In early 2014, a Florida federal judge ruled that several women had been coerced into sex trafficking using illegal prescription drugs. Their trafficker, sentenced to 34 years in prison, gave and then withheld the drugs to exploit their withdrawal symptoms. The conviction set a precedent in human trafficking cases, as coercion had historically required physical violence. It also increased attention toward the complex relationship between human trafficking and substance use.
This case is not an isolated example. Global reports indicate an increasing number of people coerced into sex or labor trafficking by traffickers exploiting their existing substance use disorder or introducing drugs to control them. Incident reports (PDF) into the National Human Trafficking Hotline from January 2015 through June 2017 found that 2,238 individuals who had potentially experienced human trafficking reported induced or exploited drug use as how their trafficker controlled them.
A 2012 study (PDF) surveying 107 individuals who had experienced human trafficking describes a similar overlap, with 84.3 percent of participants saying they used alcohol, drugs, or a combination during their trafficking experience—often as a coping mechanism—and 27.9% reporting substance use was forced by their trafficker. More recent studies have examined substance use treatment needs of youth experiencing sex trafficking , intersections between human trafficking and the opioid epidemic , and trauma-informed treatment and other treatment modalities of substance use disorders among trafficking survivors.
As these examples show, people at risk for, currently experiencing, and who have experienced human trafficking may also experience substance use and co-occurring disorders that impact themselves, their families, and their communities. The relationship between substance use disorders and human trafficking is often cyclical. Traffickers may focus and recruit individuals with a history of or existing substance use disorder. This allows traffickers to induce or exploit substance use, using it as a reward or punishment to maintain control. Individuals may also develop a substance use disorder during or after their trafficking situation as a coping mechanism to alleviate ongoing trauma, which, in turn, may make them vulnerable to further exploitation.
In recognition of National Youth Substance Use Prevention Month , here are some strategies to support individuals at the intersection of human trafficking and substance use:
Strengthen Awareness and Identification through Tailored Training and Screening Protocols. Stigma, stereotypes, or implicit bias associated with substance use can prevent health care, behavioral health, and other service providers from identifying and treating individuals at the nexus of human trafficking and substance use. Providers may focus on substance use disorders while ignoring signs or risk factors for human trafficking, and patients may not seek help or self-identify due to shame. Organizations can train staff to deliver trauma-informed, patient-centered, and culturally and linguistically appropriate care to help ensure individuals are identified and receive appropriate support. Similarly, organizations can incorporate these principles into screening protocols, building trust and rapport while promoting the safety and well-being of patients.
The U.S. Department of Health and Human Services (HHS) offers several resources to strengthen awareness, training, and screening. The ACF’s Office on Trafficking in Persons (OTIP) offers virtual, on-demand trainings that prepare professionals in various settings to identify and respond appropriately to individuals at risk for or who have experienced trafficking. Trainings include Working with Individuals with Substance Use and/or Co-Occurring Disorders , which builds on the foundational Trauma-Informed Care and Culturally and Linguistically Appropriate Services modules. These and other resources are available online and on demand through OTIP’s National Human Trafficking Training and Technical Assistance Center .
The HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) provides a full range of educational information and tools for individuals, families, schools, and prevention practitioners around substance use and misuse, including through the Prevention Technology Transfer Center . SAMHSA also has various resources available to providers and those supporting people using substances, with more available through the Addiction Technology Transfer Center . Additionally, organizations and systems will benefit from adopting the approach of SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach (PDF) to ensure the most welcoming and supportive environment for those who have experienced human trafficking and are also experiencing or recovering from a substance use disorder.
Facilitate Connection to Comprehensive Services to Ensure Long-Term Recovery. Individuals who have experienced human trafficking and have a substance use disorder have diverse needs and often require a mix of services to ensure recovery. Additionally, many may have other adverse childhood experiences that require specialized care. While referring these patients to safe, ethical substance use treatment programs is necessary, support should not stop there. Without a long-term, sustainable recovery plan, individuals may relapse or experience human trafficking again as traffickers exploit ongoing vulnerabilities. Organizations can collaborate across sectors to develop a multidisciplinary treatment and referral team to connect patients to wraparound, low-barrier programs, including medications for substance use disorders, mental disorder treatment, education opportunities, and job placements. Stable, affordable housing is especially important, as it provides the safety and security those in crisis need to obtain stability and rebuild their lives. View OTIP’s information memorandum on housing and economic mobility resources.
Enhance Client and Patient Services through Peer Support Groups. In their recommendations report , Class 2 of the Human Trafficking Leadership Academy stress peer support groups as a key part of long-term recovery. Peer support groups can reinforce, maintain, and further progress made in substance use treatment by providing leadership opportunities, mitigating social isolation, and connecting individuals to a larger community of peers where they can participate in shared learning and growth. Adapting the group structure from established 12-step addiction/recovery peer support groups can facilitate and help sustain recovery by providing a supportive, flexible environment grounded in trust, respect, and comfort. Using a trauma-informed, patient-centered approach, organizations can adapt peer support models for individuals at the intersection of trafficking and substance use to enhance service and strengthen short- and long-term health outcomes. The Peer Support Groups Explanatory Brief and Empirical Research Overview provide additional resources and examples of established peer support groups.
OTIP remains committed to supporting individuals affected by human trafficking and substance use disorders. View OTIP’s Recovery Resources and SAMHSA’s Recovery Support Tools for additional resources.