Rates of alcohol consumption are at an all-time low in the United States. According to a recent Gallup poll, only 54% of American adults consume alcoholic beverages, the smallest share ever reported in the survey’s 87-year history, and down from 67% as recently as 2022. Despite the decline, excessive drinking continues to pose a significant economic burden and public health challenge
According to the Centers for Disease Control and Prevention, excessive alcohol consumption is a technical term that includes both binge drinking and heavy drinking. Binge drinking is defined as four or more standard drinks on a single occasion for women and five or more drinks for men. Heavy drinking is eight or more drinks in a one-week period for women and 15 or more drinks for men. Any alcohol consumed by pregnant women or individuals under the legal age is also considered excessive drinking.
Heavy drinking is linked to a number of chronic, potentially fatal conditions including heart disease, liver disease, and certain types of cancer. Binge drinking, meanwhile, is often a factor in auto accidents, alcohol poisonings, and accidental overdoses. The latest data from the CDC shows that binge drinking and heavy drinking claim approximately 178,000 lives in the U.S. each year, reducing the likely lifespan of those who die by an average of about 24 years. Due to reduced performance in the workplace, car crashes, property damage, and health care expenses, excessive drinking also costs the U.S. economy hundreds of billions of dollars each year.
Using data from County Health Rankings and Roadmaps, a program of the University of Wisconsin Population Health Institute, 24/7 Wall St. identified the heaviest drinking counties in America. Counties are ranked by the excessive drinking rate, or the share of adults reporting either binge or heavy drinking. Supplemental county-level data are also from CHR and are for the latest year available.
Among the 35 counties on this list, excessive drinking rates range from 25.9% to 28.9%. All but 10 of these counties are in the Midwest, including eight in Iowa and 13 in Wisconsin. Another nine counties on this list are in the West, and only one is in the Northeast. None of the counties on this list are in the South.
Although the negative health consequences associated with excessive alcohol consumption are well established, health outcomes across the populations of these counties are often better than average. For example, in 29 of the 35 places on this list, average life expectancy at birth is in the top 25% of all U.S. counties and county equivalents. Additionally, adults in most of these places report fewer days of poor mental or physical health in a given month than a typical American adult.
Binge and heavy drinking are just two of many factors that impact health outcomes. Income is another factor that plays an even stronger role. Higher-income, financially secure households are better able to afford healthier diets and regular, preventive medical care. Alcohol consumption rates also increase with income levels. So, while higher-income Americans may be more likely to drink excessively, they are also more likely to report better health outcomes because their higher incomes allow them to make healthier lifestyle choices.
These are the heaviest drinking counties in America.
Why It Matters
Rates of alcohol consumption in the United States hit a new record-low in 2025. But while the risks associated with moderate levels of drinking are minimal, excessive drinking is a leading cause of preventable death in the U.S., according to the CDC. Over time, heavy drinking increases the risk of stroke, cancer, heart disease, and liver disease. Even short term binge drinking can cause alcohol poisoning and is often linked to automobile crashes, suicide, and interpersonal violence. Despite the risks, there are dozens of counties across the United States where more than one in every four adults drink excessively.
35. Sheboygan County, Wisconsin
- Adult excessive drinking rate: 25.9%
- Driving deaths involving alcohol: 26.5% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.1 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 4.0 days (middle 50% of 3,144 counties with available data)
- Avg. life expectancy at birth: 78.1 years (top 25% of 3,144 counties with available data)
- Median household income: $73,970 (top 25% of 3,144 counties with available data)
- Local population: 117,752
34. Flathead County, Montana
- Adult excessive drinking rate: 26.0%
- Driving deaths involving alcohol: 48.3% (top 10% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.3 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 4.0 days (middle 50% of 3,144 counties with available data)
- Avg. life expectancy at birth: 77.4 years (middle 50% of 3,144 counties with available data)
- Median household income: $74,150 (top 25% of 3,144 counties with available data)
- Local population: 113,679
33. Crow Wing County, Minnesota
- Adult excessive drinking rate: 26.1%
- Driving deaths involving alcohol: 20.5% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.0 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.7 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 78.7 years (top 25% of 3,144 counties with available data)
- Median household income: $74,540 (top 25% of 3,144 counties with available data)
- Local population: 68,304
32. Polk County, Wisconsin
- Adult excessive drinking rate: 26.1%
- Driving deaths involving alcohol: 26.0% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.2 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.8 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 77.8 years (top 25% of 3,144 counties with available data)
- Median household income: $71,613 (middle 50% of 3,144 counties with available data)
- Local population: 45,762
31. Williams County, North Dakota
- Adult excessive drinking rate: 26.1%
- Driving deaths involving alcohol: 56.8% (top 10% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.3 days (bottom 10% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.4 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 77.9 years (top 25% of 3,144 counties with available data)
- Median household income: $92,537 (top 10% of 3,144 counties with available data)
- Local population: 39,113
30. Kewaunee County, Wisconsin
- Adult excessive drinking rate: 26.1%
- Driving deaths involving alcohol: 22.2% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.5 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.7 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.9 years (top 10% of 3,144 counties with available data)
- Median household income: $77,472 (top 25% of 3,144 counties with available data)
- Local population: 20,690
29. Ozaukee County, Wisconsin
