Rethinking Wisconsin's Drinking Culture for Better Health

April is Alcohol Awareness Month and we’re looking at you, Wisconsin.

In the This Is the Drunkest City in the US: Ranking America’s Top 50 Cities article, no state has more “drunker cities” than Wisconsin—and Wisconsin has been topping these lists for as long as they’ve been making them.

This excessive alcohol use puts Wisconsin residents and communities at risk for immediate and long-term effects. These risks include injuries, automobile accidents, falls, burns, violence (homicide, suicide, sexual violence), chronic illnesses including heart disease, liver disease, diabetes, mental health conditions, memory problems, and even cancer.

The good news is that reducing alcohol intake can reduce these risks and improve your health.

Mia Croyle

We asked Mia Croyle, a project specialist in the Healthcare Transformation department at MetaStar, to share some insights on the alcohol culture in Wisconsin and ways people can reduce their alcohol use. She has a background in clinical mental health counseling which includes working with individuals receiving treatment for substance use disorder (SUD) and working in primary care with screenings, brief interventions, and referrals for individuals with alcohol and drug use. We chatted about her thoughts on how individuals can reduce their personal risk and how Wisconsin can change its reputation and maybe avoid being on the list of drunkest cities in the future.

How can we work to change the culture and reputation of Wisconsin’s drinking?

I think the culture in Wisconsin is so unique. I grew up here, I’ve worked with lots of people who weren’t born and raised in Wisconsin, and I’ve heard over and over again stories of how shocked they were when they first came to Wisconsin. They’re shocked that alcohol is available at our summer fairs and church banquets. And they’re shocked to find out that we can take our kids into a bar and if they’re with their parents, they can drink.

To change the reputation, we must change the reality that we do a lot of drinking in Wisconsin. The best way to shift the culture is to talk about it.

Can you speak about the health risks, specifically the new announcement from the Surgeon General linking alcohol use to cancer?

The report released by the U.S. Surgeon General’s Office found that alcohol contributed to 100,000 cancer cases and 20,000 cancer deaths a year.

Cumulatively, rigorous research across observational, biological, and genetic studies has shown that alcohol consumption increases the risk of cancer for at least seven sites. In 2016, a previous Surgeon General’s Report on Alcohol, Drugs, and Health found that alcohol misuse is associated with “… cancers of the oral cavity, esophagus, larynx, pharynx, liver, colon, and rectum. Even one drink per day may increase the risk of breast cancer.”

What I find most interesting [in the report] is the link to breast cancer risk because we see such health promotion efforts around breast cancer and alcohol is usually not part of the narrative. The report shows the biggest impact in the US for alcohol-related cancer is related to breast cancer in women. In 2019, 16% of the breast cancer cases in women could be attributable to alcohol use. Comparing women who drink less than one drink per week to those who drink two drinks per day, about four more women out of 100 would develop breast cancer due to drinking two drinks per day.

What are some other health issues that stem from excessive alcohol use?

We know that excessive alcohol use impacts multiple chronic conditions that we work hard to manage including cardiovascular conditions such as hypertension, diabetes, and mental health.

For me, the headline is that when consuming alcohol the risk of cancer is huge, the cardiovascular impact is huge, and it worsens nearly any chronic condition a person may be trying to manage.

Studies have shown that a reduction in alcohol intake is effective in lowering blood pressure in people both with and without hypertension. Cutting back may help to prevent the development of hypertension. People who drink heavily and cut back to more moderate drinking can lower their systolic blood pressure by 2 to 4 mm of mercury (mm Hg) and their diastolic blood pressure by 1 to 2 mmHg.

How do you know if you’re drinking too much?

There’s a great resource called Rethinking Drinking from the National Institute for Alcohol Abuse and Alcoholism (NIAAA). It offers a couple simple quizzes for you to get a sense of your drinking patterns and potential areas of concern. Another option is to speak with your healthcare provider.

What can people do if they’re starting to struggle with alcohol use?

The good news about alcohol is that for a lot of people, it’s a very modifiable behavior. There certainly are people who struggle with alcohol use disorder and for them, they may need some additional support to quit or cut back, but many of us can just decide to make a change and do it – similar to other lifestyle changes like diet and exercise.

What are some specific strategies or changes people can make to reduce or avoid alcohol use?

• Order a mocktail. A lot of restaurants now offer a variety of mocktails, often with interesting and fun flavor combinations.
• If you’re going to be drinking alcohol, have a glass of water or a soda in between each drink you have with alcohol to pace yourself.
• Find a way to keep track. If you decide to only have three drinks on a given night, put three-quarters in your pocket. Each time you have an alcoholic drink, take a quarter out. When your pocket’s empty, you’re done for the night and can switch to water or another non-alcoholic beverage option.
• If you’re attending an event, check to see if they have an alcohol-free area or support for attendees.
  • At Packer games, sober fans can connect with Section Yellow, a group supporting sober Packer fans, that sets up a table near the Kwik Trip gate inside the stadium.
  • Brewers and American Family Field have designated Family Sections where alcohol is not allowed.
• For people who might struggle with making changes on their own, your healthcare provider is a great resource. They can offer you support or make a referral to a treatment program. Treatment can look a lot of different ways. Most people think of a 28-day treatment program, which might be the best approach for some people, but not everyone. There are medications that can help reduce cravings for alcohol, which can even be prescribed by your primary care provider. Some people see a counselor a couple of times and feel like that’s what does the trick for them. It certainly isn’t one size fits all! Wisconsin has a hotline you can call if you’re wondering about treatment resources in your area.

How has MetaStar contributed to reducing alcohol use?

MetaStar has a significant history of working on projects around this space. Over the years, we have had some funding from the Centers for Medicare & Medicaid Services (CMS) and Medicare to help practices with screening patients for depression and excessive alcohol use.

We also worked on an Agency for Healthcare Research and Quality (AHRQ) funded grant that aimed to help small practices do a better job at screening and identifying patients and to help providers increase their capacity to prescribe medication for the treatment of Alcohol Use Disorder.

Finally, in our work to improve care for individuals with chronic disease, we aim to make sure alcohol use is part of the conversation.

How can health care professionals or organizations get assistance with improvement projects from MetaStar?

Reach out to Emily Nelson, vice president of Healthcare Transformation, to discuss their needs and learn about MetaStar’s services.

Making Culture Changes

Alcohol Awareness Month serves as an important reminder to recognize the significant impacts of excessive alcohol consumption and to encourage a healthier lifestyle within our communities. As highlighted by Mia Croyle’s insights, changing the ingrained culture around alcohol use in the state requires consistent dialogue, education, and practical interventions. The health risks associated with excessive drinking—ranging from chronic conditions to cancer—demand urgent attention, particularly in a state with such a high prevalence of heavy drinking. However, with the right resources, support, and behavioral changes, it is possible to reduce alcohol-related harm.

Wisconsin’s health professionals play a crucial role in promoting healthier practices and offering guidance to those struggling with alcohol use. MetaStar is dedicated to working with health care providers and organizations to help Wisconsin reduce its reputation as one of the “drunkest” states and improve overall health for its residents in the process.

Quick Links to Resources

• Rethinking Drinking, NIAAA
• Small Talks: How WI Prevents Underage Drinking, Wisconsin Department of Health Services
• Facts About Excessive Drinking | Drink Less Campaign, Centers for Disease Control and Prevention (CDC)
• Wisconsin Addiction Recovery Helpline: 211 Wisconsin
• Information about medication for the treatment of alcohol use disorder: Alcohol Use Disorder (AUD) Treatment: MedlinePlus