On a Sunday morning, the gate of Pastor Rómulo’s alcohol recovery centre flies open, and helpers flock to the back of his pickup truck to unload today’s cohort of barely conscious men.
Smelling strongly of alcohol, they are carried to a bench and questioned. “What is your name? Does your family know where you are?” Some are shaking uncontrollably from alcohol withdrawal; others struggle to move or sit straight, still experiencing its numbing effects.
According to Rómulo, this is a regular sight at the facility he founded two-and-a-half years ago on the outskirts of Intibucá, the Honduras state with the densest population of the Indigenous Lenca people.
Intibucá, home to over 250,000 people, is known for producing Indigenous fabrics and artisanal art – and for its unusually high alcohol consumption and number of alcohol-related street deaths. In 2021 it also registered 15.5 suicides for every 100,000 inhabitants, the second-highest figure nationwide and more than double the national average.
“Alcoholism is a nasty disease that has a firm grip on this region,” says Rómulo, whose full name is José Rómulo Osorio Aguiluz. “In this small city centre [in the urban part of Intibucá], there are at least 400 addicted people who wake up on the streets from their weekend bender – but some will never wake up.
“By bringing them here, we are attempting to save their lives, but they die like flies in the streets.”
According to his files, 723 people passed through the centre in 2023 alone. There are now 52 people in his makeshift rehabilitation unit.
Intibucá, in the south-west of Honduras, has a primarily rural population, and relies on its agricultural economy.
However, a 2017 study by the National Autonomous University of Honduras (UNAH) found that the state registered 27.9 alcohol-related deaths for every 100,000 inhabitants.
This suggests that Intibucá has the highest alcohol-related death toll in Honduras, more than double that of the country’s capital, Tegucigalpa (12.7), and almost three times the national average (9.8).
If Intibucá were a country, it would have the highest rate of alcohol-related deaths per 100,000 inhabitants in the world, surpassing Belarus (21.4) and nearly doubling that of second-placed Mongolia (15.8).
According to María Isabel Mejía, head of the emergency department at the central hospital of La Esperanza and Intibucá, the number might be even higher because only a few cases are linked to alcoholism and recorded as such.
“Many come to the emergency room to have their symptoms treated, which are very likely induced by the damage sustained after years of alcoholism, such as liver cirrhosis, gastrointestinal bleeding and other severe medical conditions,” she says.
The problem, Mejía adds, is that many do not mention or acknowledge alcohol misuse, which makes recording this type of data extremely difficult. “We can then only respond to the symptoms,” she says. “The real number of deaths related to alcoholism, I would say, is abnormally high. We really have a problem here.”
One of the main factors driving high alcohol consumption in the department is the availability of cheap drink. A litre of the popular nationally produced spirit aguardiente (ABV 35%), more commonly referred to as guaro, can be bought at any kiosk or supermarket for about 50 lempiras (£1.60).
However, Fernando Pachero, sociologist and lecturer at UNAH, believes the problem is not merely circ*mstantial. “We also have to look at the colonial trauma this area in particular has suffered,” he says. “It is a zone many of the Indigenous communities were pushed into while the colonialists used alcohol as a weapon of domination.”
Seeing the need for greater support in the area, Camilo* took matters into his own hands and offered a shed next to his house to host regular Alcoholics Anonymous meetings. He says more than 16 AA groups spread across mainly urban areas. An estimated 500 people participate in meetings across the municipality.
“Many people here don’t understand that alcoholism is an illness that is constant, incurable and deadly,” he says. “So many people relapse several times while participating in this programme, and we have to wait and hope they come back.”
Compared with Camilo, Rómulo has developed a more hands-on initiative to combat alcoholism in his “Ministry of Life”. Here, the police or family members drop off the person struggling with addiction, who is then locked in the building to receive a guided and strictly evangelical recovery programme.
If there is space in the centre, Rómulo drives to the city centre with helpers to pick up people who have spent the night drinking on the street – many against their will.
