Objectives: We estimated the prevalence of any drinking and binge drinking from 2002 to 2012 and heavy drinking from 2005 to 2012 in every US county.
Methods: We applied small area models to Behavioral Risk Factor Surveillance System data. These models incorporated spatial and temporal smoothing and explicitly accounted for methodological changes to the Behavioral Risk Factor Surveillance System during this period.
Results: We found large differences between counties in all measures of alcohol use: in 2012, any drinking prevalence ranged from 11.0% to 78.7%, heavy drinking prevalence ranged from 2.4% to 22.4%, and binge drinking prevalence ranged from 5.9% to 36.0%. Moreover, there was wide variation in the proportion of all drinkers who engaged in heavy or binge drinking. Heavy and binge drinking prevalence increased in most counties between 2005 and 2012, but the magnitude of change varied considerably.
Conclusions: There are large differences within the United States in levels and recent trends in alcohol use. These estimates should be used as an aid in designing and implementing targeted interventions and to monitor progress toward reducing the burden of excessive alcohol use.