Knowledge for use: Anthropology and community-centered substance abuse research

Sm. Sci. Med. Vol. 37, No. 1, pp. 1W5, 1993 Printed in Great Britain. All rights reserved

0277-9536/93 $6.00 + 0.00 Copyright 0 1993 Pergamon Press Ltd

KNOWLEDGE FOR USE: ANTHROPOLOGY AND COMMUNITY-CENTERED SUBSTANCE ABUSE

RESEARCH

MERRILL SINGER

Hispanic Health Council, 98 Cedar St, Hartford, CT 06106, U.S.A.

Abstract-The anthropological world has changed. The ethnographic Other is no longer available and pliant, awaiting anthropological representation, but has acquired a voice of his/her own. As a result, anthropology is faced with a dilemma. What is to be the anthropological role in this transformed world? Two alternatives are examined. The first, postmodernism, stresses the development of experimental ethnographic texts that inscribe the voice of the transformed Other. Noting the weaknesses of the postmodem ‘solution,’ this paper proposes community-centered research as a more appropriate response to contemporary social realities. In this approach, the anthropologist seeks collaboration with the Other in the struggle for self-determination. Illustration is provided with the case study of anthropologists employed in a Puerto Rican community based organization (CBO), with specific reference to the emergence and development of the substance abuse prevention and treatment work of this CBO. While noting the difficulties of this role, the paper argues that scholarly activism, a model adopted from the Third World, is well suited to the postmodern world.

Key words-community-centered research, substance abuse, community based organizations, applied anthropology

A growing list of authors stress that we are in the midst of a “profoundly self-reflexive moment” in anthropology [l, p. 71-a moment shaped by a postmodern questioning of the governing conventions of disciplinary work, or more deeply of anthropology’s very self-identity and mission. While several anthropological appraisals of postmodernism have ap- peared [2], few if any have been written from the perspective of applied anthropologists who generally labor outside the limelight of theoretical fads and fashions of the discipline [3]. Such an examination is useful, however, because applied anthropologists, unlike their postmodem colleagues, may not view the writing of ethnography as the only nor even necess- arily the primary ‘work’ of the discipline and yet, because of the nature of our activities and their frequent location in intersectorial settings, we too are led again and again to self-reflection.

Reflexivity in applied anthropology is emphasized especially with reference to at least five basic questions that are pervasive in the discourse of the field: (1) In our work do we really up& anthropology or are we anthropologists in name and social technicians in practice? [4]; (2) Do our efforts have any de- tectable impact on the wider world; do we make changes that matter? [S]; (3) As anthropologists, are we taken seriously by decision-makers and policy-for- mulators; does our field have credibility beyond the ivory tower? [6]; (4) What is our place in an encom- passing discipline steeped in a cultural relativist perspective that has long questioned the appropriateness of intervention in local settings? [7]; and (5) How can we inject issues, understandings, and methods that

make sense anthropologically into inter-disciplinary environments that often are innocent of a clear appreciation of our discipline [8]?

I raise these points as introduction to a paper that focuses on an examination of the anthropological role in the substance abuse prevention and treatment work of a Puerto Rican community based organization (CBO). For the past seven years this CBO has developed a growing track record of intertwined federally-funded substance abuse research projects with state, foundation, and federally funded intervention programs. This effort has involved five rather different but interrelated tasks: (1) clarifying the importance and role of research to community-oriented health educators, service providers, and health activists; (2) demonstrating to professional, primarily anthropological, researchers the benefits of a long term commitment to community-based, non-university sponsored work; (3) proving to federal funders the ability of a CBO to carry out valid and reliable substance abuse and other health research; (4) developing a methodology that enables the facile movement from research to intervention and back again; and (5) mediating the fieldwork centered anthropological approach with research using epidemi- ological and other survey methods. Underlying many of these tasks is a basic tension, the very tension, in fact, that has produced the reflexive tone in the wider discourse of anthropology. Exploring this tension within a particular applied research setting requires direct and indirect examination of all of the afore- mentioned reflexive issues within applied anthropology. Moreover, it allows opportunity to propose an

SSM 37,1-a 15

16 MERRILL SINGER

applied alternative to the increasingly popular postmodern stance within anthropology.

THE IVORY TOWER AND THE BLACKTOP STREET 191

It is of note that the starting point of the post- modernist perspective is recognition of a dramatic transformation of the traditional subjects of anthropological research. According to James Clifford, who in a sense is the quintessential figure within postmodern anthropology, “a very widespread, empowering distinction has been eroded: the division of the globe into literate and nonliterate peoples” [lo, p. 1171.

After 1950 peoples long spoken for by Western ethnogra- phers, administrators, and missionaries began to speak for and act more powerfully for themselves on a global scale. The time is past when privileged authorities could routinely ‘give voice’ (or history) to others without fear of contradic- tion [1 1, pp. 671.

Lost in this process is the ability as well as the motivation to compartmentalize people into objects and audiences, into those we study and those we educate or entertain with tales from afar. Surely humanity “has its compartments still, but the pas- sages between them are much more numerous and much less well secured” [12, p. 1321. No longer can the anthropologist escape to and from the field, treating ‘here’ and ‘there’ as largely separate worlds incommunicado. Instead, “the native informant may read and test the ethnographer’s characterization, indeed may well have heard of Jacques Derrida and have a copy of the latest Banana Republic Catalogue” [l, p. 81. Or, as I found several years ago while interviewing a voodoo priest in Haiti about his ability to magically eliminate rivals, share tastes in art and music with the anthropologist.

