201502.03

DDC Research 401: Reflecting on a Field Study into Heroin Misuse in Ireland


Research 401: Reflecting on a Field Study into Heroin Misuse in Ireland

Dr. Niall McElwee, Director & Senior Editor

www.dissertationdoctorsclinic.com

@ThesisClinic


Some years ago I completed a study into heroin misuse in two provincial Irish towns with populations of fewer than 25,000 where my research colleague and I, Gráinne Monaghan, interviewed heroin misusers, their families and a range of service providers over a nine month period. It’s safe to say this study has been the most personally challenging, exhausting, and inspiring study that I have done thus far. I want to share some of these experiences in this blog, because I believe they contribute to the developing relational discourse.

Early Influences

At the outset of our study, Gráinne and I decided we would test our methodology and our overall approach with colleagues in the field. We did this mainly because the formal field of child and youth care was an emerging one in Ireland and we wanted to be among those brave frontiers people! We also value the child and youth care practitioner as ‘experts’ in the(ir) field. We did, in fact, discuss our methodology and some of our ethical concerns with just over 250 social care students, front-line staff, supervisors, and managers in several workshops in Ireland and Canada to ensure we bought into current best practice and to share our approach and theoretical framework. I want to present just a few of the issues raised for us in undertaking research with heroin users/misusers because I think they touch on what ‘relational research’ is all about – and to argue that there is such a thing as relational research (See Gannon, 2003).

Thom Garfat  wrote an editorial in Relational Child and Youth Care Practice where he observed several key contributors to the ‘relational’ such as Aichorn, (1935) who stated that a caring affectionate relationship was preferable to punishment, Redl (1950) who believed that each young person was unique and required a unique approach in the context of a special relationship, Bettelheim (1950), who advocated that young people needed central figures in their lives who would attend to the interactive relationship, and Burmeister (1960) who argued for the place of caring in the therapeutic relationship. The late Henry Maier (1960) often encouraged child and youth care practitioners to think in terms of attachment and nurturance and Beedel (1968) believed in a focus on the growth of relationships (Garfat, 2003, p. 4).

For me, relational research is research where one maintains the integrity of relationship throughout. Not only does one set out to uncover information and facts but one is dedicated to genuinely involving the interviewee as a partner in the process and one returns to the interviewees to share the information and analysis, for the best a researcher can hope to do is interpret and analyse faithfully. Thus, the emphasis for me is on something positive happening as a result of the research being undertaken. This is, of course, easier said than done.

A Child and Youth Care Approach

Our book Darkness on the Edge of Town  starts off somewhat differently than is the established norm in Irish social policy or sociological books. Instead of jumping straight in and providing a synopsis of our findings, I make an attempt to draw the reader in by using more of a novella approach and I reproduce some of that style below.

The Court Room Shuffle

It is a late September Friday morning and Gráinne and I are sitting in a courtroom in Portlaoise. The court is surprisingly quiet as cases unfold and we are getting accustomed to court rituals. Indeed, we are now seasoned court attendees as we attempt to track the path of ‘problem’ drug users and their families involved in heroin addiction in the midlands of Ireland. The court has the usual scattering of Gardai, Prison Officers, Solicitors, Court Personnel, family members of accused, the accused – and the two of us. There are about a dozen members of the public sitting on benches that were surely constructed with the deliberate intention to reduce comfortability. Behind us sits a young woman dressed in a long green army style parka and filthy jeans. Her streaked peroxide hair badly needs a wash. Her fingernails are bitten to the quicks. She has an overnight bag at her feet and she is clearly edgy and distressed. Gráinne and I both notice that she has two prison-style tear tattoos under her left eye. She is up on a charge of robbing €80 of goods from a store in Portlaoise town. She is addicted to heroin.

