Trauma, loss and other psychosocial drivers of excessive alcohol consumption in Karamoja, Uganda

This article investigates the trends, drivers and effects of alcohol consumption in Karamoja, a primarily pastoralist area of Uganda. Although locally brewed alcohol from sorghum and millet has an important and long-standing place in Karamojong tradition, the emerging trend of excessive consumption of hard liquor is a cause for concern among government and health officials, development practitioners and, especially, community members themselves. This article explores the varied reasons for this rise in hard liquor consumption, particularly in Karamoja’s post-disarmament period. The article is based on data collected in mid-2018, as well as information gleaned from the authors’ engagement in the region over the past decade. The peace and security ushered in by the disarmament exercises of the 2000s has, on the one hand, opened up the once isolated region politically and economically. Conversely, it has accelerated external interest in Karamoja’s economic wealth, leading to further disenfranchisement of its people due to dispossession of land. Emerging from the trauma of the disarmament exercise, the drastic loss of livestock and livelihoods and the continuing negligence of pastoralism by the state, Karamoja’s rural as well as peri-urban communities are undergoing a remarkable loss not only of their economic systems, but also of their socio-cultural identity. Acknowledging the specific trauma and loss experienced by individuals and communities provides a lens through which to better understand the excessive alcohol consumption. These psychosocial factors, along with the economic and political aspects, must be considered in efforts to address this continuing crisis in the region.


Introduction
The use of alcohol among Karamojong communities in northeastern Uganda is a topic of regular and heated discussion among policy-makers and public health advocates alike (Stites 2018). Karamoja, home to predominantly pastoral and agro-pastoral communities, has witnessed a surge in alcohol production, sale and, critically, consumption over the last decade-a cause for concern among nearly everyone who has an interest in the region, but especially for local communities. Narratives on the devastating effects of alcohol use in Karamoja abound in the national news media as well as in technical reports (Ariong 2018;Cau et al. 2018;Uganda Radio Network 2018). These narratives tend to attribute excessive or harmful consumption of alcohol, especially in recent years, to the socio-economic transitions that communities are experiencing in the aftermath of years of insecurity and inter-community conflict, and the establishment of a fragile peace. Conversations in policy and practice circles tend to draw attention to the excessive and harmful patterns of alcohol consumption in Karamoja as one of the primary issues driving the region into further poverty and related issues today.
This article explores some of the purported reasons behind the trends in the growth of excessive alcohol consumption in Karamoja, particularly in the period following the disarmament campaign. Overall, alcohol consumption rates in 4Uganda are considerably higher than those in other sub-Saharan African countries (World Health Organization 2014), and, as such, this article does not claim that the prevalence of 'unsocial' 1 or harmful drinking behaviour is singularly a Karamoja problem. However, the sudden rise in alcohol consumption and the precipitous decline in health indicators in Karamoja are, as we contend, a by-product of the long history of disenfranchisement and exacerbation of social and economic strains set in motion by forced disarmament. The widespread and, arguably, irreversible loss of livestock, especially cattle, for many households robbed communities not only of their primary source of livelihoods but also of sacred entities which hold enormous socio-cultural and symbolic value (Dyson-Hudson 1966). The gradual loss of the pastoralist subsistence base-inextricably intertwined with ideas of wealth, status and identity (Anderson and Broch-Due 1999)-has been explored in the context of household resilience and asset poverty (Ayele and Catley 2018;Levine 2010), masculinity (Stites and Akabwai 2010), increased militarism and raiding (Gray 2000(Gray , 2009. This article, in part, extends the analysis of the loss of the pastoralist identity and experiences of disenfranchisement and trauma as they relate to excessive, and often harmful, alcohol consumption. We examine the distinctive contextual upheavals within which this phenomenon has occurred for those living in rural and peri-urban areas. The consumption of alcohol in Karamoja cannot be analysed only through a negative lens, given the role of drinking in creating and sustaining forms of solidarity and cooperation. In peri-urban and urban centres, the institution of drinking groups, comprised mainly of young and older men who get together in the evenings to drink local brews, has become an important feature of social life (Mosebo 2008(Mosebo , 2015. In these groups, young men pay a regular fee, which goes towards the purchase of the local brew. Drinking groups are not only a space for relaxation and socialization, they are also important forums in which ideas, knowledge and advice are shared between peers and inter-generational groups. Critically, a certain decorum is also to be maintained, and drinking too much or drinking alone is not considered proper. Mosebo's (2008) ethnographic work among drinking groups shows the 'integrative' aspects of drinking and how the drinking group 'can become a space of freedom, unity and order in lives lived in an area of chaos and disorder' (p. 2) 2 . In addition, the production, repacking, transportation and sale of alcohol bring important economic benefits, especially for women, who use the income to cover household necessities (including food, school fees and medical care) as well as investing in assets such as poultry and goats (Dancause et al. 2010). However, these somewhat positive aspects are overshadowed by some of the putative reasons for young people's harmful consumption of alcohol. We comment on the various stressors that young people in Karamoja's rural and peri-urban centres face and how delayed adulthood ('waithood'), unstructured time and an uncertain future might be shaping behaviours around alcohol consumption.
This article is based on research conducted in 2018 which sought to investigate changes in alcohol production, consumption and sale in Karamoja, with a view to informing programme and policy in the region by governmental and non-governmental actors. The study demonstrated, among other things, that the demonstrable increase in harmful alcohol consumption behaviour arose from the rapid rise in availability of cheap and potent hard alcohol, combined with contextually specific livelihood stress. Here 3 we consider factors of economic stress, gradual erosion of pastoralist identity, growing disenfranchisement and easy access to commercial liquor. While taking these factors into account, we explore in greater depth the psychosocial, emotional and trauma-related aspects that may also influence drinking in the region. This component has garnered little attention in the literature on Karamoja. We examine the drastic changes to Karamoja's economy and propose that the harmful, excessive and unsocial alcohol consumption in rural and peri-urban areas is, partly, an offshoot of livestock loss and continued marginalization. Widespread livestock poverty has led to negative diversification of livelihoods, characterized by low levels of income and poverty traps (Iyer and Mosebo 2017); it has also had psychosocial and trauma-related ramifications because of the critical socio-cultural and political importance of cattle, the primary pillar of Karamojong life (Dyson-Hudson 1966). Our findings show that the desire to escape (with the aid of alcohol) is neither extraordinary nor unexpected in the historical and contextual circumstances of Karamoja. Nonetheless, we advocate for the serious consideration of the psychosocial, in addition to the economic, needs of communities in interventions in the region.
