The impact of alcohol misuse on fathering in Northern Uganda: An ethnographic study of fathers

Abstract

The Acholi people of northern Uganda experienced decades of conflict. Alcohol misuse is high among northern Ugandan men. This is common in displaced or post-war communities. Because parents are often the most significant and proximal influence in a child’s development, it is important to understand the relationships between parental behavioral health and parenting. The purpose of this ethnographic study was to understand the impact of alcohol misuse on fathering, from fathers’ perspectives. We collected qualitative data from several sources, including in-depth interviews with 19 fathers. Informants identified three ways in which a father can “overdrink”: drinking to drunkenness, spending too much money on alcohol, or spending too much time drinking alcohol. Fathers described the specific ways in which overdrinking impacted each of the three primary roles of a father, which were identified as providing, educating, and creating a stable home. Of the negative effects of overdrinking, a compromised ability to provide for basic needs was described as the most salient. The findings suggest that support for families in this region should include support for father’s substance misuse, as a father’s overdrinking is widely understood to be problematic for the entire family.

Keywords

alcohol misuse displacement fathers parenting war

Introduction

With the Office of the United Nations High Commissioner for Refugees reporting that one in 110 people in the world is currently displaced – an all-time high – the need to better understand the effect of war and displacement on families is great (United Nations High Commissioner for Refugees, 2018). One observed impact of displacement in many communities is increased alcohol misuse. In general, parental alcohol misuse has been found to be related to a host of negative outcomes for children. Therefore, a specific area warranting greater study is the impact of parental alcohol misuse on children and parenting in communities that are affected by war and displacement. In this ethnographic study, we investigated the perceived impact of alcohol misuse on fathers and fathering practices in northern Uganda about eight years following the ceasefire between the government and the Lord’s Resistance Army (LRA).

Displacement, substance misuse and trauma

High levels of substance misuse and, in particular, alcohol misuse have been documented in populations forcibly displaced by war and organized violence, who often experience and witness multiple traumatic events over long periods of time (Ezard, 2012; Weaver & Roberts, 2010). Traumatic experiences, poor living conditions, lack of employment opportunities, psychopathology and disruption of cultural systems in displaced and war-affected populations likely contribute to high levels of substance misuse (Anda et al., 2002; Ertl, Saile, Neuner, & Catani, 2016; Kozarić-Kovacić, Ljubin, & Grappe, 2000; Porter & Haslam, 2005; Riggs, Rukstalis, Volpicelli, Kalmanson, & Foa, 2003; Roberts & Ezard, 2015; Roberts, Felix Ocaka, Browne, Oyok, & Sondorp, 2011; Roberts et al., 2014). In turn, alcohol misuse in these communities (including northern Uganda) is related to family violence, harmful parenting practices, and an increased risk that children will misuse substances in the future (Catani, Jacob, Schauer, Kohila, & Neuner, 2008; Jääskeläinen, Holmila, Notkola, & Raitasalo, 2016; Saile, Ertl, Neuner, & Catani, 2014; Saile, Neuner, Ertl, & Catani, 2013; Sørensen et al., 2011; Sriskandarajah, Neuner, & Catani, 2015).

Context of displacement and alcohol misuse in northern Uganda

Northern Uganda was the site of a fierce conflict between government forces and the LRA. Atrocities were committed by both sides and the use of forced child soldiers by the LRA is well documented. Because of the conflict, nearly the entire population, consisting mostly of members of the Acholi tribe, was displaced (Ertl, Pfeiffer, Schauer-Kaiser, Elbert, & Neuner, 2014; Pham, Vinck, & Stover, 2009; Human Rights Watch, 2005; Vinck, Pham, Stover, & Weinstein, 2007).

In a 2006 survey of forcibly displaced people in northern Uganda, 32% met criteria for probable alcohol use disorder; alcohol misuse was associated with being male, older age, and number of traumatic events experienced (Roberts et al., 2011). Alcohol misuse in northern Uganda has been found to be directly or indirectly implicated in many suicides in the region (Kizza, Hjelmeland, Kinyanda, & Knizek, 2012). Out of 26 countries surveyed, Ugandans (not restricted to northern Uganda) reported the highest levels of total alcohol-related consequences, including acute consequences (e.g., headache, nausea), personal consequences (e.g., guilt, neglecting responsibilities, hangover), and social consequences (e.g., unstable finances, employment, relationships, and getting into fights) (Graham et al., 2011). As in other displaced communities, alcohol misuse was high during and following displacement and 46% of fathers in northern Uganda have reported drinking at levels considered hazardous or higher (Ertl et al., 2016).

