Foreword: Ethnographic methods in the study of ethnicity in substance abuse

In this issue, we are the beneficiaries of research that seeks to understand and describe the subject matter of ethnicity in substance abuse through ethnography. This means culling firsthand, empirical knowledge from direct observation and participation and from listening to what people have say. It also means not relying on conventional quantitative research and structured elicitation; and it means not coming up with variables that aggregate responses and observations and then measuring associations with the aggregates. Instead, the ethnographic report usually provides a truly direct and sentient communication of findings.

I took on the task of editing this special issue because I was interested in examining how the subject was approached 40 years after my first effort when I edited a special issue of the journal Medical Anthropology titled “Ethnicity and Alcohol Use” (Gordon, 1978). Being the editor on both occasions has let me reflect on the current emphases in the ethnographic study of alcohol and drugs, and I imagined I would find substantial differences between 40 years ago and now. Ethnographic data collection has advanced considerably. Researchers now use a variety of techniques to explore cultural expressions that include terminologies, decision models, computer programs to identity themes, and cognitive maps, and the new techniques also employ computer programs to analyze qualitative data (e.g., Bernard, 2011; Handwerker, 2001; Schensul & LeCompte, 2016).

However, none of these articles employ any of the more recent techniques; they do show the distinctive advantages of the ethnographic method that relate often to the quite personal talents and personal qualities of the researcher: (a) the capacity of ethnography to access hidden populations that avoid notice by most research efforts, (b) the capacity of ethnographers to develop the sort of trust necessary to collect data, and (c) the ability of ethnography to provide a holistic and inclusive approach to the subject matter.

Access

One of the principal advantages of the ethnographic method is the way it facilitates access to people and situations essential to research. Too often, these populations are hidden and unlikely to be identified by any quantitative research, which usually involves little contact with respondents (Dunlop & Johnson, 1999; Weibel, 1990).

An enormous amount of information may be gleaned from hidden populations. It may take considerable time and effort to locate people who prefer to remain unnoticed and evade recognition by the criminal justice system, migration authorities, or simply anyone who appears to be an official. Typically, the ethnographer makes this effort. Perseverance and legwork are necessary—pounding the pavement and hanging out in public places such as streets, cafeterias, bars, restaurants, and places of clinical work and rehabilitation.

In addition, many hours of conversation may be required before a researcher arrives at any salient information. Michael Agar, an outstanding ethnographic researcher on substance abuse, stresses that ethnography requires “intensive personal involvement, an abandonment of traditional scientific control, an improvisation style (Agar, 1986, p. 12, Carlson, 1995, p. 17).”

Preble and Casey’s (1963) work among heroin users in New York City has become the archetype for a long line of research wherein ethnographers have sought to locate hard-to-reach populations. Almost half a century later, Page and Singer (2010) reflect on research since Preble and summarize the task as necessarily taking place at the “social margins” of everyday life. We have grown fascinated by and deeply involved in this tradition of looking at the social margins, and diverse audiences have devoured ethnographies such as In Search of Respect by Bourgois (1995), who studied Puerto Rican crack users in East Harlem of New York City

Uncovering hidden social spaces has been especially important in each of the articles in this issue: in reports on the production and consumption of home brew or moonshine (Nosa et al. and Ogilvie); among Mexican American women who are methamphetamine addicts with a history of sexual abuse (Cheney et al.); in the population of Hispanics resident in a network of treatment centers (anexos, Pagano et al.); among hospital staff who steal pharmaceuticals (Lowry); and in the populations who have come into the public eye through exaggerated reports about the dangers of their substance abuse (Myers).

Trust

In this issue, all the authors convey the importance of gaining the trust of their subjects, who act as informants. Gaining trust first entails entrée into a relationship of confidence with an informant, an essential feature of the ethnographer’s work. James Walters in a National Institute on Drug Abuse monograph has effectively summarized the importance of trust:

The ethnographer demonstrates the trustworthiness and reliability so essential to evaluating responses … . By gaining the respondent’s trust, ethnography is able to elicit rich data often beyond the reach of other methods. (Walters, 1979, p. 18)

Often the researcher becomes an acceptable part of the scene as a result of informal interactions: conversing, sharing information, and “hanging out.” The informant must feel comfortable with the researcher and be confident that the researcher will not betray any confidence; furthermore, those who are subjects of research need to know that no personal judgment will follow any disclosure of information. Not uncommonly, the researchers will let the informant know that they, too, share the circumstances and challenges of the informant. When researchers reveal their similar circumstances, they may indirectly increase the quality and quantity of their data. The data of Anna Pagano and her research team (this issue) greatly improved when the researchers disclosed that they or their families, and sometimes both, had experienced the challenges of addiction.

Other cases reflect different ways in which trust is gained. Ann Cheney and colleagues culled their data from interviews, underscoring how terribly important it was to let their interviewees know them personally and spend the necessary time. The research team of Vili Nosa and the work of Kristen Ogilvie convey the great importance of an interview situation that permits open and free-flowing conversations, which, in this case, enabled the researchers to gain information on the uses and consequences of the consumption of home brew, also called moonshine. Myers describes the ethnographer’s capacity to get sufficiently close to a subject—to record the feelings and practices of drug users—drawing on varied cases of users in New York City. In each case, I deeply doubt that any of this information would be forthcoming were it not for the ethnographer’s personal inclination and capacity to develop relations of trust.

