Alcohol is a superlative social lubricant — an icebreaker on the rocks — as well as an inspiration for art and literature, an attitude-adjuster, and often just a pure sensory pleasure. It can also, in moderation, have possible health benefits. That’s the good news.
The bad news is that alcohol also kills. It is implicated in three of the 12 leading causes of death in America — cancer, suicide, and liver disease — and in addition, an average of 29 people die every day of the year in this country in motor vehicle accidents involving alcohol-impaired drivers.
In all, the Centers for Disease Control and Prevention (CDC) estimates that alcohol directly or indirectly claims an annual average of 88,000 American lives. The CDC defines excessive alcohol use as binge drinking (five or more drinks on one occasion for men, four or more for women) or heavy drinking (15 or more drinks per week for men, eight or more for women) — and notes that more than half of these deaths are due to binge drinking.
The alcohol level for women is lower because women metabolize alcohol differently than men, making them more vulnerable to its effects. Nonetheless, excessive alcohol use is among the health problems that afflict more men than women.
The rates of death, illness, and injury related to alcohol consumption vary widely from state to state and city to city, with a number of factors affecting drinking behavior. According to a paper called “Social and Cultural Contexts of Alcohol Use,” published in Alcohol Research: The Journal of the National Institute on Alcohol Abuse and Alcoholism, these factors are: advertising, marketing, and social media; the influences of discrimination and immigration; community characteristics (for instance, people living in places with inferior housing, water, and sanitation facilities often turn to heavy drinking for relief); cultural norms (including beliefs regarding appropriate consumption levels); and the influences of family and peers.
Click here to see the drunkest city in every state
Click here to read our methodology
Another paper published in Alcohol Research compared drinking patterns in urban and rural areas of the country. While this study discovered that urban residents were more likely to report lifetime alcohol use than rural residents, both groups had similar risks for lifetime alcohol dependence.
When 24/7 Wall St. compiled this list, we found the list included both sizable metropolitan areas (like those of Boston and San Diego) and small ones (like Fairbanks, Alaska, and Dover, Delaware). It seems safe to say, however, that people in all of these cities drink too much and would be considerably healthier if they reduced consumption. These are the 25 healthiest cities in America.
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Alabama: Auburn-Opelika
> Adults binge or heavy drinking: 18.4%
> Alabama adults binge or heavy drinking: 14.2% (5th lowest)
> Alcohol related driving deaths: 30.7%
> Alabama Alcohol related driving deaths: 28.6% (17th lowest)
> Median household income: $52,943
> Alabama median annual income: $48,123 (6th lowest)
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Alaska: Fairbanks
> Adults binge or heavy drinking: 23.5%
> Alaska adults binge or heavy drinking: 19.1% (20th highest)
> Alcohol related driving deaths: 36.2%
> Alaska Alcohol related driving deaths: 36.6% (4th highest)
> Median household income: $76,747
> Alaska median annual income: $73,181 (7th highest)
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Arizona: Flagstaff
> Adults binge or heavy drinking: 19.9%
> Arizona adults binge or heavy drinking: 17.3% (14th lowest)
> Alcohol related driving deaths: 25.4%
> Arizona Alcohol related driving deaths: 26.6% (11th lowest)
> Median household income: $54,893
> Arizona median annual income: $56,581 (23rd lowest)
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Arkansas: Fayetteville-Springdale-Rogers, AR-MO
> Adults binge or heavy drinking: 17.3%
> Arkansas adults binge or heavy drinking: 15.9% (9th lowest)
> Alcohol related driving deaths: 27.2%
> Arkansas Alcohol related driving deaths: 26.3% (10th lowest)
> Median household income: $56,038
> Arkansas median annual income: $45,869 (3rd lowest)
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California: San Diego-Carlsbad
> Adults binge or heavy drinking: 21.9%
> California adults binge or heavy drinking: 17.8% (21st lowest)
> Alcohol related driving deaths: 28.3%
> California Alcohol related driving deaths: 29.8% (23rd lowest)
