Top 10 states with the highest overall alcohol risk
States are ranked based on their combined performance across alcohol-induced deaths, adult binge drinking, and underage drinking. A lower Overall Alcohol Risk Rank indicates greater alcohol-related harm across all three of these measures.
| State | Overall Alcohol Risk Rank |
Alcohol-Induced Death Rate Per 100k |
Adults Who Binge Drink % |
Underage Drinking Rate % |
|---|---|---|---|---|
| Montana | 1 | 23.4 | 24.0% | 7.90% |
| North Dakota | 2 | 23.3 | 23.9% | 8.20% |
| Vermont | 3 | 16.2 | 20.3% | 9.60% |
| Oregon | 4 | 22.1 | 19.4% | 9.10% |
| Wyoming | 5 | 29.7 | 19.8% | 8.20% |
| Colorado | 6 | 22.0 | 19.9% | 8.40% |
| South Dakota | 7 | 34.6 | 21.0% | 6.30% |
| Wisconsin | 8 | 14.9 | 21.8% | 8.50% |
| Nevada | 9 | 17.5 | 18.7% | 8.40% |
| Iowa | 10 | 15.8 | 23.2% | 6.60% |
Consistent risk across multiple analyzed drinking measures: Montana, North Dakota, Vermont, Oregon, and Wyoming did not rank among the highest-risk states because of one statistic alone. Each of these states performed poorly across adult binge drinking rates, alcohol-related mortality rates, and underage drinking rates. This suggests alcohol-related challenges are widespread rather than isolated to a single behavior.
Regional alcohol use pattern: Montana, North Dakota, and Wyoming sit at the top of the index. Some research has found that remote communities can often have higher rates of problematic alcohol use than urban and well-populated areas. The research suggests factors like isolation, long distances to the nearest care option, and lower access to treatment services may contribute to these findings.1
Alcohol-related challenges are not evenly distributed across the country: While every state is affected by alcohol misuse, the index findings suggest certain regions experience a substantially greater burden of impact.
Highest alcohol-related death rates
This metric counts deaths directly caused by alcohol per 100,000 people. It explicitly excludes traffic accidents.
| State | Alcohol-Induced Death Rate Per 100k |
Death Rate Rank |
|---|---|---|
| New Mexico | 35.9 | 1 |
| South Dakota | 34.6 | 2 |
| Wyoming | 29.7 | 3 |
| Alaska | 26.6 | 4 |
| Montana | 23.4 | 5 |
| North Dakota | 23.3 | 6 |
| Oregon | 22.1 | 7 |
| Colorado | 22.0 | 8 |
| Arizona | 19.7 | 9 |
| Nevada | 17.5 | 10 |
The New Mexico outlier: New Mexico recorded the highest alcohol-induced death rate in the nation at 35.9 deaths per 100,000 residents. This is nearly three times the national average of 12.1 deaths per 100,000, highlighting a significantly greater burden of alcohol-related mortality that may correlate to dependency over time, rather than binge drinking.
Alcohol-related deaths are concentrated in the West: Eight of the ten states with the highest alcohol-induced death rates are located in the Mountain West or Southwest. New Mexico, Wyoming, Montana, Colorado, Arizona, Nevada, Oregon, and Alaska all ranked among the nation’s highest. Previous research indicates that people living in rural areas often have a harder time accessing alcohol treatment because of longer travel distances to find care.2
High mortality and high alcohol risk often overlap: Several states appearing near the top of the overall Alcohol Risk Index (Montana, Wyoming, North Dakota, Oregon, Colorado, South Dakota, and Nevada) also rank among the states with the highest alcohol-induced death rates. This suggests alcohol-related deaths remain a major contributor to overall alcohol risk.
Highest binge drinking rates
This metric measures the percentage of adults who report excessive episodic drinking within the past month.
| State | Adult Binge Drinking % |
Binge Drinking Rank |
|---|---|---|
| District of Columbia | 24.2% | 1 |
| Montana | 24.0% | 2 |
| North Dakota | 23.9% | 3 |
| Iowa | 23.2% | 4 |
| Wisconsin | 21.8% | 5 |
| South Dakota | 21.0% | 6 |
| Minnesota | 21.0% | 7 |
| Missouri | 20.6% | 8 |
| Nebraska | 20.5% | 9 |
| Vermont | 20.3% | 10 |
Washington, D.C. has the nation’s highest binge drinking rate: Nearly one in four adults in D.C. reported binge drinking.
