Ethical Research with Hard-to-Reach Groups

Abstract

Individuals engaging in substance misuse present health and allied professions with a range of complex challenges that often reflect lifestyles of chaos and high risk-taking behaviors, fueled by high levels of impulsivity. By its very nature, substance misuse is antisocial and often takes place out of sight and often as part of the “nighttime economy.” Thus, people who have substance misuse problems are difficult to reach both to understand and to help. Illicit drug taking, being both anti-social and illegal, is frequently associated with other illegal activities such as dealing to others, prostitution, and other acquisitive criminal behavior. The “membership” concepts of in-group vs out-group apply to their actions. This raises issues with regard to trusting others sufficiently to allow them access for research and for assistance. This chapter examines some of these issues in order to develop a deeper understanding of the needs of the group as a way to enhance understanding of such behavior and thereby facilitate positive behavioral change to achieve a reduction in potential harm and enable these individuals to achieve their fullest potential by accessing appropriate treatment and care. Using the example of substance misuse, this chapter illustrates what makes groups and/or individuals “hard to reach” both for research purposes and subsequently to offer assistance. Ethical research in such cases has to balance issues of “access” with “understanding” and “support.”