Fathers and alcohol misuse

There is a well-documented relationship between parental alcohol misuse and negative child outcomes, but research is needed to clarify the ways in which alcohol misuse contributes to compromised parenting and the ways in which this impacts children’s development (McMahon & Rounsaville, 2002). Research related to the impact of substance misuse on fathering in Africa is particularly sparse and, therefore, most of the research cited below is based on studies outside of Africa.

Children in families with a substance-misusing parent are more likely to be at risk for a range of adjustment problems (Dunn et al., 2002; Harter & Taylor, 2000). One study found that after fathers left treatment for alcohol misuse, the number of children with adjustment problems increased for the children of fathers with high levels of alcohol misuse but decreased for children in lower use-level groups (Andreas & O’Farrell, 2007). Paternal substance misuse is associated with child behavioral problems cross-sectionally (Chassin, Rogosch, & Barrera, 1991; Kelley & Fals-Stewart, 2004) and longitudinally (Kandel, 1990). An association with psychological or emotional disturbances is likewise seen cross-sectionally (Chassin et al., 1991; Kelley & Fals-Stewart, 2004) and longitudinally in the form of depression and anxiety (Chassin, Pitts, DeLucia, & Todd, 1999; Lam, Fals-Stewart, & Kelley, 2008). Children of substance misusing fathers are also more likely to misuse substances themselves later in life (Chassin et al., 1999; Guo, Hawkins, Hill, & Abbott, 2001; Latendresse et al., 2008).

Because children of fathers who misuse substances are at increased risk of internalizing symptoms, externalizing symptoms, and their own future substance misuse, a Social Interaction Learning perspective (Forgatch, Patterson, Degarmo, & Beldavs, 2009; Mehus, Doty et al., 2018; Patterson, 1982) would suggest that this intergenerational path is mediated by changes in fathers’ parenting behaviors. While this path is not yet clearly understood, fathers’ substance misuse causes or is related to a host of negative parenting behaviors, such as inconsistent parenting (Arria, Mericle, Meyers, & Winters, 2012), neglect (Dunn et al., 2002; Stewart, Mezzich, & Day, 2006) and abuse (Harter & Taylor, 2000; Saile et al., 2014; Walsh, MacMillan, & Jamieson, 2003). The relationship between fathers’ substance misuse and neglect or abuse has also been observed in prospective longitudinal data (Chaffin, Kelleher, & Hollenberg, 1996) and heavy drinking is associated with increased punitive discipline strategies in the future (Kandel, 1990). Alcoholic fathers are also more likely than non-alcoholic fathers to become aggravated with infants and may express lower sensitivity (Eiden, Edwards, & Leonard, 2002). In studies using observational measures of parenting, father’s alcohol misuse has been associated with lower levels of engagement and congeniality, less attentiveness, and more inconsistency (Jacob, Krahn, & Leonard, 1991; Lang, Pelham, Atkeson, & Murphy, 1999; Whipple, Fitzgerald, & Zucker, 1995).

Paternal substance misuse is also associated with family-level factors that may impact children and their development. For example, paternal substance misuse is associated with family conflict (Kelly & Kowalyszyn, 2003), partner violence (Saile et al., 2013), and less forgiveness and trust in the family (Scherer et al., 2012). It is also related to disrupted organization and routines within the family (Bijttebier & Goethals, 2006), less family cohesion (Bijttebier & Goethals, 2006; Scherer et al., 2012), and financial stress (McMahon, Winkel, & Rounsaville, 2008).

Roles of an Acholi father

Elsewhere, as part of this same ethnographic research study, we described in depth the roles of a father in Acholi families (Mehus, Wieling, Achan, & Oloya, 2018). Our previous report also discussed related topics, such as a father’s financial circumstance, the larger context of the family, and the ways in which these roles convey love. A brief summary of these roles is provided here:

The goal of an Acholi father is to prepare his children for the future through three ideal roles: (a) providing for a child’s basic needs; (b) educating his children; and (c) creating a stable and peaceful home. Providing includes meeting children’s basic needs, keeping them safe, and paying school fees. While informants emphasized the importance of all roles, in practice, a father may be seen as fulfilling his minimal duty as long as he is providing. In educating children, fathers used verbal instruction, modeling, telling stories, and discipline (typically caning) to teach subjects ranging from farming and chores to appropriate interactions with others. A stable home was described as one in which there is minimal conflict, mutual respect between family members, and equitable treatment of family members.

These three roles represent the ideals of fathering and informants reported considerable variation in the ways and extent to which these roles are executed. A primary distinguishing factor described by informants was whether fathers have a “modern” (gender equality and a less authoritarian parenting style) or “traditional” perspective (in which the father is assumed to be the head of the family). Modern fathers felt that each of these roles were shared between parents, while traditional fathers felt that they were ultimately responsible for each role.

Changing culture, recovery from war, and increased urbanization necessarily influence families and fathering. Examples of these changes are numerous. As more men find formal employment (rather than farming), they are home less often and have less time with children. As families move to town, traditions and living arrangements that once tied families together become difficult to maintain. Relevant to the current study, as discussed more later, changes in fathering and alcohol misuse by fathers were also attributed to the disrupted ability of fathers to fulfill their ideal roles during displacement.

The current study

This study is part of a larger program of research that is meant to respond to the needs and requests to provide support to families voiced by this community. Most recently, our team tested an adapted parenting training program with mothers (Wieling et al., 2015; Wieling et al., 2017). During interviews from the study with mothers, men and women asked us to “not forget about fathers” and to support them as well. Following these requests, and informed by the literature above, we designed this study to learn more about fathers’ roles in the family, barriers to fulfilling these roles, and what type of support might be most beneficial. Because previous research and informal conversations during previous studies indicated that fathers’ alcohol misuse is a major concern, this study was designed to answer the research question, “From the perspective of fathers, in what ways do alcohol misuse impact fathers’ roles and interactions with their children?”

Methods

This ethnographic study is based on data collected over 10 weeks in 2014, primarily in and around Gulu and Pida Loro in northern Uganda. A lengthier discussion of the methods (including reflexivity, language issues, and additional analysis details), the setting, and the contemporaneous social situation are provided elsewhere (Mehus, Doty et al., 2018). The study protocols were approved by IRBs at the University of Minnesota (Study No: 1403P49287) and Lacor Hospital in Uganda (LHIREC No: 040/06/14), and the study was approved by the Uganda National Council for Science and Technology (ADM 154/212/03).

Dr. Mehus (CJM) was the primary investigator in this study, which was conducted as part of his doctoral dissertation. The study was supervised by Dr. Wieling (EW) and was conducted as part of her overall program of research to support parents in post-conflict settings. Ms. Achan Laura (AL) and Mr. Okot Thomas Oloya (OTO) are Acholi co-researchers and served as interpreters and cultural informants throughout the study. Dr. Ertl (VE) contributed to the manuscript based on her extensive background researching substance misuse in northern Uganda. CJM conducted all interviews and was the primary analyst. The project was conducted in collaboration with vivo Uganda (vivo.org), an NGO dedicated to fulfill the mental health and relational needs of families affected by war and organized violence in post-conflict settings.

Informants and data sources

The primary sources of data in this study were in-depth individual ethnographic interviews with 19 fathers, two focus groups with fathers, and a third focus group comprising eight fathers who participated in a previous interview. The 19 fathers that we interviewed were recruited through contacts that we made in various urban and rural communities. Through various personal connections, we identified recruiters in multiple areas and gave them a small, flat stipend for their help. We asked them to recruit fathers with children between the ages of five and 14 from a range of backgrounds, including diversity in education level and potential level of drinking. The fathers we interviewed also represented diverse socio-economic positions, urban and rural areas, and ages. They ranged in age from 29–63 (M = 42.3) and had an average (M) of 5.4 children. The mean age of informants’ youngest child was 6.6 years and the mean age of the oldest child was 17.6 years. None of the informants had any prior contact with any member of the research team.

In addition, we discussed fathering practices and alcohol misuse with a group of mothers; we spoke with a priest who leads an Alcoholics Anonymous group (the only substance misuse resource in the region); we spoke with a few children in their late teens; we had frequent brief conversations with counselors at the NGO with which this project was associated; and CJM and OTO spoke with a few men at a “drinking joint”. Through our conversations at a drinking joint, CJM and OTO were also invited and attended a traditional family/story time around the fire (wang-oo) at one father’s compound in a rural village. Finally, AL provided notes and transcriptions from local radio shows discussing substance misuse. The quotes provided in the results come from the 19 individual interviews, but all data informed the analysis. These additional informants and sources of data were particularly useful in providing general insight into alcohol misuse within the Acholi culture.

Interview procedures

The interview strategy generally followed Spradley’s recommendations for ethnographic interviewing (Spradley, 1979). Each participant was interviewed once for one to two hours; focus groups lasted two to three hours. Although interview and focus group topics were similar, we used individual interviews to solicit personal experiences and focus groups to identify areas of consensus and disagreement. In total, approximately 45 hours of audio-recorded interviews were transcribed verbatim. CJM conducted all interviews with OTO or AL, who interpreted when needed; at least half the interviews were completely interpreted, with others conducted in English for some or all of the interview. We used a semi-structured interview guide that was adapted as preliminary findings were integrated into interviews.

We began interviews with broad grand tour questions, such as, “Teach us about fathers in Acholi families” and, “How do alcohol and drugs impact fathers?” We followed up by asking for examples, personal experiences, and specific questions aimed at understanding the ways in which alcohol misuse affects the roles of a father they described.

After two focus groups and 14 interviews, we took two weeks off interviewing and conducted a preliminary analysis, as described below. In our final five interviews and the final focus group, we were able to clarify taxonomic issues and ask for additional examples to fill any gaps that we identified. In the final focus group, we discussed our preliminary analysis in detail; the participants validated much of what we learned and clarified a few remaining areas of confusion. This final step in the field served as a member check of our initial findings.

Coding and analysis

Coding and analysis followed Spradley’s developmental research sequence (Spradley, 1979), which provides a complete method for ethnographic interviewing and analysis, including domain analysis, taxonomic analysis, componential analysis, and thematic analysis. Preliminary analysis was ongoing during the interviews; as interviews progressed, we began to establish domains and a taxonomy of constructs that were emerging through discussions after each interview. The emerging findings guided subsequent interviews. Domains related to the roles of a father. As we explored the components of each domain, we explored the ways substance misuse impacted each role of a father. The preliminary analysis guided interview questions in subsequent interviews and focus groups. By the time data collection was completed, the domains and taxonomy related to the roles of a father were largely established.

After completing data collection, CJM analyzed the data for themes using strategies common to most thematic analysis, including open and axial coding (Saldaña, 2013). Spradley describes themes as underlying beliefs or values that may or may not fit within a domain (Spradley, 1979). In this case, the thematic analysis served as a search for beliefs that cut across domains and a deeper componential analysis within each domain, particularly regarding the ways in which alcohol misuse related to each domain. Findings from this analysis were then checked against the preliminary analyses and the transcripts, to evaluate the fit of the themes with the original data. Trustworthiness was increased through triangulation across and within interviews, the final focus group member check, and an audit of each step of the coding process by the EW.

Results

In asking about the relationship between fathering and alcohol misuse, we inevitably learned a lot about alcohol use and misuse in general. We learned about various types of alcohol and drinking locations, and we spent time in some of these gathering places observing and talking with men. After generally describing alcohol use and misuse (or “overdrinking”) among men, we will present fathers’ perceived relationship between alcohol misuse and the three roles of a father summarized in the introduction (providing for a child’s basic needs, educating his children, and creating a stable and peaceful home). Quotes are identified by a random identification number.

Overdrinking

There are many types of alcohol available in northern Uganda, but all are typically consumed while socializing. For those who live in villages or with relatively little income, locally brewed alcohol is readily available in plastic bags, re-used bottles, cans, pots, or buckets, as are cheap sachets of mass-produced waragi (a distilled alcohol of around 40 percent ethanol by volume). Those with more income might drink marua (non-distilled alcohol of 3 to 7 percent ethanol by volume depending on fermentation) out of long straws from a shared pot. The most expensive drink is beer and is typically only available in town or at trading centers.

“Overdrinking” was the term many people used for problem drinking. In most cases, this referred to people who get drunk. However, with investigation, it became apparent that a father could overdrink in three ways: (1) drinking to drunkenness, (2) spending too much money on alcohol, or (3) spending too much time drinking alcohol. Some of our informants thought that any alcohol was too much but most differentiated between social drinking and overdrinking.

Some Acholi women drank. but overdrinking was widely viewed as male problem. In fact, a radio show that we heard asked community members about their thoughts regarding the need for more regulation with alcohol. Overwhelmingly, women voiced support for greater regulation (often citing the troubles it leads to with their husbands), while a majority of men opposed regulation.

Everyone with whom we spoke estimated high rates of overdrinking, some reporting they think over 50% of men overdrink, while others more broadly stated that most men overdrink. Many explanations for the high levels of overdrinking were related to the war and displacement. Some suggested that idleness in the internally-displaced persons camps led to an increase in drinking. Others suggested that men lost a sense of their roles during the war or suspected a link between trauma and alcohol misuse. Other explanations included economic stress or conflicts with a wife. However, informants also told us that many men would not drink if they had more work; in other words, they believed that boredom or idleness was a primary contributing factor to overdrinking.

In spite of an awareness of widespread overdrinking in the community, we learned there was only one treatment or support group, which was modeled on Alcoholics Anonymous and was present in two locations. Intensive treatment for alcohol misuse is available hours away in Kampala, but is not affordable for most.

Overdrinking and the role of providing

Informants reported that overdrinking may impact a father’s ability to adequately provide in four basic ways: “he may be unable to work or dig” (i.e., farm), “he may spend money on alcohol instead of basic needs”, “he may steal or sell off possessions to buy alcohol”, and “he may be unable to protect the family”. One father summed this up well:

A person who does not drink at all has got no problem. The people who drink for leisure have less problems but those who drink excessively fight, steal from home, sell food that is stored at home. He will not be able to pay for education and he will not have energy to go and dig. His energy goes down as he continues to drink. (F14)

Another father gave a concrete example: “Wildcats may come to catch chickens and when you are drunk the cat will catch the chicken and go away with it” (F8). Others simply said that valuable resources can be wasted on alcohol; “maybe even if you have money, you go and drink it off” (F1).

In practice, fathers were perceived by many as fulfilling their minimum duty if they provided for their family. As a result, fathers who drink a lot of alcohol may justify their drinking by saying that, before they go away for the rest of the day to drink, they leave money for their wives to buy food for the children. A father who clearly spent a lot of time drinking alcohol said:

When I am done with my work and when I am back from the garden, I can wait for the evening hour. Then I will go to drink. But before I do that, I provide all the basic needs required at home, like salt, soap, sugar for that day. If necessities are lacking then if I have 2,000 shillings, I will give 1,500 shillings for buying what is lacking and I will go spend the 500 shillings with my friends. (F11)

We were told that when overdrinking begins to noticeably impact a father’s ability to provide, extended family might intervene. In some cases, the wife’s family may take in the wife and kids until the father proves that he can provide. In other cases, older children take up responsibility for the younger children. One informant gave an example of a family with this situation: “Some of the children never continued with their education. Fortunately, the first two children had already attained higher education and they came in to rescue the family” (F18). Another informant gave an example of a father realizing he was not fulfilling his role of providing because of overdrinking:

He stopped drinking alcohol because it was extreme, because his wife ran away and he was unable to help his children in school. He was a teacher but he was fired, so his world was crumbling down. Maybe he realized that it was all his making because of drinking. So he decided to say “no” to drinking and now he is back to work working and paying his children’s fees and that is good (F3).

Fathers who overdrank and are not able to provide were seen as bad fathers. The most common response we received when asking how to tell a good father from a bad father, or a father who does not overdrink from a father who overdrinks, was to look at his children. Illustrating this perception, informants told us that if we saw a child in the street with tattered clothes we could know that the child’s father overdrinks. Children with a father who overdrinks and is unable to provide are likely disadvantaged in tangible ways, like not being able to attend school or get medical care when needed. Some informants told us that if a father does not provide, it might drive children to steal food or other items to meet their basic needs.

Overdrinking and the role of educating children

Informants reported that overdrinking can limit a father’s ability to teach his children what he is supposed to teach them and can lead to teaching children negative behaviors. Furthermore, they reported that overdrinking can limit a father’s ability to judge the appropriate level of discipline in a situation.

We were told that fathers may simply not have the opportunity to teach their children because they are away from home drinking or, when they are home, their children may hide from them. Even if a father is around the children when he is sober, children may become distrustful: “A child may now not believe you” (F1). Our informants thought that fathers who overdrink are less likely to praise or appreciate their children and may not be able to think straight enough to be able to give good direction.

One father who drinks told us he thought that he could still teach his children not to drink alcohol by pointing out the negative impact of alcohol:

You can also tell your child not to drink alcohol and you tell him that ‘see how alcohol mistreats me, that is why you are not doing well in this house’. A child can listen to that statement and they will think that they are suffering as a result of the alcohol that their father drinks. So, in order not to have that problem they will not drink alcohol. In our community when you are teaching, when you drink alcohol, you should let your child know that it is alcohol causing the problems that you experience. (F11)

However, other fathers addressed this line of thinking and said children will think, “What he is saying, he is not doing” (F2) and that this will not work for teaching children not to drink alcohol.

Informants also believed that overdrinking can teach children a range of negative behaviors. Children may learn to drink by following their father’s example and this may be especially true for boys who look up to their father. Children may learn to drink by tasting their father’s alcohol, either when the father is not looking or because their father sent them to buy it and bring it back. If children are sent to buy the locally brewed alcohol they may choose or may be asked by their father to taste it and make sure it is good before buying it. A few of our informants reported getting their first taste of alcohol this way when they were as young as five years old.

It was believed that fathers who drink too much may set a bad example that children might follow in other ways as well. Children may learn to be aggressive by seeing their father when he is drunk. They may learn that they do not have to follow their father’s teaching because he does not follow it himself. They may also learn to lie to cover-up for their father because they see the father steal and then feel obligated to lie to the mother to protect the father.

