Barriers to Accessing Detox Facilities, Substance Use Treatment, and Residential Services among Women Impacted by Commercial Sexual Exploitation and Trafficking

ABSTRACT

More than 50% of women entering substance use treatment in the United States reported having traded sex for money or drugs. Women's participation in addiction treatment and related services is essential to their recovery and increased safety, stabilization, and quality of life. This article's aim is to explore the barriers related to accessing detox facilities and essential services including substance use treatment and residential services for women impacted by commercial sexual exploitation (CSE). Data are drawn from a larger, community-based, grounded theory study. In-depth interview data were collected from 30 adult women who traded sex as adults (through maximum variation and snowball sampling), as well as 20 service providers who come into contact with adult women who trade sex (through nominations and purposive sampling). Finding suggest that women often encountered sobriety requirements, which created barriers to accessing addiction treatment or residential services. Some organizations' policies required evicting women if they were caught using, which created additional challenges for women who relapsed. Women wanted to avoid becoming “dopesick” on the streets or at home, which partially contributed to them needing to maintain their addiction. Consequently, some returned to sex trading, thus increasing their risk of trafficking. Some women engaged in creative strategies, such as claiming they were suicidal, in order to access the detox facilities in hospitals. Some women indicated they were only able to detox when they were forced to do so in jail or prison, often without medical assistance. Implications to improve health care delivery for this population are discussed.

KEYWORDS:

• commercial sexual exploitation
• substance use
• addiction treatment
• detoxification
• sex trafficking

Note

Notes

1. The use of the term sex trafficking refers to the federal definition, which is defined as “the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act” (22 U.S. C. §7102). For adults, sex trafficking occurs when an adult is induced by force, fraud, or coercion to perform a sex act for money or anything of financial value (different statutes apply for minors). The term commercial sexual exploitation (CSE) is used inclusive of sex trafficking and experiences which may not neatly fit the legal definition. Examples may include survival sex as a form of CSE when individuals selling sex may have other options but are more easily exploited through traffickers and buyers. CSE often involves exploitation of a vulnerability, such as homelessness, lack of access to basic needs, etc. For more information, see Nichols, A. Nichols, A. J. (2016). Sex trafficking in the United States: theory, research, policy, and practice. New York: Columbia University Press.³⁸

Additional information

Funding

This study is funded by the Joseph H. & Florence A. Roblee foundation.