Rómulo believes his actions are justified by the level of need he sees. “The men who sleep on the streets are not just faceless drunks; they are lost souls who have families, and many have diplomas. We bring them here and lock them in the centre because they are not able to combat this disease by themselves,” Rómulo says.
According to Rómulo, the centre receives little financial support and mainly relies on donations, many of which come from people who send family members for treatment. “Many just donate what they can, like the head or feet of a cow or old clothes,” he says.
Hector*, a construction worker, was brought to Rómulo by family members. “My alcoholism would affect my family very badly,” he says. “My mother brought me here because I was not able to wrestle this disease by myself.”
Now, he has been sober for more than two months and has permission to leave the centre during the day to work, but remains under supervision.
Romery*, a woman living in a village outside Intibucá city, says there are many cases, especially in rural areas, where men disappear for months, forcing the remaining family to tend to the crops and take the harvest to market.
“Families, especially women and children, are the ones who carry most of the weight of a family member’s alcoholism,” she says. “Some farmers have sold their land and car just to keep on drinking.”
One such case is that of Maria* and her nine-year-old son. Every morning, she hikes for four hours from her village to the city centre to sell her harvest and returns the same day. Not only is the road long and harsh, but it has become increasingly dangerous.
“Sometimes drunk men will assault me on my way back to rob me,” she says. “These men take the money to buy more alcohol. But I have to make these trips because my brother drinks so much that he cannot be trusted with money.”
The violence linked to excessive drinking is nothing new for police officer José Morenga, especially when it comes to domestic violence.
“In my entire career as a police officer, I have never had a domestic violence case that did not involve alcohol,” he says.
Cindy Castellano, head psychologist of the central hospital of La Esperanza and Intibucá, has treated cases of violence and alcoholism for more than 20 years. “One of the main factors for this level of alcoholism and violence is the extreme machismo embedded in our culture, especially in this region,” she says. “Masculinity is idealised, whereby the man is expected to be the patron and breadwinner of the household. This imposed social pressure prevents many men from learning to handle feelings, since showing or acknowledging them is considered a weakness.”
When Norman Sánchez became the mayor of Intibucá in 2018, he was made aware of the municipality’s alcohol problem. To stem the excess sales and consumption of alcohol, he, along with other officials, introduced a measure of prohibition.
“We took away all the licences of the cantinas in the rural parts of Intibucá and have halted the renewal of alcohol licences in the urban parts,” Sánchez says.
The prohibition spans a large area, covering most of the population of Intibucá.
The question is whether the problem of violence can be tackled with repression. Pachero disputes the measure’s efficacy. He says that prohibiting alcohol without addressing living conditions and livelihoods aggravates the vulnerability of farmers, the primary demographic affected.
“As with any substance that is prohibited, a clandestine market develops and further marginalises the affected poor communities,” Pachero says. “If the communities remain within these marginalising conditions of precarity, the problem will further develop and never be resolved.”
Pachero also believes the removal of those with alcohol use disorder from the streets is less a public health strategy and more to do with protecting the city’s image. “I see this more as a cleanup crew in order to get people off the streets that might interfere with tourism,” he says.
According to the owner of one liquor store in the city, who was able to retain her licence, repression seems ineffective as sales are booming. “The only thing this prohibition has done is boost alcohol sales in the cities because now people come here to get drunk or to buy alcohol and to traffic it to the villages,” she says.
A smuggling economy has grown significantly, with profits to match. For every 100 cases of beer, sellers can expect a margin of between 48,000 and 60,000 lempiras (£1,522– £1,900), which is many times the average monthly income in Honduras of about £180.
With guaro, the mark-up is even higher: a 1-litre bottle, legally sold for 50 lempiras , fetches 150 to 180 lempiras in the villages.
Wendy*, who runs an illegal cantina in a village close to Yamaranguila, Intibucá, says smuggling is becoming increasingly competitive, leading to more violence. “Since alcohol was banned in the rural areas, the business has rocketed,” she says. “Alcohol is the biggest market here. Even bigger than food.”
* Names have been changed