In front of us, a young male from Athlone in his early twenties sits in the witness box. He, too, is edgy. He seems all-too familiar with the proceedings and his head hangs as the presiding Judge reads through his lengthy case file. His accompanying prison guards shift from foot to foot as we all await the Judge’s thoughts. ‘Derek’ is up on several charges.  He has eighteen previous convictions stretching back to the mid 1990’s.  His Solicitor informs the court that Derek has a heroin addiction. He slept rough in a doorway the night before he robbed a stereo player in Portlaoise and was apprehended and arrested by the Gardai. ‘Derek’ had missed a court appearance in Athlone town the day he was arrested in Portlaoise because he had no money for the bus, hence his stealing the stereo to get money. ‘Derek’ has started on a detox programme in Clover Hill Prison and says he is desperate to get off his heroin addiction. The Judge refers the case to a later date. He has heard it all before but treats all in the court with respect.

It’s not always so easy to see research boundaries, and there is much that remains grey in research and practice despite significant developments over the past couple of decades. Simply put, the sociological and psychological research community disagrees about much when it comes to applied research. We were, thus, left in a vacuum at times where we were unsure to where we should look for guidance. We felt that we could not look to the established academic associations such as the Irish Sociological Association or the Psychological Association of Ireland but neither the Irish Association of Care Workers not Resident Managers’ Associations had, at the time of our research, developed and agreed guidelines. Thus, we could stay true to the established fields outside of child and youth care but not to our own. This seemed crazy.

Taking Care to Care

In every country I have visited, child and youth care workers work with the most marginalised, hurt, problematized, and isolated children, youth and their families in society. The majority of children and youth coming into the care system have common troubles and–as a result–identities, such as their families of origin being unable to cope, a range of serious stressors in their home environments, and problematic behaviours to name but some.

It should follow that to gain an understanding into their lives, researchers need to work with sub-populations of children, youth, and their families who come from what many in the general public might term the dark side of town.

Our Task

Our task, then, was to explore heroin misuse in two Irish towns situated in the midlands area of Ireland (from a qualitative perspective) and attempt to come up with some recommendations that were practicable and achievable.[1] Our study was funded through a local Regional Drugs Task Force initiative (RDTF) and routed thru the Health Promotion Department of the Midland Health Board.

The Interviews & Some Reflections

I think we both agree that our single greatest problem during the 9 months of this study was in actually tracking, meeting, and interviewing persons who were frequently reported by other interviewees as “smoking gear” or “shooting up” (heroin). It is for good reason that heroin users are referred to as a ‘hard-to-reach’ population. It was very often the case that our scheduled interviewees simply did not turn up or, if they did, were unfit for lengthy interviews – and of course this is their right. Nonetheless, by the end of the study we had interviewed over 30 separate service providers and some 30 heroin misusers. To affect this, we had “hung out” in addiction services, in hospitals, in drop-in projects, in GP surgeries, in training projects, in prisons and in family homes (just not in that order!).

Let me say a little about a child and youth care approach to doing research. By this I don’t mean that one necessarily always interviews only children and youth. In fact, quite the opposite is the case and I feel there has been neglect on the wider family in child and youth care study and practice this side of the world. Early in our particular study, we agreed that we would not interview children (i.e. those under the age of sixteen), as we felt we might be placed in an untenable position if they disclosed abuse or “at-risk” situations, or were unclear about, say, what consent actually means. It is the case that a young person might give consent to be part of a study, divulge a significant amount of personal information and then deeply regret this (for all sorts of reasons) just a few years later. This raises the question, how much credence should the research community give ‘consent’ when this is given by a child or young person or, indeed, someone from a vulnerable community?

Our Findings

There is now little doubt that heroin use had grown considerably in Athlone and Portaloise since the early 1990s. We learned from our interviewees it was in the early 1990s that heroin use really started to become a feature of drug use in Athlone and more recently in Portlaoise. However, the respondents felt that heroin had been available in Athlone town as far back as the early 1980s when heroin flooded the Edinburgh, Glasgow, and Dublin markets and was brought down to Athlone. Despite the concerted efforts of the police, we were informed that established dealers could still obtain relatively large quantities of heroin for sale, and this means that individual heroin misusers did not have to travel far out of Athlone or Portlaoise to buy their supply, as was the case in the past. Heroin was readily available to those who really wanted it. The price of heroin varied as the demand  introduced a competitive market.  Usually a bag of heroin could be bought on the street for between €20 and €25.

