Perspectives of Social Workers on the Use of Harm Reduction Strategies for Trafficking Survivors with Substance Use Disorder

Background

Survivors of sex trafficking are a high risk population for substance use disorder (SUD). Conventional services targeted to this population emphasize abstinence-only and faith-based approaches, operating under the assumption that survivors’ primary goals are to end drug use and leave exploitative situations. However, survivors present a range of complex material, physical, and psychological needs that are not adequately addressed by conventional service models. Recent research highlights the potential of harm reduction approaches by emphasizing low-barrier and non-punitive approaches that meet survivors where they are at. For service providers working with trafficking survivors, there is a range of perspectives around best practices, including the utility of abstinence-oriented and/or harm reduction programming. As such, this project answers the following questions: 1) How do service providers perceive and understand the intersecting systems designed to support survivors who also struggle with SUD? and 2) How do service providers perceive the ecosystem of services available to address the complex needs of survivors?

Methods

The research team conducted 29 semi-structured, qualitative interviews with service providers directly and indirectly serving trafficking survivors in a midwestern state. We used purposive maximum variation sampling in order to capture insights from a variety of service providers working with survivors. For analysis, the research team created an iterative codebook of inductive and deductive codes, and met weekly to discuss and negotiate the application of codes to interview data. The team used Deterding & Waters’ flexible coding approach, which chunks large-scale text into specific sections to enable thorough and clear analysis, using the coded data to identify analytical themes.

Results

Providers are aware of intersecting systemic factors--lack of housing/transportation, incarceration history, inadequate healthcare--that create barriers for survivors with SUD in meeting needs. They note that this is compounded by the significant trauma that occurs within exploitation, affecting the receipt of mental health care and SUD treatment. As such, they referred survivors to organizations equipped to provide specialized survivor care. However, providers providing specialized care highlighted the difficulty of managing service demand, relying on waitlists due to limited resources, capacity, and seeking to reduce staff burnout. The importance of trauma-informed service approaches while reducing barriers to accessing basic needs was highlighted. In reference to harm reduction, providers were divided on the utility and sustainability of low-barrier services for effectively servicing this population, although initial contact with such services was discussed as a necessity for connecting survivors to additional services.

Conclusion/Implications:

Providers are highly attuned to the acute needs of survivors with SUD, as well as the barriers hindering service access and effectiveness. Our findings underscore the need to improve access to low-barrier and trauma-informed care across all levels of service delivery, given the high service demand and low capacity for trafficking-specific services. While service providers may have different perceptions around the sustainability of harm reduction services specifically, the shared perception that it is a crucial access point necessitates the continued use of individualized and low-barrier services to address the immediate needs of survivors.