1 'Unsocial' drinking is generally understood as drinking alone or as a solitary activity, without the company of others. In our observations in Karamoja, much of the drinking occurs in groups-small or large-and often as a social activity. In this context, by 'unsocial' drinking, we mean instances of alcohol consumption where hard liquor is the main choice of alcohol and is consumed alone (and not necessarily as part of a social gathering) and to excess. 2 Mosebo's study coincided with the tail end and aftermath of the disarmament exercises in Karamoja; the chaos and disorder referenced here allude to the associated upheaval that took place in the region. 3 Data for this article was collected in mid-2018 when the ban on 100ml sachet alcohol was yet to be enforced. Where appropriate, the article reports changes to alcohol consumption behaviour in Karamoja since the time of data collection. Iyer and Stites Pastoralism: Research, Policy and Practice (2021)

Context
The Karamoja region in northeastern Uganda is home to several communities, often collectively referred to as 'Karamojong' 4 , who traditionally engage in pastoralist and agropastoralist livelihoods depending on the agro-ecological zone in which they reside. The westernmost agro-ecological livelihood zone receives the most rainfall regionally and affords conditions for opportunistic cultivation (Robinson and Zappacosta 2014). In contrast, the easternmost zone is characterized by high temperatures, high rainfall variability and low soil fertility, making pastoralism the most suitable and adapted livelihood system (Ellis and Swift 1988;Scoones 1995). Historically stigmatized and even ridiculed for their reliance on livestock for socio-political and economic ends, Karamoja's pastoralist communities have withstood a series of assaults on their lives and livelihoods from colonial and post-colonial governments (Dyson-Hudson 1962;Quam 1976). Today, despite several governmental and other interventions to support and promote crop production, pastoralism continues to thrive as the most viable strategy for food security and a critical mechanism for household insurance (Levine 2010;Stites et al. 2016). After tumultuous decades (between the 1980s and 2000s) marked by widespread hunger, herd-decimating livestock diseases and armed inter-community raiding, Karamoja now finds itself in 'relative peace' 5 (Howe et al. 2015). The confiscation of weapons (discussed further below), community-led conflict transformation efforts and interventions of governmental and non-governmental bodies in building social cohesion have resulted in generally improved security in the region; consequently, not only has pastoralism rebounded (to an extent and for some households), businesses and trade from other regions of Uganda and across the border to Kenya have also proliferated (Stites et al. 2016). Of note is the growth in the extractive industries, primarily gold, limestone and marble. Ugandan and multi-national companies have flocked to Karamoja on the heels of the disarmament, exploiting the improved overall security of the area and the potential for mineral deposits. Artisanal and smallscale mining has emerged as a new economic activity, either as a form of diversification or as the primary livelihood strategy. Increased interest in Karamoja's mineral resources has also created a number of conflicts, pitting investors against community members, government representatives against elders and so forth (Hinton et al. 2011;Houdet et al. 2014;Rugadya 2020;Saferworld 2017).
Karamoja's agro-pastoralist communities have a strong and enduring tradition of brewing alcohol, which features prominently as the libation of choice in every important socio-cultural ceremony. Variations of these local brews with low alcohol content are known collectively as ngagwe. The production of these local brews such as ekweete (maize/sorghum), kutukuto (maize/sorghum), ebutia (sorghum) and marua (millet) is an intensive multi-day process involving cleaning, drying, milling, roasting and fermenting the grains and, ultimately, filtering the brew (Namugumya and Muyanja 2009). Due to the central role women play in its production and in reaping the benefits from its sale, local beer has been termed the 'cattle of women' by some authors (Dyson-Hudson 1966). In addition and particularly in times of food scarcity, traditional brews made of grains continue to enjoy the status of 'food' among communities. Historically produced in homes for ceremonies 6 (such as births, weddings and initiations) and to feed agriculture work groups, local brews took on a commercialized character in the early 2000s (Dancause et al. 2010;Stites and Akabwai 2010). As livestock numbers dwindled due to inter-group raiding and state-imposed disarmament, women were pushed to assume greater or even sole responsibility of providing for the household. The sale of brews thus became an important income-generating activity (Iyer and Mosebo 2017;Stites 2018).
The production and consumption of the low alcohol content local brew in Karamoja is not a primary health concern, especially when compared to the hard liquor which has become ubiquitous in recent decades. This hard liquor is available in either the crude 'moonshine' variety or the commercially produced version sold in small sachets or, more recently, small bottles throughout Uganda. 7 Hard liquor is known as waragi, from 'war gin' 8 , or etule in the vernacular. 9 Hard liquor is by no means new to the region; legendary stories of large-scale livestock raids are often laced with mentions of alcohol consumption. However, whereas produced mainly locally 4 The word Karimojong in the local language signifies the region of Karamoja. The following communities call the land area of Karamoja their home: Matheniko, Bokora, Pian, Jie, Dodoth, Tepeth, Labwor, Nyangea, Ik and Pokot. Even though we use the umbrella term Karamojong in the report, we recognize the distinction of the constituent communities and identify them separately where appropriate. 5 Livestock raids and general insecurity have occurred every year since the disarmament campaigns, but these have not reached the destabilizing proportions of the late 1990s and early 2000s. Recently (beginning in 2020), raiding has again become prevalent in Karamoja, even spilling over to the other regions in Uganda. See for example https://www.monitor.co.ug/uganda/news/national/cattle-raids-inlango-karamoja-blamed-on-moroto-prison-break%2D%2D3286232. 6 Epurot, fermented honey beer produced by Tepeth communities (and less frequently by Karamojong communities), continues to retain its primarily traditional/ceremonial use. 7 Alcohol sold in sachets of 50 ml was phased out between 2017 and May 2019 in favour of 200 ml packaging (Kajoba 2019). However, 50 ml sachet production continues illicitly today (Daily Monitor 2020). 8 https://www.independent.co.uk/news/world/africa/how-africas-partyanimals-drank-themselves-to-death-1792932.html 9 We use the terms waragi and etule interchangeably in the paper. Both signify 'hard liquor' or 'moonshine'. Local brews made of sorghum and millet are referred to as such.
in the past, much of today's 'moonshine' is manufactured in adjacent regions and (usually illegally) imported into Karamoja. This trade is untaxed and unregulated, and jerrycans of moonshine move throughout the region on trucks, motorbikes, bicycles and pack animals. The commercially produced variety comes from southern cities such as Kampala and Jinja. The sale of hard liquor provides income to retailers in trading centres and villages. Unlike brewing, hard liquor profits are not controlled solely by women, and men are heavily involved in the transport and sale of both the crude and commercial varieties.
