Understandings of Harm Reduction By Trafficking Survivors with Substance Use Disorder in Diverse Service Settings

Background:

Previous work with drug users has shown that while many individuals entering substance use disorder (SUD) treatment want to cease use, this is often one of multiple goals. For trafficking survivors with SUD, conventional treatment focuses on abstinence, but often fails to address the complex trauma they have endured. Harm reduction programs–programs designed to reduce adverse health consequences for certain behaviors–are low-barrier and accessible, yet research has shown these programs do not specifically target trafficking survivors. Instead, it is commonly assumed survivors’ needs are addressed in intensive anti-trafficking service programs. However, harm reduction services may serve as a low-barrier entry point for survivors to engage with non-judgmental staff to explore readiness for change. This project builds upon existing literature, addressing two key questions: 1) How do survivors with SUD conceptualize and perceive harm reduction? And 2) How can we use harm reduction frameworks in building trust with survivors who use drugs?

Methods:

The research team partnered with a syringe service program and an anti-trafficking advocacy organization to recruit adult participants with SUD who experienced sexual exploitation in a Midwestern state. 37 semi-structured interviews were conducted. Data was analyzed using Dedoose QDA software, and the team applied Deterding and Waters (2018) flexible coding approach to data analysis. The team met regularly to iteratively develop a codebook to analyze the data, drawing on established theoretical frameworks and open coding to capture new insights. Interviews were coded using a double-blind process, and the team met weekly to refine code application and ensure consistency.

Findings:

Of our participants, 64% identified as white, 32% as Black, 89% as female, and 22% as LGBTQ+. Thirty-two percent were current drug users, and 64% were parents. All but one considered themselves to be low-income. Participants’ experiences with and understanding of harm reduction programs varied. While many participants struggled to provide a concrete definition of harm reduction, the majority considers the components of harm reduction as having a positive impact on recovery efforts. This perception persisted among those who were actively in recovery or expressed a desire to cease substance use. Of the participants who had engaged or were currently engaged in harm reduction programs (about half of the sample), the non-stigmatizing support and safe spaces of these programs was cited as important to their self-perception as autonomous beings. The distinct role of harm reduction programs—offering a stigma-free, non-carceral environment where drug use is considered normal—was seen as crucial in building trust and fostering engagement among survivors.

Conclusion/Implications:

While harm reduction programs are not specifically designed for trafficking survivors, they may offer an accessible entry point before more intensive treatment programs. Their low-barrier access, stigma-free environment, non-judgmental care and support of individuals from intersectionally marginalized backgrounds make them a preferred option for many survivors. Rather than assuming survivors need immediate residential treatment, providers should initially prioritize connecting them with harm reduction services that meet them where they are, offering support without restrictive or punitive measures that may hinder recovery.