lead to a myriad serious and potentially fatal health issues, including certain cancers, high blood pressure, and cardiovascular disease. Despite the relatively few adults who binge drink or drink heavily, Tennessee has one of the highest premature death rates of any state. For every 100,000 state residents, 436 die before age 75, the eighth highest premature death rate among states. Perhaps the adult smoking rate of 21.9% — the seventh highest share among all states — contributes to the higher premature death rate.

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49. West Virginia
> Adults drinking excessively: 11.4%
> Alcohol-related driving deaths: 32.0% (25th lowest)
> Adults in fair or poor health: 23.7% (the highest)
> Drunkest metro area: Morgantown, WV

Only 11.4% of adults binge or heavily drink in West Virginia, much less than the 18.0% of adults who binge or heavily drink nationwide. States with lower excessive drinking rates are often home to lower income populations; and West Virginia is no exception. The state’s median household income of $43,385 is well below the median household income nationwide of $57,617, and the second lowest of any state.

Alcohol consumption is just one of many behavioral factors that can affect health outcomes and as a result, areas with low excessive drinking rates are not necessarily the healthiest. In West Virginia, nearly 24% of adults are in fair or poor health, the largest share of any state.

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48. Utah
> Adults drinking excessively: 12.4%
> Alcohol-related driving deaths: 19.7% (the lowest)
> Adults in fair or poor health: 12.9% (6th lowest)
> Drunkest metro area: Salt Lake City, UT

In Utah, 12.4% of adults report excessive drinking, well below the 18.0% share of adults nationwide who either binge drink or drink heavily. States with a lower share of adults drinking excessively tend to have lower rates of alcohol-related driving deaths. Only 19.7% of driving deaths in Utah involve alcohol, the lowest alcohol-related driving death rate of any state and far below nationwide rate of 30.0%.

Low excessive drinking rates in Utah are partially attributable to religious faith. Over half of the state’s population identify as Mormon, a religion that expressly forbids alcohol consumption.

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47. Alabama
> Adults drinking excessively: 13.0%
> Alcohol-related driving deaths: 29.4% (17th lowest)
> Adults in fair or poor health: 21.2% (4th highest)
> Drunkest metro area: Auburn-Opelika, AL

In Alabama, 13.0% of adults drink to excess on a regular basis. This is a considerably lower share than the 18.0% of adults who binge or drink heavily nationwide. Although excessive drinking can lead to serious health problems, including liver cancer and cardiovascular disease, states with lower shares of adults drinking excessively are often less healthy than states reporting higher shares of excessive drinking. An estimated 21.2% of adults in Alabama are in fair or poor health, the fourth largest share of any state.

Alcohol consumption is only one factor that can affect health. While Alabama adults drink less, many struggle with other health issues. For example, an estimated 34.0% of adults are obese, the fifth highest share among states.

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46. Mississippi
> Adults drinking excessively: 13.3%
> Alcohol-related driving deaths: 23.3% (3rd lowest)
> Adults in fair or poor health: 22.2% (3rd highest)
> Drunkest metro area: Gulfport-Biloxi-Pascagoula, MS

Just 13.3% of adults in this Southern state binge or heavily drink, much less than the comparable national share of 18.0%. Despite the link between excessive drinking and a myriad of health problems, states with lower drinking rates tend to report worse health outcomes than states with higher drinking rates. In Mississippi, 22.2% of adults report being in fair or poor health — the third largest share of any state. This could be a function of income, as states with lower drinking rates also tend to have lower incomes, and poorer states generally report poorer health outcomes. Mississippi has the lowest median household income of all states at $41,754 a year and the highest poverty rate at 20.8%.

While excessive drinking is never healthy, it is only one behavioral factor that can affect health. For example, lack of exercise can lead to obesity and heart problems, and in Mississippi, 31.9% of adults lead completely sedentary lives, the highest share among all states and well above the national average of 22.0%.