> Median household income: $76,207
> California median annual income: $71,805 (8th highest)
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Colorado: Boulder
> Adults binge or heavy drinking: 23.6%
> Colorado adults binge or heavy drinking: 20.6% (9th highest)
> Alcohol related driving deaths: 27.5%
> Colorado Alcohol related driving deaths: 34.4% (14th highest)
> Median household income: $80,834
> Colorado median annual income: $69,117 (11th highest)
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Connecticut: Bridgeport-Stamford-Norwalk
> Adults binge or heavy drinking: 19.8%
> Connecticut adults binge or heavy drinking: 18.4% (23rd lowest)
> Alcohol related driving deaths: 32.6%
> Connecticut Alcohol related driving deaths: 33.0% (18th highest)
> Median household income: $91,198
> Connecticut median annual income: $74,168 (5th highest)
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Delaware: Dover
> Adults binge or heavy drinking: 16.4%
> Delaware adults binge or heavy drinking: 18.4% (24th lowest)
> Alcohol related driving deaths: 33.3%
> Delaware Alcohol related driving deaths: 33.8% (15th highest)
> Median household income: $57,608
> Delaware median annual income: $62,852 (17th highest)
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Florida: Tallahassee
> Adults binge or heavy drinking: 20.9%
> Florida adults binge or heavy drinking: 17.5% (19th lowest)
> Alcohol related driving deaths: 32.7%
> Florida Alcohol related driving deaths: 24.7% (8th lowest)
> Median household income: $50,825
> Florida median annual income: $52,594 (12th lowest)
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Georgia: Savannah
> Adults binge or heavy drinking: 17.8%
> Georgia adults binge or heavy drinking: 15.1% (7th lowest)
> Alcohol related driving deaths: 24.5%
> Georgia Alcohol related driving deaths: 22.4% (6th lowest)
> Median household income: $56,610
> Georgia median annual income: $56,183 (19th lowest)
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Hawaii: Kahului-Wailuku-Lahaina
> Adults binge or heavy drinking: 20.0%
> Hawaii adults binge or heavy drinking: 20.3% (13th highest)
> Alcohol related driving deaths: 53.1%
> Hawaii Alcohol related driving deaths: 34.4% (12th highest)
> Median household income: $80,183
> Hawaii median annual income: $77,765 (3rd highest)
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Idaho: Coeur d’Alene
> Adults binge or heavy drinking: 18.9%
> Idaho adults binge or heavy drinking: 17.4% (16th lowest)
> Alcohol related driving deaths: 40.3%
> Idaho Alcohol related driving deaths: 31.4% (21st highest)
> Median household income: $57,219
> Idaho median annual income: $52,225 (11th lowest)
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Illinois: Bloomington
> Adults binge or heavy drinking: 22.5%
> Illinois adults binge or heavy drinking: 21.1% (6th highest)
> Alcohol related driving deaths: 33.8%
> Illinois Alcohol related driving deaths: 32.6% (19th highest)
> Median household income: $65,936
> Illinois median annual income: $62,992 (16th highest)
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Indiana: Bloomington
> Adults binge or heavy drinking: 20.5%
> Indiana adults binge or heavy drinking: 18.6% (23rd highest)
> Alcohol related driving deaths: 14.3%
> Indiana Alcohol related driving deaths: 20.8% (2nd lowest)
> Median household income: $49,043
> Indiana median annual income: $54,181 (17th lowest)
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Iowa: Iowa City
> Adults binge or heavy drinking: 24.2%
> Iowa adults binge or heavy drinking: 22.1% (4th highest)
> Alcohol related driving deaths: 27.1%
> Iowa Alcohol related driving deaths: 28.0% (15th lowest)
> Median household income: $60,888
> Iowa median annual income: $58,570 (25th highest)
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Kansas: Manhattan
> Adults binge or heavy drinking: 22.6%
> Kansas adults binge or heavy drinking: 17.4% (17th lowest)
> Alcohol related driving deaths: 20.0%
> Kansas Alcohol related driving deaths: 23.6% (7th lowest)
> Median household income: $50,698
> Kansas median annual income: $56,422 (21st lowest)
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Kentucky: Louisville/Jefferson County, KY-IN
> Adults binge or heavy drinking: 18.6%
> Kentucky adults binge or heavy drinking: 15.8% (8th lowest)
> Alcohol related driving deaths: 26.6%
> Kentucky Alcohol related driving deaths: 27.3% (13th lowest)
> Median household income: $57,279
