Alcohol poisoning and alcohol-related liver diseases are major contributors to the recently identified spike in mortality among middle aged, white Americans. Alcohol is the fourth leading cause of preventable death in the United States, claiming nearly 88,000 lives a year, according to the Centers for Disease Control and Prevention (CDC).

Across the country, the share of adults who drink to excess varies widely. While nationwide, 18% of adults drink unhealthy amounts of alcohol on average, only 9.2% do in Provo-Orem, Utah, and as many as 26.8% do in Appleton, Wisconsin. To identify the drunkest and least drunk cities in the United States, 24/7 Wall St. reviewed self-reported binge and heavy drinking rates among adults in U.S. metro areas from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.

[in-text-ad]

Excessive drinking can take the form of binge drinking or heavy drinking. The CDC defines binge drinking as consuming four or more drinks for women and five or more drinks for men during a single sitting. Heavy drinking is defined as some 15 or more drinks consumed per week for men and eight or more drinks for women.

Click here to see the drunkest cities in America.

Click here to see the driest cities in America.

Excessive alcohol consumption can lead to serious and often fatal health consequences. According to the CDC, negative health outcomes associated with heavy drinking include liver disease, neurological damage, and cardiovascular diseases.

Excessive alcohol consumption is only one aspect of a less healthy lifestyle, and it alone may not lead to poorer health. In fact, many of the cities with a relatively high share of binge and heavy drinkers actually rank better than most U.S. cities in certain health measures, reporting less frequent physically and mentally unhealthy days and lower premature death rates. This is likely because cities with the highest binge drinking rates also tend to have higher incomes, higher insurance coverage rates, more physically active populations, and lower smoking rates than the cities with the lowest binge drinking rates, which may help to offset or mitigate the harms from alcohol abuse.

While excessive drinking rates may not lead to overall poorer health, it can lead to riskier behavior. Drunk driving accounts for 31.0% of roadway fatalities nationwide. In many of the cities with the highest excessive drinking rates, the share of deadly car accidents attributable to alcohol is far higher. In Green Bay, Wisconsin, for example, a city where over a quarter of adults drink excessively, 47.5% of fatal car accidents involve alcohol, the seventh highest share in the country. Meanwhile, only a quarter of the cities with the lowest excessive drinking rates have a higher than average share of alcohol-related roadway fatalities.

While a recent report published by the CDC found that alcohol consumption takes a tremendous $249 billion toll on the economy, alcohol can also be a boon for certain local businesses. There are an average of 1.6 bars for every 10,000 residents across the metro areas examined. With the exception of Corvallis, Oregon, each of the 20 cities with the highest excessive drinking rates has at least that many bars per capita. The Lacrosse-Onalaska metro area, parts of which are in Wisconsin and Minnesota, is the city with the sixth highest excessive drinking rate. The region has 6.9 bars for every 10,000 residents, more than any other U.S. metro area. Perhaps not surprisingly, the vast majority of the 20 cities with the lowest drinking rates have fewer than one bar for every 10,000 residents.

Alcohol is expensive, and the CDC reports that binge drinking is more common in households that earn at least $75,000 a year. While the median household income in the majority of cities with the highest excessive drinking rates is roughly in line with the $53,657 national median, the cities with the lowest excessive drinking rates tend to be relatively poor. Three-quarters of the cities with the lowest excessive drinking rates have a higher poverty rate than the nation as a whole.

To identify the U.S. cities with the highest and lowest excessive drinking rates, 24/7 Wall St. reviewed the percentage of adults who report binge or heavy drinking across 381 metro areas. Metro level data were aggregated from county level data provided by County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. All data are as of the most recent available year. Median household income and poverty data came from the U.S. Census Bureau’s American Community Survey. The number of bars per capita came from the Bureau of Labor Statistics. Health outcomes, including the number of potential lives lost per 100,000 people due to premature death annually and the percentage of adults who report fair or poor health were also aggregated from county-level data obtained from County Health Rankings & Roadmaps.

These are the drunkest and driest cities in America.

