Cover: Sex Trafficking and Substance Use

Sex Trafficking and Substance Use

Identifying High-Priority Needs Within the Criminal Justice System

Published Feb 24, 2022

by Lynn Langton, Michael G. Planty, Duren Banks, Amanda R. Witwer, Dulani Woods, Michael J. D. Vermeer, Brian A. Jackson

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Research Questions

  1. How do SUDs and trauma affect victims of sex trafficking and complicate their ability to obtain quality treatment and legal remedies?
  2. What can service providers, criminal justice practitioners, and other stakeholders do to improve the screening and identification of victims of sex trafficking, victims' access to services that are based in harm reduction, and victims' treatment within the legal system?

Substance use disorder (SUD) is common among victims of sex trafficking. Traffickers may exploit individuals' existing opioid use or other SUDs to coerce them into sex trafficking, or they may facilitate substance use to keep trafficking victims from exiting. Additionally, trafficking victims may use substances to cope with trauma.

The intersections of sex trafficking and SUD complicate both legal responses and victim advocate responses to sex trafficking cases. Victim SUD can lead to challenges for law enforcement and prosecutors in developing cases against traffickers. On the provider side, traditional victim services are often insufficient for victims of trafficking with SUDs, who face substantial barriers to accessing services. A better understanding of the nexus between sex trafficking and SUDs is critical for implementing victim-centered and trauma-informed responses to this vulnerable population.

In this report, the authors describe an online panel, convened in April 2021 by RTI International and the RAND Corporation on behalf of the National Institute of Justice, in which subject-matter experts and criminal justice practitioners discussed how SUDs and sex trafficking complicate the identification and screening of victims and victims' ability to access treatment and legal remedies. The panel participants identified 21 high-priority needs to support a better understanding of sex trafficking and SUDs and a variety of solutions for addressing these intertwined issues.

Key Findings

When victims of sex trafficking have SUDs, they are often not properly recognized as victims

  • There are disparities and systemic racism in the perceptions and recognition of sex trafficking victims, particularly in marginalized communities.
  • Sex trafficking victims with SUDs are often frequent users of emergency services and are seen as hostile and uncooperative by first responders because of their addiction and trauma.
  • Not much is known about strategies for preventing sex trafficking.
  • The co-occurrence of sex trafficking and other types of victimization makes it difficult to identify victims of trafficking.

Victims of sex trafficking who have SUDs often have restricted or limited access to services and quality treatment

  • Without the ability to quickly access methadone or other medication-assisted treatment, victims may return to the trafficker for access to drugs or money for drugs.
  • SUD relapse and re-trafficking are common among victims.

Victims with SUDs often receive unfavorable treatment within the criminal justice system

  • Trafficking victims might not report the trafficking or other victimizations they have experienced to law enforcement because they do not trust criminal justice actors—particularly after an arrest.
  • Victims with SUDs and complex trauma might not be seen as credible witnesses by prosecutors, judges, and juries.
  • Particularly when SUDs are involved, sex trafficking victims might be unable to engage in traditional court or problem-solving courts.
  • Trafficking victims often lack the stability for long-term participation in criminal justice cases, and traffickers use SUDs to manipulate victims and keep them from participating.


  • Ongoing diversity and inclusion training and cultural competency training should be developed for communities, first responders, and those working in the criminal justice system.
  • Training for law enforcement, medical providers, service providers, and other first responders on the impacts of trauma and trauma-informed approaches to working with sex trafficking victims should be developed and implemented.
  • Sex trafficking education should be developed for schools and other venues that target students, parents, and the larger community.
  • Screening tools should be developed for first responders and service providers to identify when cases involving domestic violence, child abuse, or drugs also involve sex trafficking.
  • Strategies for providing victims with rapid access to SUD treatment should be developed.
  • Long-term sustainable care plans, peer support, and survivor-led services should be developed for survivors that incorporate harm reduction strategies and recognize that relapse can be a part of the process of overcoming an addiction and exiting trafficking.
  • Feedback and guidance should be sought from advocates, including those with lived experience, on how to make criminal justice practices and procedures more trauma-informed and victim-centered, and provide commercial sexual exploitation education.
  • The use of expert witnesses to educate juries and courts about the effects of trauma and substance use should be considered.
  • Policies should be developed to ensure that services for victims are not tied to a requirement to participate in the criminal justice process.
  • Approaches should be devised and implemented to protect the privacy of victims and witnesses involved in court processes.

Research conducted by

The research described in this report was supported by the National Institute of Justice and conducted by the Justice Policy Program within RAND Social and Economic Well-Being.

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