The age of people becoming involved in heroin use in both towns was articulated by users and the service community as “younger than it previously had been”. It was reported to us that a particularly disturbing new trend was the increasing numbers of females getting involved in heroin misuse and girls as young as thirteen in both towns were reported to be smoking heroin. I must state that it was very difficult to either confirm or deny that this presented accurate picture in both towns and the best we could try to do at the time was triangulate our sources. In doing this we found that people in the same organizations, agencies and, indeed, families frequently proffered different figures.

What we  stated with some surety was that the impact of using heroin had filtered into many domains of the interviewees lives, and one area that was returned to on a considerable number of occasions during the study was that of social isolation. Social isolation and stigma are stark features in the lives of heroin users in the midlands of Ireland who really “feel the pinch of living in a small town.” The fear of family and community members becoming aware of the heroin misuse was a serious factor in deterring the users from potentially accessing medical/intervention/treatment services. One thinks here, for example, of the local Pharmacies where Methadone had to be consumed within sight of the public shoppers.

Bearing in mind the above, we attempted a number of research methodologies to obtain interviews with heroin misusers including lengthy observation of named areas, phone calls to social welfare services, snowballing through other participants, scheduling interviews with girls who simply did not turn up (despite moving our interview schedules from morning to afternoon to evening), accessing gatekeepers who worked with teen girls, making public appeals on regional radio, and sending group texts and e mails. I detail some of these attempts below in an effort to share our strengths and weaknesses.

Lengthy On-site Observation

Adopting a child and youth care research strategy to getting to know the population, we ‘hung out’ in various areas of Athlone and Portlaoise over a 9-month period, varying the times of the day and days of the week. We spent hours walking around Athlone and Portlaoise towns sitting in our cars in various housing estates, drinking coffee in pubs and restaurants, and accompanying gatekeepers on their travels into the heroin underworld. This took up considerable time as we attempted to visit both reputable and disreputable environments. We also sat around various projects talking informally with attendees and service providers.

Snowballing

In the research literature, this is regarded as a main route into drug-using populations. We found snowballing particularly useful in our Athlone-based research but not so much in Portlaoise, with the exception of one community activist. In the last 4 weeks of the study, two women were particularly helpful in getting their friends to fill in questionnaires. We paid both of these a nominal sum for their assistance. We did this because we valued their time and we felt it would be disrespectful not to do so. Now, both of these women were ex-heroin addicts, and some may feel that we should not have offered a financial gratuity for fear that they might spend this on heroin or other drugs. Of course, we have no idea what people spend their money on. Our view is that everyone deserves a chance. Needless to say, this point raised a significant amount of discussion as our workshops with some practitioners arguing very forcefully that we should not pay for interviews and others arguing exactly the opposite.

Public Appeals for Information Specific to Heroin Use

On two separate occasions, I made public appeals on regional radio and provided phone numbers and e-mail addresses where we could be readily contacted.[2] A number of people did contact us as a result of the radio requests and I was quite satisfied that this was a useful approach given the population we proposed to research with. We also placed an on-line ad on the Athlone town website in the community section asking for people to let us know any anecdotal stories they might have, but I did not receive a single response from this. I’m not sure why this was the case as I expected at least some people that use heroin also surf the town website from time to time.

Provision of Mobile Phone Numbers[3][4]

We provided our mobile phone numbers to gatekeepers who, in turn, passed these numbers on to known heroin users. We did receive calls and texts from potential interviewees that proved useful. Toward the end of the study we provided our numbers to an ex-dealer who contacted us several times and who was successful in getting several questionnaires completed for us. Again, there is an issue around giving out one’s mobile phone number. As it happened, it was not abused too badly by anyone connected to the heroin study. I might also state that the ex-dealer in question did call and leave several texts in relation to payment as she had budgeted specific items with her remuneration and, in retrospect, I would not give my personal cell phone number out again.

Accessing Public Houses

We called into several public houses in Portlaoise and spoke with bar staff about heroin use in the town. None of the staff, male or female, reported coming across heroin addicts in their pubs which I have to note is a little surprising given the fact that several of the bars were located within a short walk of the Courthouse. One staff member in Portlaoise did say that she saw “shady” looking characters on court days hanging around, but she denied them access from buying alcohol and from using the toilet areas in her pub. Another bar man told us that he knew there was a heroin problem in town but never came across any drug paraphernalia in his pub. It was his belief that heroin misusers were “staying at home taking their drugs because the price of alcohol was too much for them.”

Attending Court Sittings

As evidenced (excuse the pun) from the selected text from our book reproduced above, we attended court sittings in both Athlone and Portlaoise to get a sense of criminal activity in both towns and saw a number of cases held in front of three judges where heroin was a central feature. This was instructive in seeing how judges interacted with and treated men and women up in front of them on charges relating to heroin misuse and criminal activity. It was also interesting to see how young children interacted with parents and authority figures whilst in court. I must say that I was impressed with the human manner in which the Judiciary dialogued with defendants.

Holding Workshops with Child & Youth Care Practitioners

We also held workshops with over 250 students of social care programmes, front line social care practitioners, supervisors, and managers in Ireland and in Canada. That’s quite a number! We specifically teased out issues of ethical consideration in these workshops around how we might progress this study whilst being true to a child and youth care approach. In Canada, one of our sub-groups at a workshop came up with a very inventive title, that of “Harry Wynne” and I promised that I would reproduce it in an article at some stage. To provide but one example, we asked our conference attendees to consider some of the ethical issues we were presented with and how they might deal with them wearing both their personal and professional hats. Of course, there was much discussion and disagreement concerning, say, the legitimacy of paying people on heroin for information if one thought that the interviewee was then going to immediately spend their interview fee buying heroin or allowing an interview to progress if an individual seemed ‘high’.

A Child & Youth Care Approach: Illegal Behaviours

Whilst there is voluminous literature around research methodology about drug use, there is far less dealing specifically with the precise responsibilities of researchers who are working with ‘hard to reach’ communities where obtaining and maintaining their trust is our main challenge. If, for example, word gets out amongst a heroin-taking community that all information they disclose might well be passed on to authorities, they simply will not talk with researchers, and the information we seek to gather will remain within the often isolated community. Rumour abounds and such populations are often mistrustful of potential interviewers so we were frequently asked “Are you Cops”, or “Are you Social Workers”, “Are you going to report us”.

This presents various difficulties. Some interviewees were more forthcoming about illegal behaviour than others, and sometimes we had to make a judgement call as to what we should do with information we received. An example of this was in relation to being told by an interviewee that he had stolen a mobile phone off a victim just prior to an interview with us. We took the view that as no violence was used and the theft was going to be reported to the police anyway, it would serve no useful purpose to stop our interview and call the police ourselves. It later transpired that our interviewee, “Kevin,” was arrested just after our interview, having been chased through a field by the police, so our call would have been redundant anyway. But let me share with you (in no particular order) some of the things we learned that we will take with is to our next study.

Be Cautious in Presenting Findings: Geographical Spread

Our first discovery was that drug-taking behaviour varies considerably from one community and region to another even when these communities are relatively close to each other. Thus not all comments about Athlone town will apply to Portlaoise town, despite the fact that both towns are located in the midlands, less than an hours’ drive from each other, and it might be attractive to speak of them in the same breath when discussing “the Irish midlands heroin problem” as is frequently the norm in the media. An obvious point in case is the geographical location of each town and points of access into and out of each area. Heroin misuse has many individual traits that preclude easy categorization.

A Child & Youth Care Approach: Be Prepared to Follow Up Interviewees

We underestimated the amount of monies that would be required for our study. We did this because we did not give enough consideration to the fact that interviewees would keep scheduling appointments at destinations an hours’ drive away and then simply not turn up – nor call to inform us of this! This required additional travel costs, time costs, and write-up costs. We had to add extra sites to our study (adult prisons some two hours’ drive away, psychiatric services in Dublin, drugs services in Dublin). Build this in to your proposals. As an example, we spent two full days in a town waiting for interviewees to turn up and only one did, which is very frustrating.

Be Prepared to Challenge Accepted Definitions

It will be apparent that any attempt to enumerate a population using heroin is fraught with difficulty around the very definition of heroin addiction, its measurement, and its interpretation. Drug users are correctly, it seems to me, divided into three distinct categories: experimental users (the curious, often under peer pressure), recreational users (taken regularly but at intervals), and problem drug users (dependent characteristics). We  met persons from all three categories for this study. Of course, not all experimental or recreational users will become “problem” drug users, so it is both unfair and misleading to write about heroin addicts when referring to categories one and two above. Unfortunately, this is often not the case in the Irish media when over-inflated figures are thrown around. Researchers need to challenge the terminology used by media, policy makers, analysts, practitioners and students.

A Child & Youth Care Approach: Look to the Whole Family

Perhaps the single major discovery in this piece of research for me was around the roles grandparents and, particularly, grandmothers, assume in the lives of their heroin-addicted children and grandchildren. We met several grandparents in their 40s and 50s who were doing their best to cope with an utterly alien situation to them. These families deserve a much more strategic ecological response from agency providers. They deserve to be supported.

We also met Moms and Dads who were struggling desperately to be effective caregivers and, indeed, role models for their children. These Moms and Dads realised the effects of their behaviour on their children but were caught up in an addictive cycle and could not step out of this no matter how well-intentioned they were. Services were available at restricted times, transport costs were expensive, privacy was not a major concern of providers, and all sorts of structural changes will need to be made if services are to be effective.

Services Must wait until the Service User is Ready

We also learned that there is little point in trying to enforce participation with psychological and addiction services until the individual is at a place where he or she wants to change. One guy we interviewed overdosed on his first two injecting experiences with heroin but came back to it and even combined his heroin use with crack. Only when he felt ready did he start to make progress. Thus, services are crucial but these must be genuinely user -friendly.

Concluding Thoughts

I emerged out of this particular study a more enlightened and humbled person. I was forced to look at my own moral value system and, once again, have been reminded “there, but for the Grace of God go I”.  Any one of us, and any one of our families, could be touched by heroin and the devastation this can bring. Don’t be too quick to judge.


References

Aichorn, A. (1935). Wayward Youth. New York, NY: Viking Press.

Beedel, C. (1968) The residential setting and the worker’s tasks within it. Approved Schools Gazette. LXI (2)

Bettelheim, B. (1950). Love is not enough: The treatment of emotionally disturbed children. New York: Free Press

Burmeister, Eva E. The Professional Houseparent. New York: Columbia University Press, 1960.

Gannon, B. (2003). The improbable relationship. Relational Child and Youth Care Practice. 16(3), 5-8

Garfat, T. (2003). Editorial. Relational Child and Youth Care Practice. 16(3), 3-6

Maier, H. W. (1960). Essential ingredients for the care and treatment of children in child care institutions, (pp. 1-16). Proceedings of the third annual conference of the Nebraska conference on child care. Nebraska Psychiatric Institute.

McElwee, N. C., & Monaghan, G. (2005).  Darkness on the Edge of Town: An Exploration of Heroin Misuse in Athlone & Portlaoise Available gratis from the Centre for Child & Youth Care Learning, Athlone Institute of Technology, Athlone, Ireland at http://www.ait.ie/faculties/humanities/ccycl.shtml. For more information contact Dr. McElwee at nmcelwee@ait.ie or Gráinne Monaghan at grainne.monaghan@mhb.ie

McElwee, CN., & Lalor, K. (1997). Prostitution in Waterford City: A Contemporary Analysis. Waterford: StreetSmart Press.

Redl, F., & Wineman, D. (1951). Children who hate: The disorganization and breakdown of behavior controls. New York: The Free Press.