As the postmodernists assert, this world change has profound consequence for the practice of anthropology. Writing of work done among American-Indians, for example, Egan-McKenna [ 13, p. 71 notes that “[tlhe growing empowerment of American Indian people to effect positive adjustments in their personal and community lives will shape and control Indian-related research in the future.” Similar conclusions can be drawn about work with a host of other peoples with a long history of anthropological interest. The new mood has crystalized among some Third World scholars in a call for the indigenization of theory, including “a morato- rium on international cooperation in the social sciences to give Third World academics times to work out their own theoretical stances without input from the West” [ 14, p. 2391. From this perspective, a critical expression of neocolonial dominance is Western academic hegemony: the international privileging of Western ideas, journals, and mono- graphs, and the scholars who produce them, a pattern that is viewed as imperialism by other means. Conse- quently, included for some advocates of indigenous

social science is support for a ban on cross-cultural research.

Under such conditions, the traditional applied anthropological roles of community expert, culture broker, advocate, and similar ‘voice giver’ statuses are subject to question as non-Westerners disavow the need for anthropological intermediaries. At the same time, notes Hill [ 15, p. 341, “[alnthropological research on indigenous modes of historical consciousness is showing how indigenous peoples have developed their own, culturally specific programs for social transformation .,” thereby undermining the legitimacy of imported, anthropologically informed development schemes. More deeply, the very nature of such schemes is called into question as are the anthropologists employed by them. If, as some assert, development programs are designed ultimately to meet the needs of Western-based multinationals, international lenders, and First World governments rather than indigenous population [16], in whose interests are applied anthropologists working?

Consequently the question is raised: in this postmodern world, what is to be the role of the anthropologist? A reading of the postmodern literature would suggest that a switch from immersion in the field to immersion in the text (that is, from extraversion to introversion) is the primary concern of anthropologists in the contemporary period. Marcus and Fischer [17, p. 51, for example, anthropological banner car- riers for postmodernism, assert that the key observation to be made about the current state of cultural anthropology is “a preoccupation. with the form and rhetoric of anthropological writing.” The focus of the disciple has switched from a global comprehen- sion of human experience and lifeway to a nervous re-thinking of “the very right to write” and to a worrisome consideration of the heavy burdens of authorship [12, p. 1331. In this, the anthropological project moves ever closer to becoming primarily a literary effort, while the vanguard of the day is defined as a band of erudite scholars who experiment with alternative approaches with blending authorial and Ethnographic Other voices in increasingly more cumbersome texts.

However, because postmodern anthropology is so deeply rooted in the ivory tower, or more exactly, in Spencer’s [18, p. 1611 playful depiction, in insular and well-stocked libraries situated in ‘student-free zone’ far from the madding crowd, one of the most significant developments of recent years remains outside the line of vision of postmodern observers. This is the employment of anthropologists, because of their ability to help design projects, write grants, and conduct research, by transformed indigenous populations struggling with adversity [19].

Collaborative work of this sort places anthropological skills at the service of communities as tools to be utilized in the process of self-development [20]. Cen- tral to this work are the principles of ‘community as

Anthropology and community-centered substance abuse research 17

client’ and ‘endorsement of the right of self determination.’

First, it is the needs and goals of a particular community- based group which are being served, and it is this ‘target group’ which has the initiative in seeking changes. Second, the applied scientist takes a clear value position and an active involvement in change events. A primary value is that democratic self-determination is the most effective and constructive means of change, both for the community group concerned and for the larger society (21, p. 2571.

This approach is founded on the understanding that communities “have the right to be actively involved in the management of their destinies, and consequently to avoid becoming the victims of others’ good [or bad] intentions” [22, p. 231 and, moreover, that anthropologists have a responsibility to provide critical assistance to those struggling to manifest this right. Adds Egan-McKenna [13, p. 1 I]: “[t]o be successful in this ‘arena,’ the anthropologist must approach community members as a researcher intent on helping them to bring about their own visions, in their own ways, and [at] their own speeds.” In other words, the primary goal of this type of work is not finding an inventive way of adding the Others’ voice to the anthropological text, as it appears to be for postmodern anthropologists, but assisting in the process of having this voice actualized in locally controlled community development initiatives and responded to by the dominant society.

I began work of this sort in 1982 at a community- based organization called the Hispanic Health Coun- cil. The Council had emerged four years earlier as a partnership between university affiliated applied anthropologists and health activists from the growing Puerto Rican community of Hartford [23]. While various factors contributed to the birth of this CBO, two events were primary in shaping its character. First, was the unnecessary death in 1972 of an 8-month old child, an event that transformed health care from a personal to a political issue for the emergent Puerto Rican community.

A young monolingual Spanish-speaking mother took her eight month old baby to the emergency room of one of the three hospitals in Hartford. The babv had a fever, was vomiting, and was very irritable. The monolingual English-speaking physicians and nurses who treated the infant sent the mother home under orders to give the baby liquids and aspirin. Although the mother could not communicate with the providers, she felt she was treated ‘harshly’ and in a ‘cold manner’ by the hospital staff. On the other hand, the providers described the mother as ‘hysterical’ and ‘overreactive’ The mother took the baby to a second emergency room on the following day when the baby’s condition worsened. Again the mother was sent home with similar instructions. That evening, the baby’s condition became critical and the police were called. The baby died in the police car as they were on their way to the third of city’s emergency rooms. The cause of death was dehydration. The death of the babv and the mother’s problem in dealing with hospital staff was widely publicized both in the Puerto Rican community and in the media [24, p. 21.

This incident crystalized many of the hardships faced by the Puerto Ricans in Hartford as they attempted to interact with the health and social service system. Despite a massive increase in Hart- ford’s Puerto Rican population during the 1960s and 7Os, health care providers and institutions had done little to examine-or address-the linguistic, cultural, and social needs of their Puerto Rican patients. In response to this incident, the Puerto Rican Health Task Force was organized as a special project of a local Puerto Rican community-based service agency.

The second event involved the timely encounter between a university-based anthropologist with prior experience in action research in Latin0 communities, and a community activist who worked in the Employ- ment Development Division of one of the hospitals involved in the above mentioned incident. While the anthropologist was hunting for contacts in the Latin0 community with whom to forge collaborative links for heath research, the health activist was experiencing frustration attempting to sensitize the hospital where she worked to the needs and culture of the Puerto Rican community. Ultimately, this meeting provided the springboard for the launching of a new community-based organization specifically focused on health issues.

The initial goals of the Council, shaped by a series of discussions between several anthropologists and community health activists, included: (1) development of empirical studies to determine health and living conditions in the local Puerto Rican population; (2) examination of popular health beliefs and behaviors among Puerto Ricans; (3) determination of felt needs in the community for health care and services; and (4) examination of the organization, ethnic composition, attitudes, and behaviors of local health institutions and providers. As this list suggests, from the beginning the Council was oriented toward research rather than simply traditional one-on-one service provision. Ever since, the Council has attempted simultaneously to function as a research institute dedicated to well designed social science of health research and a community agency involved in grassroots health education and community development. In principle, these are seen as being mutually reinforcing, with research pointing to needed areas of programmatic intervention and community education and intervention exposing arenas of uncer- tainty or confusion that warrant research. According to Schensul, who calls this the Theory/Action Para- digm, the value of this ongoing cross fertilization between research and action is twofold. On the one hand, it leads to better understanding because it provides a generative context for the development of theory that is securely grounded in a complex and constantly changing social reality. On the other, it produces better practice because action is guided by the testing of hypotheses generated from informed theory [25].

18 MERRILL SINGER

While all of this is well and good in principle, in practice, keeping these two rather different phenom- ena together confirms that in this day and age marriage takes considerable work [26]. The problems experienced in ‘living’ the Theory/Action Paradigm are several. Two in particular stand out: (I) community and social service provider distrust of research; and (2) researcher discomfort with the constraints of negotiated action in a community-controlled setting.

Despite its ubiquity in modern life, from marketing studies to the census and from attitudinal surveys to television polls, research is not universally valued, especially in communities where needs are many and resources few. For example, with reference to American-Indian critics of anthropological research, Egan-McKenna notes the following:

Often what Indian critics are trying to tell us is that they do not see or experience any outcomes that derive from our work. Or they perceive the outcomes associated with our research as having either no impact or a negative impact on the community and its members [13, p. 71.

Under these circumstances, research is not merely intrusive, it can come to be seen as either a waste of strategic resources or a further expression of external domination. This sentiment is widespread among minority health and social service providers and activists who question the ultimate purpose of the endless series of studies of the poor and comparatively power- less, the groups most often the targets of anthropological research. While anthropologists tend to think that their research is of some benefit to those they study, at the very least in dispelling myths or providing a historic record of community life, the ultimate bene- factor of anthropological research is open to debate. Writing of his work among African Americans in Washington, DC, Hannerz comments:

Perhaps if one can can build up a good case for the importance of one’s research to the community where it is conducted it might be a good strategy to give emphasis to the role and convince people to go out of their way to be cooperative, for their own sake. However, knowing that black people’s situation is what it is despite decades of social science findings which could have been helpful, I did not feel that I could honestly claim that what I did would make much difference to the future of the community [27, pp. 20442051.

Despite his sensitive portrayal of life among the inner city Black poor, in the years since Hannerz’s study his worse fears have materialized: White/Black economic disparities have widened. Recognition of this fact has created a ‘research backlash’ in groups that feel themselves to be over-researched and under- served. The result is not just community opposition to this or that research project or to any particular researcher but criticism of the entire research enter- prise as alien, self-serving, valueless, and exploitive. This attitude is expressed well in the biting lyrics of Jimmy Curtis and Floyd Westerman’s ballad ‘Here Comes the Anthros,’ a musical indictment of the history of relations between both cultural anthropol-

ogy and archeology researchers and American- Indians. Recently, Weibel-Orlando reprinted a portion of the lyrics to this song. Noting their “circa 1960” origin, she comments:

In 1990 the lyrics rankle. They seem dated, of a time when political hyperbole was taken to heart-the yardstick by which we measure the ethical nature of our own work and community relationships [19, p. 21.