Our informants reported that fathers who overdrink are more aggressive in general, but also specifically when it comes to disciplining, which they described as a form of teaching. One informant described a typical father who overdrinks by saying: “Instead of talking in a calm way and saying [to the child] ‘when you are sent you should go and come back fast’, he beats. And to me that is not helpful” (F5). Perhaps the best example of this sentiment was given by an informant who identified as a recovering alcoholic. He recounted that he often feels guilty when he thinks back over his use of caning. He caned his children for things he would not cane them for when sober and he found himself caning his children at every misbehavior because he worried that their behavior would reflect on him:

I think alcohol also contributed a lot to my caning. At times when I’m sober I feel that it is not necessary to cane this child because of his mistake, and yet I recall that this child made the same mistake some time back and I caned very seriously. I’m regretting now why I caned the child. I think alcohol contributed a lot. […] Because I’m drunk and I know people […] all look at me as an outcast now. So I had to defend myself. […] So any child who makes a mistake, would be betraying me because that child would be compared to me. ‘This kind of behavior is like that of a drunkard and you’ll grow up and become like your father.’ I don’t want that measure to be made. So to avoid that, I have to put my children in line, so that they’re not compared with me after making a mistake. (F13)

Finally, some informants also suggested that a father who drinks too much might provide an example for children of what not to do. In some cases, a child follows a father’s example and begins to drink later in life. In other cases, the opposite is true: “They can say, ‘what my father is doing is not right’. They will know straight away because they had people that in school, at home, or on the TV say that too much drinking is bad” (F3) and they decide to be different.

Overdrinking and the role of creating a stable and peaceful home

Informants described some expected impacts of overdrinking on creating a stable home. For example, they said that when some fathers are drunk, they are more likely to fight, be rude, or be otherwise aggressive. As mentioned previously, a father who is drunk may use more severe discipline, which contributes to cause chaos and fear in the home: “So when you become rude, the children begin to fear you. And they will begin avoiding you. When you come home, they hear your voice coming and they run to their bedroom. They pretend as if they’re sleeping” (F7). We were told that fathers who overdrink often spend too much time away from home, which does not show love and prevents a father from knowing his children well: “I have seen some fathers [who drink alcohol] take a lot of time outside. Up to 9:00 or 10:00 pm you go home, your children are already asleep, to me that is not a sign of love” (F6).

In other cases, the impact of overdrinking on a stable and peaceful home was described as more complex. A father who drinks too much might begin to have problems with his wife; problems with his wife may contribute to him seeking out additional sexual partners; having multiple partners can make it more likely to contract sexually transmitted diseases, including HIV. These kinds of consequences, we were told, may lead to jealousy, the wife leaving or being taken back by her family, or witchcraft. One example of the potential complexities that can arise from overdrinking was given in this statement:

At the end of the day, you even sleep separately because of the smell of the alcohol. Then, you come home with abusive language undermining or underrating the woman. You are there with your friends outside. You are getting other woman. You could even be dating another woman [or prostitutes]. You come home and you don’t value your wife. Then the woman feels so bad. Now, when the woman feels so bad, she doesn’t perform to your expectations. There is quarreling at home, the home is torn apart. The man is not giving money any longer. He's giving money to the next wife. The wife is left alone. The children are just struggling. No school fees. So many issues involved. (F4)

As this example illustrates, overdrinking was often perceived to be the root cause of most issues with families. For this reason, many of our informants discussed alcohol in the context of setting children up for stable families of their own in the future: “According to me, since I do not drink any alcohol, my children should do the same. This will help them to find ease while managing their families in the future” (F8). Another father stated, “When parents find their children drinking alcohol, they tell them not to drink […] They also wonder the kind of future this child will have if that is how they are drinking at the moment” (F17).

In sum, these findings highlight the range of effects of overdrinking on fathers, their parenting, their families, and the development of their children. While overdrinking can impact every area of fathering, it is perhaps most salient when it impacts a father’s ability to provide for his family, the role that was identified as fulfilling his minimum requirement as a father. Overdrinking seemed to be seen as the primary issue related to poor fathering and for some: “bad father” seemed almost synonymous with “drunk father”.

Discussion

This ethnographic study provides insight into the ways in which alcohol impacts Acholi fathers’ relationships with their children, from the perspective of fathers. Informants generally reported that “half of” or “most” fathers drink too much alcohol. This assessment may be slightly more than the prevalence found in large surveys in the area (Ertl et al., 2016; Roberts et al., 2011) but shows that the local population has a quite accurate sense of the scale of the problem and is alarmed by it. Highlighting the fact that these results cannot be viewed without understanding the recent historical context, many informants explained the high prevalence of overdrinking was a result of the conflicts of the last half-century. In part, alcohol misuse has been found to be related to traumatic experiences and serves the purpose of self-medication (Ertl et al., 2016). Other explanations that we heard for overdrinking revolved around the disruptions to nearly every major aspect of Acholi life that resulted from war and displacement (Human Rights Watch, 2005); nearly all families were displaced, most lost family members due to the war, and many had direct encounters with the conflict (Ertl et al., 2014). This disruption greatly impacted the ability of Acholi fathers to fulfill their traditional roles – particularly that of provider (Mehus, Wieling, et al., 2018) – and many blamed the prevalence of overdrinking on idleness or trauma related to these disruptions.

