Copyright Sociological Research Online, 2000

 

Sarah Goode (2000) 'Researching a Hard-To-Access and Vulnerable Population: Some Considerations On Researching Drug and Alcohol-Using Mothers'
Sociological Research Online, vol. 5, no. 1, <http://www.socresonline.org.uk/5/1/goode.html>

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Received: 15/2/2000      Accepted: 15/5/2000      Published: 31/5/2000

Abstract

Research indicates that the number of women using drugs, including alcohol, is increasing nationally, particularly among women of childbearing age. Nevertheless it is still largely men who contact drug or alcohol agencies for help, while women with children are particularly reluctant to access services and tend to remain a hidden population. Thus learning more about the lives of substance-using mothers is an important area of concern, pragmatically in terms of developing effective social policy which addresses their and their families' needs, and sociologically in terms of studying a little-known and vulnerable population.This article discusses the conduct of a project set up to address this gap in knowledge and investigate the everyday lives and experiences of a sample of substance-using mothers in the mid-1990s. Accessing this population proved very difficult because of such factors as the women's involvement in illegal activities, lack of stable housing, and the stigma of being a mother with a substance-use problem. Several strategies to overcome these problems were tried, of which the most successful was relying on drug and alcohol workers as gate-keepers to assist in locating and recruiting volunteers for interview. Because it was so central to the success of the project, as the research progressed the role of the drug-worker became itself a focus for analysis.Having discussed aspects of the researcher/respondent relationship, therefore, the article focuses on the drug-worker/client relationship, and concludes by suggesting that drug-workers are typically required to act in both a counsellor and an authoritarian role, which appears from the research to lead at times to a problematic relationship with clients. The article ends by questioning whether the nature of the drug-worker/client relationship and the drug-worker's status as gate-keeper may at times in itself contribute to the research inaccessibility of this vulnerable population.

Keywords:
Alcohol; Drugs; Feminist Research; Gate-keepers; Mothers; Qualitative Research; Role; Stigma; Substance-use; Women

Introduction

1.1
Recent research around the UK (Department of Health, 1996; Abraham, 1997) indicates that the number of women using drugs, including alcohol, is increasing nationally, particularly among women of childbearing age. Nevertheless it remains the case that it is still largely men who contact drug or alcohol agencies for help (ISDD, 1996) while women with children are particularly reluctant to access services (Powis et al, 1997) and tend to remain a hidden population. Thus learning more about the lives of substance-using mothers is an important area of concern, pragmatically in terms of developing effective social policy which addresses their and their families' needs, and sociologically in terms of studying a little-known, marginalised and vulnerable population.

1.2
This article discusses the conduct of a doctoral research project set up to address this gap in knowledge and investigate the everyday lives and experiences of a sample of substance-using mothers in the mid-1990s. The population of interest were women living in the West Midlands region who were self-defined as mothers and as having a problem with substances, whether street drugs, psychoactive medication, or alcohol. However, accessing this population proved very difficult because of such factors as the women's need to maintain a low profile due to illegal activities, lack of stable housing, and the stigma of being a mother with a substance-use problem.

1.3
The article discusses the strategies which were employed to try and access this population. These strategies included identification of specific locations such as drug and alcohol agencies, and relying on workers to act as gate-keepers to their clients by making initial introductions and setting up meetings. Only two women in the sample of forty-eight were recruited through snowballing, while all the other women in the sample came through contact with agencies.

1.4
Once contact had been made, interviews generally took place in the respondent's own home, in a relaxed atmosphere amid the everyday activities of the household. This contributed to building rapport with respondents, who were often psychologically vulnerable, due to factors such as lack of self-esteem, social isolation and partner violence. Building rapport was a particularly crucial factor in the conduct of this research, since the research questions framing this study encompassed the whole problematic issue of the 'doing' and 'being' a substance- using mother. This included the specific topics of the women's own upbringing, their social networks, their relationships with their partners and children, the functional aspects of psychoactive substance-use in their lives, and their interactions with such professionals as drug/alcohol workers, social workers, probation staff, and healthcare staff.

1.5
Because almost all the research- respondents were recruited via gate-keepers, the relationship between the researcher and the gate-keepers became a key aspect of the research. While relationships with the majority of gate-keepers were very positive, difficulties with a small number of agencies acted as a prompt to begin to analyse aspects of the drug-worker/client relationship. This article therefore examines not only the relationship between the substance-user and the researcher, but also between the substance-user and her drug-worker.

Defining the Research Population

2.1
The population of interest were women who identified themselves as mothers having a current or previous self-defined problem with substance-use, and living within the West Midlands area. The geographical area of the West Midlands was chosen as a large and diverse geographical area which includes both urban and rural locations, with the second-largest city in Britain and numerous inner-city and deprived areas, as well as isolated villages and affluent small towns. Both Birmingham and Coventry have thriving illegal drug economies, and drug-users in the smaller towns such as Leamington Spa and Rugby, while having their own indigenous dealers, also tend to travel to Coventry or Birmingham in order to buy their supplies.