- Adult excessive drinking rate: 26.1%
- Driving deaths involving alcohol: 28.6% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.9 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.5 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 81.0 years (top 10% of 3,144 counties with available data)
- Median household income: $98,394 (top 10% of 3,144 counties with available data)
- Local population: 93,460
28. Sauk County, Wisconsin
- Adult excessive drinking rate: 26.2%
- Driving deaths involving alcohol: 40.7% (top 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.4 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 4.1 days (middle 50% of 3,144 counties with available data)
- Avg. life expectancy at birth: 77.7 years (top 25% of 3,144 counties with available data)
- Median household income: $79,349 (top 25% of 3,144 counties with available data)
- Local population: 65,920
27. Plymouth County, Iowa
- Adult excessive drinking rate: 26.2%
- Driving deaths involving alcohol: 23.8% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.7 days (bottom 10% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.5 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.0 years (top 25% of 3,144 counties with available data)
- Median household income: $74,765 (top 25% of 3,144 counties with available data)
- Local population: 25,722
26. Custer County, Montana
- Adult excessive drinking rate: 26.2%
- Driving deaths involving alcohol: 33.3% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.4 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.9 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 76.2 years (middle 50% of 3,144 counties with available data)
- Median household income: $58,850 (middle 50% of 3,144 counties with available data)
- Local population: 11,985
25. Buffalo County, Wisconsin
- Adult excessive drinking rate: 26.2%
- Driving deaths involving alcohol: 40.0% (top 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.6 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.9 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 81.7 years (top 10% of 3,144 counties with available data)
- Median household income: $73,869 (top 25% of 3,144 counties with available data)
- Local population: 13,419
24. Dickinson County, Iowa
- Adult excessive drinking rate: 26.3%
- Driving deaths involving alcohol: 10.0% (bottom 10% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.4 days (bottom 10% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.2 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 81.2 years (top 10% of 3,144 counties with available data)
- Median household income: $80,922 (top 25% of 3,144 counties with available data)
- Local population: 18,056
23. Denver County, Colorado
- Adult excessive drinking rate: 26.3%
- Driving deaths involving alcohol: 35.0% (top 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.5 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.8 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 77.4 years (middle 50% of 3,144 counties with available data)
- Median household income: $93,572 (top 10% of 3,144 counties with available data)
- Local population: 716,577
22. Sherburne County, Minnesota
- Adult excessive drinking rate: 26.3%
- Driving deaths involving alcohol: 30.2% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.7 days (bottom 10% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.4 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.4 years (top 25% of 3,144 counties with available data)
- Median household income: $101,487 (top 10% of 3,144 counties with available data)
- Local population: 102,206
21. Chisago County, Minnesota
- Adult excessive drinking rate: 26.4%
- Driving deaths involving alcohol: 37.8% (top 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.8 days (bottom 10% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.5 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.4 years (top 25% of 3,144 counties with available data)
- Median household income: $91,338 (top 10% of 3,144 counties with available data)
- Local population: 58,535
20. Carbon County, Montana
- Adult excessive drinking rate: 26.5%
- Driving deaths involving alcohol: 42.1% (top 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.0 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.7 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 80.4 years (top 10% of 3,144 counties with available data)
- Median household income: $72,463 (middle 50% of 3,144 counties with available data)
- Local population: 11,419
19. Washington County, Vermont
- Adult excessive drinking rate: 26.5%
- Driving deaths involving alcohol: 47.4% (top 10% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.7 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.7 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.0 years (top 25% of 3,144 counties with available data)
- Median household income: $79,916 (top 25% of 3,144 counties with available data)
- Local population: 60,142
18. Winneshiek County, Iowa
- Adult excessive drinking rate: 26.6%
- Driving deaths involving alcohol: 26.7% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.6 days (bottom 10% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.3 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 81.8 years (top 10% of 3,144 counties with available data)
- Median household income: $80,932 (top 25% of 3,144 counties with available data)
- Local population: 19,815
17. Johnson County, Iowa
- Adult excessive drinking rate: 26.6%
- Driving deaths involving alcohol: 27.3% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.2 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.5 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 82.0 years (top 10% of 3,144 counties with available data)
- Median household income: $74,665 (top 25% of 3,144 counties with available data)
- Local population: 157,528
16. Madison County, Montana
- Adult excessive drinking rate: 26.7%
- Driving deaths involving alcohol: 26.7% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.7 days (bottom 10% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.6 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 80.3 years (top 10% of 3,144 counties with available data)
- Median household income: $73,316 (top 25% of 3,144 counties with available data)
- Local population: 9,521
15. Green County, Wisconsin
- Adult excessive drinking rate: 26.8%
- Driving deaths involving alcohol: 33.3% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.4 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.7 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.2 years (top 25% of 3,144 counties with available data)
- Median household income: $78,114 (top 25% of 3,144 counties with available data)