The Drunkest Cities

20. Corvallis, OR
>Pct. adults drinking to excess: 23.2%
>Pct. driving deaths involving alcohol: 32.0%
>Premature death: 229 deaths before age 75 per 100,000
>Median household income: $52,486

More than 23% of adults in the Corvallis metro area report either binge drinking or heavy drinking. Corvallis is the heaviest drinking city in Oregon, but alcohol related driving fatalities in the city are not the highest and in line with the national average. In Corvallis, 32% of driving deaths are alcohol related, versus 31% nationwide.

[in-text-ad]

19. Iowa City, IA
>Pct. adults drinking to excess: 23.2%
>Pct. driving deaths involving alcohol: 24.6%
>Premature death: 249 deaths before age 75 per 100,000
>Median household income: $59,791

Binge drinking is more common among households earning at least $75,000 a year. In Iowa City, where 23.2% of adults report an excessive drinking habit, 41.6% of households report such high earnings, well above the 35.6% of American households with incomes of at least $75,000.

18. Lincoln, NE
>Pct. adults drinking to excess: 23.3%
>Pct. driving deaths involving alcohol: 26.7%
>Premature death: 270 deaths before age 75 per 100,000
>Median household income: $52,046

In Lincoln, 23.3% of adults report an excessive drinking habit, more than in any other city in the state. Across Nebraska, 21.4% of adults drink to excess, a larger share than in all but four other states.

17. Milwaukee-Waukesha-West Allis, WI
>Pct. adults drinking to excess: 23.3%
>Pct. driving deaths involving alcohol: 37.2%
>Premature death: 347 deaths before age 75 per 100,000
>Median household income: $53,164

Home to several of America’s oldest and largest breweries, beer is a major part of Milwaukee’s culture. It is perhaps no surprise that heavy drinking is relatively common in the metro area. In Milwaukee, 23.3% of adults either binge or drink heavily, a considerably larger share than the 18.0% of American adults.

16. Janesville-Beloit, WI
>Pct. adults drinking to excess: 23.4%
>Pct. driving deaths involving alcohol: 40.0%
>Premature death: 346 deaths before age 75 per 100,000
>Median household income: $50,610

Only 15 U.S. metro areas have a higher excessive drinking rate than the Janesville-Beloit metro. Alcohol use often comes with more risky behaviors, like driving while intoxicated. In Janesville, 40% of fatal car accidents are alcohol related, a far higher share than the 31% nationwide proportion.

15. Racine, WI
>Pct. adults drinking to excess: 23.5%
>Pct. driving deaths involving alcohol: 35.5%
>Premature death: 319 deaths before age 75 per 100,000
>Median household income: $54,525

A growing body of evidence suggests higher alcohol consumption can lead to a higher risk of obesity. In Racine, 23.5% of adults report excessive drinking, and 31.8% are obese — each a higher share than the respective 18.0% and 27.0% national rates.

[in-text-ad]

14. Grand Forks, ND-MN
>Pct. adults drinking to excess: 23.7%
>Pct. driving deaths involving alcohol: 32.7%
>Premature death: 332 deaths before age 75 per 100,000
>Median household income: $49,691

Unhealthy behaviors can often feed into each other. In Grand Forks, 23.7% of adults drink to excess, a higher share than the 18.0% national rate. Adults in the Grand Forks metro are also more likely to smoke than most American adults.

13. Missoula, MT
>Pct. adults drinking to excess: 23.8%
>Pct. driving deaths involving alcohol: 48.6%
>Premature death: 285 deaths before age 75 per 100,000
>Median household income: $44,289

Excessive drinking is more common in Missoula than in all but a dozen other U.S. metros. One consequence is the high share of fatal roadway accidents attributable to alcohol. In Missoula, 48.6% of roadway fatalities involved alcohol, the sixth highest such rate of any U.S. city.

