Cycles of harm: Problematic alcohol use amongst women involved in prostitution

Research by Eaves and London South Bank University, Breaking down the barriers (Bindel, Brown, Easton, Matthews and Reynolds, forthcoming), identified problematic drug and/or alcohol use as the most common barrier (obstacle) faced by women exiting prostitution. Following the completion of this study, Eaves obtained funding from Alcohol Research UK to explore this barrier in greater depth, focusing specifically on problematic alcohol use.

This new research aimed to:

• Look at why and when women involved in prostitution use alcohol problematically
• Explore and compare the ways in which women involved in different aspects of the sex industry use alcohol
• Explore the different ways in which women use alcohol and how this relates to their involvement in prostitution and impacts on exiting
• Enable practitioners working with women involved in prostitution who have problematic alcohol use to gain a better understanding of the relationship between the two, thereby informing more effective interventions.
  

The research took a mixed methodological approach, collecting both quantitative and qualitative data. The main focus of the study was nine interviews with women who were currently or formerly involved in prostitution who had current or past problematic alcohol use. Seven interviews were also undertaken with eight practitioners working in the drugs and alcohol fields and in services supporting women involved in prostitution. Given the small scale and short time frame of the project, the majority of interviews with women and stakeholders were confined to London. An online survey was also distributed to a range of organisations and services that may come into contact with women involved in prostitution. The survey was distributed across England and Wales, extending the geographical scope of the study.

Women involved in prostitution and problematic alcohol use

This study found that alcohol is a substance used problematically amongst women involved in prostitution. Furthermore, it appears that the prevalence of problematic alcohol use may be increasing amongst this particular group. Alcohol was also used in combination with other substances (poly-substance use).

The research identified a tendency for women to minimise their alcohol use or not recognise the problematic nature of it. The harms of alcohol, both to the individual user and wider society, were repeatedly mentioned by women and stakeholders. Increased risks posed to women’s safety, impacts on their physical and mental health and the harms of poly-substance use were particularly noted.

Women involved in both on and off-street prostitution were found to use alcohol problematically, although when and why women used alcohol did differ by place of involvement. However, because of the increasingly transient nature of prostitution, there was sometimes overlap and a blurring of the boundaries between on and off-street involvement in this sample. Therefore, the alcohol use and related needs and circumstances of women involved in different aspects of the sex industry may not be as dissimilar as previously thought. As a result, women involved in different aspects of the industry require a response that is tailored to their individual needs and circumstances.

It is apparent that there is a link between prostitution and problematic alcohol use but this link is complex and can also evolve as a woman’s involvement in prostitution progresses. Whilst alcohol was not found to be a major driver of women’s involvement in prostitution, it was used in a self-medicating way: to mask feelings of distress, anxiety, and the experiences of selling sex, as well as to cope with previous traumatic experiences. Some women continued to use alcohol after exiting from prostitution to cope with trauma, distress and mental health problems that were a legacy of their involvement in prostitution. Women also used alcohol problematically before they were involved in prostitution, to cope with experiences during childhood and early adulthood.

Problematic alcohol use can be a barrier to exiting prostitution, but is perhaps less significant than other substances in this regard. Although most women did not view alcohol as one of the most significant barriers to exiting, alcohol use could be an obstacle in another sense. Since alcohol may be used as a coping mechanism, fear of losing this means of coping could make some women reluctant to access support and treatment for their alcohol use.

Services and support

Women seeking to exit require support for their alcohol use and involvement in prostitution. Support which was holistic and addressed all of women’s needs was found to be the most beneficial to women in this study. Specialist services[1] and exiting-focused support were also seen to be important, although these provisions were reported to be limited in availability and inconsistent. One-stop-shop services where women can access a range of support in one place were also favoured, along with women-only services. Women preferred support which was provided on a one-to-one basis.

Drug and alcohol services need to understand the needs and circumstances of women involved in prostitution and recognise possible links between prostitution and alcohol use. This includes awareness that alcohol can be used as a coping mechanism whilst in prostitution. Identifying and addressing the root cause of alcohol use is essential. All of this needs to be borne in mind when providing interventions. However, some drug and alcohol workers, as well as other service providers, lack knowledge and understanding of the needs and experiences of women involved in prostitution. This can pose a variety of challenges to women’s successful engagement with service providers and the support they then receive. Many services are also failing to identify whether women are involved in prostitution in the first instance. As well as this, not all drug and alcohol services are inclusive of women involved in prostitution, and women in general.

Policy and society

On a policy level, the Government’s approach to problematic alcohol use does not appear to be compatible with the needs and circumstances of women involved in prostitution. The focus on abstinence and quick recovery is not appropriate for every problematic alcohol user. Women involved in prostitution, and in fact all problematic users, need support and treatment that is individualised and provided at their own pace.

The everyday use and acceptability of alcohol in society poses a range of overarching challenges to addressing problematic alcohol use. Alcohol has become increasingly more available and appealing for a number of reasons and it was suggested that this may be the reason why an increasing number of women involved in prostitution are using alcohol problematically. The acceptability of alcohol in society was also seen to act as a barrier to problematic alcohol users firstly recognising the problematic nature of their alcohol use, and then addressing it.

• There needs to be increased and sustainable funding for specialist services for women involved in prostitution, including exiting-focused support. There also needs to be increased provision of one-stop-shop services and women-only services, or at least women-only sessions.
• Exiting support needs to be provided as part of a range of options within all services, including drug and alcohol support services. Alternatively, support workers need to be able to refer women to other services which do have this provision.
• Support for women involved in prostitution needs to take a one-to-one approach and be holistic, addressing all of women’s needs, not just their alcohol use.
• Drug and alcohol services need to understand the needs and circumstances of women involved in prostitution and recognise the possible links between involvement in prostitution and alcohol use. Any interventions and support then needs to account for this link, as well as the other multiple and complex needs of women in these circumstances.
• Drug and alcohol services, and indeed all services, need to ensure that they are accessible to women involved in prostitution, for example by providing women-only sessions and a women’s worker.
• Services, including drug and alcohol services, need to actively identify women involved in prostitution, although this needs to be undertaken in a sensitive way. Alcohol use also needs to be identified and monitored as women may minimise their use.
• Training needs to be provided for practitioners, including drug and alcohol workers, who may come into contact with women involved in prostitution. Training should focus on identifying and supporting women involved in prostitution. This would lead to an improved understanding of women’s needs and the intersecting issues, and a more consistent approach to service delivery.
• On a policy level, there needs to be a change in emphasis, moving away from quick recovery to longer term, more sustainable recovery. This approach would recognise that recovery can be a lengthy process. It would also account for, and help to address, the trauma which can often result from involvement in prostitution alongside problematic alcohol use. There also needs to be a wider focus in terms of the goals of treatment, recognising that abstinence is not an appropriate goal for every problematic alcohol user.
• Education and awareness raising campaigns, particularly in schools, need to be undertaken in order to highlight the harms of alcohol.

For more information on the research you can visit Eaves’ website.

Bindel, J., Brown, L., Easton, H., Matthews, R. and Reynolds, L. (forthcoming). Breaking down the barriers. A study of how women exit prostitution. London: London South Bank University.

[1] A ‘specialist service’ is a service which provides targeted support and provision to women who are or have been involved in prostitution, addressing their specific needs in this regard.