The Collection and Interpretation of Data from Hidden Populations U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • Public Health Service • Alcohol, Drug Abuse, and Mental Health Administration The Collection and Interpretation of Data from Hidden Populations Editor: Elizabeth Y. Lambert, M.S. Division of Epidemiology and Prevention Research National Institute on Drug Abuse NIDA Research Monograph 98 1990 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Drug Abuse 5600 Fishers Lane Rockville, MD 20857 For sale by the Superintendent of Documents, US Government Printing Office. Washington, DC 20402 The Collection and Interpretation of Data from Hidden Populations ACKNOWLEDGMENT This monograph is based upon papers and discussion from a technical review on the collection and interpretation of data from hidden populations that took place on July 13 and 14, 1988, in Rockville, MD. The review meeting was sponsored by the Division of Epidemiology and Prevention Research, National Institute on Drug Abuse. COPYRIGHT STATUS The National Institute on Drug Abuse has obtained permission from the copyright holders to reproduce certain previously published material as noted in the text. Further reproduction of this copyrighted material is permitted only as part of a reprinting of the entire publication or chapter. For any other use, the copyright holder’s permission is required. All other material in this volume except quoted passages from copyrighted sources is in the public domain and may be used or reproduced without permission from the Institute or the authors, Citation of the source is appreciated. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this publication are used only because they are considered essential in the context of the studies reported herein. DHHS publication number (ADM)90-1678 Printed 1990 NIDA Research Monographs are indexed in the Index Medicus. They are selectively included in the coverage of American Statistics Index, BioSciences Information Service, Chemical Abstracts, Current Contents, Psychological Abstracts, and Psychopharmacology Abstracts. iv Contents Page Introduction 1 Elizabeth Y. Lambert and W. Wayne Wiebel Identifying and Gaining Access to Hidden Populations 4 W. Wayne Wiebel The Role of Ethnography in Substance Abuse Research and Public Policy: Historical Precedent and Future Prospects 12 Harvey W. Feldman and Michael R. Aldrich Methodological and Design Issues: Techniques for Assessing the Representatives of Snowball Samples 31 Karl M. van Meter Requirements for Inductive Analysis 44 Peter Adler Computer Analysis of Qualitative Data 59 Richard B. Fritz Ethnographic Field Stations 81 Paul J. Goldstein, Barry J. Spunt, Thomas Miller, and Patricia Bellucci Ethnographic Research on Hiddcn Populations: Penetrating the Drug World 96 Patricia Adler v Page Recovery From Opiate Addiction Without Treatment: A Summary 113 Patrick Biernacki Women and Addiction: Process, Treatment and Outcome 120 Marsha Rosenbaum and Sheigla Murphy Chicano Intravenous Drug Users 128 Reyes Ramos The German Bridge: A Street Hookers’ Strip in the Amsterdam Red Light District 146 Hans T. Verbraeck List of NIDA Research Monographs 156 vi Introduction Elizabeth Y. Lambert and W. Wayne Wiebel The relative merits of qualitative versus quantitative research designs have long been debated in scientific literature. Each brings its own strengths and weaknesses to the process of analyzing and understanding complex human behavior. The National Institute on Drug Abuse publishes numerous docu- ments, reports, and monographs about quantitative studies of drug abuse and drug-related problems. This particular monograph is different because it addresses qualitative approaches to the study of drug abuse, namely, ethnog- raphy and ethnographic research designs. The intent here is to examine unique attributes of ethnographic research and review how these attributes support efforts to understand issues often obscured by more quantitative methods. Specific focus is on ethnographic methods and techniques de- signed to access the so-called “hidden populations.” “Hidden populations” euphemistically refers to those who are disadvantaged and disenfranchised: the homeless and transient, chronically mentally ill, high school dropouts, criminal offenders, prostitutes, juvenile delinquents, gang members, runaways, and other “street people”-those we are all aware of to one degree or another, yet know so little about. These populations are often omitted from nationally representative surveys, largely because they have no fixed address or because they are less likely to be found at home or to agree to an interview. Ironically, those who belong to hidden