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The Challenge of Change: Improving services for women involved in prostitution and substance use

Funded by The Pilgrim Trust A report by DrugScope and AVA

Women involved in street-based prostitution who misuse drugs and/or alcohol are one of the most marginalised and stigmatised groups in our society. However, they are rarely discussed in these terms, and too often they are absent from policy and practice addressing the needs of the most vulnerable. At a time when 'sex work' can be normalised, and even glamourised, the reality is that women involved in prostitution often use drugs and/or alcohol to cope with selling sex (and the violence and abuse in their lives) and often sell sex to support addiction. It is a vicious circle.

The focus of this research study has been on policy and practice to address the drug and alcohol treatment needs of women involved in street-based prostitution. Tackling substance misuse is fundamental to reducing harm and supporting women to exit prostitution. So, what kinds of interventions work best? How widely are they available? And, critically, what do the women themselves say about their expectations and experiences of services?

We found that while there are good services and positive stories, there remains a lot to be done. Many women involved in prostitution see no alternative; no other viable future for themselves; and no support for 'recovery', or prospect of ‘a normal life'.

Currently, appropriate support that addresses substance misuse in the context of 'sex work' can be difficult to access. With evidence that a significant proportion of women seeking help for drug and alcohol problems (and many others who are not accessing help) have been involved in prostitution in some form, this is the 'challenge of change' identified in the report's title. Many of the women we spoke to recognise and accept this challenge on a personal level, but need more and better support from policy makers, planners and commissioners, and from services on the ground. We hope that the report's recommendations provide a framework to enable us all to rise to this challenge and respond to the needs of a marginalised, stigmatised and traumatised group.