Each day, at dinner tables and social gatherings across the country, millions of adults enjoy alcohol responsibly. Moderate drinking — defined as two standard drinks per day for men and one standard drink for women — carries relatively little risk, and may even have some health benefits. However, beyond this threshold, alcohol can only be detrimental.

Excessive drinking — along with tobacco use, inadequate exercise, and poor nutrition — is one of four main risk factors for preventable disease identified by the CDC. In addition to short-term consequences, such as impaired judgement and motor skills, excessive alcohol consumption is associated with liver disease, certain cancers, increased risk of a heart attack or stroke, and poor mental health. Here is a look at 23 ways a drinking habit can harm you. 

Each year, alcohol misuse is directly linked to diseases and accidents that kill an estimated 95,000 Americans. Excessive drinking also costs the economy hundreds of billions of dollars annually, mostly in lost productivity. 

Using data from County Health Rankings & Roadmaps, a joint program between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, 24/7 Tempo identified America’s drunkest states.

States are ranked on the share of adults who either binge drink or drink heavily. CHR defines binge drinking as consumption of more than four drinks in a single occasion for women and more than five drinks for men. Heavy drinking is defined as more than one drink a day on average for women and more than two drinks a day for men. 

Depending on the state, excessive drinking rates range from as low as 11.1% all the way up to 27.1%. All five states with the highest excessive drinking rates are in the Midwest, while four out of the five states with the lowest excessive drinking rates are in the South. Nationwide, 19.2% of adults drink excessively. 

It is important to note that alcohol affects everyone differently, and as a general rule, drinking less is better than drinking more. Additionally, the vast majority of Americans who drink excessively — about 90% of them — do not have a severe alcohol use disorder, a chronic disease commonly referred to as alcoholism.

Click here to see America’s drunkest states
Click here to read our detailed methodology