Charleston has always been known as a drinking city, but newly available statistics show exactly how much alcohol is behind the reputation: Its consumption levels far exceed the national average, contributing to a situation that public health researchers describe as worrisome.

But the numbers that trouble researchers are also deeply reflective of Charleston's history and culture, which is currently being promoted on an unprecedented global scale. To better understand the incipient clash between a centuries-long tradition of private drinking and rabid public interest in the city that spawned it, The Post and Courier is taking a two-part look at the state of local alcohol consumption, starting with this review of relevant data.

According to statistics compiled independently by the University of Wisconsin's Population Health Institute and the University of Washington's Institute for Health Metrics and Education, Charleston's alcohol consumption patterns are oddly upper Midwestern in nature. The city's imbibing habits most closely mirror those of places such as Milwaukee, where nearly half of the population claims German ancestry and enough snow falls every year to bury an average fourth-grader.

In the Southeast, Charleston out-drinks perennial party destinations, such as Myrtle Beach; cities that share its Lowcountry attitude toward alcohol, such as Savannah; and cities with vibrant dining scenes, such as Asheville. Charleston also is home to a higher percentage of heavy drinkers than New Orleans.

“Yeah, that's not low,” says Amanda Jovag, data lead for University of Wisconsin's county health study, when asked to size up the finding that 23 percent of Charleston County resident adults engage in excessive drinking. The report defines excessive drinking as a self-report of binge drinking (for women, that means four or more drinks in a single sitting; for men, the binge begins with five) or heavy drinking (an average of one drink a day for women, or two drinks a day for men) over the past 30 days.

“People don't like to sound like big drinkers on surveys, so if anything, this is probably an underestimate,” she says. “It's not high for Wisconsin, but you're kind of surrounded by counties that have pretty substantially lower drinking rates. That's unusual. Overall, South Carolina is not a huge drinking state, but Charleston is really starting to approach a problematic level of excessive drinking.”

With the exception of Beaufort County, where drinking statistics are largely on par with Charleston County, South Carolina looks like much of the rest of the South on color-coded maps reflecting drinking habits. The region is a sea of blue, the color reserved for counties where fewer than 20 percent of adult residents are classified as alcohol users: Researchers say that's a result of religious beliefs and high rates of poverty. Although the effect is muted closer to the coast, in Berkeley County, 40 percent of adults drink, as compared to 55 percent of adults in Charleston County.

Charleston's dining scene has benefited enormously from the local acceptance of alcohol, since booze pays the bills at high-end restaurants, and nourishes a culture of culinary experimentation and appreciation. “We use food and drink to celebrate the deliciousness of Charleston,” says Harry Root of Grassroots Wine Wholesalers.

Yet as the numbers associated with irresponsible drinking spiral upward, residents may be forced to confront the tension between the civilized glasses of Madeira that symbolize a longstanding tradition of hospitality and the Sunday Funday bottomless Mimosa sessions that end in a hospital or jail.

How Charleston compares to other cities

 

To put the figures in perspective, Charleston County didn't come close to cracking the Institute for Health Metrics and Education's list of counties leading the nation in binge drinking, which includes four representatives of North Dakota and one apiece from Texas, Nebraska, Nevada, Michigan, Montana and Wisconsin. In Menominee County, Wis., which encompasses the Menominee Indian Reservation north of Green Bay, 36 percent of adults are binge drinkers. By contrast, 15.8 percent of Charlestonians are so classified.

Nor is Charleston setting any records for drinking prevalence, or the percentage of adults who report having at least one drink over the past 30 days. The countywide measure is 55.8 percent, as compared with Falls Church, Va., where 78.7 percent of residents are considered drinkers. (Among the factors associated with compromised health, alcohol consumption is unusual because it correlates inversely with poverty: Falls Church has the lowest poverty level of any U.S. county.) Counties located in Wyoming, Colorado and Wisconsin also made the Top 10 list, far ahead of Charleston.

As the study's lead author points out, statisticians deal with a margin of error when trying to determine exactly how much people are drinking. Researchers had to make various corrections to data gathered by the Centers for Disease Control and Prevention to account for changes in questions related to consumption and the increased use of cellphones, for example, since only a small segment of the population currently uses landlines. What is clear, though, is the results are not skewed by tourists. “It's people who live here, who are not visiting,” Ali Mokdad says.

Because South Carolina is a three-tier state, there's no easy way to crosscheck the self-reported statistics with alcohol sales. In a three-tier system, distributors sell liquor to stores, which in turn sell to bars and restaurants, so there isn't a taxation trail showing where alcohol goes, or how much of it is drunk in a particular locale. “We're rather data deprived here,” says Marty Fettig of Ben Arnold Beverage Company, one of three major wholesalers serving the area. “We've got a lot of little hurdles that make it hard to understand what's really going on.”

