A Critical Review of Substance-Use Services for Individuals Engaged in the Sex Industry Through In-Person Work

In the United Kingdom, drug use has been reported to be higher among individuals involved in the sex industry through in-person work, compared to those not engaged in such work. Additionally, those who engage in more visible forms of in-person work in the sex industry —such as street-based exchange—are more likely to have challenges with drug and alcohol use compared to individuals working in less visible, in-person settings. Services often struggle to adequately support people who participate in the sex industry, particularly those with intersecting health and social care needs, including problematic drug and alcohol use. It is therefore important to understand how services can better support the needs of individuals who engage in the sex industry and who have experienced challenges with their drug and alcohol use. This critical review examined available literature to assess how individuals who engage in the sex industry, particularly individuals participating in visible and in-person forms of sexual commerce, currently access support for drug and alcohol use and how this could be improved within the UK. Written contributions on the most important considerations in service provision for substance use treatment for individuals who participate in the sex industry were gathered from six experts—four academics and two practitioners—who work and conduct research in this field. These insights were thematically analysed alongside relevant literature they recommended. Findings suggest that individuals who engage in the sex industry would benefit from non-judgmental and flexible care that considers their specific and intersecting needs both as someone who uses drugs and alcohol and as an individual engaged in sexual commerce. It is vital that individuals engaged in the sex industry have access to gender and trauma informed, sex industry specific services that provide support for intersectional health and social care needs. Multi-agency working in this field is essential so that individuals have access to integrated support that prioritises relationships and builds trust between service providers and the individuals they support.