Though alcohol is enjoyed responsibly by millions of Americans every day, it is also misused by many — and over consumption can have serious consequences. Excessive drinking is the third leading preventable cause of death in the United States.
About a fifth of American adults regularly consumed unhealthy amounts of alcohol in 2018, the latest year for which data is available.
To identify the U.S. metro areas with the highest excessive drinking rates, 24/7 Tempo reviewed the percentage of adults 18 and older who report binge or heavy drinking within a 30-day period across all 382 metro areas in the country. Data came 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.
Excessive alcohol consumption rates appear associated with some economic factors. Alcohol can be expensive, and people’s ability to drink to excess can be limited by their income. Cities with higher excessive drinking rates tend to have higher incomes, and vice-versa.
Social factors also play a role. In Wisconsin, alcohol consumption is, for many, an integral part of the state’s culture. Twelve of the 20 heaviest drinking cities on this list are in Wisconsin.
On the other end of the spectrum, large segments of the population in Utah are teetotalers. Four of the five cities with the lowest rates of excessive drinking are in Utah. About 68% of the state’s population identify as Mormon, a religion that teaches its followers to avoid alcohol consumption.
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.
Click here for the 50 drunkest cities in the U.S.
While the health risks associated with excessive alcohol consumption are well established, having a large share of excessive drinkers often does not translate to poor health outcomes across a population. Alcohol consumption is just one of many factors that can affect a person’s health. In fact, because cities with higher excessive drinking rates also tend to have higher incomes, residents tend to have easier access to quality health care and can afford healthier diets and lifestyles.
In fact, just one of the 20 cities with the highest excessive drinking rates is home to a larger share of adults in fair or poor health than the 16.5% national average.
Fatal car accidents that involve alcohol appear to be more common in the cities with the highest excessive drinking rates. Nationwide, 27.0% of all driving deaths involve alcohol. In all but 14 of the 50 cities with the highest excessive drinking rates, the share is lower than the nationwide rate.
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50. Reno, Nevada
> Pct. of adults who drink excessively: 22.3% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 38.9% — No. 23 out of 382 (US rate: 27.0%)
> Median household income: $72,132 — No. 57 out of 382 (US median: $65,712)
> Metro area population: 475,290
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49. Buffalo-Cheektowaga, New York
> Pct. of adults who drink excessively: 22.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 17.5% — No. 353 out of 382 (US rate: 27.0%)
> Median household income: $60,105 — No. 186 out of 382 (US median: $65,712)
> Metro area population: 1,127,983
Source: DenisTangneyJr / E+ via Getty Images
48. Scranton–Wilkes-Barre, Pennsylvania
> Pct. of adults who drink excessively: 22.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 27.2% — No. 214 out of 382 (US rate: 27.0%)
> Median household income: $54,304 — No. 267 out of 382 (US median: $65,712)
> Metro area population: 553,885
Source: Asher196 / Wikimedia Commons
47. Bay City, Michigan
> Pct. of adults who drink excessively: 22.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 34.0% — No. 74 out of 382 (US rate: 27.0%)
> Median household income: $49,610 — No. 328 out of 382 (US median: $65,712)
> Metro area population: 103,126
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46. Norwich-New London, Connecticut
> Pct. of adults who drink excessively: 22.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 35.2% — No. 54 out of 382 (US rate: 27.0%)
> Median household income: $75,633 — No. 47 out of 382 (US median: $65,712)
> Metro area population: 265,206
Source: DenisTangneyJr / Getty Images
45. Fargo, North Dakota
> Pct. of adults who drink excessively: 22.5% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 36.5% — No. 40 out of 382 (US rate: 27.0%)
> Median household income: $62,820 — No. 129 out of 382 (US median: $65,712)
> Metro area population: 246,145
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44. Deltona-Daytona Beach-Ormond Beach, Florida
> Pct. of adults who drink excessively: 22.5% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 22.2% — No. 309 out of 382 (US rate: 27.0%)
> Median household income: $54,533 — No. 264 out of 382 (US median: $65,712)
> Metro area population: 668,365
