Each day, at dinner tables and social functions 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 abuse 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 the U.S. metropolitan areas with the highest excessive drinking rates. In every metro area on this list, more than 22% of adults drink excessively, while nationwide, the excessive drinking rate is 19.2%

Metro areas 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, while heavy drinking is defined as more than one drink a day on average for women and more than two drinks a day for men. 

The majority of metro areas on this list are located in the Midwest — including 12 in Wisconsin alone. 

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 metro areas
Click here to see our detailed methodology