12. Sheboygan, WI
>Pct. adults drinking to excess: 24.0%
>Pct. driving deaths involving alcohol: 29.3%
>Premature death: 294 deaths before age 75 per 100,000
>Median household income: $54,042

In Wisconsin, 24.2% of adults drink excessively, the highest share of any state in the nation. The percentage of adults who drink excessively in Sheboygan, at 24%, while slightly lower than the state rate, is still among the highest of all U.S. metro areas. Sheboygan is one of 12 cities in Wisconsin where the excessive drinking rate exceeds the 18.0% national rate by 5 percentage points.

11. Wausau, WI
>Pct. adults drinking to excess: 24.1%
>Pct. driving deaths involving alcohol: 27.0%
>Premature death: 270 deaths before age 75 per 100,000
>Median household income: $53,300

Excessive alcohol consumption can have any number of negative health impacts. Despite having one of the highest excessive drinking rates of any U.S. city, however, Wausau residents tend to be healthier than most Americans. Only 11.8% of metro area adults report being in fair or poor health, less than the 14.0% of Americans reporting less than optimal health.

10. Mankato-North Mankato, MN
>Pct. adults drinking to excess: 24.2%
>Pct. driving deaths involving alcohol: 20.8%
>Premature death: 250 deaths before age 75 per 100,000
>Median household income: $54,055

According to the CDC, men are two times more likely to binge drink than women. Mankato is one of a few U.S. metro areas where more than 50% of the population is male. This could partially explain the relatively high rate of excessive drinking in the Mankato metro area.

[in-text-ad]

9. Eau Claire, WI
>Pct. adults drinking to excess: 24.3%
>Pct. driving deaths involving alcohol: 43.3%
>Premature death: 278 deaths before age 75 per 100,000
>Median household income: $48,873

Eau Claire residents report some of the heaviest drinking in the country. As is the case in a number of other metros with high rates of excessive drinking, the Eau Claire area is home to quite a few drinking establishments. For every 10,000 residents, there are 6.4 bars, the second most of any U.S city.

8. Ames, IA
>Pct. adults drinking to excess: 24.4%
>Pct. driving deaths involving alcohol: 11.8%
>Premature death: 214 deaths before age 75 per 100,000
>Median household income: $46,091

In Ames, 24.4% of adults report either binge or heavy drinking within the last month, a larger share than in all but seven other U.S. cities. While adults in Ames may be more likely than most to drink excessively, they also appear less likely to engage in risky behavior associated with drinking. Only 11.8% of fatalities on roads in Ames involved alcohol, far less than the 31.0% that did nationwide.

7. Fond du Lac, WI
>Pct. adults drinking to excess: 24.6%
>Pct. driving deaths involving alcohol: 25.9%
>Premature death: 285 deaths before age 75 per 100,000
>Median household income: $51,717

In Fond du Lac, nearly one in every four adults drink to excess. By contrast, fewer than one in every five adults nationwide report excessive drinking. While alcohol consumption frequently leads to adverse health outcomes, Fond du Lac has one of the lowest premature death rates. Financial distress from poverty can be an even greater hindrance to health. Less than 10% of people in Fond du Lac live in poverty, one of the lowest rates nationwide.

6. La Crosse-Onalaska, WI-MN
>Pct. adults drinking to excess: 25.1%
>Pct. driving deaths involving alcohol: 26.9%
>Premature death: 273 deaths before age 75 per 100,000
>Median household income: $50,568

There are 6.9 bars for every 10,000 people in La Crosse-Onalaska, more bars per capita than in any other U.S. city. La Crosse is also one of only six U.S. cities where more than one-quarter of adults drink excessively.

5. Fargo, ND-MN
>Pct. adults drinking to excess: 25.2%
>Pct. driving deaths involving alcohol: 29.5%
>Premature death: 280 deaths before age 75 per 100,000
>Median household income: $53,867

As is the case with many of the cities with relatively high shares of heavy drinkers, Fargo has plenty of bars. There are 63 drinking establishments in the metro area, or about 2.8 bars for every 10,000 residents — enough to put Fargo among the top 50 U.S. cities with the most bars per capita.