And yet, to American-Indian audiences of the 1990s Westerman continues to be a popular per- former and ‘Here Comes the Anthros’ remains a regular and much appreciated component of his repertoire. Suspicion of research survives, unabated by the passage of time or even the many efforts and accomplishments of numerous committed anthropologists.

This attitude, expressed in various ways in the daily life of the Hispanic Health Council, is captured in the following example. Several years ago the Council’s executive director resigned and a search committee was organized composed of members of the Board of Directors, staff, and a community representative. During the interviewing, the community representative asked one of the applicants to explain her goals for the organization. When she listed research as a priority, the community representative responded, “The Council has done enough research already on the community. What are you going to do for the community?” The idea that research could be both on and for the community simultaneously was not self- evident because the weight of past experience teaches that research is for someone else, someone outside the community.

Adding to the difficulties raised from the perspective of the community are problems encountered by the Council’s professional research staff, most of whom over the years have been anthropologists interested in applied research. University trained and socialized in academic culture, these researchers, in- chiding me, often come to the Council not fully prepared for life in a community institute. Ways in which working at the Council may differ from our prior experience as university-based researchers in- clude: (1) working in close collaboration with and being supervised by other anthropologists or by community health activists who do not have ad- vanced degrees in any field; (2) having to consistently worry about ‘supporting’ the organization by planning/developing grant proposals in order to justify one’s continued employment; (3) being expected to give priority to the goals of the organization while at the same time attempting to develop professional careers through publications and participation in professional organizations; (4) experiencing significant time demands in meeting the daily needs of the organization that make it difficult to engage in reflection, study, and writing; (5) having to negotiate research decisions and research design with others inside and outside of the organization; (6)


having to switch quickly to new projects on topics that may be outside our areas of expertise; (7) learning to write in a style that is expected by funders; (8) forfeiting the flexible and self-managed work schedule of the university because of institutional needs for equity and accountability among staff; (9) receiving salaries that may be lower than our university counterparts; and (10) having less access to the kinds of intellectual and cultural resources concen- trated at universities.

While researchers at the Council have varied back- grounds and experience, as well as different career goals, at least some of these issues have emerged for all of us during our work. The problems of researchers in community-based settings are multiplied by the narrow recognition or stature given to this kind of employment in the academic world, the lack of glamour attached to U.S.-based research in anthropological circles, a limited understanding among community staff about the amount of time, resources, and energy invested (often outside of working hours) in honing research skills and maintaining professional credibility (a currency that has value in the funding marketplace), and the tremendous uncer- tainty of long-term employment in a ‘soft money’ institution.

RESEARCHER- VS COMMUNITY-CENTERED RESEARCH

Over the years, the Council has attempted to mediate some of the conflicting concerns of community and research staff by differentiating conventional or researcher-centered and alternative or community- centered research. By conventional research, we mean: (1) university, academic institute, or for-profit agency based research, that (2) tends to be guided by the interests of the researcher, (3) who, in turn, is the primary beneficiary of public and professional recognition bestowed on the research, and (4) who decides in what form and to what degree, if at all, the research findings are made available to the research subjects. The ‘we’ve been researched to death’ sentiment commonly expressed by community activists appears to be a direct product of these features of researcher- centered research.

However, the problem is not research per se, but rather the replication of exploitive social relations through outsider-centered research on low income or otherwise disadvantaged populations struggling for self-determination. When, in the words of the afore- mentioned song by Curtis and Westerman, the researchers complete their research and “go back to write their books,” the sense is created that they are taking something away, something essential that rightfully belongs to the subjects of the research, something that will now become the property of the researchers. The researchers are not depicted as stay- ing and sharing their finding but as leaving once the research ‘holiday’ is over. As Chambers reports, this attitude is widespread. Many traditional subjects of

anthropological research “are now more likely to complain that, while anthropologists have taken a lot from them, they have left very little in return” [22, p. 91. The song concludes that researchers are not troubled by their acquisitiveness because they believe ‘education gives them the right.’ And what is education? In part, socialization in the accumulated and refined knowledge garnered by prior research. Thus, research centered in the academy comes to be experienced by subjects as a necessary step in the reproduction of class and ethnic stratification and like oppression generally it is predicated on theft.

At the Council, the attempt is made to implement an alternative approach that we label community-centered research, by which we mean research: (1) that is developed through a ‘perpetual discussion’ [28] between experienced researchers and experienced community health educators and activists, and consequently (2) tends to reflect issues, concerns or pressing problems as perceived by members of the community being researched, that (3) is carried out by a heterogeneous research team; and (4) leads to recognition not only for the researchers but also for the community-based agency that sponsors it, as well as (5) a transfer of research skills to minority researchers, while (6) contributing to the intervention, public education, social development, advocacy, and/or empowerment goals of the sponsoring agency.