Source: Spondylolithesis / Getty Images
43. Napa, California
> Pct. of adults who drink excessively: 22.6% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 39.7% — No. 20 out of 382 (US rate: 27.0%)
> Median household income: $92,769 — No. 7 out of 382 (US median: $65,712)
> Metro area population: 137,744
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42. Billings, Montana
> Pct. of adults who drink excessively: 22.7% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 37.0% — No. 35 out of 382 (US rate: 27.0%)
> Median household income: $60,962 — No. 165 out of 382 (US median: $65,712)
> Metro area population: 181,667
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41. Albany-Schenectady-Troy, New York
> Pct. of adults who drink excessively: 22.7% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 24.1% — No. 281 out of 382 (US rate: 27.0%)
> Median household income: $73,398 — No. 53 out of 382 (US median: $65,712)
> Metro area population: 880,381
Source: csfotoimages / Getty Images
40. Monroe, Michigan
> Pct. of adults who drink excessively: 22.8% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 40.6% — No. 14 out of 382 (US rate: 27.0%)
> Median household income: $62,839 — No. 128 out of 382 (US median: $65,712)
> Metro area population: 150,500
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39. Springfield, Massachusetts
> Pct. of adults who drink excessively: 22.8% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 31.1% — No. 123 out of 382 (US rate: 27.0%)
> Median household income: $62,346 — No. 139 out of 382 (US median: $65,712)
> Metro area population: 697,382
Source: StevenGaertner / Getty Images
38. Minneapolis-St. Paul-Bloomington, Minnesota
> Pct. of adults who drink excessively: 22.9% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 31.4% — No. 117 out of 382 (US rate: 27.0%)
> Median household income: $83,698 — No. 18 out of 382 (US median: $65,712)
> Metro area population: 3,640,043
Source: peeterv / Getty Images
37. Rapid City, South Dakota
> Pct. of adults who drink excessively: 23.0% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 34.3% — No. 70 out of 382 (US rate: 27.0%)
> Median household income: $58,361 — No. 205 out of 382 (US median: $65,712)
> Metro area population: 142,191
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36. Kahului-Wailuku-Lahaina, Hawaii
> Pct. of adults who drink excessively: 23.0% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 49.0% — No. 3 out of 382 (US rate: 27.0%)
> Median household income: $80,754 — No. 24 out of 382 (US median: $65,712)
> Metro area population: 167,488
Source: DenisTangneyJr / Getty Images
35. Sioux Falls, South Dakota
> Pct. of adults who drink excessively: 23.1% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 27.4% — No. 212 out of 382 (US rate: 27.0%)
> Median household income: $65,566 — No. 105 out of 382 (US median: $65,712)
> Metro area population: 268,833
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34. The Villages, Florida
> Pct. of adults who drink excessively: 23.1% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 13.1% — No. 373 out of 382 (US rate: 27.0%)
> Median household income: $60,287 — No. 183 out of 382 (US median: $65,712)
> Metro area population: 132,420
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33. Fort Collins, Colorado
> Pct. of adults who drink excessively: 23.2% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 32.6% — No. 92 out of 382 (US rate: 27.0%)
> Median household income: $75,186 — No. 50 out of 382 (US median: $65,712)
> Metro area population: 356,899
Source: Wicki58 / iStock via Getty Images
32. Cape Coral-Fort Myers, Florida
> Pct. of adults who drink excessively: 23.2% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 24.4% — No. 278 out of 382 (US rate: 27.0%)
> Median household income: $62,240 — No. 140 out of 382 (US median: $65,712)
> Metro area population: 770,577
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Source: ChrisBoswell / iStock via Getty Images
31. Iowa City, Iowa
> Pct. of adults who drink excessively: 23.3% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 25.9% — No. 248 out of 382 (US rate: 27.0%)
> Median household income: $63,761 — No. 118 out of 382 (US median: $65,712)
> Metro area population: 173,105
Source: Sean Pavone / Getty Images
30. Boston-Cambridge-Newton, Massachusetts
> Pct. of adults who drink excessively: 23.3% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 29.7% — No. 160 out of 382 (US rate: 27.0%)
> Median household income: $94,430 — No. 5 out of 382 (US median: $65,712)
> Metro area population: 4,873,019
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29. Cedar Rapids, Iowa
> Pct. of adults who drink excessively: 23.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 18.3% — No. 345 out of 382 (US rate: 27.0%)