[in-text-ad]

4. Madison, WI
>Pct. adults drinking to excess: 25.5%
>Pct. driving deaths involving alcohol: 38.7%
>Premature death: 259 deaths before age 75 per 100,000
>Median household income: $60,903

Wisconsin tops all states in alcohol consumption, and more than half of the 20 cities on this list are in the state. In Madison, 25.5% of adults report heavy or binge drinking on a regular basis, fourth highest nationwide. While excessive drinking does not always lead to adverse outcomes, it may be causing serious problems in the Madison area. Of driving deaths in a given year, 38.7% are alcohol related, one of the highest percentages nationwide.

3. Green Bay, WI
>Pct. adults drinking to excess: 25.6%
>Pct. driving deaths involving alcohol: 47.5%
>Premature death: 290 deaths before age 75 per 100,000
>Median household income: $53,208

More than one in every four adults report heavy or binge drinking on a regular basis in the Green Bay area, nearly the highest excessive drinking rate in the country. While premature death in Green Bay is not more common compared to other metros, it would certainly be much lower if the current level of excessive drinking were to decline. Nearly half of all driving fatalities in Green Bay can be linked to alcohol consumption, the seventh highest percentage in the country.

2. Oshkosh-Neenah, WI
>Pct. adults drinking to excess: 26.0%
>Pct. driving deaths involving alcohol: 44.6%
>Premature death: 299 deaths before age 75 per 100,000
>Median household income: $52,387

In the Oshkosh-Neenah metro area, 26.0% of adults drink excessively, a considerably higher share than the corresponding 18.0% national rate. Excessive drinking is taking a heavy toll on metro area residents. Alcohol is involved in 44.6% of roadway fatalities in Oshkosh-Neenah, one of the highest shares in the country and far higher than the corresponding 31% national rate.

1. Appleton, WI
>Pct. adults drinking to excess: 26.8%
>Pct. driving deaths involving alcohol: 30.3%
>Premature death: 257 deaths before age 75 per 100,000
>Median household income: $60,106

Appleton is home to the largest share of binge and heavy drinkers in both Wisconsin and the country. According to the CDC, binge drinking is more common in households earning at least $75,000 annually. In Appleton, 38.5% of households earn that much, a higher share than the 35.6% of household nationwide earning at least this much. Also, for every 10,000 area residents, there are 4.4 drinking establishments, the ninth highest concentration of bars of any U.S. area.

The Least Drunk Cities

20. Anniston-Oxford-Jacksonville, AL
>Pct. adults drinking to excess: 12.9%
>Pct. driving deaths involving alcohol: 25.0%
>Premature death: 521 deaths before age 75 per 100,000
>Median household income: $41,428

Only 13.9% of adults in Alabama drink to excess, a far smaller share than the corresponding 18.0% national rate. Excessive drinking is even less common in the Anniston-Oxford-Jacksonville metro area, where only 12.9% of adults are either heavy or binge drinkers.

[in-text-ad]

19. Gadsden, AL
>Pct. adults drinking to excess: 12.9%
>Pct. driving deaths involving alcohol: 27.4%
>Premature death: 546 deaths before age 75 per 100,000
>Median household income: $40,529

Excessive drinking is more common in relatively affluent households, and only about one in five Gadsden households earn $75,000 or more a year, one of the smallest such shares of any U.S. city. Only 12.9% of Gadsden adults report excessive drinking habits.

18. Kingsport-Bristol-Bristol, TN-VA
>Pct. adults drinking to excess: 12.7%
>Pct. driving deaths involving alcohol: 20.6%
>Premature death: 457 deaths before age 75 per 100,000
>Median household income: $39,213

In the Kingston-Bristol metro area, only 12.7% of adults drink excessively, one of the smallest such shares in the country. With lower-than-average excessive alcohol consumption rates, only 20.6% of fatal car accidents involve alcohol, far fewer than the 31.0% national rate.