As such, community-centered research is an example of what Orlando Fals Borda [29] terms ‘participatory-action research’ (PAR). From the PAR perspective, “science should be purposive, aimed at the modification of reality, and should unite with efforts to do so” [30, pp. 1241251. This dis- tinctly Third Word perspective incorporates an in- herent critique of (alleged) value-neutrality in anthropology and the social sciences generally on several grounds: (1) all researchers possess and are influenced by values and thus the “dogma of immac- ulate perception” is a chimera [31]; (2) all research “has class bias, and this ideological responsibility of research cannot be avoided” [30, p. 1251; (3) fair and scrupulous procedures in research “do not demand neutrality, but only strict adherence to the rules of the craft” [32, p. 171; (4) effective change necessitates development of the most accurate description possible of the problems to be addressed rather than ideologically convenient constructions [25]; and (5) “the methodological premise that knowledge must be produced by detached observation has also contributed to the creation and perpetuation of a class of intellectuals (experts, technocrats) distinct from the masses of direct producers, constituting a separation of mental from manual labor.” Of note, the last of these items reveals the very separation that underlies and fuels community hostility to research, and, just as telling and not unrelated (see below), it brings to light an unexplored assumption of the postmodern project [30, p. 1261.

20 MERRILL SINGER

As an expression of participatory-action research, community-centered applied research, we believe, has a number of direct benefits for communities, community agencies, and their staffs, including providing:

5.

6. 7.

8.

9.

10.

11.

12.

Locally grounded and empirically sound information for community education projects. Up-to-date information for staff training. A tool for refuting oppressive stereotypes. A vehicle for use in advocating for the creation of culturally and socially appropriate health and social services from institutional providers. A resource to direct and structure interven- tions. Data for demonstrating need to funders. A weapon for supporting community struggles with information about critical needs. An aid for influencing the direction of policy development. A means to monitor and evaluate the efficacy of programs. A tool for tracking changes in the community over time. A resource for sustaining the institutional structure of the organization. A form of therapeutic intervention with respondents, in that they receive:

(a) attention from a trained and sensitive

listener, (b) a chance to air their feelings and share

their experiences, (c) an opportunity to examine their life and

crystallize their ideas. (d) referral for needs identified during the

research (e) a feeling of contribution to their

community because of the ultimate goal of community-centered research

These benefits, as well as many of the community/ researcher conflicts discussed above, can be seen in the Hispanic Health Council’s work in substance use.

SUBSTANCE USE AND COMMUNITY-CENTERED RESEARCH

In 1984, the Council added substance use and abuse to its set of concerns. Because of a belief among staff members that rates of drinking were increasing among Puerto Rican adolescents, and that with adolescents there was an opportunity to implement prevention, a new researcher grant was developed by Council staff with me as Principal Investigator. The grant was approved and funded by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) to collect baseline data on drinking quantity, frequency and context in a random sample of adoles-

cents and their respective mothers. A central concern of the study was to determine the relative effect of peer and family relations and behaviors on adolescent drinking. Given the immediacy and enormity of the health and social problems facing the Puerto Rican community, the felt need of the organization’s staff to serve the community in direct and unambiguous ways, and community expectations about the proper role of community agencies, this project encountered a certain degree of staff resistance. Newer staff, in particular, questioned the need for more research or the need to adhere to strict research protocols. Some felt that their own experience of patterns of drinking in the community was a sufficient gauge of the problem, saw research as an imposition on the community, and were unclear about the ultimate benefits of the study. Conducting the study was perceived as causing a delay in getting to the real issue, namely addressing an already identified social problem. Being ‘inside’ the situation, it was not easy to step outside and recognize that in order to explain the problem to others (e.g. funders) or to advocate for change, externally comprehendible data were necessary. Community staff simply assumed ‘everyone un- derstands the problem.’ As the study was to reveal, even insiders are able to gain new ‘insight’ through systematic research.

At the same time, as a researcher new to employment in a community agency, but with almost ten years of experience in university-based research, there were considerable adjustments for me to make. First, I was used to steering projects by myself, as is typical in anthropological fieldwork. As Salzman asserts,

Academic anthropologists do not have to account to anyone but themselves. We are not accountable to the people we study, to the societies that support us. or even to the wider academic community [33, p. 161.

Everything in my prior research experience, to use Salzman’s phrase, emphasized research “as a solitary quest of a lone stranger” [33, p. 161. Negotiating project design and activities with an agency oversight committee seemed an intrusive imposition and a waste of time. Secondly, as a typical ‘lone wolf’ anthropologist I was not used to being supervised by a Director of Research, even though this role was congenially filled by a fellow anthropologist. University training, which emphasizes a “relaxed supervisory process” [33, p. 441, had ill prepared me for systematic supervision, especially if this involved seeking prior approval for research activities [34]. Finally, I had trouble accepting the need to negotiate the publication of research findings with the oversight committee. What had previously been determined by personal decision and inclination was now subject to the approval of others. The issue at hand was not the biasing of research findings to reflect desired ends (e.g. more positive evaluation of project impact than experience warranted) or the imposition of censor- ship on politically troublesome findings, but the


collective setting of publication priorities, authorship hierarchies, and rules of access to project data.

As time passed, however, the benefits of the community-centered approach to our alcohol research became clearer to all concerned. To determine the nature and kinds of peer involvement among Puerto Rican adolescents, the preliminary phase of the research involved administration of a short question- naire to an opportunistic sample of Puerto Rican adolescents. Adolescents were recruited for this component through the premier showing of several youth oriented films. Teenagers who attended these show- ings were asked to identify the types of peer groups in which they participate and the types of peer groups that exist generally. Using this approach, 200 adolescents were questioned about peer involvement. This information was utilized in the construction of the peer component of the main research instrument used in the study. However, this activity also demonstrated the ability of research to attract large numbers of youth to the agency, where, after data collection, they could be introduced to available services.