> Kentucky median annual income: $48,375 (7th lowest)
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Louisiana: Lake Charles
> Adults binge or heavy drinking: 20.4%
> Louisiana adults binge or heavy drinking: 18.5% (25th lowest)
> Alcohol related driving deaths: 35.4%
> Louisiana Alcohol related driving deaths: 34.4% (13th highest)
> Median household income: $52,314
> Louisiana median annual income: $46,145 (4th lowest)
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Maine: Portland-South Portland
> Adults binge or heavy drinking: 21.9%
> Maine adults binge or heavy drinking: 20.5% (12th highest)
> Alcohol related driving deaths: 38.0%
> Maine Alcohol related driving deaths: 37.4% (3rd highest)
> Median household income: $68,570
> Maine median annual income: $56,277 (20th lowest)
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Maryland: California-Lexington Park
> Adults binge or heavy drinking: 17.9%
> Maryland adults binge or heavy drinking: 16.5% (10th lowest)
> Alcohol related driving deaths: 41.4%
> Maryland Alcohol related driving deaths: 29.9% (24th lowest)
> Median household income: $81,495
> Maryland median annual income: $80,776 (the highest)
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Massachusetts: Boston-Cambridge-Newton, MA-NH
> Adults binge or heavy drinking: 21.4%
> Massachusetts adults binge or heavy drinking: 20.1% (15th highest)
> Alcohol related driving deaths: 29.8%
> Massachusetts Alcohol related driving deaths: 29.2% (20th lowest)
> Median household income: $85,691
> Massachusetts median annual income: $77,385 (4th highest)
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Michigan: Ann Arbor
> Adults binge or heavy drinking: 24.6%
> Michigan adults binge or heavy drinking: 20.5% (11th highest)
> Alcohol related driving deaths: 28.4%
> Michigan Alcohol related driving deaths: 29.1% (18th lowest)
> Median household income: $70,286
> Michigan median annual income: $54,909 (18th lowest)
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Minnesota: Mankato-North Mankato
> Adults binge or heavy drinking: 25.4%
> Minnesota adults binge or heavy drinking: 22.9% (3rd highest)
> Alcohol related driving deaths: 18.2%
> Minnesota Alcohol related driving deaths: 29.3% (21st lowest)
> Median household income: $61,241
> Minnesota median annual income: $68,388 (12th highest)
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Mississippi: Hattiesburg
> Adults binge or heavy drinking: 15.6%
> Mississippi adults binge or heavy drinking: 13.7% (4th lowest)
> Alcohol related driving deaths: 18.4%
> Mississippi Alcohol related driving deaths: 21.2% (4th lowest)
> Median household income: $46,167
> Mississippi median annual income: $43,529 (2nd lowest)
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Missouri: Columbia
> Adults binge or heavy drinking: 20.8%
> Missouri adults binge or heavy drinking: 19.5% (18th highest)
> Alcohol related driving deaths: 31.0%
> Missouri Alcohol related driving deaths: 29.1% (19th lowest)
> Median household income: $51,340
> Missouri median annual income: $53,578 (15th lowest)
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Montana: Missoula
> Adults binge or heavy drinking: 26.0%
> Montana adults binge or heavy drinking: 20.7% (7th highest)
> Alcohol related driving deaths: 36.6%
> Montana Alcohol related driving deaths: 44.7% (2nd highest)
> Median household income: $54,311
> Montana median annual income: $53,386 (14th lowest)
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Nebraska: Lincoln
> Adults binge or heavy drinking: 24.7%
> Nebraska adults binge or heavy drinking: 21.1% (5th highest)
> Alcohol related driving deaths: 27.0%
> Nebraska Alcohol related driving deaths: 34.8% (11th highest)
> Median household income: $60,057
> Nebraska median annual income: $59,970 (21st highest)
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Nevada: Reno
> Adults binge or heavy drinking: 21.1%
> Nevada adults binge or heavy drinking: 17.6% (20th lowest)
> Alcohol related driving deaths: 38.1%
> Nevada Alcohol related driving deaths: 30.6% (25th lowest)
> Median household income: $61,360
> Nevada median annual income: $58,003 (25th lowest)
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New Hampshire: Manchester-Nashua
> Adults binge or heavy drinking: 19.7%
> New Hampshire adults binge or heavy drinking: 20.1% (16th highest)
> Alcohol related driving deaths: 27.8%
> New Hampshire Alcohol related driving deaths: 31.3% (22nd highest)
> Median household income: $78,769
> New Hampshire median annual income: $73,381 (6th highest)
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New Jersey: Ocean City
> Adults binge or heavy drinking: 18.8%
> New Jersey adults binge or heavy drinking: 17.1% (13th lowest)
> Alcohol related driving deaths: 35.1%
> New Jersey Alcohol related driving deaths: 22.3% (5th lowest)
> Median household income: $66,953
> New Jersey median annual income: $80,088 (2nd highest)
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New Mexico: Las Cruces
> Adults binge or heavy drinking: 17.3%
> New Mexico adults binge or heavy drinking: 16.6% (11th lowest)
> Alcohol related driving deaths: 29.8%
> New Mexico Alcohol related driving deaths: 31.3% (23rd highest)
> Median household income: $37,144
> New Mexico median annual income: $46,744 (5th lowest)
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New York: Kingston
> Adults binge or heavy drinking: 23.4%
> New York adults binge or heavy drinking: 18.8% (22nd highest)
> Alcohol related driving deaths: 20.2%
> New York Alcohol related driving deaths: 21.0% (3rd lowest)
> Median household income: $63,621
> New York median annual income: $64,894 (14th highest)
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North Carolina: Jacksonville
> Adults binge or heavy drinking: 22.6%
> North Carolina adults binge or heavy drinking: 16.7% (12th lowest)
> Alcohol related driving deaths: 33.6%
> North Carolina Alcohol related driving deaths: 29.7% (22nd lowest)
> Median household income: $49,883
> North Carolina median annual income: $52,752 (13th lowest)
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North Dakota: Grand Forks, ND-MN
> Adults binge or heavy drinking: 24.7%
> North Dakota adults binge or heavy drinking: 25.9% (2nd highest)
> Alcohol related driving deaths: 29.5%
> North Dakota Alcohol related driving deaths: 46.3% (the highest)
> Median household income: $48,609
> North Dakota median annual income: $61,843 (18th highest)
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Ohio: Columbus
> Adults binge or heavy drinking: 19.4%
> Ohio adults binge or heavy drinking: 19.1% (21st highest)
> Alcohol related driving deaths: 30.8%
> Ohio Alcohol related driving deaths: 33.1% (17th highest)
> Median household income: $63,764
> Ohio median annual income: $54,021 (16th lowest)
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Oklahoma: Tulsa
> Adults binge or heavy drinking: 14.0%
> Oklahoma adults binge or heavy drinking: 12.8% (2nd lowest)
> Alcohol related driving deaths: 31.2%
> Oklahoma Alcohol related driving deaths: 27.1% (12th lowest)
> Median household income: $52,275
> Oklahoma median annual income: $50,051 (8th lowest)
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Oregon: Medford
> Adults binge or heavy drinking: 20.7%
> Oregon adults binge or heavy drinking: 18.5% (24th highest)
> Alcohol related driving deaths: 37.4%
> Oregon Alcohol related driving deaths: 31.4% (20th highest)
> Median household income: $51,409
> Oregon median annual income: $60,212 (20th highest)
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Pennsylvania: State College
> Adults binge or heavy drinking: 23.3%
> Pennsylvania adults binge or heavy drinking: 20.5% (10th highest)
> Alcohol related driving deaths: 22.7%
> Pennsylvania Alcohol related driving deaths: 28.3% (16th lowest)
> Median household income: $55,895
> Pennsylvania median annual income: $59,195 (24th highest)
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Rhode Island: Providence-Warwick, RI-MA
> Adults binge or heavy drinking: 19.6%
> Rhode Island adults binge or heavy drinking: 17.4% (18th lowest)
> Alcohol related driving deaths: 34.1%
> Rhode Island Alcohol related driving deaths: 35.6% (8th highest)
> Median household income: $65,226
> Rhode Island median annual income: $63,870 (15th highest)
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South Carolina: Charleston-North Charleston
> Adults binge or heavy drinking: 21.4%
> South Carolina adults binge or heavy drinking: 18.5% (25th highest)
> Alcohol related driving deaths: 34.9%
> South Carolina Alcohol related driving deaths: 35.5% (9th highest)
> Median household income: $60,546
> South Carolina median annual income: $50,570 (9th lowest)
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South Dakota: Sioux Falls
> Adults binge or heavy drinking: 19.8%
> South Dakota adults binge or heavy drinking: 20.2% (14th highest)
> Alcohol related driving deaths: 27.4%
