Excessive drinking is the third leading preventable cause of death in the United States. According to research by the National Institutes of Health, alcohol was involved in 72,558 deaths in 2017, about 2.6% of all deaths in the country that year and more than double the number of alcohol-related deaths in 1999.

To determine the drunkest city in every state, 24/7 Tempo reviewed the percentage of men and women over 18 who report heavy or binge drinking in each state’s metro areas. Delaware, New Hampshire, Rhode Island, and Vermont have only one metro area and ranks on the list by default. Metro-level data was aggregated from the 2021 County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.

Excessive drinking includes both binge and heavy drinking. Heavy drinking is defined as consuming at least 15 drinks a week or averaging two or more drinks a day for men, according to the CDC. For women, it’s eight drinks or more per week or more than one drink on average a day. Binge drinking is defined as a pattern of alcohol consumption that brings a person’s blood alcohol concentration level to 0.08% or higher — estimated to take about five or more drinks within two hours for men and four or more drinks for women.

On average, 19.2% of adult Americans report binge or heavy drinking, but the rates vary greatly from city to city and between states. For example, in Salt Lake City, Utah, about 13.6% of adults drink excessively, the lowest share among all 382 U.S. metropolitan areas. In Appleton, Wisconsin, however, the excessive drinking rate is 30.8%, the highest of all metro areas in the U.S.

Within states, residents of urban areas almost always report higher excessive drinking rates than adults in non-metropolitan areas. There are exceptions, however. The drunkest metro areas in four states – North Dakota, South Dakota, New Hampshire, and Vermont — have lower excessive drinking rates than their respective states.

Regular and excessive consumption of alcohol can result in chronic conditions and other long-term health problems, such as high blood pressure, heart disease, stroke, liver disease, and certain cancers. About half of alcohol-related deaths nationwide are due to liver disease or overdoses involving alcohol or alcohol combined with other drugs. These are the 25 most dangerous drugs currently on the market.

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