The sampling frame for this study consisted of all Puerto Rican households in high-density Latin0 neighborhoods as defined by census reports (25% Latin0 surnames) in which mothers and appropriate age adolescents resided. The sampling unit consisted of 210 randomly selected adolescents and their respective mothers (one adolescent subject per participating household). Participants were interviewed individually in their home. The final sample of 210 adolescents consisted of 88 boys and 122 girls. By using a community design rather than school-based research, and including both adolescents and their mothers, the study provoked household discussion about adolescent drinking practices and consequences. Mothers used the presence of the interviewer to raise questions about drinking problems among adolescents in the neighborhood and to review their own adolescent social control practices. Parents who expressed interest were referred to programs within or outside the Hispanic Health Council for additional services or health education.

The adolescent drinking study found that while Puerto Rican adolescents were increasingly likely to report alcohol consumption with age, rates of problem drinking were lower than expected and lower than commonly had been reported for comparable non-Latin0 samples. This finding suggested the importance of reinforcing existing controls on drinking among Puerto Rican youth, an approach that had not been suggested in prior discussions at the Coun- cil. Problem drinking, the study concluded, appears to be associated among Puerto Ricans youth with a post-adolescent transition into a world of lessened parental control and a narrow opportunity structure. In addition, the study found higher than expected rates of heavy drinking in the mothers sample. Seven percent of the mothers indicated that they consume

alcohol every weekend, 5% reported drinking every week, and 3% engaged in daily drinking. In terms of the usual quantity of alcohol consumed, 10% reported they normally had 3-5 drinks per drinking occasion, 2% consumed 6 or more drinks per occasion, and 5% usually kept drinking until ‘high’ or drunk. While the focus of the study was on adolescent drinking, research findings suggested the need for intervention targeted to women, a group whose drinking had not previously been an object of special concern.

As indicated, community-centered research by nature tends to be action research [35]. Our adolescent alcohol study quickly led to a number of programmatic efforts. First, based on initial research findings, the Council organized a statewide conference on alcohol use and abuse among Latin0 youth that brought together approx. 200 providers and educators serving the Latin0 community. The conference provided an opportunity to present a state-of- the-art evaluation of the Puerto Rican drinking literature, review existing knowledge on Latin0 adolescent drinking, exam alternative prevention models for adolescents, and disseminate preliminary results of the Council’s study. A published conference vol- ume that addressed issues and strategies in Latin0 adolescent alcohol abuse prevention was distributed nationally through the Council’s publications department.

Second, Council staff designed a school-based peer leadership and substance abuse prevention program that was funded by the state department of youth services. Now in its fifth year of operation, the program prepares adolescents for the effects of post- adolescent transition through participatory training sessions that emphasize: (1) enhancement of cultural pride; (2) development of a myth-free understanding of the nature of mind altering substances; (3) exploration of a socially based explanation of substance abuse; (4) development of problem-solving skills; (5) development of self-confidence and peer pressure resistance skills; (6) provision of insights and self-understanding in the face of adversity; and (7) development of an identity as a committed peer helper. A parallel community-based project, also funded by the state government, targets gang-oriented Latin0 and African American youth, inner city adolescents who are most at risk for early substance abuse.

Third, the Council received national funding from several Latin0 organizations to develop a drama workshop on adolescent alcohol abuse prevention. Through this program, a group of adolescents was given training in acting and provided with the opportunity to participate in several abuse prevention plays that were showcased at local churches, school, and community agencies. Participation in this project grew out of the Council’s involvement in the summer production of an educational video on substance abuse prevention developed by and for Latin0

22 MERRILL SINGER

adolescents and now shown in our peer leadership programs.

Fourth, based on its growing role in substance abuse prevention in Hartford, the Council was selected to participate in a city-funded school and community-based prevention program for elemen- tary age students. This program, which builds on our peer leadership model, combines after-school and summer recreational and skill-building activities with students, parents educational and school-involvement workshops, and community involvement in neighborhood-based prevention campaigns.

Fifth, the Council developed and received state government support for a city-wide pregnancy and drinking prevention educational effort. As part of this initiative, Council staff developed a bilingual poster on the risks of drinking during pregnancy, distributed this poster to community stores, agencies, recreational facilities, government offices, health clinics, and community bulletin boards. At the same time, a series of public service announcements explaining the risks of drinking during pregnancy were played on local radio stations and community access television programs. Additionally, the Council organized several maternal and child health fairs to provide direct community education on the teratogenic effects of alcohol.

Finally, as a direct follow-up to the adolescent drinking study, the Council developed and was funded by NIAAA to conduct a study of the natural history of drinking patterns and consequences among Puerto Rican men. The study examined the quantity/frequency of consumption, contexts of consumption, experiential effects of drinking, health and social consequences, attitudes toward drinking, and individ- ual and family drinking histories, based on a door-to- door random sample of 398 Puerto Rican men. This study began with a three month ethnographic examination of drinking practices in this population. Find- ing from this study, which included evidence of comparatively high rates of heavy drinking and social problems associated with heavy consumption, confirmed the results of the adolescent research project about the initiation of problem drinking and the set of life history and social environmental factors that contribute to this pattern among Puerto Rican men [36].

