“The percentage of people who drink is not changing much, but among drinkers, we are seeing more heavy drinking and more binge drinking,” says Ali Mokdad, a lead author of the study who is a professor at the Institute for Health Metrics and Evaluation at the University of Washington. “We’re going in the wrong direction.”

Heavy drinking, defined as more than two drinks a day for men and more than one drink a day for women, is linked to heart disease, cancer, liver damage and many other health problems. Binge drinking, defined as at least five drinks on one occasion for men and at least four drinks for women, is linked to car crashes, injuries and alcohol poisoning.

Leading the nation in binge drinkers: Wisconsin’s Menominee County, home of the Menominee Indian Reservation, where 36% of drinking-age adults binge-drink. Least likely to binge: heavily Mormon Madison County, Idaho, where just 5.9% do.