populations are often at greater risk of drug abuse and drug-related morbid- ity than the general population. That is, the very individuals who might benefit the most from drug abuse treatment and prevention efforts are the least studied, the least understood, and the most elusive to epidemiologists, clinicians, researchers, and others concerned with understanding and improv- ing the public health of these populations. Ethnographic research methods are appropriate for topics about which little is known, primarily because ethnography is by its nature fundamental and exploratory, preparing the way for more rigorous studies that strive for pre- cision and quantification. An example is the advent of acquired immuno- deficiency syndrome (AIDS) in the early 1980s, a mysterious disease that challenged medical research and epidemiology throughout the world. Eth- nography served to fill knowledge gaps and set the groundwork for further scientific inquiry. Such efforts included, for example, studies of needle- 1 sharing behaviors and sexual practices, particularly among prostitutes. It is at this exploratory, descriptive stage of research that ethnographic and quali- tative methods can make significant contributions to the knowledge and understanding of problems and to the formulation of subsequent questions for quantitative research, including clinical studies, laboratory experiments, and population-based surveys. This monograph reviews ethnographic methods used to study drug abuse and drug-related issues, then presents case studies that illustrate practical applications of ethnography. The first paper, by Dr. Wayne Wiebel, sets the tone for the entire monograph. It provides the rationale for the techni- cal review meeting and gives an overview of issues related to ethnography and qualitative science, then describes sources of drug abuse indicator data and several well-known studies of drug abuse that were conducted using ethnographic research methods. Dr. Harvey Feldman, author of the next paper, provides an historical perspective on the use of ethnography in substance abuse research by describing one of the first events ever recorded (back in the 5th Century BC), moving through time to current applications like the study of the AIDS epidemic, and projecting future uses of ethnographic methods in efforts to prevent and treat drug abuse and AIDS. The next set of papers focuses on methodological issues in ethnography. Dr. Karl van Meter’s paper addresses snowball sampling, while Dr. Peter Adler reviews the history, application, strengths, weaknesses, and current status of the method of sociologic cthnography known as inductive analysis. The paper by Dr. Richard Fritz is devoted to a thorough review of the analytic needs of ethnographic researchers, including a survey of current word-search and text-retrieval programs that can support the analysis of qualitative data. Dr. Paul Goldstein’s contribution focuses on the ethno- graphic field station and includes descriptions of real-life situations and experiences common to the conduct of substance abuse research from such settings in New York City. The next set of papers merges theory with actual case studies. The first, by Dr. Patricia Adler, presents a candid review of practical considerations, constraints, and experiences encountered while conducting ethnographic research in the world of drug distributors and smugglers. The next, by Dr. Patrick Biernacki, describes recovery from opiate addiction without treatment and reviews findings from a study that used the chain referral method to identify its sample and used the retrospective approach for data collection. Dr. Marsha Rosenbaum and Ms. Sheigla Murphy discuss the issue of addicted women and heroin abuse from the perspective of ethnographic interviews with female drug abusers in California. Dr. Reyes Ramos provides unique insights into the world of heroin abuse among Chicano intravenous drug users, demonstrating the value of ethnography as an approach for the discovery and exploration of relatively unknown or poorly understood hidden populations. The final paper in this monograph, 2 by Dr. Hans Verbraeck, presents an ethnographic view of heterosexual prostitution, drug use practices, and AIDS in Amsterdam. We are grateful to the authors for their valuable contributions to the tech- nical review meeting and to this monograph. It is our expectation that this monograph will serve important educative functions in the years to come, not only as a methodological guide for ethnographic research, but also as a sourcebook for examining case studies and practical applications of ethnog- raphy in substance abuse research among hidden populations. AUTHORS