Field observations over the past few years have made apparent the extent (of both the commercial and moonshine varieties) of waragi's availability, reach and negative health impact, extending from Karamoja's urban and peri-urban centres to the farthest villages. Officials in some of the region's sub-counties and districts have attempted to address the widespread over-consumption of hard alcohol by prohibiting the production and import of the crude version. These efforts, combined with the national ban on the sale of liquor sachets, should have reduced the availability of hard alcohol in the region. However, consumption of hard alcohol in Karamoja appears to continue largely unabated. Coming across people in rural and urban areas walking around casually with a sachet or inebriated to incapacitation at any hour of the day was extremely common at the time of the research (mid-2018). This sachet has been referred to as 'the silent gun'-slowly leaving a trail of bodies in its path (Iyer et al. 2018).
The passing of a country-wide ban on sachet waragi in early 2019 brought visible changes to the drinking culture in Karamoja within months of our data collection. 10 In place of the 50-ml sachets sold for 500 Ugandan shillings approx. 15 cents USD are now bottles of at least 200 ml, sold at approximately three times the price. The paucity of cash to feed the waragi habit at a price which is exorbitant for most people has effected a shift back to crude or illegally produced waragi, sold in large drums and smuggled into the region. Although the ban on the sale of sachets was meant to quell 'unsocial' drinking, excessive drinking remains widespread. As such and despite national and local regulations, an examination of the reasons behind the continuing demand for hard alcohol, the changes in drinking behaviour and the drivers of excessive alcohol consumption remain highly relevant. While many reports and studies raise the issue of 'alcohol' or even 'alcoholism' in reference to food security, maternal and child health, or nutrition, no systematic study has examined local communities' perspectives and experiences of these changes.
This article and the associated research study are primarily concerned with Karamoja's rural and peri-urban communities. Nevertheless, high alcohol consumption is not a distinctly rural and peri-urban phenomenon, and makeshift and established bars, drinking areas and groups proliferate in urban centres around Karamoja (Mosebo 2008). Several informants from the salaried class who participated in the study-and provided extensive commentary on the alcohol problem in rural areas-also consume alcohol, and we do not have evidence of unusually higher consumption among rural communities. However, this article is, at its core, concerned with the majority population of Karamoja, who are primarily rural pastoralists and agro-pastoralists and who bore the brunt of the forced disarmament exercises of the 2000s and subsequent social and economic transformations (Stites and Akabwai 2009;Stites et al. 2007). They have also, simultaneously, faced new socioeconomic and health-related challenges related to (but not solely because of) misuse of alcohol. Through our study and years of observation in Karamoja, we know that urban and rural classes have different drivers of (excessive) alcohol consumption and that the findings detailed below may not apply to those living in fledgling cities in salaried and other jobs and/or who have been urbanites for several generations. We do touch upon some of the purported drivers for harmful alcohol consumption among people in peri-urban or urban centres, but our primary motivation is to examine some of the putative causes and consequences of excessive alcohol consumption among individuals and households that have experienced extensive livestock loss. We argue that these losses not only affect food security and nutrition, but also greatly influence the many social institutions and networks of solidarity that define Karamojong 'culture' and leadership (Ayele and Catley 2018).

Research objective and methods
The research study behind this article sought to investigate the following: the changes in alcohol consumption, production and sale in the period following the disarmament that began in 2006; the structural drivers of alcohol consumption in the post-disarmament period; the effects of changes in alcohol consumption on interpersonal relations; the effects of alcohol production, sale and consumption on household economy and livelihoods; and the effectiveness of local initiatives in addressing changes in alcohol consumption. This article briefly presents the central findings on consumption from this research and then moves beyond these initial queries to discuss some of the potential drivers behind the undeniably high rates of alcohol consumption.
Data collection took place between May and July 2018 and used a primarily qualitative methodology. A total of 503 individuals participated in 61 focus group discussions (FGDs) and 56 key informant interviews (KIIs). Approximately 40% of respondents were female and 60% were male. Interviewees and discussants included community members (male elders, women, male and female youth); government representatives at the district, sub-county and village levels; and representatives of non-governmental organizations (NGOs). The team worked in five districts of Karamoja-Moroto, Kotido, Kaabong, Nakapiripirit and Amudat-and sampled two sub-counties in each district. 11 We purposively selected the study sites to explore differences in rural and peri-urban locations. In addition, the research team visited recent settlements near to mining and aloe vera processing locations, such as Naput and Kosiroi in Moroto District. We selected these sites due to their reputation for heavy and occasionally fatal alcohol use (Ariong 2018).
Facilitated participatory methods were used in a subset of nine FGDs to collect data on group perceptions regarding alcohol production, consumption and sale. These methods included diagramming, proportional piling and ranking, and creation of calendars. Seasonal calendars illustrated how alcohol consumption, production and sale changes over the course of the year. Daily calendars illustrated averages for the types and quantities of alcohol consumed and the portion of the household budget spent on alcohol. Proportional piling depicted the peak and low seasons for alcohol production, sale and consumption. One hundred twenty-seven participants (83 women and 44 men) participated in the nine gender-specific focus groups that included the participatory methods. The study team received ethical approval for human subject research for this study from the Institutional Review Board of Tufts University, the MildMay Uganda Research and Ethics Committee (MUREC) and the Ugandan National Council for Science and Technology (UNCST).

