During a week that includes St. Patrick’s Day and the opening weekend of the NCAA Tournament, trying to avoid activities involving alcohol is often easier said than done.

The premise may be even harder to fathom in Wisconsin, where 41 of the 50 heaviest-drinking counties in the country are located, according to data from County Health Rankings & Roadmaps, produced by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

As a result, the state’s drinking culture can have an impact on a person’s health beyond impairment or hangovers. Door County Medical Center licensed clinical social worker Ally Bretl says many people feel they have to drink to fit in, which can lead to higher anxiety, strained relationships and social isolation. She adds that in a state like Wisconsin, where drinking is part of the social fabric, it can be difficult for some people to manage.

Bretl encourages people to reframe the situations they are in — whether it’s a tailgate or a family party — and shift the focus away from alcohol.

Bretl also encourages people to reach out to her, or to their own health care provider, if alcohol is affecting their physical or mental health or straining their relationships.