Drug Abuse and Prostitution Researchers

Drug Abuse and Prostitution

Researchers have known for a long time that drug abuse and prostitution frequently go hand in hand (Medrano, Hatch, Zule & Desmond, 2003; Yacoubian, Urbach, Larsen, Johnson & Peters, 2000; Young, Boyd, & Hubbell, 2000; Potterat, Rothenberg, Darrow, & Phillips-Plummer, 1998; Kerr, 1988, and Goldstein, 1988). For its failure to address the problem effectively, the cost to society is great. The U.S. Postal Service is doing an ongoing study comparing the job performance of drug users to non-users. Absenteeism is 66% higher among drug users and health benefit payouts amount to 84% more. The study also reports that disciplinary actions are 90% higher among drug users!

The toll on society can only partially be measured. How do you measure quality of life in neighborhoods where drug-related crime is occurring? Drug related arrests number more than a million a year, and drug offenders are the reason for three-quarters of the increase in federal prison inmates that has occurred since 1980. According to a joint survey of federal and state prisoners, about 10% of federal prisoners and 17% of state prisoners report they committed crimes in order to pay for drugs. Women arrested for prostitution are far more likely to test positive for drugs as well (America's drug abuse profile web site).

Prostitution has a long history, of course. Goldstein (1979) reported that 40% to 80% of women involved in prostitution were drug abusers. He also reported that high class prostitutes (call girls, for instance) often started out with prostitution before they went on to drug abuse, but lower class prostitutes (such as streetwalkers) began with drugs and took up prostitution to support the habit. The young age at which many of them start is dismaying. Potterat et. al (1998) reports a mean age of 16.1 years (13 for juvenile prostitutes and 18 for adults). Furthermore, nearly 95% of prostitutes have histories of drug abuse, and 61% report having been sexually abused as children.

Potterat et al. (1998) attempted to find out about the sequence, timing, and prevalence of sexual and drug abuse events in the lives of prostitutes. They did a cross-sectional study that compared 237 prostitutes to 407 non-prostitutes, trying to determine if there is a causal link between drug use and prostitution. They found that "substance abuse generally precedes entry into prostitution" (p. 345).

Medrano et al. (2003) point out that a great many studies have shown "a higher prevalence of child sexual abuse among male and female drug users compared to the general population" (p. 463). In an earlier study Medrano et al. found 60% of female drug abusers had been sexually abused in childhood -- significantly higher than 38% in the general population. In another study 34% of male drug abusers reported having been physically abused. Medrano concludes, "victims of physical abuse have a greater likelihood than non-victims to be diagnosed with substance abuse disorders" (p. 463). In their study of prostitution among drug users, they included men as well as women. They found women were five times more likely to have suffered severe to extreme abuse in childhood than men were. Women reported more sexual abuse, while men reported more physical abuse. Where prostitution and drugs were concerned, their behavior differed as well. Abused women reported being depressed and were often re-victimized. Abused men were likely to become aggressive and violent, particularly towards women: "The use of prostitutes may be a means of men controlling [and hurting] women via the purchasing of sex" (p. 474).

The Arrestee Drug Abuse Monitoring (ADAM) Program (National Institute of Justice, 2000) reports that more then 50% of the people in the criminal justice system test positive for at least one illegal drug and that returning these people to the community without treating them poses a threat to public health. The greatest number of arrests among women are for prostitution. If they are addicted, most frequently they are addicted to opiates. Moreover, Yacoubian et al. (2000) report that prostitutes start taking drugs at an earlier age than drug users who are not prostitutes. They did a study of 3,587 female arrestees in which they found significant differences between prostitute drug users and non-prostitute drug users. Of the prostitutes, 73% tested positive for cocaine, but only 38% of non-prostitutes tested positive for cocaine. Crack cocaine, they report, has been devastating to women, partly because it is cheaper to use. It is also much more quickly addictive. Some prostitutes are reimbursed with crack instead of money for their services. The authors also state, "…drug abuse (particularly crack cocaine abuse) is highly correlated with unsafe sex practices and mental illness…" (p. 18).

Perhaps the greatest cost to society, which cannot be measured, is what happens to the children of addicts. Crack-addicted mothers, for example, typically neglect their children, emotionally and physically. "Without an environment in which legitimate goals and attitudes can be fostered, children are at increased risk for anti-social behavior" (cited in Yacoubian, Urback, Larsen, Johnson, & Peters, 2000, p. 19). If the addicted mother is also a prostitute, the children are likely to see not one but many violent scenarios. HIV and other STDs are also increasingly prevalent as a result of risky sexual behavior.

While drug addiction is an explanation increasingly given for entering into prostitution, Young, Boyd, & Hubbell (2000) found that prostitution increases the drug use. Prostitutes often cope with the negative aspects of what they do for a living by taking more drugs: "…the psychological distress caused by activities associated with their occupation leads them to increase their drug use as a means of coping" (p. 789). In their study they found that prostitutes showed significantly higher levels of stress and distress because of the violent and degrading aspects of their work. Crack-addicted street prostitutes, for example, have little control of what happens during their sexual transactions. The client who is paying has the power and often will make her do things that amount to sexual abuse. Prostitutes often use drugs to cope with the bad experiences. This particular study found that women drug users who are prostitutes are often more severely addicted to drugs and more likely to use them to make the prostitution bearable and to bolster faltering confidence. "The subservient, humiliating nature of prostitution suggests that these women would tend to feel less confident and in control while working, and would wish to regain these feelings, and the ability to feel close to others, after being sexually involved with a stranger or strangers" (p. 794). Drugs also help them to get rid of their inhibitions and to desensitize them to trauma. Drugs take their minds off what they are doing and allay their fears of violence. Addicted prostitutes who give sex in exchange for crack-cocaine experience the worst working conditions. They have little control over what they have to do or how many partners will be involved. "In some crack houses, a 'house girl' is hired to provide sex, in whatever form and with however many people, to the house's customers in exchange for crack, food, and a place to stay. Other women who come to crack houses to get high are often willing to perform debasing and perverse acts for even a hit off a crack pipe" (cited in Young, Boyd, & Hubbell, 2000). it's clear that while women start prostitution to finance their drug habits, the job leads to increased drug use in a vicious and terrible cycle.

Lest we think crack-cocaine is the only problem, in New York heroin is abused at high levels. Treatment admissions for heroin addiction in publicly funded programs rose from 29,279 in 1997 to 35, 314 in 2001. This is much higher than nationwide heroin statistics for admissions per 100,000. In 2000 there were 194 heroin-related deaths in the New York metropolitan area. In most cases the heroin was mixed with another drug. Among New York high school students, 2.6% report they have tried heroin at least once, only slightly higher than the national rate of 2.4%. Violent behavior is not usually associated with heroin abuse, but addicts do have an overwhelming need to buy drugs and often engage in prostitution as well as other crimes (Heroin -- New York drug threat assessment web site).

Young teenagers, under16, are turning to prostitution to support their habits. An article in the New York Times in 1988, during the height of the crack epidemic, reported that many young teen-agers were abusing the drug and turning to prostitution. Unfortunately, the courts and social service agencies often do not see that the teen has a drug problem or send the child for drug treatment. In New York, it was estimated that at least 97,000 "people under the age of 16…are heavy drug abusers in the state, most of them in New York City" (Kerr, 1988, p. 1). Lack of treatment facilities, data, and programs for young adolescents abusing drugs is a major problem.