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Alcohol abuse cost the United States $250 billion in 2010, according to a 2015 study from the Centers for Disease Control and Prevention. These costs include health care expenses associated with alcohol consumption as well as estimated lost productivity. Binge drinking was related to three-quarters of the total cost. Residents of different states report different drinking habits, as do residents of metropolitan areas within each state.

The CDC defines binge drinking as the consumption of four or more drinks for women and five or more drinks for men during a single occasion. Heavy drinking is defined as the consumption per week of 15 or more drinks for men, and typically eight or more drinks for women.

24/7 Wall St. reviewed the metropolitan areas reporting the highest levels of binge and heavy drinking in each state. Appleton, the drunkest city in Wisconsin, also leads the nation with 26.8% of adults reporting excessive drinking in the metropolitan area. The Nashville-Davidson–Murfreesboro-Franklin, Tennessee metro area, where 13.5% of adults report such a drinking habit, is the booziest city in Tennessee. Nationwide, 87.6% of adults have drank alcohol at some point in their lives, 71.0% consumed alcohol in the past year, 56.9% say they drank in the past month, and 18.0% of adults report excessive drinking.

22. Michigan

> Drunkest city: Monroe
> Pct. of MSA adults binge or heavy drinking: 22.9%
> Pct. of state adults binge or heavy drinking: 20.4%
> Pct. of alcohol related driving deaths: 37.9%

Monroe is the heaviest drinking metro area in one of the heaviest drinking states in the country. Nearly 23% of adults in Monroe and more than 20% of adults across Michigan drink excessively.

The relatively high alcohol consumption may partially explain Monroe’s drunk driving problem. About 38% of the area’s traffic fatalities involve alcohol, a far larger share than is typical nationwide.

While there can be health benefits to moderate drinking as an adult, consuming excessive amounts of alcohol is associated with a range of health problems. Close to 88,000 people die from alcohol-related causes each year, and one in 10 deaths among U.S. adults is due to excessive drinking. According to the National Institute of Health, alcohol is the fourth leading cause of preventable death in the United States.

While it is established that excessive drinking can lead to negative health outcomes, drinking is only one of the many factors that can affect the health of a population. For this reason, many of the cities with high rates of excessive alcohol consumption do not exhibit the negative consequences that might be expected to accompany alcohol abuse.

For example, just under half of the cities with the highest rates of alcohol consumption in their state report an above average incidence of premature death. Similarly, in slightly less than half of the 50 cities, relatively more adults report being in fair or poor health than the average nationwide.

To identify the drunkest city in each state, 24/7 Wall St. reviewed the percentage of men and women over 18 who report binge or heavy drinking in each state’s metro areas. Metro level data was 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. Health outcomes, including the number of deaths before age 75 per 100,000 people, also known as the premature death rate, and the percentage of adults who report fair or poor health were also aggregated from county-level data obtained from County Health Rankings & Roadmaps. All data are as of the most recent available year. Social and economic characteristics, including median household income and percentage of adults who have completed at least a bachelor’s degree came from the U.S. Census Bureau’s 2015 American Community Survey.

Click here to see the drunkest city in each state.