- Local population: 36,951
14. Waupaca County, Wisconsin
- Adult excessive drinking rate: 26.9%
- Driving deaths involving alcohol: 31.6% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.3 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.9 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 76.5 years (middle 50% of 3,144 counties with available data)
- Median household income: $68,545 (middle 50% of 3,144 counties with available data)
- Local population: 51,388
13. Lincoln County, Wisconsin
- Adult excessive drinking rate: 27.0%
- Driving deaths involving alcohol: 36.0% (top 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.7 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 4.1 days (middle 50% of 3,144 counties with available data)
- Avg. life expectancy at birth: 75.9 years (middle 50% of 3,144 counties with available data)
- Median household income: $71,871 (middle 50% of 3,144 counties with available data)
- Local population: 28,405
12. Louisa County, Iowa
- Adult excessive drinking rate: 27.0%
- Driving deaths involving alcohol: 12.5% (bottom 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.2 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 4.3 days (middle 50% of 3,144 counties with available data)
- Avg. life expectancy at birth: 78.7 years (top 25% of 3,144 counties with available data)
- Median household income: $76,120 (top 25% of 3,144 counties with available data)
- Local population: 10,513
11. Benton County, Iowa
- Adult excessive drinking rate: 27.0%
- Driving deaths involving alcohol: 7.4% (bottom 10% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.8 days (bottom 10% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.7 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.2 years (top 25% of 3,144 counties with available data)
- Median household income: $86,364 (top 10% of 3,144 counties with available data)
- Local population: 25,796
10. Portage County, Wisconsin
- Adult excessive drinking rate: 27.0%
- Driving deaths involving alcohol: 37.8% (top 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.4 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.7 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.3 years (top 25% of 3,144 counties with available data)
- Median household income: $71,295 (middle 50% of 3,144 counties with available data)
- Local population: 71,024
9. McCone County, Montana
- Adult excessive drinking rate: 27.1%
- Driving deaths involving alcohol: 50.0% (top 10% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.0 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.6 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 83.5 years (top 10% of 3,144 counties with available data)
- Median household income: $56,696 (middle 50% of 3,144 counties with available data)
- Local population: 1,676
8. Grundy County, Iowa
- Adult excessive drinking rate: 27.3%
- Driving deaths involving alcohol: 22.2% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.5 days (bottom 10% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.3 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.3 years (top 25% of 3,144 counties with available data)
- Median household income: $81,093 (top 25% of 3,144 counties with available data)
- Local population: 12,384
7. Powell County, Montana
- Adult excessive drinking rate: 27.3%
- Driving deaths involving alcohol: 40.0% (top 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.2 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 4.0 days (middle 50% of 3,144 counties with available data)
- Avg. life expectancy at birth: 75.8 years (middle 50% of 3,144 counties with available data)
- Median household income: $61,354 (middle 50% of 3,144 counties with available data)
- Local population: 7,133
6. Gallatin County, Montana
- Adult excessive drinking rate: 27.3%
- Driving deaths involving alcohol: 53.8% (top 10% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.1 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.4 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 82.0 years (top 10% of 3,144 counties with available data)
- Median household income: $90,942 (top 10% of 3,144 counties with available data)
- Local population: 126,409
5. Washington County, Wisconsin
- Adult excessive drinking rate: 27.4%
- Driving deaths involving alcohol: 27.7% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.0 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.4 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.6 years (top 10% of 3,144 counties with available data)
- Median household income: $93,830 (top 10% of 3,144 counties with available data)
- Local population: 138,168
4. St. Croix County, Wisconsin
- Adult excessive drinking rate: 27.7%
- Driving deaths involving alcohol: 48.0% (top 10% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.2 days (bottom 25% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.6 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.8 years (top 10% of 3,144 counties with available data)
- Median household income: $103,731 (top 10% of 3,144 counties with available data)
- Local population: 96,763
3. Chippewa County, Wisconsin
- Adult excessive drinking rate: 27.9%
- Driving deaths involving alcohol: 22.0% (middle 50% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.3 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 4.0 days (middle 50% of 3,144 counties with available data)
- Avg. life expectancy at birth: 78.8 years (top 25% of 3,144 counties with available data)
- Median household income: $76,637 (top 25% of 3,144 counties with available data)
- Local population: 66,970
2. Buchanan County, Iowa
- Adult excessive drinking rate: 28.1%
- Driving deaths involving alcohol: 36.4% (top 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 4.9 days (bottom 10% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.5 days (bottom 10% of 3,144 counties with available data)
- Avg. life expectancy at birth: 79.0 years (top 25% of 3,144 counties with available data)
- Median household income: $80,402 (top 25% of 3,144 counties with available data)
- Local population: 20,691
1. Missoula County, Montana
- Adult excessive drinking rate: 28.9%
- Driving deaths involving alcohol: 36.0% (top 25% of 3,144 counties with available data)
- Avg. number of mentally unhealthy days in past month: 5.5 days (middle 50% of 3,144 counties with available data)
- Avg. number of physically unhealthy days in past month: 3.9 days (bottom 25% of 3,144 counties with available data)
- Avg. life expectancy at birth: 78.6 years (top 25% of 3,144 counties with available data)
- Median household income: $72,882 (middle 50% of 3,144 counties with available data)
- Local population: 121,849
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