17. Farmington, NM
>Pct. adults drinking to excess: 12.7%
>Pct. driving deaths involving alcohol: 39.4%
>Premature death: 384 deaths before age 75 per 100,000
>Median household income: $48,773

While alcohol is indisputably linked to negative health outcomes, it is only one factor that can lead to poorer health, and low binge drinking rates by no means guarantee positive health outcomes. In Farmington, a city with one of the lowest excessive drinking rates in the country, adults report an average of 4.4 physically unhealthy days a month, nearly a full day more than the typical American.

16. Rocky Mount, NC
>Pct. adults drinking to excess: 12.5%
>Pct. driving deaths involving alcohol: 31.2%
>Premature death: 444 deaths before age 75 per 100,000
>Median household income: $40,407

Heavy drinking is most common among affluent households. In Rocky Mount, only 12.5% of adults drink excessively, and only 19.4% of households earn more than $75,000 a year — each some of the smallest such shares in the country.

15. Knoxville, TN
>Pct. adults drinking to excess: 12.0%
>Pct. driving deaths involving alcohol: 27.9%
>Premature death: 426 deaths before age 75 per 100,000
>Median household income: $45,151

Only 12.0% of adults in Knoxville report an unhealthy drinking habit, a full 6 percentage points below the nationwide excessive drinking rate. Despite low excessive drinking rates, area residents report some of the worst health outcomes in the country due in part to exceptionally high smoking and physical inactivity rates.

[in-text-ad]

14. Huntington-Ashland, WV-KY-OH
>Pct. adults drinking to excess: 12.0%
>Pct. driving deaths involving alcohol: 29.6%
>Premature death: 465 deaths before age 75 per 100,000
>Median household income: $40,830

According to the CDC, excessive drinking can lead to risky sexual behavior and an increased risk of contracting sexually transmitted diseases. The low rate of excessive drinking in Huntington-Ashland may therefore partially explain the low rate of sexually-transmitted diseases in the area. Chlamydia, for example, is far less common among adults in Huntington-Ashland than it is across the country.

13. Cleveland, TN
>Pct. adults drinking to excess: 11.8%
>Pct. driving deaths involving alcohol: 35.1%
>Premature death: 455 deaths before age 75 per 100,000
>Median household income: $41,176

With only three drinking establishments and well over 100,000 residents, Cleveland, Tennessee, has fewer bars per capita than all but 20 other U.S. metro areas. Relatively few drinking establishments reflects low demand. Only 11.8% of adults in the city drink heavily, a considerably smaller share than the 18.0% of American adults.

12. Memphis, TN-MS-AR
>Pct. adults drinking to excess: 11.8%
>Pct. driving deaths involving alcohol: 21.3%
>Premature death: 451 deaths before age 75 per 100,000
>Median household income: $45,844

Only 11.8% of adults in Memphis drink to excess, one of the smallest such shares of any U.S. city. With a population of 1.3 million, Memphis is by far the largest city to report such low heavy and binge drinking rates.

11. Owensboro, KY
>Pct. adults drinking to excess: 11.7%
>Pct. driving deaths involving alcohol: 30.4%
>Premature death: 405 deaths before age 75 per 100,000
>Median household income: $41,827

Alcohol sales are prohibited in a number of Kentucky areas. Daviess County, which contains the Owensboro metro area, is not a “dry” county. Still, only 11.7% of metro area adults report drinking excessively, the smallest such share in the state.

10. Charleston, WV
>Pct. adults drinking to excess: 11.7%
>Pct. driving deaths involving alcohol: 27.6%
>Premature death: 497 deaths before age 75 per 100,000
>Median household income: $42,761

While excessive alcohol consumption can lead to a host of negative health outcomes, responsible drinking alone is not enough to ensure good health. While a relatively small 11.7% share of Charleston adults drink excessively, area adults also experience an average of 5.0 physically unhealthy days a month, the highest share of any metro in the country.

[in-text-ad]

9. Johnson City, TN
>Pct. adults drinking to excess: 11.5%
>Pct. driving deaths involving alcohol: 29.0%
>Premature death: 444 deaths before age 75 per 100,000
>Median household income: $38,813

While many counties and cities in Tennessee forbid liquor sales, Johnson City does not. Despite the lack of legal restrictions, only 11.5% of adults report unhealthy drinking habits, one of the smallest such shares in the country.

