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Background Alcohol use disorder (AUD) is a growing clinical problem in Uganda. The alcohol consumption is among the most voluminous worldwide. Explanatory models (EMs) of illness are important as they have consequences for treatment. Clinicians´ knowledge about patients´ EMs can improve understanding of the latter´s perspectives and adapting treatments. There is a lack of African studies about EMs of AUD. The aim of this study was to explore EMs for AUD among hospitalized patients and their relatives at the alcohol and drug unit (ADU) at Butabika hospital in Uganda. Methods An adapted version of the Explanatory Model Interview Catalogue (EMIC) was used for interviews with ten patients and five relatives to investigate how both hospitalized patients with AUD and their relatives understand the disease. Data were analysed for themes with a qualitative content analysis and support of the software program, OpenCode 4.03. Results Five major themes were identified from the patient interviews: “Context promotes AUD”; “Alcohol is part of culture”; “Spiritual causes of AUD in the community”; “Help through Western medicine and religious sources is preferred” and “Social problems and stigmatization”. Six major themes identified from the interviews with relatives were: “Numerous causes of drinking alcohol”; “Devastating consequences of drinking alcohol”; “Exploiting persons with AUD”; “Others’ suffering”; “Relatives struggling for help” and “Suggested solutions”. Conclusions Patients’ EMs of AUD included social and spiritual explanations. Alcohol is seen as an important part of the Ugandan culture among both patients and their relatives. The results indicate it is important in clinical contexts to investigate the EMs of the patients and relatives.