Dissertation concept development and framework

¶ … ameliorating the threat to at risk populations is a leading motivation for scientific investigation. The possibility that social and cultural tensions are responsible, even in part, for the incidence of alcohol and substance abuse in a particular group of individuals, more so than is experienced by counterparts in other countries of comparative social and economic standing, is cause for investigation into the reason for a groups' significantly higher instance of substance dependence and abuse. In the Republic of Armenia, there are several factors which facilitate, even encourage the use of illicit substances and the misuse of substances such as alcohol. Namely among those factors is the relative unavailability of clinical analgesics and inaccessibility of affordable reliable health care (Hinote,, Cockerham, & Abbott, 2009). Additionally, many areas of Armenia are extremely difficult to access which not only allows for a flourishing criminal industry but further insulates residents of those areas from the protections of organized government as well as what little access there is to health care.

Since the dissolution of the U.S.S.R., former member states have faced extreme economic hardship. The incidence of organized crime involving the trafficking of narcotics and even people out of the country has risen exponentially. Natural disasters such as the devastating earth quake which wrought havoc on the country in 1988 have presented a perfect host country to criminal organizations. Though the use of intravenous drugs within the country is relatively low given the prominence of the production and smuggling industries, the transmission of diseases such as HIV / AIDS as a result of the sex industry has risen exponentially since 1998 (Drug Law & Health Policy Resource Network, 2001).

In a country steeped in centuries of cultural heritage which has remained reasonably intact despite the relative transience of governments and continuously changing economic climate, gaining access to genuine reliable information regarding the nature and causes of addiction within the population is dependent upon a firsthand understanding of the cultural conventions which govern Armenians. As with other reasonably culturally insulated countries, the willingness of the population to cooperate with a study decreases exponentially with the degree to which the researcher is removed from the culture itself. Also, the contextual usefulness of even intact and accurate information is diminished by a lack of understanding of the role of such information within the greater workings of the specific society. It is essential then, to acquire first hand experiential reports of the objectionable behavior and all of the societal correlates and contexts which ultimately lead to its presentation.

The identification of specific factors which increase the risk of a group of individuals to a potentially life threatening and socially maladaptive habit is essential in the development of intervention and prevention programs. Systemic addiction to either narcotics or alcohols is an extremely negative social phenomenon which results in increased incidences of co-morbid psychological disorders and numerous long-term health problems for offspring born to parents with such health concerns.

The women of Armenia are perhaps subject more acutely to the particular economic, health, and criminal threats of their country. Women are effectively a commodity which can be bought and sold. Also in what is an already economically distressed country where work place sexism is still rampant, the employment opportunities for women are extremely limited and often result in the exposure to and eventual reliance on substance abuse (U.S. Department of State, 2006). Aiding this particular population which may be not only at increased risk but in less position to receive assistance is of significance not only to the researcher but should be also significant to the scientific community at large.

Literature Review:

Hinote, B., Cockerham, W., Abbott, P. (2009). The specter of post- communism: Women and alcohol in eight post - Soviet states, Social Science & Medicine, 68, 1254- 1262.

Following the collapse of the U.S.S.R., the rate of mortality relating to alcohol abuse. The majority of research though regarding the proliferation of self-medication for increased social pressure, economic hardship and a shift in deeply engrained ideology had been focused on men. It was believed that men who bore more of the burden of the shift were more likely to develop psychological disorders relating to and occurring with addiction to alcohol. However, it has been observed that the mortality rate for women in former Soviet states is also high in connection with alcohol abuse. This paper specifically addresses the role of gender and social role shift as a possible exacerbating factor for the increase in dependence on alcohol by women.

Drug Law and Health Policy Resource Network. (2001). Drug Policy and Health in Armenia . Yerevan, Armenia.

This report compiled by a non-governmental organization which monitors drug law and its impact worldwide is a crucial piece of statistical data representing the growth of narcotic dependence within the populace of Armenia. Further this report identifies both domestic and international sources not only of drugs, but also of the activities which lead to traceable infections such as HIV / AIDS. Though the scope of this project is limited to substance abuse, contracting diseases such as HIV / AIDS is a genuine risk specifically in the context of intravenous drug use. This profile identifies growth patterns and systemic deregulation of the government which allow industries based on human and narcotic trafficking which exacerbate the already growing problem.

U.S. Department of State. (2006). Annual Narcotic Control Reports. Washington, D.C.

The inclusion of the Annual Narcotics Control reports allows the researcher to observe the increase in narcotic trafficking both into and out of Armenia. The reports indicate that while previously the majority of the products which came out of Armenia were simply transported through the Republic, an increasing amount is being distributed within its borders indicating that the number of people using those drugs is increasing. A current estimate indicates that between 12 and 20% of the population is currently dependent on illicit substances where formerly only approximately one in one thousand were substance dependent. Though the source of this information is beyond reproach, the fact that information regarding accurate substance dependence numbers is extremely difficult to acquire. The wide range represented above is an indication of how poor the flow of empirical data is out of Armenia.

Amnesty International. (2008). No Pride in Silence: Domestic and Sexual Violence Against Women in Armenia. London, U.K.

Stress is among the leading reasons an individual will develop an addiction to an analgesic substance such as alcohol or narcotics. In Armenia, the patriarchal society is one in which physical and psychological violence against women is part of the cultural heritage and is largely an accepted aspect of society. Though the crimes commonly reported range from minor injuries to murder and even torture there are extremely lax rules in place to protect women and children and virtually no shelters where battered women and children may seek refuge. This fact of existence may be a significant contributor to the reason for such high dependence rates. Instituting stricter laws may ultimately result in the decrease in new cases of addiction as well as encouraging women already struggling with addiction to seek help.