> South Dakota Alcohol related driving deaths: 35.8% (5th highest)
> Median household income: $64,882
> South Dakota median annual income: $56,521 (22nd lowest)
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Tennessee: Nashville-Davidson-Murfreesboro-Franklin
> Adults binge or heavy drinking: 16.7%
> Tennessee adults binge or heavy drinking: 14.4% (6th lowest)
> Alcohol related driving deaths: 25.5%
> Tennessee Alcohol related driving deaths: 26.2% (9th lowest)
> Median household income: $63,939
> Tennessee median annual income: $51,340 (10th lowest)
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Texas: Austin-Round Rock
> Adults binge or heavy drinking: 22.2%
> Texas adults binge or heavy drinking: 19.4% (19th highest)
> Alcohol related driving deaths: 29.3%
> Texas Alcohol related driving deaths: 27.7% (14th lowest)
> Median household income: $73,800
> Texas median annual income: $59,206 (23rd highest)
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Utah: Salt Lake City
> Adults binge or heavy drinking: 16.0%
> Utah adults binge or heavy drinking: 13.4% (3rd lowest)
> Alcohol related driving deaths: 23.8%
> Utah Alcohol related driving deaths: 20.4% (the lowest)
> Median household income: $71,510
> Utah median annual income: $68,358 (13th highest)
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Vermont: Burlington-South Burlington
> Adults binge or heavy drinking: 21.8%
> Vermont adults binge or heavy drinking: 20.6% (8th highest)
> Alcohol related driving deaths: 40.0%
> Vermont Alcohol related driving deaths: 35.2% (10th highest)
> Median household income: $63,160
> Vermont median annual income: $57,513 (24th lowest)
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Virginia: Blacksburg-Christiansburg-Radford
> Adults binge or heavy drinking: 19.0%
> Virginia adults binge or heavy drinking: 17.4% (15th lowest)
> Alcohol related driving deaths: 23.3%
> Virginia Alcohol related driving deaths: 31.1% (24th highest)
> Median household income: $52,075
> Virginia median annual income: $71,535 (9th highest)
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Washington: Bellingham
> Adults binge or heavy drinking: 20.6%
> Washington adults binge or heavy drinking: 18.2% (22nd lowest)
> Alcohol related driving deaths: 19.8%
> Washington Alcohol related driving deaths: 33.1% (16th highest)
> Median household income: $61,186
> Washington median annual income: $70,979 (10th highest)
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West Virginia: Morgantown
> Adults binge or heavy drinking: 16.7%
> West Virginia adults binge or heavy drinking: 11.8% (the lowest)
> Alcohol related driving deaths: 28.0%
> West Virginia Alcohol related driving deaths: 30.7% (25th highest)
> Median household income: $49,475
> West Virginia median annual income: $43,469 (the lowest)
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Wisconsin: Madison
> Adults binge or heavy drinking: 28.7%
> Wisconsin adults binge or heavy drinking: 26.2% (the highest)
> Alcohol related driving deaths: 30.7%
> Wisconsin Alcohol related driving deaths: 35.8% (6th highest)
> Median household income: $71,301
> Wisconsin median annual income: $59,305 (22nd highest)
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Wyoming: Casper
> Adults binge or heavy drinking: 19.8%
> Wyoming adults binge or heavy drinking: 19.9% (17th highest)
> Alcohol related driving deaths: 36.8%
> Wyoming Alcohol related driving deaths: 35.7% (7th highest)
> Median household income: $60,546
> Wyoming median annual income: $60,434 (19th highest)
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Methodology
To identify the drunkest city in each state, 24/7 Wall St. reviewed the percentage of men and women over 18 who reported engaging in binge or heavy drinking in in each state’s metro areas in 2016. Metropolitan area data and state level data were aggregated from county level data assembled in 2019 by County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.
Alcohol-related driving fatalities are for the years 2013-2017 and came from the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System (FARS). To qualify as a FARS case, the incident had to involve a motor vehicle on a public trafficway and result in a motorist or non-motorist death within 30 days of the incident.
Social and economic factors, including median household income, came from the U.S. Census Bureau’s 2017 1-year American Community Survey.
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