Ideally, the attitudes and postures of the researcher will be authentic and obvious. A possible exception is David Lowry’s use of autoethnography, in which his previous personal experiences become the ethnographic record. Lowry was a pharmacist as well as an ethnographer of his own work scene. He draws on his own observations among fellow hospital staff members and describes their free and unlawful use of various controlled substances stored in the hospital. For some, his work may raise ethical questions because his sources of information, the hospital staff, had no idea that their actions and words would appear in print. Review boards of universities and health-care institutions stipulate that those who provide information need to be apprised that research is taking place and that their actions may become public through print publication or other means of transmission. However, many of Lowry’s academic colleagues may think that his autoethnography does not violate these codes of ethics because specific individuals cannot be identified; the place of description is sufficiently well hidden; and finally, and perhaps most crucial, the information is so overwhelmingly important that it needs to come out and autoethnography is the necessary means.

A holistic, inclusive approach

Good ethnography involves the collection of an expansive but also focused set of data. Ethnography ideally pursues all the relevant aspects of a way of life, what is called the ethnos, which draws our attention to the fact that the ethnographic method requires the researcher to remain open to a wide range of data. Frequently, the ethnographer uses many sources of information and the researcher arrives at a picture that throws into relief the connectedness of past and present events, individuals in social relations, and the linkages connecting thoughts, feelings, and actions.

On the other hand, quantitative research is frequently in search of data points, and the direction of inquiry is embedded in the research design rather than found in the lives of research subjects. In ethnographic research, by contrast, the researcher will follow the actions and thoughts of their subjects, pursuing information that is not the result of any premediated ideas about social structure and social relations.

The ethnographer needs to be skilled in documenting connections and associations as they appear in the research situation (Carlson, 1995, p. 19). Robert Carlson reflects that the emphasis in ethnographic (or qualitative) research should be

on deriving an understanding of how people perceive and construct their lives as meaningful processes, how people interact with one another and interpret those interactions in the context of the social and natural worlds, and the importance of observations in natural settings. As such, the central methods of qualitative research include interviewing people through various techniques and recording what they say, observing people in the course of their daily routines and recording their behaviors. (Carlson, 1995, pp. 7–8)

We can point to two phases of development in the history of ethnographic approaches. An earlier phase of ethnography examined ways of life as self-contained subcultures, not going beyond the perimeter of the actor’s world. We see examples of this in the work on heroin addicts appearing in the publications by Preble and Casey (1969), Sutter (1966, 1972), and Agar (1973). Then came a new generation of studies that analyzed the ways of an ethnic group in light of the social, political, and economic forces impinging on the world of the substance abusers. Then we learn about power, control, and authority in relation to that group (e.g., Bourgois, 1995; Maher, 1997; Sterk, 1999; Williams, 1992). The articles in this issue follow that second tradition of examining ethnos of a group in the context of larger social forces.

From Ogilvie and from the team led by Vili Nosa, we discover information that is somewhat unexpected and counter to our intuitions. In both cases, legislative attempts to limit drinking in fact increased drinking and associated disruption. Consequently, their findings suggest an approach wherein harm reduction and health education are appropriate interventions rather than interdiction against use. Pagano and associates stress the importance of ethnography as a means by which we may witness a full scope of unanticipated activity. As often happens with participant observation, the researchers on the scene came upon a scenario that would have been missed had they not been open to the experience of new unexpected information. Having gained access to and trust of the residents of the Anexos, the researchers viewed an almost ritualistic process of induction into the treatment center: new entrants were suspended in a liminal state for several days, reclining on mattresses, during which time they were detoxed for drugs and learned about the norms and routines of the residential treatment center. They were entering a state in which they were neither part of the outside world of alcohol and drugs nor on the inside being rehabilitated. Therefore, they were particularly receptive to new information and their new status.

Cheney and co-authors observed the connections linking family background, sexual abuse by family members, and drug use. Without an orientation toward holism, these links may well have escaped the researchers’ notice. Lowry’s work in autoethnography was even more far ranging, showing how as an observer and participant, Lowry was able to soak up the gestalt of the pharmacology scene, in which White people were not prosecuted for taking drugs. The work by Myers, particularly his observations on the impression management of methadone addicts, shows us how he was able to understand methadone users by spending so much time on the street and learning their code.

Final thoughts

All the contributions to this issue provide important observations that highlight what happens when researchers are sentient, intellectually curious, open, and personally involved. Necessarily, the approach requires an intense focus on the subject of research yet without the constraints of a research plan that predetermines who may be involved, that requires an impersonal approach from the researcher, and that limits data collection.

The reader benefits from knowing the research situation like the researcher did, uncovering what may be hidden, what escapes all too frequently from an impersonal and sometimes distant gaze that is often part of quantitative work. The ethnographic method brings us closer to understanding the range of an ethnic group’s experiences with drugs. I suggest that the articles in this issue not only contribute to our fund of knowledge and understanding of ethnicity in substance abuse, but also allow us to appreciate the special personal and professional qualities of the researchers.