81.8
South Dakota
Number one in the Alcohol Harm Index.
A nationwide data study
Alcohol Across America
Where alcohol harm is highest, where it is rising fastest, and how access to treatment differs across all 50 states and Washington, DC.
The national picture
One country. Very different outcomes.
This analysis brings together mortality, road safety, treatment access, and treatment client data to show how the effects of alcohol differ from state to state. Explore the overall Alcohol Harm Index, then compare each state across the five core campaign tables.
State explorer
Explore the state-by-state map.
Switch between the Alcohol Harm Index and the four tables behind it. Hover over a state to see its rank and value for the active category.
LowerHigher
At a glance
Top 5 states by Alcohol Harm Index
Key findings
The number one state in each table.
142.31%
Mississippi
Largest increase in the alcohol-induced death rate.
124.50%
Washington, DC
Largest increase in the alcohol-impaired road death rate.
94.6
Wyoming
Number one in the Treatment Access Index.
1,444
Delaware
Highest rate of clients in treatment involving alcohol.
Alcohol Harm Index
The top 10 states.
Higher scores indicate greater alcohol harm across mortality and alcohol-impaired road-death measures.
- 01South Dakota81.80
- 02Montana76.00
- 03New Mexico74.70
- 04Tennessee74.00
- 05Iowa73.60
- 06Arizona71.90
- 07South Carolina71.90
- 08Colorado71.10
- 09Nevada71.00
- 10Mississippi70.00
Explore the data
Five focused state rankings
Explore the five core campaign tables and search for any state. Each table retains the full underlying ranking supplied in the workbook.
No matching state found.
Scores and rates are shown as supplied in the campaign workbook. Scroll horizontally on smaller screens.
2015 to 2024
10-Year Trend Explorer
Compare how alcohol-impaired traffic fatalities and alcohol-induced mortality changed over ten years. Choose up to three states, compare each trajectory with the US baseline, and move the timeline to update the annual ranking boards.
Compare up to 3 states
NHTSA published estimates
Alcohol-impaired traffic fatalities
Each line is indexed to its 2015 value, allowing states of different sizes to be compared.
KFF and CDC/NCHS
Alcohol-induced mortality rate
Age-adjusted deaths per 100,000, indexed to each geography's 2015 rate.
Selected year
Highest alcohol-impaired fatality counts, 2024
Selected year
Highest alcohol-induced death rates, 2024
How to read the charts: 2015 equals 100 for every line. A value of 125 means the measure is 25% above its 2015 level. Traffic rankings use published alcohol-impaired fatality counts. Mortality rankings use age-adjusted alcohol-induced death rates per 100,000. The 2024 traffic figures use the FARS Annual Report File and may be revised.
Methodology
Built from national public data.
The study covers the 50 states and Washington, DC. It combines published government tables with state-level calculations from public-use files. Rankings use the campaign workbook without altering its values.
Alcohol Harm Score
The composite score weights the 2024 alcohol-induced death rate at 35%, the 2024 alcohol-impaired road death rate at 30%, change in alcohol-induced mortality from 2015 to 2024 at 20%, and change in the alcohol-impaired road death rate at 15%. Each measure is converted to a percentile rank across all 51 jurisdictions.
Mortality measures
Alcohol-induced death rates are age-adjusted rates per 100,000 residents from KFF State Health Facts, which republishes CDC/NCHS mortality data. Alcohol-induced deaths include alcohol-specific underlying causes and exclude road fatalities.
Road fatality measures
NHTSA defines an alcohol-impaired-driving fatality as a death in a crash involving a driver or motorcycle rider with a blood alcohol concentration of 0.08 g/dL or higher. This does not establish that alcohol caused the crash. The 2024 figures use the Annual Report File and may be revised.
Treatment access measures
The Treatment Access Score combines facilities treating alcohol use disorder per 100,000 adults, weighted at 65%, with the share of substance use facilities accepting Medicaid, weighted at 35%. SAMHSA facility counts are unweighted counts of responding facilities and do not measure capacity or real-time availability.
Client data
Client figures are one-day census counts for March 29, 2024, not annual admissions. A high caseload may reflect greater need, stronger treatment access, or both, so it should not be interpreted in a single direction.