A Qualitative Study of Local Perspectives on Problem Drinking in Peruvian Andean Highlands: Control, Power, and Responsibility

Background The public health approach to alcohol consumption that encourages moderate alcohol consumption and self-control often sits in tension with an ever-expanding profit-driven alcohol industry and an unwillingness of governments to regulate alcohol supply. The Peruvian Andean highland has seen the change of the Andean practice of collective drinking in response to the increased availability of alcohol and the experience of political violence. This paper sheds light on the ways that control, and specifically lack of control, intersects with the growing influence of alcohol companies and the reconfiguring of alcohol in Andean cultural practice.Methods Data were collected through focus group interviews (n=19) with community participants, teachers, and health workers, and key informant interviews (n=28). Thematic analysis was conducted to identify patterns of individual and collective meaning and social, political and economic factors associated with alcohol use. Results Local perspectives regarding loss of control over alcohol highlight the complex patterns of power and meaning exerted and experienced by different actors, shaping both understanding and behaviour. Participants’ focus on parents’ lack of control over alcohol use by some “abandoned” children reflects the structural vulnerability of some Andean families struggling with economic hardships. Another focus was on the money spent by men to engage in problem drinking. Participants interpreted alcohol consumption in this context as a way that men demonstrate their masculine identity and symbolic power as the breadwinner who controls the household economy. The third focus is superimposed onto the market economy. Participants expressed that the expansion of the alcohol market and perceived absence of government control coupled with macroeconomic conditions shaped patterns of alcohol consumption.Conclusion Echoing the political economy perspective, participants’ perspectives on control illustrate how problem drinking is shaped not simply by an individual drinker’s lack of self-control but also by an environment that enables the unrestrained marketing of alcohol products and the creation of a culture of consumption. Furthermore, harmful consumption is mediated by the reshaping of the Andean cultural practice of collective drinking. Attending to local perspectives is essential for policies and interventions that connect structural dynamics with the cultural and experiential aspects of alcohol consumption.