Main findings
Key drivers of alcohol consumption in Karamoja Shifting livelihood profiles Karamoja has seen major shifts in livelihoods over the past two decades. Authors have documented the erosion of pastoral production systems as a result of livestock loss, conflict, frequent droughts, limitations on pastoral mobility, growing inequity of animal ownership, and anti-pastoral policies. Local people have had to shift their activities and strategies accordingly, and studies show the extent to which people are relying on wage labour and petty trade to both fulfil household needs and manage risk (Fernandes 2013;Iyer and Mosebo 2017;Stites and Akabwai 2009;Stites et al. 2014). Although livestock-based livelihoods may be gradually recovering (Stites et al. 2016), the widespread loss of animals has had cascading effects on household food security, customary authority, gender roles and future prospects (Carlson et al. 2012;Stites and Akabwai 2010). In addition, the growing inequity in livestock ownership means that while some households may be thriving within or re-entering the pastoral economy, many others remain on the margins (Ayele and Catley 2018;Catley and Aklilu 2013;Marshak et al. 2019). Ultimately, this shift in livelihoods is also a key driver of the changes in alcohol consumption, production and sale.
The most direct connections between shifts in livelihoods and the increase in alcohol consumption, production and sale relate to the increase in urbanization and monetization. The growth of towns and the concurrent decline in livestock ownership means that a growing number of people seek economic activities in towns, whether on a daily, occasional, seasonal or sporadic basis (Stites 2020). Cash is more widely available in both urban and rural households due to extensive informal employment in both urban and rural areas (primarily in farm labour or mining in rural locations) (Iyer and Mosebo 2017). This is a change from the period prior to disarmament, when insecurity deterred trade and people relied more heavily on subsistence production.
The availability of cash is thought by some to be responsible for the increase in alcohol consumption. Prior to disarmament, it was difficult both to find hard liquor in large quantities and to purchase it due to lack of money. Explaining this change, a Jie elder recounted 12 : Those days people didn't like having money. People looked at people having money like these are some (other) kind of people. But nowadays people like having money. Everybody has money. That is why everyone is taking too much etule. People never say, "I lack money for drinking etule".
Although cash is a necessity today in Karamoja as elsewhere, the low wages and rising costs of living in Uganda deter productive savings. Young people, are especially affected by the inability to substantially save their earnings in order to invest in education or training. As recounted 11 Moroto District: Rupa and Nadunget Sub-Counties (SC); Nakapiripirit District: Lorengedwat and Namalu SC; Kotido District: Kotido Town Council and Rengen SC; Kaabong Distrcit: Loyoro and Kapedo SC; Amudat District: Amudat and Loro SC by some youth, the problems of poverty force them to spend 'the coin' (signifying a small amount of money that is typically earned from daily labour) on liquor because they do not see many prospects for that 'little' money. 13 Whereas this rationale may be extended to other age groups, particularly those in the middle age, youth appear particularly vulnerable to the urge to quickly spend small amounts of cash in hand.
Nevertheless, there is an acute understanding of the ills of hard liquor consumption among community members, young and old. Observations on the effects of excessive consumption of liquor on health, inter-personal relationships, household economy, livelihoods and the community at large were reported animatedly by participants. It was not uncommon to hear that 'the land is now spoiled' because of the proliferation and excessive use of hard spirits. Deaths from excessive consumption of waragi were regularly reported by respondents. Respondents were careful to differentiate between local brews and hard spirits, with the former seen as having many fewer negative effects (Stites 2018). The reasons respondents gave for consuming the two types of alcohol also varied greatly. Whereas 'hunger' and social/traditional reasons are typically attributed to the consumption of local brew, the triggers for the consumption of hard spirits range from economic to social and psychological reasons.

Livelihood and employment-related stress
Respondents often cite stress related to the loss of livelihoods and the associated economic impacts as contributing to excessive consumption of hard liquor. These struggles appear particularly acute for male and female youth (generally greater for young men). In urban and peri-urban settings, young people have few prospects for skilled or semi-skilled jobs without attaining at least a secondary education. However, the high cost of secondary and higher education are a critical barrier to educational attainment in Karamoja. Compared to average wage rates in the region, covering the costs of education is often an insurmountable task even for urban households with multiple earners. 14 Businesses fill the gap in qualified applications by bringing in workers from outside the region (Iyer and Mosebo 2017). Because of incomplete education, inability to secure relatively better paid semi-skilled or skilled jobs, and an exploitative and highly competitive labour market, many male and female youth in urban and peri-urban areas express hopelessness in their current and future prospects. This hopelessness, according to youth respondents, is one of the main reasons for alcohol consumption.
The problems are different for rural youth. According to some respondents, the confiscation of guns as part of the disarmament campaign has left a void in the lives of young men in rural areas. In addition to human rights violations which primarily targeted young men, the forced disarmament campaign resulted in widespread erosion of livestock holdings due to the protected kraal policy, whereby animals were kept in enclosures within or near military barracks, purportedly to minimize raids Akabwai 2009, 2010). Animal mortality and morbidity were extremely high, young men and boys were prevented from engaging in socially expected roles of herd management, and households suffered from the lack of regular access to milk and blood and the ability to sell an animal when needed for cash or to make a horizontal social exchange. Animal stocks did not recover in the years following the protected kraal policy, and ownership became increasingly inequitable.
The loss of guns coupled with the decline in animalbased livelihoods brought a fundamental shift in gendered responsibilities at the household and community level. While young men in pastoral and agro-pastoral households had previously served critical roles as providers and protectors, in the post-disarmament period, they found themselves with few clear roles or activities. As male youth in a focus group discussion in Namalu Sub-County in Nakapiripirit reported, following the loss of animals, rural male youth have little to do but 'sleep under the tree' 15 . This idleness contributes to drinking, as explained by a group of men interviewed in Nadunget Sub-County in Moroto: During those days, the herders were wise enough. People used not to drink ngagwe a lot, the youth also never used to drink…but now there are no animals to care for, we are all just here wandering going to town, there is nothing to herd…what [animals] is there is just for the young kids to herd and the youth now have resorted to drinking. 16 Complaints about lack of things to do, however, are not restricted to rural male youth. Young men in urban and peri-urban centres also reported a lack of activities to occupy themselves as a reason for drinking to 'pass time'.
