Substance Use Among Victims of Human Trafficking: Current Research and Clinical Considerations
Author: Lia Smith, M.A.
Doctoral Student, Clinical Psychology
University of Houston
Human trafficking is a human rights violation and a major global public health concern. It is defined as a crime involving the exploitation of persons for the purpose of compelled labor or commercial sex acts through the use of force, fraud, or coercion (UNODC, 2014). There are approximately 40.3 million human trafficking victims globally, including hundreds of thousands of trafficked persons within the United States (International Labour Organization, 2017). Human trafficking victims span all ages, races, genders, and socioeconomic brackets. Clinically, they are likely to present with complex psychological symptoms, resulting from a history of repetitive abuse, social and/or physical (i.e., nutritional, sleep, or movement) deprivation, and/or hazards related to forced labor (Zimmerman, Oram, Borland, & Watts, 2009).
Substance use and substance use disorders (SUDs) represent a major health issue for human trafficking victims. Emerging literature suggests that this population reports high rates of substance use and SUDs, a frequently cited concern among human trafficking victims presenting for healthcare (e.g., Geynisman-Tan, Taylor, Edersheim, & Taubel, 2017). While this emerging literature is somewhat limited, available reports suggest that substance use is a relevant concern among both child/adolescent and adult populations of human trafficking victims.
Substance use is common among child/adolescent human trafficking victims, even when compared to adjudicated youth (O’Brien, Li, Givens, & Leibowitz, 2017), youth in the US child welfare system (O’Brien, White, & Rizo, 2017), and youth who have been sexually abused/assaulted but not trafficked (Cole, Sprang, Lee, & Cohen, 2016). Substance use among trafficked child/adolescent samples is associated with parental substance use (e.g., Goldberg, Moore, Houck, Kaplan, & Barron, 2017), a history of abuse (e.g., Hickle & Roe-Sepowitz, 2018), and/or a means of coping with experiences of sex work and violence (e.g., Gupta, Raj, Decker, Reed, & Silverman, 2009). Research has demonstrated that early experiences with illicit drugs and parental alcohol and illicit drug use may also be a risk factor for entry into trafficking (e.g., Panlilio, Miyamoto, Font, & Schreier, 2019; Servin et al., 2015). Finally, alcohol and/or illicit drug use among child/adolescent victims is associated with increased mental health concerns (e.g., depression or anxiety; Goldberg et al., 2017).
Alcohol and illicit drug use is prevalent among adult human trafficking victims as well. For example, alcohol use is often utilized during a victim’s first sex work episode (e.g., Gupta et al., 2009) and may continue during subsequent experiences involving sexual exploitation (e.g., Goldenberg et al., 2013). Studies have documented how traffickers may use substances as a means to control their victims and how victims may also utilize substances as a means to cope with the trauma and distress associated with being trafficked (e.g., Lederer & Wetzel, 2014; Ravi, Pfeiffer, Rosner, & Shea, 2017; Servin et al., 2015). Finally, a longer length of time being trafficked and past history of abuse has been associated with increased substance use among adult human trafficking victims (Muftic & Finn, 2013).
Theoretically, substance use among human trafficking victims may be motivated by various factors and may serve diverse functions. For instance, substance use may be motivated by an effort to cope with stress or other negative emotions related to the trafficking experience (Ravi et al., 2017; Todd, 2005). This is a pertinent clinical concern as substance use motivated by internal avoidance goals (i.e., coping motives) has been consistently linked to increased SUD severity over time (e.g., Beseler, Aharonovich, Keyes, & Hasin, 2008). Alternatively, traffickers may utilize substances in an effort to coerce and/or force victims to work longer or more efficiently, induce debility, or to trap their victims (Baldwin, Fehrenbacher, & Eisenman, 2015; Hom & Woods, 2013). For example, opioids, in particular, have been reported as an effective coercion tool due to their ability to numb both emotional and physical pain (Stoklosa, MacGibbon, & Stoklosa, 2017). Traffickers may utilize substances to coerce a victim with a SUD or to incentivize a victim to remain captive by maintaining their access to substances.
As students and early-career psychologists, how can we best serve human trafficking victims that present with SUDs? Fortunately, the extant literature examining SUDs among human trafficking victims provides some clinical insights. First, it is imperative that clinicians realize the widespread impact of human trafficking and integrate a trauma-informed perspective into their clinical procedures.
Second, the development and dissemination of clinician trainings to better recognize signs and symptoms related to human trafficking would be a significant contribution across clinical contexts. Research has demonstrated that approximately 88% of survivors saw a health care professional during the time that they were trafficked (Lederer & Wetzel, 2014)! Some common signs that individuals are being trafficked include inconsistent historical accounts, chronic untreated medical conditions, and not being allowed to speak for themselves if they present to treatment with another person/translator (Geynisman-Tan et al., 2017).
Third, human trafficking victims may use substances during their trafficking experience for a variety of reasons (e.g., forced use, to increase/improve performance, to cope). Thus, it is important for clinicians to carefully assess motivations and reasons for substance use in order to implement appropriate treatments. Fourth, human trafficking victims present with unique needs related to financial and medical concerns. Clinicians may support clients by connecting them to services that target medical needs, financial and housing concerns, and/or vocational training. Indeed, multidisciplinary approaches have been recommended to increase access to care (e.g., Ravi et al., 2017). Residential programs, in particular, may be attractive to human trafficking victims as they may provide a safe space with regular support, access to interdisciplinary services, and that is free of alcohol and other substances so that human trafficking victims may focus on their recovery.
Finally, clinicians may consider developing specialized treatments for human trafficking victims. This inherently traumatized group presents with unique symptomatology and comorbidities that may not adequately be targeted by current treatment modalities. Psychologists are in a unique position to care for and support this extremely vulnerable population. I encourage all student and early-career psychologists, particularly those in addiction-related services, to be mindful of ways they may support the needs of this unique and particularly at-risk population.
Note. This blog post is based on Smith, L. J., Zegel, M., Bartlett, B. A., Lebeaut, A., & Vujanovic, A. A. (under review). Substance use among human trafficking victims: A systematic review.
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