2.2
'Mother' was originally defined for the purpose of the research as only including those biological mothers whose children were currently with them - that is, actively mothering. It rapidly became clear that life is messier than that. Some mothers had some of their children at home and others elsewhere; children moved in and out of their mother's care; mothers usually maintained parental responsibility even when their children were not physically with them; and all of the sample of women who had given birth to children continued to regard themselves as mothers even when their children were permanently living away. It also seemed appropriate to include in the sample women who had not themselves given birth but who were raising step-children: in the event only one respondent fell into this category.

2.3
The category of 'substance-user' encompassed any woman who defined herself as having, or having had, a problem with psychoactive substances. These substances included illegal opiates such as heroin, and legal opioid-based medication such as methadone, Diconal, Temgesic, Palfium, DF118s and cough linctus; benzodiazepine anxiolytics and hypnosedatives such as Valium and Temazepam; inhalant solvents and gases; amphetamines; cocaine and crack (a derivative of cocaine); and alcohol. The women also took other substances such as nicotine, caffeine, cannabis, Ecstasy, LSD (or 'acid'), and psilocybin (or 'magic') mushrooms but no woman identified these substances as causing a problem for her. While the initial focus of the research was on illicit drug-use, primary alcohol-use was added as a research focus a year into the fieldwork when it became increasingly difficult theoretically to justify its exclusion. This allowed the theory to develop away from an artificial distinction between 'illegal' and 'legal' drugs and towards a more holistic understanding of psychoactive substance-use generally.

2.4
Having defined the research- population under investigation, the article now turns to the issue of how a sample of substance-using mothers was actually contacted for participation in the research.

Contacting the Research Sample

3.1
Contacting the research sample proved even more difficult than anticipated. As Renzetti and Lee (1993 :30) discuss, 'the more sensitive or threatening the topic under examination, the more difficult sampling is likely to be, because potential participants have greater need to hide their involvement.' Substance-using mothers offer a prime example of the need to hide involvement, and thus offer a substantial challenge to any researcher attempting to locate an appropriate sample (Gurdin and Patterson, 1987).

3.2
There are three main reasons why substance-using mothers are such a hidden and hard-to-access population. The first is clearly that some substance-users are breaking the law by the possession of illegal drugs. They may also be involved in other illegal or illicit activities in order to finance their drug-use. Such activities are likely to include selling drugs, shop-lifting, handling stolen goods, credit-card and cheque-book fraud, fraudulently obtaining Income Support payments and, for a small proportion of women drug-users, using various forms of sex- work. Some women are also likely to be currently 'on the run', with a warrant out for their arrest, often for non-appearance at court or non-payment of fines. If not wanted by the police, they may perhaps need to avoid a creditor, violent ex-partner, or local thug they have displeased. All of these activities make it expedient for them to keep a low profile and avoid detection and ease of contact. For a few women, pimps or jealous partners may circumscribe their social life to the extent of literally locking them into the house, making them almost inaccessible to either research or help.

3.3
The second reason also links into their personal and social circumstances and is one which they share with many other women living marginalised existences. The majority of women who experience problems with psychoactive substances, including heavy cigarette-smoking, are likely to be those with the least access to supportive resources, living in insecure housing and regarding their neighbourhood as unfriendly and unsafe (Graham, 1993). In this current study, where multiple interviewing took place and contact was maintained with some respondents for up to two years, respondents tended to have moved home several times in that period, and to have had their fixed or mobile telephone numbers changed or terminated. Thus contacting the women to set up interviews either by post or by telephone could prove very difficult. Contact might be maintained erratically through professionals such as drug-workers or solicitors or through a loose network of casual acquaintances. This was not the case with all respondents, but represented a significant challenge to the conduct of the research.

3.4
The third reason why substance- using mothers are a hard-to-access group with a strong motivation to hide their involvement relates to stigma and the social construction of both 'mothers' and 'junkies' or 'alkies'. Throughout history there have been strong social prescriptions of what a mother is and how she ought to behave (Rich, 1977; Ribbens, 1994). Across many cultures and historical periods, normative motherhood has been regarded as incompatible with the use of a variety of psychoactive substances, of which alcohol can be seen as the paradigmatic case (Gomberg, 1982; Ettorre, 1997). In common with earlier research (Rosenbaum, 1981; Taylor, 1993; Kearney et al, 1994), the current study found that substance-using mothers value motherhood and that their attitudes and everyday lives have more in common with non-substance-using mothers than with their substance- using male counterparts. They develop strategies to protect their children from knowing about or being affected by their substance-use, and one unfortunate consequence of these protective strategies may be that the mothers do not seek help for their substance- use problems, preferring not to risk social service intervention (Powis et al, 1997). Theorists have suggested that, as adult relationships become increasingly fragile in contemporary society, one's relationship with one's children becomes ever more central (Beck, 1992; Jenks, 1996). At the same time, one could argue that this increasing social valuing of the child leads to greater hostility towards those mothers who are seen to fail, for example by being a 'junkie' (Sun, 1997; Daily Mail, 1998; Guardian, 1998). This increases the likelihood that mothers who find themselves in difficulties with substance-use will avoid contact with services to a greater degree than their male counterparts, and will similarly avoid contact with researchers. Issues of trust, rapport and vulnerability are therefore highly salient in research in this area, and will be explored further in this article.

3.5
The main strategies used by researchers (Kish, 1965; Becker, 1970; Sudman and Kalton, 1986; Sudman et al, 1988) to obtain samples of 'deviant' or rare populations include the use of organisation membership-lists; multipurpose surveys; household screening procedures; the identification of locales within which sample members congregate as sites for the recruitment of respondents; the use of networking or snowballing; advertising for respondents; and obtaining study participants in return for providing a service (Renzetti and Lee, 1993). Thus, for example, Rosenbaum (1981) recruited heroin-using women in San Francisco using advertisements and payments for interviews and asserted that, although she was able to recruit a sample of one hundred women, she could easily have recruited five hundred using this method. Kaplan et al (1987) used snowball sampling to investigate community samples of heroin users in the United States, and Taylor (1993) in Glasgow and Inciardi et al (1993) in a range of cities in the United States, studying women injectors and crack-using women respectively, relied on locales (such as drug-dealing areas and crack-houses), key informants, and networking and snowballing strategies, and successfully recruited around fifty respondents in Taylor's case, and several hundred in combined studies by Inciardi and others.

3.6
To this list could be added the additional two strategies of reliance on peers as 'privileged access interviewers', key informants, or 'insiders' to provide entree into the population (Griffiths et al, 1993), and use of more formal gate-keepers, such as outreach workers, to make initial introductions (Taylor, 1993).

3.7
In this research, it was found that respondents were reluctant to come forward without prior introduction, and relying on advertising in known drug-dealing areas, as Rosenbaum had done in the United States, led to no recruits. This may be due to a greater cultural reluctance among British people to telephone strangers, and both drug workers and drug-users expressed the view that potential respondents would be highly unlikely to make any initial contact in this way.

3.8
To begin the research, a great deal of effort was put into publicising the project and negotiating access with drug-agencies. The project was first publicised through the establishment and distribution of a regular free national newsletter, Women Who Use Heroin, from January 1994 onwards. General publicity was also achieved through display stands at two national conferences on women and substance-use, and talks at relevant West Midlands forums. As well as the newsletter, one-page and two-page summaries were also made available, and posters and cards publicising the project were handed out. A letter on the project was initially sent from the (then) West Midlands Regional Health Authority to all drug agencies in the West Midlands region, and was followed up by a letter and telephone-calls. The response-rate was encouraging, with thirteen out of sixteen West Midlands drug- agencies granting access, although not all the agencies which had agreed to grant access were finally used in the project.

3.9
To alert substance-using mothers to the existence of the project, cards and posters were displayed in drug-agencies, a Black and an Asian women's centre, GP surgeries, mother and baby clinics, local schools and nurseries, family centres, a launderette, chemists and shops. The research also headlined the evening news programme of a regional television network and was publicised in two local newspaper articles and local radio news bulletins. All this activity resulted in contact from only one woman, who nervously set up a meeting at a public place but then cancelled and was too afraid to re-contact. She did not disclose what substances she was using, but said that she had never told anyone before that she had a problem with drugs, and was too scared to go for help. Another woman was aware of a pregnancy handbook written in connection with the research project, and telephoned requesting a copy, but was then too frightened to say anything about her drug problem, and did not even want the book left somewhere where she could collect it. This again highlights the levels of fear and secrecy surrounding substance-use by women.

3.10
Later in the research, access was negotiated with a range of probation centres, an alcohol advisory centre, two firms of solicitors, a prescribing general practitioner, a family centre and a primary school. As the fieldwork progressed, it became increasingly obvious that the decisive factor in the success of the research was the positive attitude of a small number of committed and enthusiastic staff-members at various sites, who were able to get the project off to a good start and who introduced the majority of respondents.

3.11
Thus, during this study, six main strategies to recruit respondents were employed with varying success, which were: the identification of specific locations (such as drug and alcohol agencies and a specialist GP); relying on gate-keepers to make introductions; asking respondents to recruit others to the study; advertising using cards, posters, newspaper articles and items on local radio and regional television; offering 5 telephone-cards or telephone-stamps in thanks for participation; and asking key informants for introductions to events and places. The most successful strategies turned out to be using the waiting-room of a specialist GP as a recruiting-ground, relying on enthusiastic and helpful substance-workers and probation-officers to make introductions, and offering remuneration to encourage volunteers.

3.12
The strategy of snowball sampling was a dismal failure. Although this technique of snowballing out into the community has been found effective in previous research in drug-using communities (Kaplan et al, 1987; Taylor, 1993), almost all attempts in this research to recruit participants in this way did not meet with success. This was because women reported that they were either very socially isolated and knew no other women drug-users, or because all of the peer-group of drug- users known to them were in contact with the same drug-agency, and thus could not constitute a community sample. This is in itself an interesting finding, but disappointing from a recruitment point of view. Of forty-eight respondents, only two women constituted the 'community sample'. It was thus unrealistic to hope to recruit particular subsets, due to the extreme difficulty of recruitment generally. When recruiting from agencies, staff were encouraged to approach women from minority ethnic backgrounds, and older women, but overall the sample was very much opportunistic. Of the final sample, only four women were not of White European descent, being African- Caribbean, Asian, or of dual heritage.

3.13
Altogether, a total of eighty interview transcripts were obtained, giving accounts from forty-eight substance-using women and six partners or relatives.

Characteristics of the Research Sample

4.1
The respondents ranged in age from 20 to 59 years, with a mean age of 33 years, and seven of the respondents were grandmothers. They had an average of 2.4 children. Of the total 105 children mothered by the women in this sample, 38 of the children (36%) had lived away from their mothers at any time. This situation had been experienced by almost half (49%) of the mothers in this sample.

4.2
Regarding substance-use, seventeen women used only opiates, nine women used only alcohol, and five women used only amphetamine, with one further woman using only 'pills'. All the remaining sixteen respondents were classified as having two primary substances of dependency, of whom twelve used opiates and another substance, while four used amphetamine and another substance.

4.3
Of the 31 respondents who were involved in a relationship at some point during the interview-series, 16 (52%) had partners who were known to also be using substances, of whom the great majority, 13 of the 16, used opiates, (three in conjunction with other substances).

Conducting the Interviews

5.1
In addition to the forty-eight women interviewed, another four expressed interest but did not follow this up. For those women who did decide to go ahead with the interview, almost all interviews took place in the respondents' own homes, contributing to a relaxed atmosphere, with only fourteen (single or initial) interviews taking place on agency premises. The majority of respondents appeared to find being interviewed a comfortable rather than daunting experience. They visibly relaxed after a couple of minutes and conversation usually flowed with little prompting. In fact I was often surprised at the rapidity at which intimate details of the women's lives were disclosed. Several women also explicitly commented that they valued the opportunity to talk and be heard (cf. Finch, 1984; Kennedy Bergen, 1993), saying for example 'it's lovely talking to you, Sarah, it really is, it's so therapeutic I can look at my drug problem logically when I talk to you, and I never get the opportunity any other time'. It is of course important to bear in mind that, with this as with any similar sample, the women selected themselves into the research process and only those women who were comfortable being interviewed were in fact interviewed.

5.2
For those interviews conducted in the respondents' homes, the conduct of the interview was often woven into the daily life of the household, with telephones ringing, visitors calling, children talking, meals being prepared and eaten, and so on, as the interview continued over a period of perhaps several hours. For those respondents involved in drug-dealing, constant interruptions occurred from visitors keen to buy or sell drugs and, with one respondent, the interview was put on hold when a client arrived for sexual servicing.

5.3
Ethical dilemmas were posed when respondents and their partners discussed their criminal activities with me and showed off items they had recently shoplifted. I was also told of crimes where the respondents were the victims rather than the perpetrators, and where the police had failed to intervene. While this is clearly a wider issue which affects more than the drugs field alone, drug researchers in Australia (Fitzgerald and Hamilton, 1996) have found that a researcher is technically liable as accessory to the crime if s/he knows of a criminal act and does not report it, and from this concluded that it is impossible to conduct research on illicit activities if ethical guidelines are followed strictly. In this study it seemed to me more important to address the macro-level issues of domestic violence and power inequity than to break confidentiality by reporting instances of theft or fraud.

5.4
Another issue that arose during the fieldwork was that some respondents used alcohol, heroin, cannabis or crack during the actual conduct of the interview, and the majority of respondents had already taken some form of psychoactive substance earlier in the day prior to being interviewed (as part of their usual routine and also occasionally to give them 'Dutch courage' for the interview). Apart from the criminal aspects already noted, it seems that the effects of psychoactive substances on the quality of data from respondents is an interesting methodological issue which has not previously been addressed. Only three respondents showed slurred speech and loss of concentration during interviews, which appeared to result from alcohol or tranquilliser-use rather than illegal drugs. For the majority of the respondents, however, the presence of psychoactive substances in their bodies was physiologically normal and did not noticeably impair cognitive functioning.

5.5
An issue that ran throughout the research process was the question of my own position vis á vis both respondents and gate-keepers. As well as the ethical dilemmas encountered, there were also political issues of power, such as control over access to respondents. The discussion will now look at aspects of my relationship with, firstly, the respondents and secondly the gate- keepers.

Research Relationships with the Respondents

6.1
Prior to starting the research, my concerns centred around the issue of developing rapport with the respondents. I wondered, as a feminist researcher, how involved I might become, or want to become, in other people's lives; how mutual or reciprocal information-giving should be; and to what extent would I, or should I, be able to preserve my detachment, impersonality, and anonymity. I questioned the possibility of 'research subjects' becoming 'friends', and wondered to what extent a researcher could or should offer help, for example offering to baby-sit or helping with transport, as an acknowledgement of respondents' assistance with the research.

6.2
While previous feminist research provides pointers on these issues, it has never been part of the feminist project to be prescriptive on the ways in which research should be conducted (Duelli Klein, 1983), and to a large extent I discovered that I had to find my own way through these dilemmas. For example, while the focus of the research was clearly not primarily ethnographic - that is, not concerned primarily with observing the women's everyday activities in the community - it shared elements of ethnography in that it was impossible (and undesirable) to separate the women's participation in the research from the rest of their daily lives. Thus, both epistemologically and methodologically, the boundaries separating 'research' from 'non-research' relationships and contexts tended to be permeable.

6.3
In relation to the conduct of the interviews, where respondents were interested in discussing my personal background, I answered all questions fully and honestly as part of a commitment to feminist praxis (Stanley, 1990; Reinharz, 1992; Stanley and Wise, 1993; Maynard and Purvis, 1994). The only questions I would not answer related to my full name and address, for security reasons. It was curious that the only time this confidentiality was broken was by the actions of two drug-agency workers who, separately, casually informed their clients of my full name despite having been specifically requested to withhold this information. This was particularly surprising in view of the fact that confidentiality is so salient in their everyday work.

6.4
We often found that I had much in common with my respondents, for example they were often interested to know that I was a mother, and several wanted to know about my own substance-using experience, which I was happy to discuss with them when asked.

6.5
While conducting the interviews, I often brought with me cigarettes, lighters, biscuits, and little toys for their children. I chose attractive cards to send to respondents to make appointments or thank them. I gave some women flowers at the end of the interviewing. Towards the end of the fieldwork, when I made the final major push for respondents, I bought 5 telephone- cards and telephone-bill stamps to thank women for completing interviews. I baby-sat for one woman while she popped out on an errand. For women experiencing specific problems such as childcare problems, I tracked down the telephone numbers of appropriate agencies to contact. After completion of the research, I took one ex- respondent and her child to the circus, and supported another ex-respondent by accompanying her to social services' and solicitor's meetings and court hearings. These gestures of courtesy and support were to some extent dependent on the nature of the relationship established during the interviews, and varied according to the depth and length of interview process with that particular respondent.

6.6
These gestures of support and gratitude for their participation were given added impetus by my awareness of the respondents' vulnerability and need for support. The respondents were vulnerable in that many of them lacked confidence and self-esteem, and often mentioned feeling lonely, miserable, easily hurt, and hopeless about the future. They were also vulnerable in being liable to be socially isolated, ill, in pain, impoverished, tired and possibly hungry, or homeless. A number of respondents at the time of interview were currently in abusive and physically violent relationships with male partners. For example, when I asked one respondent in conversation whether her current partner was raping her, she replied hesitantly, 'I don't know what rape is. Is it rape when they get you drugged so you don't know what you're doing? Or when they tell you enjoy it like that? Or when they don't care if you like it or not?' She concluded sadly, 'I don't know what it's supposed to be like any more, so I don't know if it's rape or not.'

6.7
Other women talked about ex- partners they no longer loved, who continued to stay at their homes and demand food and other favours, with the threat of violence if the women did not comply. There was no recourse for these women, since they knew police injunctions would only increase the violence, and they refused to make themselves 'intentionally homeless' by leaving their family homes. As a researcher going into their homes, collecting data, and departing, I often felt helpless outrage mixed with intense respect for women who could continue to make a life for themselves out of such crushing adversity. The women understood that I was visiting them only as a researcher collecting data, and that I could offer them neither advice nor commitment. I could not solve any of their problems, but I could simply sit quietly listening to them with empathy and without judgement, and, as is the experience of other researchers (Finch, 1984; Kennedy Bergen, 1993), this seems at times to have been of value in itself, at least to some of the women.

6.8
This research project is probably unusual in the level of ethical complexity it entailed, mainly because the sample was largely composed of women who were intensely vulnerable, needy for help, and in a number of cases not receiving the help they required. Alongside the ethical demands of the research went emotional demands on myself, as other writers have noted (Rothman, 1986; Cannon, 1989; Duncombe and Marsden, 1993; Jackson, 1993; Ribbens, 1994). Although the fieldwork for this research project was, for much of the time, difficult and demanding, my enduring memory of the research is of the respondents themselves and of their pain, courage and tenacity in the face of overwhelming odds.

Research Relationships with Gate-Keepers

7.1
Alongside these issues of rapport, research-boundaries and the vulnerability and neediness of the respondents, ran the related issue of the relationship with gate-keepers. Since access to this sample was largely controlled by professional gate-keepers, the perforce somewhat 'fuzzy' nature of the research boundaries became a key element in the relationship with a small number of the gate-keepers. Particularly in view of the acute vulnerability of this client-group, gate- keepers had a clear responsibility to protect them from exploitation by unscrupulous researchers, or from direct or indirect harm and thus, in negotiating access and working with their clients, I took pains to explain the research process (and the implications of their agreement to participate) clearly in lay terms to all relevant members of the gate- keeping organisation. Whether accessed via gate-keepers or not, all respondents were made aware of the parameters of the research and were able to give their informed and voluntary consent. Respondents were informed that they were in control of the information-giving process, that the research was confidential and anonymous, and that the interviews would be taped (unless requested otherwise) and transcribed by a responsible person aware of the confidentiality of the subject-matter.

7.2
While the majority of gate-keepers were happy with the conduct of the research, and appeared comfortable with the methodology of qualitative research, one set of gate-keepers in particular struggled with this approach, and appeared to remain firmly entrenched in an aggressively quantitative and survey-based approach to research, finding it hard to acknowledge issues of rapport and empathy in the research process. Operating from within a 'medical model' of research, they found it appropriate to suggest that interviewees should provide urine- samples in order to give an objective assessment to confirm or challenge the women's own accounts of their levels of drug-use. More seriously, as a requirement of participation by their agencies, I was told that I had a duty to report any cases of child abuse I encountered, and that I must declare this duty to potential respondents prior to interviewing. This duty is one which is common to any member of the public, but a requirement to declare it explicitly was very damaging to the conduct of the research. It could clearly break rapport with the respondents, who were being interviewed specifically on the difficulties of parenting (and hence were encouraged to be open about discrediting and shame-filled experiences of poor parenting). In the event, no specific incidents of child abuse of any nature were encountered, and where problems with parenting did exist, it was typically the case that the children concerned were already known to and monitored by social services.

7.3
Another requirement laid on me by this set of agencies was that I not participate in any activity not strictly within their definition of a researcher role. Thus, for example, I was warned against anything they regarded as 'counselling', and was thus required not to talk with distressed women on the telephone, or 'counsel' them in the interview setting. I was also forbidden to meet with respondents outside the formal research setting. Such requirements are at odds with the ethic of feminist praxis (Oakley, 1981; Cook and Fonow, 1984; Stanley, 1990; Stanley and Wise, 1993; Reinharz, 1992; Maynard and Purvis, 1994) and moreover were clearly unworkable in the field, where respondents were often distressed during interviews, due to the painful nature of the subject-matter, and where informal encounters were an integral aspect of the research process.

7.4
The researcher's response to distress in a research setting has been discussed in the literature (for example, see Rothman, 1986; Cannon, 1989; Renzetti and Lee, 1993), and Oakley (1981: 41), for example, has stated categorically 'when a feminist interviews women [the] use of prescribed interviewing practice is morally indefensible'. When women were distressed in my presence, I would respond by simply sitting quietly and listening empathically, which, as a qualified occupational therapist trained in counselling techniques, I knew to be the essence, coincidentally, both of good researching and good counselling. I probably entered less into respondents' lives than other researchers have at times done, who for example have exchanged Christmas gifts, accepted dinner-invitations, offered emotional support and counselling, or become part of a circle of friends with certain respondents (Oakley, 1981; Finch, 1984; Cannon, 1989; Kennedy Bergen, 1993; Taylor, 1993), but my participation was nevertheless perhaps more than these agencies felt was proper.

7.5
While raising interesting sociological questions about the nature of the researcher/agency relationship, the experiences with this particular set of agencies was fortunately not typical of the research process generally. As noted earlier, the research was only able to take place at all due to the enthusiastic support of a number of key staff, who went out of their way to introduce potential research-volunteers and help to set up meetings.

Discussion: Relationships between Drug-Agency Staff and their Clients

8.1
While the relationships between workers and clients has been explored in sociological terms with reference to therapeutic communities (Manning, 1989), there appears to have been a lacuna to date in theorising such relationships in the context of drug or alcohol agencies. Because alcohol agencies do not offer substitute prescribing, some of the complexities of the relationship between drug-workers and their clients are avoided. This discussion therefore focuses only the example of drug agencies.

8.2
My attention was initially drawn to the issue because, although the research was centred in one geographical area, it was curious that the main drug agency in that area were unable to introduce any clients at all to the research project, during the two years of fieldwork. It appeared that they usually had contact with only around eight or nine mothers at any one time (out of a client caseload of around one hundred drug-users), and all their clients were judged by the staff as being too 'emotionally vulnerable' to be interviewed for this project. In fact, a high proportion of their women clients were eventually interviewed, but via other contacts. Interestingly, this agency also asserted that their clients felt 'researched to death' and would therefore avoid any further interviews. Again, the reality was that women approached for this research had generally never been interviewed before and welcomed the opportunity to narrate their experiences. It therefore appeared that what was occurring was less about protection of vulnerable clients than about micro-political processes of power in which agencies, while ostensibly co-operating with the research project, actually exercised their gate-keeping role to place barriers between the researcher and potential research-volunteers.

8.3
Clearly, there are several related levels of analysis within which such actions can be located. In common with all social science research enterprises, there are the macro-level structural issues of the social location and agenda of institutions such as the Economic and Social Research Council (which funded the project) and local Health Authorities, funders, purchasers and service-providers. All these different bodies will have different and possibly competing agenda. When actual or potential clashes arise, these large institutions naturally privilege collective and longer- term concerns (such as future researchers' interactions with these gate-keepers, or a funding agency's continuing relationship with the local service-provider) over the immediate needs of any particular individuals.

8.4
On the macro-level interaction between substance-users and the helping agencies, there is little research as yet which has explored the wider social implications of the relationship between them, for example being notified as a drug-user (Newcombe, 1993), the use of methadone as a form of social control (Smith and Kronick, 1979), the increase of surveillance technology such as drug-testing and urine-screening in society generally (Goode, 1996), and the role of social services as agents of surveillance and control (Smart, 1989; Maher, 1992; Boyd, 1994). The rise of Community Drug Teams in the 1980s, and shortly thereafter the development of methadone maintenance and needle exchange programmes, can be seen as forms of social control over not merely illicit drug-users, but over disorder, contamination, and disease. The view that these developments relate more to control than treatment is given weight, for example, by the assertion that a key impetus in their development was fear over the spread of HIV (Newcombe, 1996), and by the fact that enrolment on a methadone maintenance programme entitles the drug-user to enhanced rates of benefit, as a person with chronic sickness or disability, and also may entitle them to purchase a car on the Motability scheme. These can be significant incentives in continuing to be maintained on a methadone programme rather than aiming for reduction and eventual abstinence.

8.5
At the more microscopic level, several interesting issues were raised regarding the role-interactions between agency workers, their clients, and the researcher. At this level, it appeared from this research that social interactions between workers and clients ranged from empowering to almost feudal. Drug-workers wield great authority over aspects of their clients' lives, writing welfare, childcare and court reports on them, and exercising their own discretion in decisions which the client has little ability to challenge or appeal against. Drug-workers, because of their knowledge of clients' daily lives, are also able to over-ride clinical decisions by the prescribing doctor. It is likely to be their view, rather than the doctor or client's, which determines whether, when, and how much of what kinds of psychoactive medication a client receives. In this research, respondents spoke of incidents occurring which they interpreted as being punishment or a form of rank-pulling by their drug- worker.

8.6
Examples of this included having medication withheld. The medication denied was usually methadone, so that the client was likely (unless they could afford alternative sources of opiate) to spend several days undergoing physical withdrawal, with flu-like symptoms, muscle-cramps, vomiting and diarrhoea, until their source of methadone was re-instated. Another example was being put on a 'daily pick-up' (a prescription for one day's medication at a time) rather than a weekly or fortnightly pick-up. This was experienced as being highly restrictive. Again, clients could find themselves threatened with exclusion or be actually excluded from the services of the local drug agency, so that their source of maintenance medication could be permanently removed unless they were able to find an alternative source.

8.7
There is clear scope for mismanagement of the relationship of trust between the drug-worker and the client. As with earlier studies (Rosenbaum, 1981; Taylor, 1993), this research found that substance-users tended to isolate themselves from the non-using world, and in turn considered themselves excluded by it. The majority of the respondents in this study did not find relationships with other women easy or congenial, and often preferred the company of men. However, a number of the respondents were or had been in long-term relationships with jealous male partners who explicitly discouraged friendships with other men. Thus women could easily find themselves isolated, with few if any close friends, either male or female, and they tended to report that, if they did know other women drug-users, it was likely to be as acquaintances rather than friends.

8.8
In contrast to the lack of informal friendship networks, and doubtless as a response to it, respondents talked about their relationships with professionals as an important aspect of their social networks. For example, one respondent talked about her relationship with her drug-worker:

'for the first time in all my life since I got raped by my brother-in-law I found somebody that I could talk to. Somebody I could - who wanted to listen to me. Who cared about what was happening to me.'

8.9
It would seem that the more isolated women felt, the more their interactions with professionals such as their drug-worker took on emotional significance. This finding of the importance of professional support has received little mention so far in the drugs literature. However, it is similar - although probably overall not as marked - as a finding in a study of single parents (Evason, 1980:51) where a quarter of the sources of support cited by respondents were professional and voluntary workers such as 'doctors, social workers, health visitors, samaritans and other members of self-help groups such as Gingerbread'.

8.10
In this context of social isolation and loneliness, where the drug-worker may become a significant source of emotional support, while simultaneously exercising authority over the client, the relationship clearly has the potential for mismanagement. One respondent discussed a situation exemplifying this, with her drug-worker X:

'it's too personal with X now. We shouldn't have become as friendly as what we did. if me and her weren't getting on friendly- wise, she wouldn't give me an increase in me methadone, for instance but if we were friends, she would. X could write on the folder '[respondent] needs another four amps [ampoules of injectable methadone] per day' and the doctor would have to do it, because X's the counsellor but it's all wrong, cos if X's in a mood with you, you won't get your extra four amps a day. If you're friends with X, you'll get them, and that's how it is.'

8.11
A sense of possessiveness and control over clients was observed alongside what at times appeared to be a clear distancing from clients. This seemed most evident in the occasional confusion over the worker's role and the researcher role. Agency workers tended to assume that the researcher would observe similar professional boundaries as themselves, and reacted strongly when this was not the case. For example, as noted earlier, workers might be casual about breaking confidentiality in terms of disclosing my full name, but reacted with strong disapproval when they realised that I freely gave out my home telephone number, even though this number was ex-directory and was used as a contact-number for arranging interviews. I was at times regarded as a definite oddball, with a curious status which on occasion hovered uncertainly between nave school-kid and dangerous spy. This ambiguous status related both to lack of clarity over the role of a qualitative researcher and also to a sense of disgust, as though my empathy with certain clients contaminated me with the same stigma and low status as they appeared to hold in some workers' eyes.