8. Jackson, TN
>Pct. adults drinking to excess: 11.4%
>Pct. driving deaths involving alcohol: 27.0%
>Premature death: 411 deaths before age 75 per 100,000
>Median household income: $40,338

While a relatively small 11.4% share of adults in Jackson drink excessively, the metro area is not without its unhealthy vices. The adverse health effects associated with smoking are well established, yet 22.1% of metro area adults report a smoking habit — a considerably larger share than the comparable 17.0% national figure.

7. Morristown, TN
>Pct. adults drinking to excess: 11.3%
>Pct. driving deaths involving alcohol: 32.6%
>Premature death: 478 deaths before age 75 per 100,000
>Median household income: $38,542

People who report a heavy drinking habit are more likely to live in relatively high income households. In Morristown, a metro area where excessive drinking is relatively uncommon, 22.3% of residents live in poverty, one of the highest shares in the country.

6. Parkersburg-Vienna, WV
>Pct. adults drinking to excess: 11.3%
>Pct. driving deaths involving alcohol: 29.9%
>Premature death: 422 deaths before age 75 per 100,000
>Median household income: $41,793

While adults in the Parkersburg-Vienna metro area are far less likely to drink excessively than most Americans, they are more likely to identify as smokers. The metro area’s 11.3% excessive drinking rate is the sixth lowest in the country, while the 24.2% smoking rate is the fifth highest.

5. Ogden-Clearfield, UT
>Pct. adults drinking to excess: 11.2%
>Pct. driving deaths involving alcohol: 18.7%
>Premature death: 290 deaths before age 75 per 100,000
>Median household income: $64,301

In Ogden-Clearfield, only 11.2% of adults drink excessively, one of the smallest shares in the country. As a result, alcohol related roadway fatalities are far less common in Ogden than they are across the country. Only 18.7% of deadly car accidents involve alcohol compared to a 31.0% national rate.

[in-text-ad]

4. Logan, UT-ID
>Pct. adults drinking to excess: 11.2%
>Pct. driving deaths involving alcohol: 16.0%
>Premature death: 226 deaths before age 75 per 100,000
>Median household income: $51,497

Only 11.2% of adults in Logan drink excessively, a smaller share than in all but three other U.S. metro areas. Healthy behaviors often lead to healthy outcomes, and only 226 Logan residents per 100,000 die annually before age 75, one of the lowest premature death rates in the country.

3. Beckley, WV
>Pct. adults drinking to excess: 10.4%
>Pct. driving deaths involving alcohol: 32.7%
>Premature death: 553 deaths before age 75 per 100,000
>Median household income: $39,498

Despite having the lowest excessive drinking rate in West Virginia and the third lowest such rate in the country, the health of Beckley residents is relatively poor. Due in part to a number of poor health measures, including high smoking and inactivity rates, Beckley has the highest rate of premature death in the country.

2. St. George, UT
>Pct. adults drinking to excess: 9.9%
>Pct. driving deaths involving alcohol: 14.5%
>Premature death: 269 deaths before age 75 per 100,000
>Median household income: $49,981

Unhealthy behaviors are uncommon in St. George. Only 9.9% of adults drink excessively and only 8.4% of the adult population smokes, each the second lowest such rate of any U.S. metro area.

1. Provo-Orem, UT
>Pct. adults drinking to excess: 9.2%
>Pct. driving deaths involving alcohol: 14.9%
>Premature death: 251 deaths before age 75 per 100,000
>Median household income: $60,890

Utah is home to a large Mormon population, a religion that explicitly forbids alcohol consumption. Only 9.2% of adults in the Provo-Orem metro area drink excessively, the smallest such share in the country. Excessive alcohol consumption can lead to a number of health complications, and premature death is far less common in Provo-Orem than it is across the country.

Thank you for reading! Have some feedback for us?
Contact the 24/7 Wall St. editorial team.