Dr. Jasleen Salwan, board-certified addiction medicine physician and member of the American Society of Addiction Medicine, notes that D.C.’s workplace culture may contribute to the city's high binge drinking rate. She commented:
“Evening work events with open bars, networking pressure, and just a generally high-stress culture seem to be the driving factors. Combine these with the hierarchical nature of political jobs -- is an intern more likely to tell their boss that they think they need to slow down their drinking, or to join the boss in drinking more than they intended for themselves?”
The Upper Midwest and Northern Plains rank highest: Iowa, Wisconsin, Minnesota, North Dakota, South Dakota, Nebraska, and Montana all rank among the nation’s highest for adult binge drinking. This concentration suggests heavy episodic drinking is particularly common in these areas.
Binge drinking alone does not determine overall alcohol risk: While D.C. ranks first for binge drinking, it does not appear among the states with the highest alcohol-related death rates or highest overall alcohol risk. This demonstrates why looking at multiple measures provides a more complete picture of problematic alcohol use.
Highest underage drinking rates
This metric tracks the percentage of youth aged 12–17 who report consuming alcohol within the past 30 days.
| State | Underage Drinking Rate | Underage Drinking Rank |
|---|---|---|
| Vermont | 9.60% | 1 |
| Oregon | 9.10% | 2 |
| Kansas | 8.90% | 3 |
| New Hampshire | 8.80% | 4 |
| Illinois | 8.80% | 4 |
| District of Columbia | 8.60% | 5 |
| Massachusetts | 8.60% | 5 |
| Wisconsin | 8.50% | 6 |
| Colorado | 8.40% | 7 |
| Nevada | 8.40% | 7 |
| Rhode Island | 8.40% | 7 |
Vermont leads the nation for underage drinking: Nearly one in ten young people ages 12–17 reported recent alcohol use in Vermont, making it the highest underage drinking rate in the country.
Youth alcohol use is concentrated in several regions: States in New England, the Midwest, and the Pacific Northwest appear frequently throughout the rankings for youth alcohol use.
Several states rank high for both youth and adult alcohol use: Vermont, Oregon, Wisconsin, Colorado, and Nevada all appear near the top of both the underage drinking rankings and the overall Alcohol Risk Index. This finding suggests alcohol-related challenges extend across age groups within these states.
The 10 states with the lowest risk
States with the highest Overall Alcohol Risk Rank performed best across the three measures throughout the U.S. and experienced the lowest overall impact of alcohol-related harm.
| State | Overall Alcohol Risk Rank |
Alcohol-Induced Death Rate Per 100k |
Adults Who Binge Drink % |
Underage Drinking Rate % |
|---|---|---|---|---|
| Maryland | 51 | 7.6 | 14.4% | 6.20% |
| Alabama | 50 | 8.6 | 13.7% | 6.10% |
| Utah | 49 | 10.9 | 12.7% | 2.90% |
| New Jersey | 48 | 6.1 | 16.7% | 6.20% |
| West Virginia | 47 | 10.9 | 15.5% | 4.60% |
| Kentucky | 46 | 11.9 | 14.0% | 5.30% |
| Georgia | 45 | 9.6 | 15.2% | 6.70% |
| Mississippi | 44 | 12.6 | 14.4% | 5.50% |
| Texas | 43 | 9.8 | 16.9% | 6.20% |
| Oklahoma | 42 | 15.3 | 14.4% | 5.00% |
Maryland ranks as the lowest-risk state overall: Maryland performed well across all three measures included in the index, combining one of the nation’s lowest alcohol-induced death rates with below-average binge drinking and underage drinking rates.
Dr. Salwan, who practices just outside Washington, D.C., commented:
“The heartening news is that Maryland, which borders D.C., ranked lowest risk for alcohol use. Other protective factors would be a general focus on wellness and a strong sense of community, with opportunities for connection that do not center alcohol. It is often said in the recovery world that the opposite of addiction is not just abstinence but also community.”
Several Southern states rank among the lowest-risk states: Alabama, Kentucky, Georgia, Mississippi, Texas, and Oklahoma all appear in the ten lowest-risk states. Unlike the concentration seen among high-risk states, the lowest-risk states are distributed across several regions of the country.
Consistently strong performance matters: Just as the highest-risk states ranked poorly across multiple measures, the lowest-risk states generally avoided extreme rankings in any single category. Lower alcohol-related death rates, lower binge drinking rates, and lower underage drinking rates combined to produce stronger overall outcomes. Utah stands out in particular, recording the nation’s lowest adult binge drinking rate and one of the lowest underage drinking rates.