Alcohol Use Disorders (25) Stigma (5) Personal experience

7 February, 2024

WHO estimates there are 280 million people worldwide with an alcohol use disorder. This is 1 n 20 of the world population. Extrapolating this to the HIFA community (20k members) it seems likely that around 800 of us have an alcohol use disorder.

The number may be even higher because the largest professional group on HIFA are healthcare providers, and healthcare providers have higher than average rates of alcohol disorder (at least this is the case in the UK and US)

I have been lucky. Like most of my friends, I drank a lot of beer when I was at medical school back in the late seventies and early eighties. At medical school, drinking beer was part of our self-identity. The same was true of smoking cigarettes. Social groups would form around these habits, perhaps more so than any other characteristic.

I rode a Honda 400 Four motorbike at the time, and I confess there were times when I was over the limit and could have got myself (or someone else) killed. In putting this message together I learned that I was typical of young male drivers at the time. Research carried out in 1979 showed that nearly two thirds of young male drivers admitted drink driving on a weekly basis.

If we go back further, to before 1967, we find - amazingly - that people were able to drive under the influence of alcohol with impunity, provided they could 'handle it'. A policeman might ask you to "step out of the car sir and walk in a straight line". If you could do that, you might be deemed 'capaple'. In 1967 the roadside breathalyser was introduced and the emphasis changed from walking a straight line to measurement of alcohol level.

In childhood and adolescence, alcohol was very much part of my life, including at home where my mother and stepfather frequently had parties, always lubricated with wine and beer. My stepfather gradually drank more and more, and this led to the breakdown of the marriage. He continued to get worse over subsequent years and died from a head injury after a drunken fall. He had been taken to hospital but he refused admission. They let him go and he died 2 days later alone, likely from a subdural haematoma.

I expect most of us know a relative or a friend whose life has been wrecked by alcohol. What can we learn from it?

I have learned that alcohol use disorder is insidious and is driven by social norms and expectations. Some individuals are more prone to develop severe disorder than others, for many different reasons. We need better ways of encouraging people to recognise they have a problem and to seek a solution, without stigma or shame.

Best wishes, Neil

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: