Charlotte De Kock

Studying ethnicity, problem substance use and treatment: From epidemiology to social change

Abstract In this paper, we elaborate on the premises of studying problem substance use and treatment disparities among migrants and ethnic minorities. Due to the growing medicalisation of research on problem substance use and disparities in this group, policy makers, health researchers and practitioners often feel compelled to rely on epidemiological studies when grounding and understanding the link between ethnicity, problem substance use and treatment disparities. We argue that the bulk of epidemiological research suffers from crucial methodological and conceptual flaws that necessitate a reconsideration of their usefulness in policy and treatment practice. First, epidemiological research is based on static concepts of ethnicity and race as primordial analytical categories. Second, and as a consequence of the first argument, such research rarely distinguishes sufficiently between ethnic and non-ethnic determinants and mechanisms influencing problem substance use and treatment disparities. And third, these studies often depart from methodological individualism and subordinate contextual and structural determinants and mechanisms. This paper aims to re-evaluate (the factors and mechanisms mediating) the relationship between ethnicity, the nature of problem substance use, and treatment disparities, and to overcome some of the gaps in existing research methods mentioned above. More specifically, this implies (1) a critical revision of the ethnicity concept in epidemiology, (2) the inclusion of non-ethnic determinants and mechanisms by means of applying intersectional analysis and ethnic boundary making perspectives, (3) the broadening of methodological individualism in order to include all levels (from micro to macro) and loci (individual, community, society) of research in holistic research designs. Such “doubled research” allows researchers to analyse and have an impact on treatment disparities among migrants and ethnic minorities.

Implementing Community-based Participatory Research in the study of substance use and service utilisation in Eastern European and Turkish communities in Belgium

Abstract Community-Based Participatory Research (CBPR) is an effective strategy to promote action research regarding health and substance use issues. The London-based Centre for Ethnicity and Health’s CBPR model was replicated in Belgium to study substance use and service utilisation in Bulgarian, Slovakian and Turkish communities in the city of Ghent. This article focuses on the implementation of the CBPR model, challenges and adaptions linked to the Belgian context. In this paper, we describe the study design and actors involved, namely (1) community organisations, (2) the community advisory board and (3) community researchers. Furthermore, we focus on the challenges and pitfalls of the CBPR method and its implications, including (1) community collaboration, (2) co-ethnic researchers, (3) characteristics of the respondents and (4) empowerment of the respective communities. We conclude by discussing potential pathways for future CBPR in the field of substance use and service utilisation among migrants and ethnic minorities.

A Belgian Story of CBPR Among People with a Migration Background

about the conduct of research to be completed were daunting. The long standing relationship of the academic and community partner co–leads prevented this from happening as the academic partner worked closely with the community team members to successfully complete the research training. While it is clear the necessity of assuring all members of the research team are held to the highest standards of research ethics, our non-academic community partner felt that their team was at a distinct disadvantage. The research conduct course appeared to be derived from graduate level material about the conduct of research including complex policies about the ethical conduct of research with which they did not have previous experience. The expectation that community partners from various backgrounds, different areas of expertise, and academic achievement must complete the CITI training prior to the project beginning can create a major obstacle. We believe that that academic partner and funders must reach out to community partners and provide more direction and help with this expectation or the expectation of the training needs to be re–considered as does who really needs have such training. We realize that this is a universally accepted and utilized training requirement, academia needs to understand that what was developed within the academic community, when applied to the greater community, puts the greatest burden on the community and quickly places the community at a disadvantage and diminishes egalitarianism so important for building team. While our team was able to support each other as we completed the CITI training requirements, there may be other partnerships that fail or never begin because of this onerous expectation.

Communities That Care (CTC) : a comprehensive prevention approach for communities

Community coalitions are a strategy to coordinate activities and resources to prevent adolescent substance use and delinquent behaviour. They can bring together diverse community stakeholders to address a common goal and have the benefit of mobilising communities in prevention and health promotion initiatives. The Communities That Care (CTC) approach is based on the premise that the prevalence of adolescent health and behaviour problems in a community can be reduced by identifying strong risk factors and weak protective factors experienced by the community’s young people and by then selecting tested and effective prevention and early intervention programmes that address these specific risk and protective factors. For this review, we found a total of five studies evaluating the effectiveness of CTC and one narrative review of international organisations, mainly from outside the EU. Overall, our analysis suggests some evidence of effectiveness of the CTC approach as a drug prevention initiative in the non-EU studies. As cultural factors probably play an important role in the implementation of this sort of community mobilisation approach, this review suggests that effectiveness still needs to be assessed in a European context. It would then be possible to evaluate the CTC approach in Europe through a multisite randomised controlled trial. Given the findings from existing studies and the well-developed theoretical model behind CTC, further investigation of this prevention model within the European context appears to be merited.

Exploring problem use, discrimination, ethnic identity and social networks

Purpose Possessing a strong ethnic identity and ethnic network are described in some epidemiological literature as moderating factors in the relation between perceived discrimination and varying types of substance use in people with a migration background (PMB). The purpose of this paper is to qualitatively explore problem use, discrimination, ethnic identity and social networks in a small purposive sample of users with a Turkish and Eastern European migration background in Ghent, Belgium. Design/methodology/approach The authors present data retrieved within the framework of a qualitative community-based participatory research study that primarily aims to understand the nature of substance use in PMB. In the secondary analysis, the authors focus on a sub-study examining substance use by people with a Turkish (n=55) and Eastern European (n=62) migration background and explore how individuals perceive discrimination, ethnic identity and (ethnic) social networks in 117 qualitative interviews. Findings Almost all the respondents in this study reported perceived (inter-)ethnic discrimination. The authors establish that problem users in this study have a complex but albeit weak sense of ethnic identity nor do they have a strong ethnic network. This, in combination with perceived discrimination, is a risk factor for continued problem substance use and may hamper recovery related to problem use. Originality/value This article intends to lay the groundwork for future research that should focus more on longitudinally studying the intertwined relation between problem use, discrimination, ethnic identity and especially social instead of solely ethnic networks, their complex nature as well as their relation to recovery processes among persons with a migration background.