Barriers to Accessing Detox Facilities, Substance Use Treatment, and Residential Services Among Women Impacted By Commercial Sexual Exploitation & Trafficking

Background and Purpose: More than 50% of women entering substance use treatment in the U.S. reported having traded sex for money or drugs in their lifetime. Nearly 80% of women impacted by commercial sexual exploitation (CSE) experience high rates of substance use. Women impacted by CSE may experience adverse health and mental health consequences, including posttraumatic stress disorder, depression, STIs and HIV. Women’s participation in detox, addiction treatment and related services may be essential to their recovery. Yet, no study has provided an in-depth exploration of barriers and facilitators to access and engaging with such services with this population. Drawing from a larger community-based, grounded theory study, we aim to understand the barriers related to accessing detox facilities and essential services including substance use treatment and residential services for women impacted by CSE.

Methods: Partnering with a local trafficking coalition and an addiction treatment center for women, we conducted semi-structured, in depth interviews with 30 adult women who trade (or had 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 coalition-based purposive sampling. The research team conducted independent, co-coding to uncover preliminary themes. A coding schematic was created to be used for focused coding. Emergent themes were continually compared and defined in the coding schematic. Multiple steps were taken to enhance methodological and analytic rigor of the study, such as collaboration with multiple key stakeholders, snowball sampling of women to capture narratives of those not currently connected to services, the use of non-stigmatizing language in recruitment materials, use of the life calendar interview method with women, analytic memo-writing and multi-phase member checking.

Results: Women often encountered sobriety requirements, which created barriers to accessing critical services including evidence-based addiction treatment or residential services for women. Some organizations’ policies required evicting women if they were caught using, which created additional challenges for women who relapsed. Providers also described their frustrations in attempting to refer clients to detox facilities, which was often denied for multiple reasons. According to women and providers, barriers to detox facilities typically included lack of bed space. Thus, women wanted to avoid becoming “dopesick” on the streets or at home, which partially contributed to them needing to maintain their addiction. Consequently, they often continued or were exploited into trading sex, 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.

Conclusion and Implications: With limited access to detox facilities, women impacted by CSE may experience severe withdrawal symptoms in detoxing on the street or may be less likely to physically detox. Substance use treatment facilities that provide detox along with post-detox residential services may increase likelihood of recovery among women involved in CSE.