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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