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.

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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.