The cost of being America’s drunkest city

Boston tops The Daily Beast’s 2011 list of the 25 tipsiest towns in America, moving up from the eighth position last year. The Beast credits its click-ready rankings to a mixture of market research surveys and CDC statistics. I don’t know about the scientific accuracy, but from my perspective in its trenches, ranking Boston the booziest rings true.

You see, I spent 2011 seeing most of the traumatic brain injury cases at two of New England’s busiest rehabilitation hospitals. During the first half of the year, I completed my time in training on the south shore of Boston, and then I moved across town to take charge of my own, similar program at another hospital situated on the north shore. Combined, the two hospitals treat most of the serious head injury cases requiring acute level rehabilitation in the Boston region.

I just completed my own informal survey of my professional experience with Boston’s alcohol problem this year. My methods involved personal reflection for a good ten minutes before sitting down to write this item. A summary of my findings:

Alcohol contributed to the vast majority of traumatic brain injury cases I treated this year.

Scientifically conducted studies indicate alcohol is involved in a least a fifth of motor vehicle accident brain injuries. By contrast, my ten-minute personal reflection indicates Boston’s drug of choice is involved in at least three quarters of crashes generating a traumatic brain injury severe enough for the rehabilitation hospital. One of my patients eventually emerged from the vegetative state he was in after a meaningless drunken fight. (While the clinical anecdotes here bear some resemblances to the real cases, I’ve altered many details to further obscure identification.)

Another high-functioning Bostonian had too many cocktails at an after-work party and made the mistake of driving home (why her similarly high-functioning coworkers didn’t stop her is part of Boston’s problem). Quite a few of Boston’s elders enjoy an alcoholic nightcap. I see them after nighttime falls in the bathroom, where they sustain subdural hematomas. Many cases I see have little to do with the addiction pathology of alcoholism. These are people whose alcohol usage is normal for the society in which they live: New England. Until the day of their brain injury, many were experiencing no health, social, or work problems because of their alcohol use.

And then there is the case of the woman who suffered from vicious alcoholism, as reflected in her record of previous DUI’s, her estranged family’s testimony, and now a brain injury after a fall while intoxicated at home. She was a success story within walls of the rehabilitation hospital, coming back from her confusion and nixing her post-traumatic vertigo with vestibular therapy. She grew in her commitment and self insight, aided by addiction counseling all along the way, but we thought she still needed more. Given the severity of what happened this time, there couldn’t be a next time. We recommended an inpatient alcohol treatment program following discharge from the rehab hospital. But all the alcohol treatment programs in the Boston area she qualified for were filled up to capacity (if the Daily Beast’s assessment is accurate, we know why). Outpatient counseling would have to suffice. Well, it didn’t. Despite the weeks of physical and cognitive therapy that got her back home, she came right back in her car a few days later. Multiple collisions followed in a single drunken spree. The last I heard, she was in prison. Had Boston’s addiction centers not been filled to capacity with cases like hers, could this have been avoided, or only delayed? We’ll never know.

So when I see some media outfit has named Boston America’s Drunkest City, I think that sounds right. I see the aftermath every day.

Ford Vox is a physician and medical journalist who has written for Reuters, U.S. News & World Report, and Newsweek. This piece originally appeared in The Atlantic, and is reprinted with the author’s permission.

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  • C. St Juste Jr, L.Ac

    It would be interesting to see the cities with the most DUI’s, and I wouldn’t be surprised if I found a couple of those cities listed.

  • ninguem

    Are these college cities or demographically “younger” cities? Would that explain the higher drinking rate? I don’t know……

  • Anonymous

    I also wonder if Boston’s puritanical laws around alcohol contribute. It is illegal for establishments to offer discounts on drinks (happy hours), and open bars are illegal as well, and then there are also strict limits on the number of grocery stores that can sell alcohol in a particular radius – I sort of feel like these sorts of measures often backfire, like how college kids drink too much “pregaming” before going out because they aren’t able to legally purchase alcohol till 21. The subway in Boston also closes an hour and a half before last call at bars, and Boston cabs will often refuse to take passengers who are going to Cambridge and vice versa because they are technically two different cities. After having waited upwards of an hour for a cab at 2am in the dead of winter in Boston, it becomes a lot easier to see how someone could get behind the wheel after a night out (though it’s still certainly no excuse). 

    • ninguem

      My only quibble is the alcohol laws have nothing to do with Puritanism.

      The Puritans drank. They drank more than we do. There was beer on the Mayflower. John Winthrop brewed beer. It was considered healthier than water at the time… English standards anyway.

      Massachusetts liquor laws had nothing to do with Puritanism and morality, and everything to do with protecting Mom-and-Pop package stores and liquor oligopolies. They call it preserving morality, though in reality they could care less.

      Veteran of the New Hampshire “packie runs” on Sunday……long time ago. I fled the People’s Republic of Massachusetts a long time ago, I hear they allow Sunday sales now.

  • Betsy Murphy

    Considering that many states in the west and midwest have not even criminalized drunk driving, I wonder if some of the numbers area a result of higher rates of enforcement. In Missouri, for example, repeat drunken drivers get only a fine and a suspended sentence until their fifth conviction or their first fatality. I don’t deny that a college town like Boston, with a large Irish Catholic population has a high rate of drunkeness. It’s a problem everywhere, though, and New England is one of the few regions willing to tackle it.

  • Shannon

    Where is the link to Boston as the drunkest city? The Link I clicked on showed Boston as #8 and Milwaukee as #1. You may need to update this link. That being said, being from Milwaukee, it is always a surprise when I hear of any city beating Milwaukee out for the drunkest, as Milwaukee is one of the hardest drinking cities there is. Plus, other cities have larger college populations that may skew the data, but Milwaukee is chock full of heavy drinkers, binge drinkers, and alcoholics and it is part of the lifestyle, not just a college aged phenomenon. This is a true problem. When alcohol is so ingrained into the day to day living of a population, those who try to quit are truly cut out of a major aspect of their society. The problems lie in many areas, but crucial to changing these stats in Milwaukee, or any city, is to effect a real sea change in the thinking and culture of a population. No small task!

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