The Organization for Security and Co-Operation in Europe. (2007). Women Empowerment and Cooperation in Armenia with a focus in the Syunik Region. Yereven, Armenia.

This paper looks specifically at the gender equalities facing women in Armenia. The participation of women in the sex or narcotics trade is in some instances the only possible means for them to support their family. Not only does this ultimately result in their increased exposure to potentially life threatening illnesses but also to narcotic substances and a culture of alcohol dependence to address the trauma of their life situations. A clear understanding of the social and economic reality facing women in Armenia is essential for contextual understanding of their narrative interviews.

Rehm J, Monteiro M, Room R, Gmel G, Jernigan D, Frick U, Graham K. (2001). Steps towards constructing a global comparative risk analysis for alcohol consumption: determining indicators and empirical weights for patterns of drinking, deciding about theoretical minimum, and dealing with different consequences. Eur Addict Res, 7,138-147.

This paper discusses the options facing young people in terms of alcohol addiction. Though the women interviewed for this project are all adults, it is likely that their difficulties with addiction began in adolescence. This report compiles information from not only Armenia but regions around the globe where similar problems are being faced. Within the report is a discussion of possible solutions some of which have and are being implemented and some which are purely theoretical. It is interesting to see the social and cultural factors addressed in this report compared to those revealed by the participants.

World Health Organization, The World Health Report .(2002). Reducing risks, promoting healthy life. Geneva: World Health Organization, 2002.

The lifestyle in which substance dependence is possible, is one which denotes high risk. This WHO report identifies a number of Eastern European countries, including Armenia in which addiction and other high risk activities are becoming a significant problem within the population. Drawing information from around the globe the report suggests a number of social welfare organizations and outreach programs in order to prevent younger children from beginning to abuse either drugs or alcohol and assisting those members of the population already addicted in their rehabilitation.

Pomerleau, J., McKee, M., Rose, R., Haerpfer, C., Rotman, D., Tumanov, S. (2008). Hazardous drinking in the former Soviet Union: A cross sectional study of eight countries. Alcohol and Alcoholism, 43, 351- 359.

This paper discusses the prevalence of alcoholism within the countries that once comprised the Soviet Union as a regional phenomenon. Observing the behavior trends within a group of people formerly linked ideologically provides a great deal of insight into the specific problems facing these eight countries as a unified population as opposed to eight distinct population samples. This approach may be crucial in understanding the social divergence of addiction facing Armenian women as it has been observed in women of other formerly Eastern block countries.

*Creswell, J.W. 2006. Qualitative Inquiry and Research Design: Choosing Among five approaches. Thousand Oaks, CA. Sage

Statement of Research Problem:

The rate of reported substance abuse and alcohol abuse in Armenian women has increased exponentially beginning in 1996 (Pomerleau et al., 2008). Though it is acknowledged that the actual reported incidence of addiction is inaccurately low the uptrend in rates of dependence constituting clinical impairment is apparent. Though there has been research regarding the general rate of substance dependence in that region, there has been no research specifically addressing women. The rate of liver toxicity in women though as a result of substance abuse indicates that this population within the Armenian demographic may be specifically at risk (Amnesty International, 2008). Their status as a potentially high risk demographic sector bears further research into social, cultural, and economic reasons that women specifically are presenting with such high rates of addiction.

Research Question:

What are the primary causes for the rapid increase in the number of Armenian women suffering from addiction to either prescription drugs or alcohol?

Method:

Methodology:

This paper will employ a narrative methodology of qualitative research as well as an extensive literature review. Rather than selecting a single method of addressing the void in existing research a combined methodology will prove most effective. This combination allows for the first hand narrative of individuals who are members of the target population as well as empirical evidential sources regarding the severity and possible larger social influences resulting in the problem. More significantly though, it may allow for a unique insight into the mindset of the individual members of the target population and their understanding not only of the state of their addiction but the social and potentially cultural influences behind their position.

As discussed earlier, it is extremely difficult for researchers such as those participating in this project to understand completely the context and circumstances of addiction in a culture which is reasonably isolated and not completely accessible culture. As outsiders the most effective and efficient manner of investigating the nuances of such a culture is through the collection of thorough narratives. These narratives are collected during an interview in which the researcher and the participant sit and discuss at length their experience in a given context (Creswell, 2006). In this instance the context is the participant's experience as an Armenian woman with an addiction to either prescription drugs or alcohol.

A narrative interview not only provides critical cultural context for the chronological progression of events which lead to the development of the dependency, it also frames them in the manner in which the participant experienced them (Creswell, 2006). The greatest value of such an interview is in the critical contextual information which would be excluded from articles such as those reviewed in the literature review.

The use of narrative though must be carefully applied in the instance of scholarly articles. A narrative while rich with information about a single person's personal experience is also colored by that individual's perception of their experiences (Creswell, 2006). In the instance of traumatic events, painful events, distant events, or events characterized by the long-term dependence on an illicit substance the memory of the event itself will likely be altered. It will be nearly impossible for the researchers to verify individual facts or events within the context of these narrative interviews. It is therefore necessary for the information acquired via interview not be treated as empirical evidence. Rather the evidence from the narratives in conjunction with verifiable fact as found in the literature review will serve to help identify specific stressors resulting in the addictions that are perhaps unique to Armenian women.