5 US States That Drink The Most Alcohol

Alcohol has long been a part of social life in the United States. From celebratory champagne to casual beers over the weekend, drinking is woven into the fabric of American culture. But while moderate consumption may be normalized and even encouraged in certain settings, excessive alcohol use remains a critical public health concern. A new report by Drug Helpline reveals stark disparities in alcohol consumption across US states—highlighting regions with particularly high usage rates, and raising pressing questions about the health implications of these patterns.

Alcohol consumption in the US is both widespread and deeply ingrained. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), over 85% of adults have consumed alcohol at some point, and more than half of all adults report drinking in the past month. But it’s not just about frequency—binge drinking and high-intensity consumption have become alarmingly common.

Approximately 1 in 4 adults binge drink at least once a month, and those engaging in “high-intensity drinking” (twice the binge threshold) are 70 times more likely to need emergency healthcare. As a result, alcohol is responsible for nearly 1 in 5 ER visits and claims over 140,000 lives annually. The ripple effect isn’t just health-related—the economic cost of alcohol misuse was estimated at $249 billion in 2010, with 75% of that tied to binge drinking.

Why Where You Live Matters for Longevity?

While alcohol is accessible nationwide, some states drink far more than others. Geography influences access, social norms, climate, tourism, and legislation around alcohol—all of which affect consumption patterns.

1. New Hampshire

Despite being one of the smallest and least populated states, New Hampshire consistently tops the list for alcohol consumption. According to data from the NIAAA, residents consume more than 4 gallons of ethanol (pure alcohol) per capita annually—nearly double the national average.

One key reason is tax policy. New Hampshire has no sales tax and minimal excise taxes on alcohol, making it a magnet for out-of-state buyers from neighboring Massachusetts and Vermont. In fact, a significant chunk of alcohol sold in New Hampshire isn’t consumed by residents at all—but it still skews the per capita figures.

However, public health experts warn that easy access combined with low prices can still encourage higher in-state consumption, potentially contributing to increased alcohol-related harm over time.

2. Delaware

With a modest population of under a million, Delaware might seem like an unexpected entry on this list—but its residents drink over 3.5 gallons of alcohol per capita annually.

The state also has a high prevalence of binge drinking, particularly among young adults. Proximity to major urban centers like Philadelphia and Baltimore makes Delaware a hub for weekend tourism, which adds to local alcohol sales. Moreover, the state reports concerning rates of alcohol-related driving fatalities, signaling a growing need for intervention.

3. Nevada

Home to Las Vegas, Nevada’s position on this list comes as no surprise. The state’s vibrant nightlife, relaxed alcohol laws, and 24/7 availability contribute to an environment where drinking is not only accepted but encouraged.

But beyond the casinos and neon lights, Nevada faces real health consequences. High alcohol consumption is linked to above-average rates of alcohol-related deaths and emergency room visits. The state also struggles with alcohol use disorders (AUD), especially in its more remote rural areas where access to treatment is limited.

4. North Dakota

In North Dakota, the long winters and sparse population have contributed to a drinking culture that’s rooted in social tradition. Whether it’s beer at a hockey game or whiskey on a snowy evening, alcohol is often part of community gatherings.

Yet, this culture comes at a cost. North Dakota sees elevated rates of binge drinking, especially among college-age individuals. The state also experiences higher-than-average alcohol-impaired driving deaths, and its rural setting complicates access to mental health and substance abuse services.

5. Montana

Rounding out the top five is Montana, a state known for its natural beauty—and, increasingly, its high rates of alcohol consumption. Like North Dakota, Montana’s rural landscape and weather conditions may play a role in shaping drinking behaviors.

Montana’s per capita alcohol consumption exceeds 3 gallons annually, and the state records frequent alcohol-related fatalities, both on and off the road. Its widespread rural communities often lack the healthcare infrastructure needed to support those with alcohol use disorders, creating a silent public health burden.

It’s easy to reduce alcohol consumption statistics to curiosities or state pride, but these figures reflect broader health, social, and economic challenges. States that rank highest in alcohol consumption are also more likely to face:

• Higher rates of liver disease, certain cancers, and heart conditions
• Increased emergency department visits
• A heavier economic burden on healthcare systems
• Strained family and workplace dynamics

Public health experts continue to call for greater awareness, better alcohol education, and increased access to treatment for alcohol use disorder, especially in high-consumption states.

The numbers don’t lie—America has a drinking problem, and where you live can influence just how serious that problem is. While some states are beginning to roll out initiatives aimed at responsible drinking, there's a long way to go in addressing the deeper health crisis at play.