Other contextual factors are also relevant. We previously reported (Mehus, Doty et al., 2018) that fathers spoke at length about changing gender roles, urbanization, and modernization. As fathers seek to redefine or reassert their roles in the family amidst these changes, there is undoubtedly the potential for conflict within relationships and families. Others have reported that as gender norms change in Africa, men have been less able than women to adapt to new roles and a changing society (Silberschmidt, 2005). While our interviews primarily addressed the perceived impact of alcohol on relationships, informants also stated that men might drink because of relational, economic, or other stress. Therefore, the relationship between alcohol misuse and family conflict is likely more cyclical than our findings might suggest.

Fathers spoke about the impact of alcohol misuse on each of the three primary roles of a father: providing, educating, and providing a stable home. Within these three areas, findings were consistent with previous research on the relationship between substance misuse and parenting. Fathers described a relationship between overdrinking and a range of financial strains on the family, as has been seen in other populations (McMahon et al., 2008). Fathers also described the impact of alcohol on a father’s ability to educate children, including greater use of harsh discipline. Consistent with a social learning perspective (Andrews, Hops, & Duncan, 1997), informants explained that some children will model their father’s drinking behaviors if they look up to him, or might see him as an example of what not to do if they do not respect him. Previous research in this area indicates that substance misuse may also be effectively passed on as a result of the associated increase in maltreatment, neglect, and family violence (Ertl et al., 2016; Potthast, Neuner, & Catani, 2014). The relationship that informants described between overdrinking and a stable family also aligned with previous research; they described families with a substance misusing father as being characterized by more conflict, more disruption and chaos, and more violence or aggression (Kelly & Kowalyszyn, 2003; Murphy, Winters, O’Farrell, Fals-Stewart, & Murphy, 2005; Saile et al., 2014; Sriskandarajah et al., 2015).

The relationship between alcohol and the roles of a father is likely complicated by competing views of masculinity. Some might say that, on the one hand, a man is supposed to find a wife, have children, and then fulfill the idealistic roles of a father and head of the family (Dolan, 2002); on the other hand, at least in a traditional view, a man should be able to drink alcohol with friends and spend money he earned on alcohol after ensuring his children’s basic needs are met. In other words, not drinking has the potential to challenge one’s masculinity, but failure to fulfill one’s roles as a father could do so as well. This tension might be further exacerbated by societal factors (e.g., poverty, increasing female empowerment) which can make it more difficult to fulfill traditional roles, can threaten one’s own sense of masculinity, and can result in men feeling disempowered (Silberschmidt, 2001).

These findings have specific relevance to prevention and intervention at the individual and family levels. For example, it is apparent that providing treatment and support to men for alcohol misuse would have a broader impact on the family (e.g., by improving their financial situation and decreasing conflict in relationships). Even if standalone services are not available, the topic of alcohol misuse can be discussed as it relates to a father’s ability to care for his children in the way he would like. In addition, because all fathers with whom we spoke clearly wanted the best future possible for their children, discussing parenting might provide an inroad to discussing harmful alcohol misuse in a non-confrontational way. The idealistic roles identified by our informants – and the threat to these roles posed by overdrinking – may provide a means to motivate change or to prevent overdrinking within individuals and communities. As men reexamine their roles in the family amidst a changing culture, there are also lessons to be gleaned from those who have found success in redefining masculinity in ways that help them achieve the ideal roles of a father and maintain their own health as well. For example, for men who choose to be more actively involved with child-rearing than was traditionally the case, overdrinking becomes even less compatible with fulfilling one’s role as a father. There are many such examples; of course, even though rates of alcohol misuse are high, a significant portion of men do not misuse alcohol. New models of fatherhood may provide a foundation upon which larger societal changes can be made in the area of overdrinking.

Strengths and limitations

Utilizing ethnographic methods was appropriate for the research questions and allowed us to engage in open-ended conversations with informants that were not restricted to a rigid interview guide or predetermined measures. This gave us insight into areas of which we might not have been aware had we used standardized measures. Our use of local interpreters/co-researchers provided us with additional cultural insight through reflection after interview and experiences. Having multiple sources of data (individual interviews, observations, informal conversations, media, and focus groups) allowed us to triangulate the information we gathered. The final focus group served as a thorough member check and provided valuable adjustments and validation; it was also a way to immediately provide information back to a few members of the community regarding this topic.