> Median household income: $64,088 — No. 115 out of 382 (US median: $65,712)
> Metro area population: 273,032
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28. Missoula, Montana
> Pct. of adults who drink excessively: 23.5% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 36.2% — No. 44 out of 382 (US rate: 27.0%)
> Median household income: $57,347 — No. 221 out of 382 (US median: $65,712)
> Metro area population: 119,600
Source: Anh Luu / Shutterstock.com
27. St. Cloud, Minnesota
> Pct. of adults who drink excessively: 23.5% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 28.6% — No. 184 out of 382 (US rate: 27.0%)
> Median household income: $66,076 — No. 100 out of 382 (US median: $65,712)
> Metro area population: 201,964
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26. Santa Rosa-Petaluma, California
> Pct. of adults who drink excessively: 23.6% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 32.7% — No. 91 out of 382 (US rate: 27.0%)
> Median household income: $87,828 — No. 12 out of 382 (US median: $65,712)
> Metro area population: 494,336
Source: EQRoy / Shutterstock.com
25. Ames, Iowa
> Pct. of adults who drink excessively: 23.7% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 20.0% — No. 329 out of 382 (US rate: 27.0%)
> Median household income: $62,181 — No. 142 out of 382 (US median: $65,712)
> Metro area population: 123,351
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24. Omaha-Council Bluffs, Nebraska
> Pct. of adults who drink excessively: 23.9% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 32.9% — No. 89 out of 382 (US rate: 27.0%)
> Median household income: $70,373 — No. 71 out of 382 (US median: $65,712)
> Metro area population: 949,726
Source: Sean Pavone / Getty Images
23. Hilton Head Island-Bluffton, South Carolina
> Pct. of adults who drink excessively: 24.1% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 26.7% — No. 225 out of 382 (US rate: 27.0%)
> Median household income: $71,252 — No. 62 out of 382 (US median: $65,712)
> Metro area population: 222,195
Source: Sean Pavone / Getty Images
22. Portland-South Portland, Maine
> Pct. of adults who drink excessively: 24.2% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 30.4% — No. 145 out of 382 (US rate: 27.0%)
> Median household income: $71,913 — No. 59 out of 382 (US median: $65,712)
> Metro area population: 538,500
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21. North Port-Sarasota-Bradenton, Florida
> Pct. of adults who drink excessively: 24.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 26.4% — No. 237 out of 382 (US rate: 27.0%)
> Median household income: $65,526 — No. 106 out of 382 (US median: $65,712)
> Metro area population: 836,995
Source: russokm1105 / Getty Images
20. San Luis Obispo-Paso Robles, California
> Pct. of adults who drink excessively: 24.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 40.5% — No. 17 out of 382 (US rate: 27.0%)
> Median household income: $77,265 — No. 37 out of 382 (US median: $65,712)
> Metro area population: 283,111
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19. Des Moines-West Des Moines, Iowa
> Pct. of adults who drink excessively: 24.7% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 35.0% — No. 61 out of 382 (US rate: 27.0%)
> Median household income: $71,164 — No. 63 out of 382 (US median: $65,712)
> Metro area population: 699,292
Source: Jeramey Jannene (Grassferry49) / Wikimedia Commons
18. Janesville-Beloit, Wisconsin
> Pct. of adults who drink excessively: 25.1% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 42.1% — No. 8 out of 382 (US rate: 27.0%)
> Median household income: $61,243 — No. 158 out of 382 (US median: $65,712)
> Metro area population: 163,354
Source: DenisTangneyJr / iStock via Getty Images
17. Racine, Wisconsin
> Pct. of adults who drink excessively: 25.2% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 36.4% — No. 43 out of 382 (US rate: 27.0%)
> Median household income: $60,779 — No. 169 out of 382 (US median: $65,712)
> Metro area population: 196,311
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16. Duluth, Minnesota
> Pct. of adults who drink excessively: 25.2% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 34.5% — No. 67 out of 382 (US rate: 27.0%)
> Median household income: $60,316 — No. 182 out of 382 (US median: $65,712)
> Metro area population: 289,383
Source: ChrisBoswell / Getty Images
15. Lincoln, Nebraska
> Pct. of adults who drink excessively: 25.3% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 29.4% — No. 168 out of 382 (US rate: 27.0%)
> Median household income: $61,539 — No. 150 out of 382 (US median: $65,712)
> Metro area population: 336,541