These projects on alcohol, in turn, paved the way for the development of a National Institute on Drug Abuse-funded demonstration research project on IV drug users and AIDS prevention as well as a broader set of AIDS prevention initiatives [37]. An outgrowth of this work was the formation of two new research and programmatic units at the Council, the Sub- stance Abuse Unit and the AIDS Unit which currently have a combined staff of ten people.

As our awareness of the need for expanded drug treatment deepened, the Council also initiated ongoing efforts to fund culturally appropriate residential treatment for Latinos and street outreach to recruit

Latin0 drug users into treatment. The first fruit of this labor is Project Recovery, a new women’s treatment program motivated by findings from the mothers sample of the adolescent drinking study. This project is designed to: (1) implement community identification of chemically dependent pregnant women by high risk pregnancy outreach workers; (2) provide a critically needed triaging and advo- cated referral system to facilitate the rapid entry of identified women into existing or new substance abuse detoxification and treatment; (3) initiate hospital-based substance abuse day treatment with close linkage to hospital departments of obstetrics, pedi- atrics, social service, psychiatry, and child psychiatry; (4) offer professional day care with attention to the special training and care needs of children of substance abusing parents; (5) provided intensive long- term case management to address continuity of care needs, family-level problems, referral needs, and re- lapse issues among project participants; (6) address the wider range of survival needs of participants and their children, including AIDS prevention, vocational training, housing, life skills acquisition, self-esteem enhancement, and family violence prevention; (7) work to raise the consciousness of participants about the wider set of socio-economic factors that contribute to substance abuse in low-income communities; and (8) seek to empower women as community-based agents of change.

The substance abuse research conducted by the Council has contributed directly to the various programs and activities listed above. Findings from our adolescent alcohol study, for example, have been used in educational presentations to our peer leadership training programs. Because the research was conducted locally, it is possible to relate our findings closely to the lives and experiences of program participants. Through the Council’s Projects Committee, a bi-monthly meeting to review existing work and plan future activities, grant development procedures and research findings have been used in staff training. Research findings also have been used in testifying at needs assessment hearings of Connecticut’s state commission on alcohol and drug abuse. Specifically, the Council has used these opportunities to advocate for community-based and culturally appropriate substance abuse treatment programs for the Latin0 community. Similarly, we have been able to use findings from a state-funded study of community AIDS knowledge, attitudes, and risk behaviors to develop and receive funding from the Robert Wood Johnson Foundation for a project designed to use churlus (informal house meetings of friends, neighbors, and relatives) as a culturally appropriate strategy for AIDS education for Latina women. Additionally, this project brings together a group of women, recovering IV drug users, and persons with AIDS in a series of reuniones (community gatherings) to discuss community response to the AIDS crisis. Further, we have been able to use the research setting


for direct supportive intervention with participants. For example, mothers in our infant mortality review study, many of whom have lost a child because of substance use during pregnancy, are provided an opportunity to ventilate their loss and their grievances with the health care system, examine their life experience, receive referral for ongoing needs, and contribute, through the presentation of case sum- maries to a panel of medical providers and legislators, to improving the health care system for pregnant women. A significant programmatic outcome of this study has been the recognition of a pressing need for support groups for women who have experienced the death of a child, both to assist them in recovery from loss and to prevent future mortality. Development of this intervention is currently under way, although its implementation, as always, is subject to securing institutional funding.

Finally, because of the experience gained by Coun- cil staff in organizing, implementing, and conducting substance abuse education, prevention programs, and treatment for the Puerto Rican community, they have been asked on numerous occasions to speak at youth group meetings, in-service training sessions for community-based agencies and educators, and regional and national conferences. In this fashion, research findings have been shared with the staffs of many other CBOs that are not organized to conduct social science research.

As the various grants received by the Council suggest, the model of a community health activist/anthropologist partnership has proven appeal- ing to funders, who have become convinced of the benefits of collaboration. Into such a partnership, health activists bring a commitment to community health development, a broad awareness of community values, attitudes, history, social relations, organization, internal diversity, experience, and needs, a base for action through local contacts and connec- tions, and various other skills depending on experience and training. Anthropologists contribute a range of conceptual skills, qualitative and quantitative research and analytic ability [38], an appreciation of culture as something that matters both in research and in intervention, linkages to professional organizations and colleagues, grantwriting ability, a natural history and social model of heath problems [39], and a concern with the development of socially useful knowledge. The success of such a partnership de- pends, in part, on the willingness of anthropologists to break free somewhat of academic culture and make a long-term commitment to grass-roots community organizational development and social change. Only such a commitment, expressed through day-to-day practice, overcomes the natural caution of oppressed communities toward professional strangers. Through entering such partnerships, applied anthropologists gain the opportunity to put their professional skills to use meaningfully in the direct service of communities, without being bur-

dened by institutional devaluing of anthropological approaches and knowledge.

CONCLUSION

As the postmodernists stress, life has changed. How to be anthropologists in this transformed world is the contemporary dilemma of our discipline. To date, the primary approach postmodernists have offered involves modifying the conventions of ethnographic writing to allow for multivocal, dialogic texts. But, as Geertz [12, pp. 1461451 so accurately points out, this experimental twist fails to overcome its central pretense: there simply is no getting “round the un-get-roundable fact that all ethnographical descriptions are homemade, that they are the de- scriber’s descriptions, not those of the described.” Ultimately, it is still the anthropologist who inscribes and it remains the anthropologist, therefore, who exercizes authority over textual content and style. And, as a result, it is the anthropologist who constructs the Other, even if the building blocks are the informant’s own words and deeds. As such, there is no real collaboration in the postmodern text, as before there is only the anthropologist as writer serving as final arbiter of what goes into and what stays out of a constructed representation of the Other [40].