At the same time that young men in rural areas have seen their identities as protectors and providers erode in conjunction with the removal of the weapons and the loss of animals, young women in rural areas have had to step in to provide for their families. As towns and trading centres have expanded and movement has become safer in the wake of disarmament, women have increasingly engaged in exploitation and sale of natural resources (including firewood, charcoal, thatch and wild vegetables), petty trade and services (including working at breweries and in hotels or restaurants and doing casual domestic work). This means that women are away from the homestead for extended periods (which may contribute to drinking by men), women are engaged in the cash economy (making more cash available for the purchase of liquor by household members) and women are moving regularly between rural and urban areas (where hard liquor is cheap and readily available).
The shift in gendered responsibilities at the household level has also increased pressure upon women, who already faced extreme time burdens due to their domestic and reproductive duties. Women recount taking up drinking to remove the stress of managing their households single-handedly in the absence of a contributing spouse and with little earnings. Compounding the issue is the generally low wage rates in sectors dominated by women, such as domestic work, and the high costs of education, food and non-food commodities. These problems are also faced by women who are widowed, divorced or abandoned. A woman in a focus group discussion in Kotido explained: I have two children. I don't have a husband; now it's seven years without a husband. So, I am a mother, I am a father. There is no business I am doing, but the children must go to school, must eat, must dress, (treat) sickness when it is there, and rent. But all these things should be paid. But now, if now I sit only in one place without drinking, the thoughts will kill me (laughter). So I just drink, drink! The child wants food, the child wants soda -I am just there drunk! All these thoughts are not there (then). 17 A second woman in the same group added: I have two children. Their father got another woman, and the other woman spoiled his mind. If I go to him sometime to give me some money to buy food for child, [sometimes] he does not give me money. So, I stay stressed. If someone gives me either 1000 or 500 (Uganda shillings), I go and get someone who's drinking. I also join drinking to forget the stress. …So, when you think of the prices of other things, it just makes you stop and drink. So, you just continue drinking to forget.
For both men and women, low wage rates and an inability to save translated to a lack of ability to invest in productive assets, including education or livestock, drive alcohol consumption. This is especially critical for male youth who aspire to establish a family. For most young men, establishing a livestock herd is the first step in preparing for marriage. Those without animals for bridewealth are unable to secure rights to a female partner. This has negative impacts upon a youth's status as a 'man' within his community, as evident in the discussion by a group of young men in Kotido town: The views expressed by the young men above were common among respondents of both genders in middle age and youth groups. Clubbed under the term 'thoughts' (ngatameta), a great number of respondents listed stressors such as marred inter-personal relationships, inability to provide for children, lack of or loss of employment, and problems in sufficiently meeting basic household needs. Forgetting these 'thoughts' was a motivating factor in excessive alcohol consumption. Respondents are keenly aware that, due to its high alcohol content, waragi can help them 'pass out' and thus, at least temporarily, relieve stress. Importantly, the desire to obliterate thoughts is in stark contrast to the typical reasons for consuming local brews, which are mainly ceremonial, to socialize with kin and non-kin and to alleviate hunger.
We conducted a participatory exercise in an attempt to quantify consumption levels of hard alcohol. Using a daily calendar exercise, male and female respondents indicated that many people drank local brew and waragi from sachets in the morning, kwete in the afternoon and beer and waragi from sachets in the evening. Others explained that local brew was particularly popular in the morning as a warm substitute for porridge and then again at mid-day because it stays in the stomach 'like food'. On the other hand, the evenings see a mix of both local brew and hard liquor. At times, drinking is regularly continuous and can last for more than 6 h at a time, with expected impacts on functionality.

Dispossession and disenfranchisement
Although not explicitly phrased as such by informants during data collection, what we observe in Karamoja visà-vis increased alcohol consumption might also reflect a consequence of disenfranchisement that has blighted the region for decades. This dispossession in recent history began with the coordinated and brutal disarmament exercises by the Uganda People's Defence Forces (UPDF). While disarmament exercises in Karamoja were a recurring experience since early in the colonial era (Bevan 2008), the disarmament that began in 2006 was significantly more coordinated, prolonged and systematic (Human Rights Watch 2007; Akabwai 2009, 2010). It was also much more brutal. Data collected from communities in the months and years following the start of the disarmament and one of the author's first-hand observations illustrated the manner in which communities were cordoned and men were rounded up and exposed to humiliation and painful and degrading treatment (such as lying naked in the hot sun for hours with bricks on their chests), and arbitrarily detained, including in unofficial cells and prisons. Young men detailed that they were afraid to walk to towns or visit markets because soldiers would attack them, beat them in public and accuse them of being raiders and having guns. A number of young men who had experienced detention reported sexual violence in the form of beatings to their genitalia. Numerous young men in different communities told one of the authors, without prompting, of having their scrotums twisted around sticks, which resulted in impotence for some. For their part, women detailed the experiences of attempting to locate and secure the release of male relatives who had been detained. The UPDF did not document or record detentions, and women often had to visit multiple locations at significant costs in order to locate their men. Once found, the primary means of securing release was by turning in a weapon, but many households either did not have a gun or had already given it up. Women reported selling livestock in order to purchase a weapon, which they would then exchange for the release of their male relative.
Not only did this disarmament result in trauma, humiliation and actual loss of lives, it also resulted in widespread loss of livestock and increased dependence on wage labour, petty trade and natural resource exploitation (Human Rights Watch 2007; Stites and Akabwai 2009). In parallel and further undermining local livelihood systems is the on-going large-scale land dispossession in Karamoja, a result of substantial commercial interest in the region following the disarmament (Human Rights Watch 2014; Rugadya et al. 2010;Saferworld 2017;Wambede and Mukooli 2017). By one recent estimate, approximately 3.7 million acres (approx. 1.5 million hectares) of land in Karamoja has been parcelled out for sundry mining activities (Mutaizibwa 2019). Local communities have witnessed not only their land being appropriated for commercial interests that do not directly benefit them, but also mining concessions and activities which sometimes cut directly through critical rangeland areas, indispensable for pastoralist production.