Yet the popular perception of Charleston squares neatly with the available numbers. “Charleston is the place all liquor suppliers want to be,” says Reed Davis, S.C. district manager for liquor giant William Grant & Sons.

Visitors to Charleston who arrive via I-26 are typically greeted by a succession of billboards promoting various beers and liqueurs. While the ad campaigns change regularly, the come-on scenes usually depict sandy beaches or festive parties. But as residents of the city know, drinking is very much part of everyday life in Charleston.

Patty, a recovering alcoholic who uses only her first name in accordance with Alcoholics Anonymous tradition, retired from the Medical University of South Carolina. She recalls fellow employees “would have baseball night, or some kind of event, and there was always liquor. It was never just 'let's get together.' Liquor is the social lubricant. It's hard. But that's the way it is and we have to get used to it. You walk downtown and every third place is a bar; all of the restaurants have bars. If you can't get ... your table, you're supposed to wait at the bar.”

Beyond bars, there are charity car washes with drink specials; organized beer runs with kegs along the course; cut-rate nail salons offering complimentary wine; yoga classes at breweries and distilleries; cash bars at Sunday school fundraisers; and private dog parks with cocktail menus.

The ubiquity hasn't gone unnoticed by high school seniors who gravitate toward the College of Charleston. According to the college, 34 percent of 2,300 incoming first-years “already drink in a high-risk/binging manner,” compared with the national average of 22 percent.

While 49 percent of incoming first-years describe themselves as non-drinkers (significantly less than the 64 percent figure that holds nationwide), 76 percent of underage College of Charleston students have had a drink in the past month. Statistics also show they drink harder and more frequently than their peers on other campuses. According to Dean of Students Jeri Cabot, 33 students last fall were transported to a hospital for alcohol-related reasons. Another 28 were transported this spring.

Local hospitals are increasingly seeing more patients of all ages suffering from alcohol overdoses. At Roper St. Francis sites, the annual number of alcohol-related emergency room visits climbed from 419 admissions in 2010 to 616 admissions in 2015, a 47 percent increase. The hospital is on track to match or exceed that number this year. Over the past year, Medical University Hospital's emergency unit has treated 659 people for alcohol-related complaints, or nearly two people a day.

“It's not entirely a tourist problem,” says Charleston police Lt. Heath King of the hospitalizations and disorderly conduct arising from alcohol consumption. Annual alcohol-related arrests citywide surged by 78 percent between 2010 and 2014, from 1,559 arrests to 2,784 arrests. King attributes the uptick partly to the city's growth and partly to increased enforcement on King Street. But he concedes the nightly influx of visitors drawn to a city known for its easy way with alcohol can complicate public safety.

“We're getting people coming from Columbia just to eat and party on King Street,” King says. “We're having to address that to keep it safe and livable for the rest of the residents that do live here.”

In the context of alcohol consumption, “livable” isn't just an expression. Between 2009 and 2013, Charleston County recorded 126 drunken driving deaths, more than any other county in South Carolina. By contrast, 95 people died in Atlanta because of drunk driving. Milwaukee County, which is 2.5 times bigger than Charleston County, had 107 drunken driving fatalities over the same period.

Alcohol is involved in more than half of the vehicular deaths in Charleston County, the University of Wisconsin team found.

“Not only are they drinking, they're also drinking and driving,” Jovag says. “That's actually a little bit unusual. We tend to see more drinking and driving in rural counties.”

There is no definitive evidence that people are dying on Charleston County roads because residents are more apt than their fellow Southerners to have wine with dinner. Maybe taxi service was traditionally better in Atlanta than Charleston. Perhaps it's too cold for Milwaukeeans to drink anywhere but at home. Still, Charleston's outlier status should be reason enough for residents to re-examine their drinking habits, public health advocates say.

“We know that overuse of alcohol can have a number of problematic effects,” Jovag says, citing liver disease, cancer, crime and unemployment. According to the College of Charleston, the likelihood of ethnic or racial violence on campus increases by 16 percent if alcohol is present. The risk of unwanted sexual intercourse jumps 83 percent.

For Mokdad, the Institute for Health Metrics and Education researcher, the message of the statistics is simple: “We would like people to reduce alcohol intake. We're hoping to empower local communities to know their numbers and act on them.” But does that course of action make sense for Charleston? Coming next week, a look at the city's drinking culture and its consequences.