The reason all of this is so, in part, is because the basic rules (and rulers) of the game really have not changed. Postmodern anthropology is academic sport (and like other professional sports, a life or death career matter for the players). Inavoidably, like researcher-centered research, writer-centered texts are products of the academy. Thus,

For all their self-proclaimed angst regarding the moral and social responsibilities of ethnography, one sees little evidence that postmodernists wish to abandon the power, privileges, and salaries they enjoy as part of the academic establishment [41, p. 4231.

Trapped within the concerns and motivations of academic culture, “few postmodernists have been so reflexive as to examine the institutional advantages that their decenteredness confers” within the academic setting despite their expressed regard for context [41, p. 4101. While postmodern texts regularly evoke the notion of power, as Rabinow [42, p. 2521 stresses, “what politics is involved is academic politics.”

Asking whether longer, dispersive, multi-authored texts would yield tenure might seem petty. But those are the dimensions of power relations to which Nietzsche exhorted us to be scrupulously attentive. . My wager is that looking at the conditions under which people are hired, given tenure, published, awarded grants, and feted would pay the effort.. . How are careers made now? How are careers destroyed now? What are the boundaries of taste? [42, pp. X3-2541.

The danger remains, therefore, that postmodem discourse is but expensive wrapping “designed to

24 MERRILL

move intellectual goods in a competitive [academic] market” [12, p. 1421.

In sum, although certainly not without benefit [43], it is debatable whether the postmodern “voice from the campus library” [42] has been a completely salutary one. At the simple level, there is a question about the ultimate value of postmodern anthropology taken to its logical extreme as meta-meta anthropology (Paul Rabinow studying James Clifford studying Clifford Geertz studying the Balinese cock- fight). At a deeper level, as anthropologists become embroiled in self-study (the study of the anthropologist who has studied and written about the Other), what of the Other whose ‘discovery’ or creation (or ruination) by the West called forth the discipline?

This paper has argued that from the perspective of the community-centered applied anthropologist, a more formidable solution to anthropology’s postmodern predicament is community-based partnership in research and intervention. Like feminist theory, “the other major trend in the academy in the past decade” [42, p. 2531, but unlike postmodernism, community-centered research “knows its politics” [ 1, p. 71. Indeed, both community action anthropology and feminism are similar in their unapologetic em- brace of scholarly-activism and activist scholarship. [44]. In both cases, the choice of research questions is guided by the needs of an oppressed group, which, typically, asks “questions about how to change its conditions; how its world is shaped by forces beyond it; how to win over, defeat or neutralize those forces arrayed against its emancipation, growth or development; and so forth” [45, p. lo].

Postmodernists, of course, recognize the activist

option.

If, from the post-modern perspective, theory and application, subject and object merge, we are forced to consider the practical implications. These are the more complicated when the people we study are articulate about their own opinions and rightfully expect something in return for their information. What should be the anthropologist’s position if ‘anthropologist’ as such no longer suffices? One possible position is that of advocate [46, p. 3021.

But this alternative is quickly dismissed on the grounds that it is incompatible with anthropology as university-centered scholarship: “To be advocates anthropologists have to step outside their profession, because no ‘cause’ can be legitimated in anthropological terms” [46, p. 3011. Moreover, advocacy is criti- cized as a form of ussrption, an act of speaking for a silent (silenced) Other.

The first of these points, the legitimacy of the role of political praxis in anthropology, demarcates a fundamental distinction between much Third and First World scholarship and underlies Third World critique of contemporary anthropology [47]. Third World scholars, whose lives and studies commonly are intertv.ined, are “not allowed the comforts of imagined [scholastic] distance” [48, p. 2881. Unavoid- ably and irrespective of the nai’vette and insulation of

SINGER

some of their First World colleagues, they recognize that anthropology is enacted on a politicized world stage. Neutrality, even in the guise of scholarly, value-free objectivity, and despite the best intentions of the scholar, becomes a form of side-taking, and is perceived as such by those engaged in struggle. In light of the second point, it must be stressed that

advocacy, in the form of community-based partnership, can serve not to drown out but to harmonize the anthropological voice with that of community-based activists. The postmodern critique of advocatorial work is faulty because it assumes “that the anthropologist must advocate for rather than with the Other” [49, p. 5491. To borrow Gregory Bateson’s phrase, in the postmodern world, this special form of advocacy is precisely one way anthropologists can help produce a difference that makes a difference.

Acknowledgements-1 would like to thank Jean J. Schensul. M. Jean Gilbert, Lorna Rhodes, and Lani Davison for reading and providing helpful comments on earlier versions of this oft revised text. The substance abuse studies mentioned in this paper were supported by grants R23 AA06057 and R01 AA07161 from the National Institute on Alcohol Abuse and Alcoholism and grant R18 DA05750 from the National Institute on Drug Abuse.

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Documents

Knowledge for use: Anthropology and community-centered substance abuse research