At the same time, policies of the central and district governments and international actors over the past decade have encouraged households and communities to sedentarize and adopt cultivation. For many, this has meant moving away from traditional homesteads and to areas deemed more suitable for agrarian livelihoods. Such shifts by one sector of the population have severed systems of customary authority as well as up-ending the intergenerational transmission of knowledge and practice. Cultivation as a form of livelihood diversification may benefit those households with the resources to remain simultaneously engaged in animal husbandry, and some of these households are benefitting from some rebounds in the pastoral economy (Stites et al. 2016). However, a significant number of households remain 'livestock poor' without animals to fall back on as insurance when harvests fail, a common event in a semi-arid region characterized by highly variable rainfall (Ayele and Catley 2018). The loss of livestock has critical implications for household resilience (Little et al. 2001), and diversification into wage labour and petty trade has not proven beneficial for staving off poverty for the majority of the population (Iyer and Mosebo 2017). The mix of destructive policy and practice has spelled further destitution of the pastoralist economy with many 'moving out' of pastoralism altogether (Catley and Aklilu 2013). While destitution alone does not drive people to consume excessive amounts of alcohol, numerous respondents for this study spoke of the combination of poverty, despair and a lack of ability to envision a life that looked any different from their current reality. People spoke of the challenge of saving enough money to make any real investments, and, when faced with this dilemma, many saw no reason not to spend a day's wages on waragi or etule.

Effects on communities of alcohol production, consumption and sale Effects on physical health and well-being
Respondents in the study were acutely aware of the physical consequences of excessive liquor use and were quick to recount negative health effects. People who drink excessive amounts of waragi reportedly lose weight, become frail, have reddened mouths and lips and look like 'AIDS victims'. 19 Respondents reported that etule affects the mind as well as the body. Fighting among family members at night and the inability to remember the fight the next morning is one such manifestation. 'Madness' is another, as an elder in Kotido explained 20 : When you look at these people moving naked, these people of madness (ngicen), they are becoming so many. Because that thing (waragi) is confusing the brain. Some people drink until the blood becomes only etule. The head goes from normal to something abnormalthen it becomes madness.
Local respondents also associated erratic behaviour with excessive drinking, as explained by men in Loyoro in Kaabong: 'alcohol is just bad…you see those days, someone drank alcohol, ran mad and started climbing over the mountain'. 21 A man in Moroto shared a similar account: a 'bad thing is when someone drinks alcohol; he/she becomes confused [and] mad and can just get up and run somewhere far away because of confusion'. 22 One of the more notable physical effects of drinking etule, according to community members and health and government officials alike, was the inability 'to reproduce'. Although scientific evidence is lacking, it is assumed that the heavy consumption of hard alcohol has contributed to male impotence. 23 In addition, the high level of inebriation is reportedly an obstacle to sexual relations within couples, further undermining strained inter-personal relations, discussed further below.
Medical centre staff listed various health ailments believed to relate directly to waragi consumption. A senior nursing officer in Matany Hospital, the largest hospital in the region, cited alcohol as a factor in the rise of cardiovascular problems, cirrhosis of the liver, and pancreatitis, as well as contributing to trauma, accidents and homicides. 24 Excessive alcohol consumption was also said to be a leading cause of suicide and depression among young drinkers. 25 A health officer in Nadunget Sub-County in Nakapiripirit noted that vision loss had been reported in some instances. 26 A sub-county official in Loyoro said that problems associated with 'heavy' alcohol consumption include 'paralysis, madness, complaints of barrenness, quarrelling, [and physical] fighting'. 27 The sub-county official added that children suffered in households with heavy drinking. 28 Some of these impacts are likely emotional due to increased tensions and conflicts within family members, while some are physical. For example, a nurse at Matany Hospital discussed the problems of intoxicated adults caring for children, 'We have seen children dying as a result of alcohol consumption [by parents]….mothers sleeping on their babies because they are drunk'. 29 Drinking also has negative impacts on maternal health in the region. The health official in Loyoro mentioned that miscarriage due to excessive drinking was a problem in his area 30 and the nurse at Matany reported a connection between heavy drinking and premature births. 31 Medical officials reported specific and negative physical health impacts for children, including those associated with alcohol consumption by children. However, it is difficult to know either the extent or type of alcohol consumed by children, as evident in the explanation from a health official in Lorengedwat Sub-County in Nakapiripirit: Sometimes, children are brought to us when they are comatose as a result of alcohol consumption….however, we normally do not document whether they have been given local brew or waragi…we just have to fight to save their lives 32 .
In line with the medical personnel cited above, most of the study participants agreed that the excessive consumption of waragi was contributing to mortality and morbidity among both men and women. Death rates are particularly high around mining sites, where miners are sometimes paid in hard alcohol (Ariong 2018;Eninu 2015). Respondents pointed to convenient packaging, low price points and widespread availability of waragi sachets as factors in the rise of heavy drinking, in addition to the desire to kill 'lingering thoughts'. 33

Effects on inter-personal relations
One of the most-cited consequences of excessive liquor consumption is destabilized inter-personal relationships. Drinking waragi is said to lead to fighting between spouses, between children and parents, and between individuals in general. Respondents mentioned increased rates of divorce, separation and extramarital relations. Relations between generations have also suffered. Elders say that they are losing authority as a result of youth's alcohol consumption, but observations indicate that many elders also drink heavily. As explained by a group of male elders in Nakapiripirit District: The youth have lost respect for their parents. They are getting spoilt. You can't advise these young boys these days. They will want to fight you. They have even gone to the extent of abusing and insulting their parents. No respect at all. Sometime even we the parents are the ones who are [in] the wrong. We go and drink and start disturbing these young ones. At the end of the day we end up being beaten. 34 Alcohol is consumed by and adversely affects most demographic groups, but women and girls appear to bear the brunt of the inter-personal consequences. Numerous respondents cite the role of alcohol in domestic violence, and this was confirmed by medical workers in several locations. 35 Respondents in Tapac Sub-County in Moroto explained how alcohol was playing a role even in marriage negotiations. Families of grooms are said to ply the brides' fathers with waragi in hopes of facilitating quick wedding arrangements, sometimes with underaged girls. 36 This has reportedly contributed to an increase in the number of adolescent girls running away from their natal homes.

