One in 289 people on the East Coast have been in a drink-driving crash, with one in 2310 dying in the last five years.
The rate was up to seven times higher than the rest of the country, the Dominion Post reported.
Attitudes towards alcohol and drugs, as well as young people willing to "take a chance" were driving the region's grim statistics to the top of the list, Gisborne Mayor Meng Foon says.
The region had a "marijuana goes well with Steinlager" mentality, and needed stronger enforcement and more help from the government, he says.
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"The message just seems to go in one ear and out the other. They're just not listening."
