Trauma and Substance Abuse Among Women in Prostitution: Implications for a Specialized Diversion Program

Wiechelt, Shelly A.; Shdaimah, Corey S.

doi:10.1080/1936928x.2011.598843

Cited by 35 publications

(19 citation statements)

References 64 publications

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“…In some cases, the stigma associated with certain types of criminal behavior, and those who commit it, may also play a role in staff insensitivity and inadequate attention to complex treatment needs. 38 While some acknowledge the role trauma can play in SMI entering the system, 39 we would argue that many seeking to expand the criminalization hypothesis still overlook the role trauma plays in continued criminalization of this population once incarcerated or remanded to care.…”

Section: Trauma: the Missing Piecementioning

confidence: 99%

From trauma-blind to trauma-informed: re-thinking criminalization and the role of trauma in persons with serious mental illness

Thordarson

Rector

2020

CNS Spectr.

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Trauma-informed approaches offer a new perspective for understanding how and why individuals with serious mental illness (SMI) become entangled in the criminal justice system. There is growing awareness that many individuals with SMI have experienced significant life trauma, and factors beyond SMI that contribute to criminalization are being identified; however, the role of trauma continues to be overlooked in many formulations. In trauma-blind systems, trauma-related behaviors are often misunderstood and met with responses that exacerbate psychiatric and behavioral problems. Trauma-informed approaches provide a richer understanding of underlying drivers of behavior, and view trauma as an integral component of risk management, case formulation, relationship-based care, and referral. Embedding trauma-informed principles across organizations promotes continuity of care, safety, and more compassionate cultures that help reduce the flow of individuals with SMI into the criminal justice system. An expanded view of the criminalization hypothesis is offered, which incorporates all factors addressed in current research.

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Section: Trauma: the Missing Piecementioning

confidence: 99%

From trauma-blind to trauma-informed: re-thinking criminalization and the role of trauma in persons with serious mental illness

Thordarson

Rector

2020

CNS Spectr.

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“…High levels of poor mental health, a significant problem among SSWs, 26 27 have previously been highlighted as contributing to poor drug treatment outcomes. 28 Experience of abuse and violence, common among SSWs, 29 30 has led to recommendations for female-only trauma-focused drug treatment interventions 31 and there is some evidence that certain subgroups, such as SSWs, 32 may benefit from a trauma-focused approach. A recent Cochrane review of treatment of comorbid post-traumatic stress disorder (PTSD) and drug dependency 33 suggested that individual trauma-focused therapy alongside drug treatment appeared to have best outcomes for PTSD and reducing levels of drug use in the longer term.…”

Section: Introductionmentioning

confidence: 99%

Drug use in street sex workers (DUSSK) study protocol: a feasibility and acceptability study of a complex intervention to reduce illicit drug use in drug-dependent female street sex workers

et al. 2018

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IntroductionPoor health of sex workers continues to be a source of international concern. Sex work is frequently linked with problematic drug use and drug-dependent sex workers typically work on the street, experiencing the greatest risks to health compared with the general population. Street sex workers (SSWs) are much more likely to have experienced incidences of physical and sexual assault, increasing their risk of developing post-traumatic stress disorder (PTSD). We have developed a novel complex intervention designed to reduce illicit drug use in drug-dependent female SSWs which involves: female SSW drug treatment groups (provided by a specialist charity) in a female SSW setting (female sex worker charity premises) provided by female-only staff, PTSD care with eye movement desensitisation and reprocessing (EMDR) therapy provided by female staff from National Health Service (NHS) mental health services.Methods and analysisA mixed methods study investigating the feasibility and acceptability of this intervention to inform the design of a future randomised controlled trial. The study aims to recruit up to 30 participants from November 2017 to March 2018 at a single site, with the intervention being delivered until December 2018. It will gather quantitative data using questionnaires and group attendance. Drug treatment group observations and in-depth interviews undertaken with up to 20 service users and 15 service providers to examine experiences and acceptability of the intervention. Study feasibility will be assessed by evaluating the recruitment and retention of participants to the intervention; the feasibility of NHS and third sector organisations working closely to coordinate care for a SSW population; the potential for specialist NHS mental health services to screen and provide EMDR therapy for drug-dependent SSWs and potential costs of implementing the intervention.Ethics and disseminationThis study was approved by South West–Frenchay Research Ethics Committee (REC reference: 17/SW/0033; IRAS ID: 220631) and the Health Research Authority (HRA). Findings will be disseminated through research conferences and peer-reviewed journals.

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“…Such findings have led to recommendations that SSWs receive drug treatment services that include psychological support,39 mental healthcare40 and trauma-informed services 41. However, clear guidance on which interventions will be most effective for SSWs or how different elements of service delivery could improve outcomes for SSWs is lacking.…”

Section: Introductionmentioning

confidence: 99%

“…38 Such findings have led to recommendations that SSWs receive drug treatment services that include psychological support, 39 mental healthcare 40 and trauma-informed services. 41 However, clear guidance on which interventions will be most effective for SSWs or how different elements of service delivery could improve outcomes for SSWs is lacking. The aim of this study was to explore SSWs' views and experiences of drug treatment services in order to identify factors that affect their engagement with, and response to, drug treatment.…”

Section: Introductionmentioning

confidence: 99%

Identifying possible reasons why female street sex workers have poor drug treatment outcomes: a qualitative study

et al. 2017

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AimsTo explore street sex workers (SSWs) views and experiences of drug treatment, in order to understand why this population tend to experience poor drug treatment outcomes.DesignIn-depth interviews.SettingBristol, UK.Participants24 current and exited SSWs with current or previous experience of problematic use of heroin and/or crack cocaine.FindingsParticipants described how feeling unable to discuss their sex work in drug treatment groups undermined their engagement in the treatment process. They outlined how disclosure of sex work resulted in stigma from male and female service users as well as adverse interactions with male service users. Participants highlighted that non-disclosure meant they could not discuss unresolved trauma issues which were common and which emerged or increased when they reduced their drug use. As trauma experiences had usually involved men as perpetrators participants said it was not appropriate to discuss them in mixed treatment groups. SSWs in recovery described how persistent trauma-related symptoms still affected their lives many years after stopping sex work and drug use. Participants suggested SSW-only services and female staff as essential to effective care and highlighted that recent service changes were resulting in loss of trusted staff and SSW-only treatment services. This was reported to be reducing the likelihood of SSWs engaging in drug services, with the resultant loss of continuity of care and reduced time with staff acting as barriers to an effective therapeutic relationship.ConclusionsSSWs face many barriers to effective drug treatment. SSW-only treatment groups, continuity of care with treatment staff and contact with female staff, particularly individuals who have had similar lived experience, could improve the extent to which SSWs engage and benefit from drug treatment services. Service engagement and outcomes may also be improved by drug services that include identification and treatment of trauma-related symptoms.

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Trauma and Substance Abuse Among Women in Prostitution: Implications for a Specialized Diversion Program

Cited by 35 publications

References 64 publications

From trauma-blind to trauma-informed: re-thinking criminalization and the role of trauma in persons with serious mental illness

From trauma-blind to trauma-informed: re-thinking criminalization and the role of trauma in persons with serious mental illness

Drug use in street sex workers (DUSSK) study protocol: a feasibility and acceptability study of a complex intervention to reduce illicit drug use in drug-dependent female street sex workers

Identifying possible reasons why female street sex workers have poor drug treatment outcomes: a qualitative study

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