Discussion
The loss of Karamojong herds and the pace of sedentarization and economic diversification in the region have previously been analysed for their impact on household resilience, food security, poverty and other indicators of human well-being. The drastic changes to livelihoods, changes to ideas of masculinity and identity, increase in economic pressures for women, and the experience of dispossession from not only land but an entire way of life are some of the many transformative events that have characterized Karamoja. While the roots of these changes may have been in place for an extended period, the speed of change has increased dramatically over the past two decades. Likewise, while drinking alcohol is not new in the region, the extent and widespread nature of excessive and harmful alcohol consumption appear to have greatly increased in this same period. Many policymakers, development practitioners and members of Karamoja's salaried classes view this heavy consumption as resulting from 'idleness' and an inability to move past a headstrong reliance on livestock and livestock-based livelihoods, which, despite the copious evidence base, finds few champions among those deciding the region's trajectory. 37 The psychosocial, emotional and traumarelated aspects of alcohol-related behaviour remain, to a large extent, unexamined.
These, perhaps hidden, drivers find commonality in livelihood stress, which a number of respondents and observers-including community members, practitioners and policy-makers-hold responsible for the unchecked and deleterious alcohol consumption. For young people, however, congregating around alcohol, games and other social forums is a way to seek solidarity, compassion and companionship (Jones 2020;Mosebo 2008Mosebo , 2015. At the same time, alcohol use may also be analysed as an escape from their realities and the complex and prolonged transitions to adulthood-also referred to sometimes as 'waithood'-that many young people around Africa today face (Dawson 2014;Honwana 2014). The worries for the future, as explained to us by Karamojong youth sampled for the study, were grouped together under the term ngatameta (or 'thoughts'); often, these thoughts revolve around completing an education, finding stable and suitable sources of income and the inability to do so in a fraught and uncertain economic situation (Iyer and Mosebo 2017). Exorbitant school fees, a competitive market and the conditions of informal employment are some of the constraints faced by many young people in Karamoja (especially those living in peri-urban and urban areas, and who have had some form of education). Young people from rural areas face a different, yet related, economic precarity, vis-à-vis generally decreased numbers of livestock, the main economic asset and social currency of the rural Karamojong economy. The lack of adequate veterinary facilities, repercussions from the protected kraal policy, losses through raiding, increased inequality and an overall lack of interest on the part of policy-makers to support the mobility regime and land management policies required for pastoralism to thrive have had a significant impact on the livestock asset base, driving many Karamojong into poverty (Ayele and Catley 2018;Levine 2010;Stites et al. 2007 For many rural communities, the decreasing livestock asset base is accompanied by the even further harrowing prospect of land loss, which appears to have sped up in the aftermath of the disarmament campaign. A combination of political and financial interests, increased security, and destitution has produced the scale of land grabs and other land-related conflicts that plague many communities today (Rugadya 2020;Rugadya et al. 2010). Large-scale land acquisitions by a host of private companies (mostly extractive industries) have cut pastoralists off from grazing areas, with negative impacts on the health of herds 38 (Rugadya et al. 2010). Conflicts implicating politicians and local leaders who have utilized their elite status to acquire large tracts of land have become increasingly common and contentious (Czuba 2017). At the same time, communal and customary tenure systems that have, for centuries, guaranteed access and arbitration around disputes through elder-led governance institutions are facing a grave threat. The shift of power from traditional institutions to mining companies and government agencies, and the erosion of traditional management systems, has increased the likelihood of future land conflicts (Rugadya 2020). The weakening of these socio-political institutions, the cornerstone of pastoralist communities, is by no means limited to Karamojong; however, it is an accelerating phenomenon that has repercussions for such imperative issues as land and water governance, peace and security and, ultimately, well-being among community members.
In his study on changing food systems, diet and cultural identity among agro-pastoral Suri people of southwestern Ethiopia, remarks on the phenomenon of 'selfdestructive' (sic) consumption of alcohol. A steep rise in alcohol use among Suri agro-pastoralists is explained along generational, cultural, gender and economic lines. Disarrayed family life and social organization, changing production systems and, crucially, state policy and largescale changes such as land dispossession, resettlement and villagization schemes all contribute to increased use of hard liquor among Suri. Abbink writes: There is a certain 'alcoholization' of Suri society going on, an ambivalent and health-threatening process also seen elsewhere in Southern Ethiopia; the strong liquors have not yet been properly 'absorbed' into local drinking culture: local people usually consume it to excess, predictably stimulating drunken brawls, theft and robbery on market days…the abuse of alcoholic drinks has led to numerous brawls with a deadly outcome, to widowed women and young unmarried girls brewing local beer to gain cash to compensate for loss of family or husband's economic support, and to neglect of regular food production. There are elements of 'self-destruction' present here. Many male Suri also started to drink because of personal despair at having lost their cattle in raids by enemies or by government punitive action. (pp 133, 138) Abbink's analysis of hard liquor consumption and 'alcoholization' as stemming from changing political, social and economic phenomena among Suri resonates with this study's authors' experiences in Karamoja. The combined loss of livestock-based livelihoods and the removal of weapons has undermined the identity of men as the providers for and protectors of their families and communities. A similar 'personal despair' as described by Abbink affects men in Karamoja who have lost their prized animals and critical assets, but the damage to the male identity goes beyond this loss and has a significant effect on the underlying social fabric (Stites and Akabwai 2010). In some ways, the ubiquitous drinking seems designed to address this rupture; today hard liquor accompanies every significant and insignificant event and ceremony in Karamoja, from quotidian meetings under the village tree to initiation, birth and wedding ceremonies. Consumption of waragi or etule at all such events seems to emerge more out of necessity than from recreational pleasure. As such, we posit that what we are witnessing in Karamoja is an 'alcoholization' akin to that among the Suri. We surmise that this overconsumption of liquor stems from underlying psychosocial stress that has resulted from incremental, continuous and often drastic changes to people's economic, political and socio-cultural lives.