8.12
The gender dimension of worker- client relationships has not been explored in this article, and would provide a fruitful area for future study. It may be noted, however, that women clients tend to be more likely to have women workers. While it is clear that this is to be recommended (DAWN, 1994; Powis, 1995), there is some suggestion from the social work literature that, given the patriarchial emphasis upon mothers particularly as 'copers' (Graham, 1982; Lawrence, 1992) it is possible that female workers may unconsciously blame and punish female clients who are failing to cope. Again, it is possible that, where women workers have experienced their own mothers as subordinate and victimised, they may unconsciously reject any female clients who have similar characteristics, and allow emotions such as resentment and contempt to colour their professional dealings with them (O'Hagan and Dillenburger, 1995). This attitude of contempt is shown, for example, in Taylor's (1993:119) study of drug-users, where a mother expresses realistic concerns about her child's health and is peremptorily told by her social worker that she is 'regressing to your thirteen-year-old again ... I feel like going out and buying you a dummy.'

8.13
As noted earlier, however, it is important to recognise that relations between workers and clients could also be empowering. Examples from this research include incidents and relationships which were clearly highly beneficial to some of the most vulnerable women. Women valued receiving emotional warmth, attention and care from workers, and a personal interest and knowledge of them which sometimes extended over many years. Gestures of care which occurred or were reported during the research included a worker giving money from her own pocket to a desperate client, and another worker, whose vulnerable client needed to visit another city, arranging for her to be met and taken out for a meal by a friend of the worker. For women substance-users such as these, to have someone care for them was a rare and welcome experience.

Conclusion

9.1
This article has discussed a range of issues arising from a research project investigating the everyday lives of drug and alcohol-using mothers. There are many factors in the lives of such women which make them hard to access for research purposes. These factors include criminal or illicit activities in which they may be involved, which encourage them towards a low profile; their sometimes fluid and marginalised lifestyles, which may result in frequent changes of address or loss of a telephone-service; and the wider factors of the stigmatising nature of drug or alcohol-dependency and the resultant reluctance by mothers to approach agencies for help, in case they are labelled as bad mothers and lose custody of their children.

9.2
Despite these difficulties, forty-eight women were recruited into the research project and interviewed at length about their everyday experiences. Although it is not possible to define the characteristics of a hidden population, and thus assess whether this sample was representative in a statistical sense, their demographic and biographical characteristics appear consonant with other research into substance-using mothers (for example, see Taylor, 1993). The research was unusual in the complexity of the ethical and methodological dilemmas posed, not least because of the vulnerability and neediness of the respondents, and thus the salience of establishing rapport within the research- relationship.

9.3
A key aspect of the research process was the relationship not only with the respondents but with the gate-keepers, and this raised questions also about the relationship between the gate-keepers and their clients. Because substance-users tend to be a hidden population, access to them is facilitated by the use of gate-keepers such as drug and alcohol workers, and therefore an important part of the research process becomes understanding the dynamics of the worker-client relationship. This article has therefore discussed at length some aspects of this relationship, particularly with regard to the role of drug-workers.

9.4
It is clear from this discussion that drug-workers are in an invidious position, where their role contains within itself two potentially incongruent dimensions: a counselling dimension and an authoritarian dimension. In order to support their client, a drug-worker needs to be empathic and warm, moving beyond the typically more formal and distant professional role. At the same time, unlike other professionals in counselling relationships, a drug-worker exercises clear and significant authority over her/his client. The worker has responsibility for influencing such decisions as whether a client is offered access to detoxification or rehabilitation facilities, whether her children are taken into care or returned to her and, through court welfare reports, the worker influences whether a client may receive a custodial or non-custodial sentence. The worker is also able to exercise control even over the client's body and physical health, through advising whether and what prescribed medication is given or withheld.

9.5
Few other professionals are able to exert that degree of control over those in their care. Few other professionals also work with such a stigmatised and vulnerable group of people, with such limited recourse to appeal or to a second opinion. In fact, due to the strong emphasis on high levels of confidentiality in the substance-use field, other professionals outside the agency are unlikely to know the details of any interactions or be in a position to monitor situations. For the substance-using mothers studied in this research, an additional factor in the relationship was the limited levels of alternative social support available to them, so that their relationship with professionals such as their drug-worker or prescribing doctor could become of key emotional importance in their everyday lives.

9.6
While systems of professional supervision and managerial lines of responsibility are clearly in place, the key safeguard against misuse of authority, in this as in any other professional situation, remains the integrity of the individual worker. It is obvious from the foregoing discussion that the worker/client relationship holds the potential for abuse of vulnerable clients, either through emotional over-involvement/rejection or through withdrawal of services. This research found no evidence to suggest that such abuse occurs, but it did come across examples where respondents felt unhappy with services and unable to voice complaints for fear of possible repercussions. To hold such far-reaching influence and significance in another person's life is a profound responsibility, and it may perhaps explain why some workers felt ambivalent about exposing this relationship to the light of sociological research.

9.7
The majority of professionals encountered during the course of this research were highly committed and supportive of a client-group with a range of problems such that working with them is frequently demanding, difficult and unrewarding. It is the unusual patterning of the drug-worker's role, with its unique responsibilities and tensions, rather than any individual factors, which may at times lead to a sense of possessiveness and control over clients, which then in itself contributes to the continuing difficulties of researching this hard-to-access and vulnerable population.

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