In keeping with the ethnographic purpose of this study, we investigated “overdrinking” as it was defined by informants; however, the Alcohol Use Disorder literature has identified different typologies of misuse (Casey, Adamson, & Stringer, 2013; Castaldelli-Maia et al., 2014), and our use of overdrinking likely obscured differences that might exist in the impact of different types of misuse. The sampling method was a strength and a weakness of the study. By paying local community members to recruit fathers, we gained access to fathers that we might have otherwise not had access to, including a wide range of fathers in terms of education, level of alcohol use and misuse, and family composition both in town and in villages. On the other hand – even though it is not generally considered a goal of qualitative research – it is worth noting that this sampling method was non-probabilistic and that, therefore, the sample is not necessarily representative of the entire community. Additionally, because our interviews were focused on fathers’ perceptions of their roles and the impact of alcohol misuse on fathering, we left other relevant topics (e.g., the role of religion, changing public policy, perspectives of women and children) less explored.

Conclusion and future directions

In terms of intervention, these findings suggest that parenting may be a valuable access point to the life of a father in need of support for alcohol misuse. Regardless of how much fathers drink, they want the best for their children. Some could be empowered to participate in treatment for alcohol misuse as part of a multipronged effort to ensure the best possible future for their children. Our team’s future goals include developing and implementing multicomponent interventions to address some of these related areas (e.g., parenting, traumatic stress symptoms, and substance misuse).

Research in this area can build on the findings of this study through longitudinal studies, both within and outside this community, to further elucidate the relationship between paternal substance misuse and child outcomes. The present findings show great variation in these associations. Future quantitative studies could attempt to use continuous and nuanced measures of constructs such as alcohol misuse, corporal punishment, family stability, father-mother relationship dynamics, and the ways in which parents convey love to their children to examine these relationships. Observational father-child data could provide deeper insight into how fathers interact with their children and may help to establish baseline norms and cultural expectations for parent-child interactions. Mixed-methods studies might be particularly useful in examining these associations across cultures to illuminate cultural variance. In particular, there is a need to better understand the paths from parental substance misuse to children’s future substance misuse.

Footnotes

Acknowledgements

The study was funded by grants from the College of Education and Human Development at the University of Minnesota and the Center for Personalized Prevention Research at the University of Minnesota. Dr. Mehus was also supported by the Health Resources and Services Administration (HRSA) of the U.S. Dept. of Health and Human Services (HHS) under National Research Service Award in Primary Medical Care grant number T32HP22239 (PI: Borowsky), Bureau of Health Workforce. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. This research was supported by vivo international (vivo.org).

Christopher J. Mehus, PhD, is a researcher at the Institute for Translational Research in Children’s Mental Health at the University of Minnesota. Dr. Mehus is a prevention scientist with an overarching goal to improve public health by supporting parents in raising healthy children. He pursues this goal through research aimed at fostering engagement in and creating sustainable access to effective parenting interventions and support, with an emphasis on highly stressed families. This research agenda includes gaining a better understanding of the role of parent-child relationships in developmental pathways, understanding the intersection of trauma and parent-child interactions, and evaluating the effectiveness and implementation of parenting programs. Dr. Mehus is a member of the NGO, vivo international.

Elizabeth Wieling, PhD, is Professor and Director of the Marriage and Family Therapy Program at the University of Georgia. A central focus of Dr. Wieling’s prevention and intervention research agenda is to address mental health disparities and family functioning in populations affected by mass traumas – war and organized violence – in the United States and abroad by developing multicomponent, systemic, and culturally relevant interventions. Her publications document work with immigrant and refugee displaced populations and in war-affected, low-income countries. Dr. Wieling is a member of vivo international.

Okot Thomas Oloya, BA, is a social worker in northern Uganda. He worked with vivo Uganda as an interpreter, research staff, and counselor. He is focused and passionate about working with communities to help them cope with the challenges that life brings to them.

Achan Laura, MA, is part-time lecturer at Gulu University. She also worked as a counselor with vivo Uganda’s outpatient clinic in Gulu, northern Uganda. She took part in a number of studies and research work under vivo in selected districts of northern Uganda. She now works with Thrive Gulu as a psychosocial counselor in a refugee settlement in Lamwo district, northern Uganda.

Dr. Verena Ertl, PhD, is currently assistant professor (Akademische Rätin) at the Chair of Clinical Psychology and Biopsychology, KU Eichstätt-Ingolstadt. Her published works revolve around epidemiological, prevention and intervention research in crisis-affected populations and survivors of interpersonal trauma. She is interested in combining research and practice in the development, implementation and evaluation of pragmatic mental health interventions in low and middle-income countries in order to break cycles of violence and foster development. Dr. Ertl is also a licensed psychotherapist with a focus on cognitive behavior therapy and has additional training in client-centered approaches. She is a member of the NGO vivo international, an alliance that works to overcome and prevent traumatic stress and its consequences within the individual, the family and the community.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Christopher J. Mehus

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