Karamojong socio-cultural and economic identity as pastoralists has been under threat for decades; political repression, territorial containment, economic isolation and ecological disaster have given rise to an explicit loss of livestock assets and an implicit loss of cultural identity (Gray 2000). Alongside these drastic and lasting shifts is an on-going 'theft' of Karamoja's land and the communities' primary livelihood. 39 This 'theft', according to informants and our own observations, is an underlying reason for the growing 'alcoholization' of Karamojong society. Based on numerous conversations with key informants in the region, there appears to be a resignation within some segments of the population vis-àvis their future as pastoralists, what support they can expect from the government and what government policy means to their lives and livelihoods.
A critical component of the collective experience of trauma was the experience of forced disarmament at the hands of the UPDF. A number of studies have detailed the negative human rights, security and socio-political impacts of the disarmament campaign, particularly at the height of the campaign (2006)(2007)(2008)(2009) and in the immediate aftermath (Bevan 2008;Human Rights Watch 2007;Stites and Akabwai 2010). Nonetheless, today the disarmament campaign is most often understood in light of its positive impacts on peace and security in the region, particularly by private sector investors and many government representatives. 40 We do not deny these developments and have written widely about some of the benefits of improved security on livelihoods, mobility and opportunity that were not possible prior to disarmament in the region (Stites & Akabwai, 2009;Stites et al., 2016). However, when considering the rampant and widespread excessive consumption of alcohol, we feel compelled to revisit the role of disarmament in creating collective trauma. Importantly, while young men were the primary targets of the (also young male) UPDF soldiers' efforts to flush weapons from communities, disarmament and associated fear and suffering were experienced much more widely. The extensively employed cordon-and-search practice drove all residents-young, old, male, female-from their homes, often in darkness, and forced them to remain outside while huts and homesteads were ransacked and searched. The military used carefully targeted practices of community humiliation and threat in an effort to uncover weapons: male elders were reportedly stripped naked and put on public display; children were rounded up and marched through villages until their parents handed over guns. Simultaneous to the experiences of trauma for individuals, households and communities, people were losing access to their most important assets-their livestock. Purportedly to minimize losses from raids while disarmament was on-going, the protected kraal system cut owners, herds and communities off from their animals. Extremely high rates of morbidity and mortality of livestock in the protected kraals and in the aftermath undermined livestock-based livelihoods of numerous households in the region, many of whom never recovered their herds and stepped out of pastoral production entirely. As such, we see the direct impacts and experiences of trauma on people's bodies, families, assets and way of life.
Drinking, thus, is an escape, a brief respite from the present worries and future uncertainty. Excessive and 'self-destructive' alcohol use may be viewed as one manifestation of this trauma. For young people in precarious educational and economic conditions, alcohol provides a lubricant for social interaction as well as an outlet for escape, giving them the opportunity to seek amusement and sociality (see also Jones 2020). However, as in other parts of Uganda and sub-Saharan Africa, Karamojong young people's expectations of progress (particularly for those who live in peri-urban or urban centres) are often incongruous with the realities of the market (Iyer and Mosebo 2017). Expanding educational requirements and shrinking economic prospects, brought on by a host of historical, economic and political factors, appears to have created a context where a sense of 'progression' among youth has not kept pace with available opportunities. 41 This has led to the over-abundance of unstructured time, which, in turn, gives rise to stress-related thoughts 42 (Mains 2017). The inability to invest in productive assets, entrepreneurship opportunities, and the intense competition of a job market overrun by young people from outside the region, Karamoja's young people find an ever-widening period of 'waithood'.
Our study on the drivers of excessive alcohol consumption in Karamoja points to a multitude of explanations for what appears to be an increase of this behaviour in recent years. Drastic and continuing alienation from the pastoralist identity, growing poverty and disenfranchisement, and violence at the hands of the state are some of the reasons for growing resignation among Karamoja communities, particularly those who live in rural areas. Public servants and development practitioners continue to blame rampant alcohol abuse for the region's staggered 'progress' and halting 'development'. 43 From the livelihood, nutrition and health standpoints, interventions attempting to improve food security and asset wealth are supposedly severely hindered by the drunkenness of prospective beneficiaries. 44 Although such narratives tend to view alcohol use as a causal factor in violence and poverty, the 'alcoholization' of Karamojong communities is 'more symptomatic of cultural displacement' akin to a 'social pathology in 40 This one-sided view of disarmament as positive is troubling given its brutality and long-term repercussions. It is even more worrying when Karamoja's leaders actively advocate for a return to 'serious' disarmament to address the recent resurgence in insecurity in the region, as this indicates a failure to recall or recognize the extent of suffering experienced. See for example https://www.monitor.co.ug/uganda/news/ national/karamoja-leaders-demand-fresh-disarmament-exercise-186 9732. 41 Young men also cannot fulfil initiation rites or marry in the absence of livestock (Stites 2013). 42 As in Mains' analysis, we find that in Karamoja, this over-abundance of time is distinctly a male phenomenon as young women in rural, peri-urban and urban settings are tasked with the lion's share of household and other work. 43 In a similar way, Bodi pastoralists in Ethiopia are blamed for selling animals and using money for alcohol consumption (Gebresenbet 2019 other culturally and politically marginalized societies' (Gray 2000: 414). Simplistic explanations and moralistic approaches to the alcohol problem would necessarily overlook the underlying psychological and emotional drivers of alcohol use. Whereas we do not attribute all alcohol use in Karamoja to these factors, we find that the drastic changes in alcohol use, besides being a result of the availability of alcohol and cash for purchase, are symptomatic of larger contextual and livelihood shifts and unaddressed violence and collective trauma. Any resulting action to address these issues must directly link to the question of the loss of livelihoods, delayed and uncertain employment (for those in peri-urban and urban areas), and associated identities. Ultimately, the most positive interventions may come in the form of acknowledgement of the trauma and losses experienced, by customary leaders, local officials and politicians. Discussions of disarmament today focus primarily on the positive results-the increased security, the improved mobility, the greater economic investment and the opening of the region to trade and commerce. These outcomes have certainly benefitted the region; such results should be lauded while also recognizing-and even apologizing for-the brutality, trauma and damage to a sociocultural identity that was part and parcel of disarmament and its aftermath. At present, too much of the discussion of the past two decades ignores the negative impacts and externalities, at the same time that perplexity is expressed about the rapid increase in alcohol abuse.