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14. Milwaukee-Waukesha, Wisconsin
> Pct. of adults who drink excessively: 25.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 30.5% — No. 140 out of 382 (US rate: 27.0%)
> Median household income: $65,845 — No. 102 out of 382 (US median: $65,712)
> Metro area population: 1,575,179
Source: Thieded / Wikimedia Commons
13. Eau Claire, Wisconsin
> Pct. of adults who drink excessively: 25.9% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 37.7% — No. 28 out of 382 (US rate: 27.0%)
> Median household income: $63,460 — No. 122 out of 382 (US median: $65,712)
> Metro area population: 169,304
Source: benkrut / iStock via Getty Images
12. Wausau-Weston, Wisconsin
> Pct. of adults who drink excessively: 26.1% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 17.2% — No. 357 out of 382 (US rate: 27.0%)
> Median household income: $65,094 — No. 109 out of 382 (US median: $65,712)
> Metro area population: 163,285
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Source: DenisTangneyJr / iStock via Getty Images
11. Pittsfield, Massachusetts
> Pct. of adults who drink excessively: 26.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 27.7% — No. 208 out of 382 (US rate: 27.0%)
> Median household income: $58,895 — No. 197 out of 382 (US median: $65,712)
> Metro area population: 124,944
Source: Jacob Boomsma / Getty Images
10. Waterloo-Cedar Falls, Iowa
> Pct. of adults who drink excessively: 26.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 18.2% — No. 347 out of 382 (US rate: 27.0%)
> Median household income: $63,131 — No. 124 out of 382 (US median: $65,712)
> Metro area population: 168,522
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Source: Jason_Ray_Photography / iStock Editorial via Getty Images
9. La Crosse-Onalaska, Wisconsin
> Pct. of adults who drink excessively: 26.4% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 26.0% — No. 245 out of 382 (US rate: 27.0%)
> Median household income: $59,608 — No. 191 out of 382 (US median: $65,712)
> Metro area population: 136,616
Source: Kevin Rutherford / Flickr
8. Barnstable Town, Massachusetts
> Pct. of adults who drink excessively: 26.5% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 37.3% — No. 34 out of 382 (US rate: 27.0%)
> Median household income: $85,042 — No. 16 out of 382 (US median: $65,712)
> Metro area population: 212,990
Source: DenisTangneyJr / Getty Images
7. Fond du Lac, Wisconsin
> Pct. of adults who drink excessively: 26.5% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 31.6% — No. 112 out of 382 (US rate: 27.0%)
> Median household income: $65,329 — No. 107 out of 382 (US median: $65,712)
> Metro area population: 103,403
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6. Madison, Wisconsin
> Pct. of adults who drink excessively: 27.6% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 31.7% — No. 109 out of 382 (US rate: 27.0%)
> Median household income: $75,545 — No. 48 out of 382 (US median: $65,712)
> Metro area population: 664,865
Source: DenisTangneyJr / iStock via Getty Images
5. Oshkosh-Neenah, Wisconsin
> Pct. of adults who drink excessively: 27.6% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 31.4% — No. 119 out of 382 (US rate: 27.0%)
> Median household income: $58,347 — No. 206 out of 382 (US median: $65,712)
> Metro area population: 171,907
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Source: DenisTangneyJr / iStock via Getty Images
4. Green Bay, Wisconsin
> Pct. of adults who drink excessively: 27.8% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 42.9% — No. 7 out of 382 (US rate: 27.0%)
> Median household income: $65,026 — No. 111 out of 382 (US median: $65,712)
> Metro area population: 322,906
Source: DenisTangneyJr / iStock via Getty Images
3. Sheboygan, Wisconsin
> Pct. of adults who drink excessively: 27.9% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 31.5% — No. 115 out of 382 (US rate: 27.0%)
> Median household income: $60,706 — No. 172 out of 382 (US median: $65,712)
> Metro area population: 115,340
Source: cosmonaut / Getty Images
2. Dubuque, Iowa
> Pct. of adults who drink excessively: 28.1% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 15.6% — No. 366 out of 382 (US rate: 27.0%)
> Median household income: $62,178 — No. 143 out of 382 (US median: $65,712)
> Metro area population: 97,311
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Source: DenisTangneyJr / iStock via Getty Images
1. Appleton, Wisconsin
> Pct. of adults who drink excessively: 30.8% (US rate: 19.2%)
> Pct. of fatal car accidents involving alcohol: 31.1% — No. 123 out of 382 (US rate: 27.0%)
> Median household income: $68,335 — No. 83 out of 382 (US median: $65,712)
> Metro area population: 237,974
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