Alcohol Use Disorders (15) Alcohol consumption in Uruguay (2) Stigma

5 February, 2024

Dear Eduardo and all,

Thank your for your message on alcohol consumption in Uruguay.

"We encourage you to share what is the situation in your country and, if you dare, some personal or professional experience linked to alcohol."

Your words "if you dare" are a reflection of the stigmatisation of those who have alcohol use disorders (AUD). This stigmatisation is deeply rooted. It prevails in any community, including the 20,000 members of the HIFA community.

Also, it is notable that stigmatisation only applies to those with visible AUD, who form the minority of the total AUD population.

To take this further, it seems to me that there is a large number of people with AUD whose disorder is not (yet) visible, but who are seeking to deny to themselves and others that they have a problem. Stigma plays a part here too. A person may deny they have a problem because it is hard for them to accept this, given society's stigmatisation of those with AUD. And the person may hide their problem from others because of shame, rooted in stigma.

There is also stigma against thos who do NOT drink. Whhen I was a medical student at St George's London in the early 80s, our pharmacology lecturer was Professor Joe Collier. He puts it like this:

'I am a teetotaller... What bugs me, however, is how society so often tries to paint me as someone with something wrong, as an object of suspicion, as an outsider ripe for enquiry. As a teetotaller, I regularly have to explain why I don’t drink. Ten minutes at a dinner party can be spent defending my position. I often feel that if I were to say that I was either a reformed alcoholic, or taking a medicine that interacts with alcohol or was a devout muslim, these would satisfy. Not having a “legitimate” reason for abstaining seems worrying. Perhaps, they conjecture, I am mad, or frightened, or even a Puritan. Whatever I say there might well be demands for me to drink anyway. “Go on, try some, it won’t do you any harm”; “it’s an acquired taste so give it a whirl,” “fill your glass and have a sip, how can we all enjoy toasting someone if you don’t join in?” and so on. Somehow if I don’t drink I will spoil the atmosphere for others.'

In the UK there is stigma against the person with visible AUD and stigma against the person who doesn't drink at all. Those at risk of developing severe AUD are, by contrast, encouraged on that path, especially among young men. Here is Joe Collier again: 'Finally, and bizarrely, alcohol is used as a right of passage to adulthood. Telling of last night’s “bender,” coming to college with a hangover, describing the more unsavoury events of a “pub crawl,” or being able to drink umpteen pints of beer in an hour without collapsing (the capacity to “hold drink” is a classical challenge among some students), are all the stuff of bravado and greeted by peers with a certain sense of admiration.'

I look forward to hearing the experience in other countries.

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: