Culture and Its Meaning to Substance Addiction Research A lthough the term culture

is widely used, and most appreciate what the term brings to the research
environment, few agree on its meaning or de nition, and even less on how we
operationalize culture in research. Even fewer use similar operational de nitions
within the context of addiction research. Part of the problem in gaining a solid grasp
on a unifying de nition of culture is that its use varies with norms, beliefs, power
(including issues of oppression), organizations, and institutions such as academic
culture or prison culture. Culture does not always refer to heritage or ethnicity.
Culture, as supported by social science researchers, encompasses all of lifes
patterns, socialization practices, religious ideals, habits in thinking, and
organizations, which groups of persons pass on from one generation to the next.
Lum () notes that cultural pluralism signi cantly a ects our current society.
Cultural pluralism involves the coexistence of many group associations and values
that beg to be tolerated and acknowledged in research. Respondent substance
addictions can no longer conceptually exist outside of the multiple in uences
impinging on expressed behavior. Th e culture in which research on addiction takes
place must be carefully identi ed, and the parts applicable to the speci c research
project clearly de ned. E ective cross-cultural social science research accurately
describes conditions of the research participants lives by discovering pertinent
cultural information about the de ned group (Lum, ). How might researchers
gain a better sense of cultural information when budgets are limited? One way is to
develop places throughout the research study to support interactive exchanges of
information (data collection between researchers and participants). Th e exchange
of information throughout the research process can assist substanceaddicted people
in negotiating their environment, nding networks of support, and exploring
culturally relevant ways of reducing harm. For addiction researchers, the
information exchanges help with interpreting research ndings and transform
researchers into the culturally formed. Th e exchange of cultural information o ers
researchers an insiders view of addiction because the position of the researcher is
transposed into a position of being an avid learner. Many researchers would agree
that publishing research that communicates new knowledge would be improved if
posed research questions were developed with a cultural consciousness. I nitializing
research with an overall de nition of population culture may be misguided. Instead,
starting by identifying a group and then deciphering its

24 Faces of Addiction, Then and Now

culture would serve as a more e ective manner to advance research knowledge. In

addition to referring to the addiction literature and exchanging information with
other researchers, there are other valuable means of learning about a groups
culture. One is through the emic approach of interviewing members of the target
population to glean an understanding of the values, behaviors, norms, and symbols
of that group that provide coherence for its members. Another means is through
ethnographic accounts like those of Philippe Bourgois in his book In Search of
Respect: Selling Crack in El Barrio, about the culture of urban Puerto Rican addicts
and dealers. Ethnographies provide insight into culture and the intersections of
race, ethnicity, and geographic or physical environments. By having the group
reveal its culture, researchers can examine the mechanisms in the culture that
create or sustain addiction and problems in locating help. Including culture in the
research enterprise also includes the realization of situations in which cultural
practices both constrain and sanction those who use substances. For example,
women of Mexican descent drink alcohol, but where these persons and their social
groups follow customs, they are also ridiculed for participating in the alcohol
drinking behavior (Vega et al., ).

Dimensions of Culture Culture is a key factor in the helping process. Dawson ( )

o ers three reasons why using race to symbolize culture will not advance
knowledge: () racial or ethnic labeling reinforces notions that racial identity
operates as a determining factor in substance addiction and ignores other
characteristics known to vary in alcohol use and its associated problems (Collins,
); () stating racial categories from three racial groups (mainly, African
American, Latino, and white) ignores other minority populations, such as the rapidly
growing category of Latino immigrants from South America and Mexico and black
immigrants from the Caribbean, either by omitting them altogether or lumping them
into an other category; and () listing race ignores heterogeneity within groups,
the other category included. Th e task, therefore, charged to contemporary cross-
cultural researchers is to conduct research studies that record cultural
interpretations of addictive behaviors and treatment practices from both the
researcher and research participant perspective. B eyond the challenges of using
race as an organizing category, there is the matter of culture, which iswhen it is
attended totreated as a static construct. Culture is organic, dynamic, and uid. It
interacts heavily with the environment and with both race and ethnicity. Along with
what Dawson () has pointed out, Bentancourt and Lopez ( ) note that
researchers are apt to point to so-called culture when they discover di erences
among racial and eth

Cross-Cultural Issues in Substance Addiction Research 25

nic groups. Left out is the fundamental question of what cultural mechanisms
account for the di erence.. To ascribe di erences to culture without attention to
its operationalization at the individual or group level leaves open a wide gap in our
understanding of addictions. To avoid the traps that Dawson ( ) and Betancourt
and Lopez () caution researchers about, this chapter focuses on the research
context to advance addiction research. Th e research context must take into
account di erences among people, situations, and treatment implementations. Th
is refocusing calls for diversity-inclusive research thinking, planning, and
conducting. To begin, a brief argument is presented for utilizing mixed-method
research as its tenets may o er a means to generate new knowledge about
addiction within racially diverse communities.
 Mixed Methodology: An Argument for Addiction Research Although we know
unequivocally that addiction is a disease like any other medical disease and that
disparities exist among racial demographic characteristics, the literature is not clear
on how to move beyond current ndings. Th is reluctance among researchers is
partly due to researchers adherence to choosing either quantitative or qualitative
methods. While addiction in communities of color remains a stigmatized disease,
the stigma spills over to all aspects of addiction research, experiences of alcohol
consumption, drug use, prevention, and treatment (e.g., obtaining measures of use,
safety and legal concerns) and what to do about denial. T o perhaps enjoy greater
depth in exploring the new frontier and the dramatic changes in addiction among
racially diverse communities (e.g., gambling, prescription drugs, etc.), researchers
might want to utilize mixed research methods. Quantitative and qualitative methods
are often depicted as dichotomous, separate approaches to conducting research.
Each di ers in underlying assumptions, purpose, approach, and the appropriate
role of the researcher. For example, quantitative methodologies purport that
researchers can objectively investigate addictions, while qualitative methodologies
suggest that addictions are socially constructed. When quantitative and qualitative
methods are viewed as ends of a continuum, one logical argument put forth is that
mixing these methods can improve our understanding of addiction. Ercikan and
Roth () explain the di culties to adequately answer any social research
questions without both approaches. M ixed-method research designs, proper
notation, terminology, and strengths and weaknesses are still being discussed and
ne-tuned within the emerging eld of mixed-method research (Creswell & Plano-
Clark, ). Th e last years witnessed a growing number of social science and
public health research

26 Faces of Addiction, Then and Now

ers accepting mixed methods as a legitimate form of research. While some scholars
continue to debate the wisdom of mixing methods traditionally associated with the
postpositivist or constructivist paradigms, many researchers are beginning to adopt
a pragmatic perspective by allowing community-informed research questions to
drive the scienti c enterprise. It is acknowledged in the addiction research eld
that racial and ethnic populations are adversely a ected by the stigma of
addiction; however, unknown are the cultural interpretations of addiction. Also
depicted in the literature are the deleterious e ects of addiction, which lead to
misperceptions about communities in a manner that a ects how prevention and
treatment programs are delivered. What mixed-method research o ers to social
scientists is a means with which to produce new knowledge. Th e contemporary
literature points to many areas of disparity for diverse communities, yet available
data often lack information on how populations ascribe meaning to addiction.
Enhancing data to better depict populations in depth will lead researchers to a
greater level of understanding of health service needs. Perhaps a mixed-method
approach might provide an avenue to lling in the gaps.
Limited Data U nderstanding why addiction disparities exist continues to challenge
researchers. It appears that on nearly every index measured, African Americans su
er more severely in relation to white Americans, and often in relation to other racial
and ethnic groups. While the causes of and correlations for addiction are immense,
researchers are o ered a great opportunity to learn more about understudied
populations, especially how the concepts of health and disease hold social and
cultural meaning. Th ere are deeply entrenched ideologies for all arguments. Th
ough it is clear to many researchers that race is a culturally constructed notion,
agreement on the study of racial and ethnic health disparities requires data to
illuminate contemporary issues. National data sets are often inadequate to support
addiction research because in some cases, the sample is insu ciently diverse, and
in other circumstances, the sample includes small numbers of minority respondents
compared to whites (LaVeist, ). Also, data sets with su cient sample size
frequently lack the range of psychosocial variables that are often of interest in
understanding social and behavioral aspects of minority health. For example, most
national data sets (such as the National Health Interview Survey, the National
Health and Nutrition Examination Survey, or the Behavioral Risk Factor Surveillance
System) have limited psychosocial variables. Because these data sets are designed
to produce prevalence rates of morbidity and other health-related characteristics of
the population, they have broad coverage across a variety of health domains but
are

Cross-Cultural Issues in Substance Addiction Research 27

limited in their ability to test novel hypotheses related to the etiology of health
disparities. A s one response to the lack of data examining racial and ethnic health
disparities, and addiction disparities in particular, the National Institute of Mental
Health Collaborative supported the completion of four psychiatric epidemiology
surveys that included three national surveys: the National Survey of American Life
(NSAL), the NCS-R, and the National Latino and Asian American Study (NLAAS;
Pennell et al., ). Each of the studies provides a rich opportunity to focus on
culture-speci c aspects of mental health and substance addiction among U.S.
communities of color. Th ough each study collected data independently, all can be
combined with unifying diagnostic interview questions. A slightly modi ed version
of the World Mental Health Composite International Diagnostic Interview was used
to ascertain mental disorders as de ned by the DSM-IV. Th is instrument was
developed for the World Mental Health Project and was also used in the NLAAS and
the NCS-R. To explain, a description of the NSAL is provided. Th e primary goal of
NSAL was to utilize contemporary methodological advancements to gather the best
data possible about the physical and mental health as well as the structural and
economic conditions of diverse groups of Americans, with a particular focus on
African Americans and Caribbean Blacks. Th e survey instrument included speci c
assessments of mental disorders, stress, coping, neighborhood characteristics,
religion, social support, and work. As background, the NSAL is a national area
probability sample based on a race-strati ed screening procedure to determine
where the sample would be obtained (Jackson et al., ). Trained interviewers
completed face-toface interviews with , adults (, African Americans; ,
Caribbean Blacks; non-Hispanic whites) and , adolescents ( African
Americans; Caribbean Blacks) aged years, for a total of , participants
from across the nation.