Abstract
In their article titled, “Exiting Prostitution: An Integrated Model,” published in Violence Against Women in May, 2010, Baker, Dalla, and Williamson present and review four models of the exiting process from street-level prostitution. Their article is important and has many merits; however, we think that the perspective that “addiction leads into selling sex in order to finance the addiction and if the primary addiction is successfully treated the prostitution will vanish away” is less well described than the other (also important) models, especially given the large empirical literature that supports this model.
Prostitution and addiction are strongly associated (Cusick, 2002; Gunne, Grönbladh, & Öhlund, 1995), and although Baker et al. cite publications in this area (e.g., Potterat, Rothenberg, Muth, Darrow, & Phillips-Plummer, 1998) and list substance abuse as a barrier to exiting street-level prostitution, they do not fully take into account the consequences of that relationship. They seem to argue that selling sex is always the primary problem. We argue that there is strong empirical support for the perspective that addiction leads to selling sex to finance the addiction and that if the primary addiction is successfully treated, prostitution will no longer be a problem for this group of women.
For most heroin-addicted prostitutes, for example, initiation into drug use precedes selling sex (Graham & Wish, 1994; Öhlund & Grönbladh, 2009; Potterat et al., 1998). In many cases, initiation into injection drug use precedes or coincides with selling sex (Graham & Wish, 1994; Öhlund & Grönbladh, 2009; Potterat et al., 1998). In addition, the correlation between age at initiation into opiate use and age of initiation into selling sex is usually high (r = 0.69 to 0.70; Gossop, Powis, Griffiths, & Strang, 1994; Öhlund & Grönbladh, 2009). Thus, there is strong support for the perspective that selling sex is a way to finance the addiction. There is also strong evidence that life events, such as running away from home (Cusick & Hickman, 2005) are associated with both drug use (Moen & Öhlund, 2003) and selling sex (McClanahan, McClelland, Abram, & Teplin, 1999; Öhlund & Grönbladh, 2009), and that such life events strengthen the association between drug use and selling sex.
As Baker et al. partly acknowledge, for many women the addiction maintains the need for selling sex. For instance, Gunne et al. (1995) found that if heroin dependence is successfully treated, prostitution diminishes almost entirely (by 97%) during the 1st year of treatment. From clinical experience, we have found that the drug-addicted prostitute has a day-to-day economy. She earns enough money from selling sex to pay for heroin for about 24 hr, seldom more. Often the money earned from selling sex is used almost exclusively for the purchase of heroin, whereas other expenses, such as rent, food, and clothing are covered by social welfare. Thus, when the expensive “abstinence mortgage” no longer needs to be paid everyday, the need for selling sex to raise that money no longer exists.