Substance use services for sex industry workers must be flexible, non-judgmental, and responsive to complex needs

A critical review of relevant research suggests that substance use services for individuals working in the sex industry must be flexible, non-judgmental, and responsive to the complex needs of this group. The review, conducted by a team involving ARC West and University of Bristol researchers, is published in Health & Social Care in the Community.

Multiple challenges

Drug use is more common among people working in the sex industry than in the general population.

People involved in the sex industry who have faced challenges with drugs and alcohol often suffer multiple health and social problems. They may experience sexual violence, verbal and physical abuse, and poor mental, physical and sexual health.

Despite their need, this group frequently struggle to access support for their physical and mental health. Stigma, discrimination and criminalisation can be barriers to accessing help.

Critical review

Researchers conducted a critical review – an in-depth analysis of the issues on a particular topic – of the research on substance use services for individuals working in the sex industry, to identify problems and ways these services could be improved.

The reviewers consulted relevant literature and the views of 6 experts who research or work in substance use treatment for people in the sex industry.

Sex-industry-specific substance use services

Their findings suggest that this group need sex-industry-specific substance use services, which consider their needs both as people who use drugs and alcohol and as individuals engaged in sexual commerce.

Services need to be person-centred, reflecting the diverse experiences within this group, and adaptable to an individual’s priorities, according to the review. Services must build trust and support people to feel safe, acknowledging gender issues and possible effects of trauma.

The review also highlights the importance of tailoring services to the lifestyles of people who work in the sex industry. For example, providing flexible appointment times, transport to appointments, and encouragement and emotional support to attend them.

For these services to be successful, the review found that multiple agencies must work together to address the wide range of health and social care needs experienced by this group, including substance use, housing, and mental health.

Lived experience

Crucially, the review stresses that people with lived experience need to be involved in designing and delivering substance use services for sex industry workers, to ensure they are relevant, effective, and empowering.

Dr Jo Kesten, Research Fellow at the University of Bristol and a member of the team who conducted the review, said:

“It is vital to identify ways to reduce the health inequalities experienced by individuals involved in the sex industry who face challenges related to drug and alcohol use.

“To achieve this, services require adequate funding to work in multi-agency partnerships and deliver person-centred, tailored support, as highlighted in the recommendations of this review.”

Dr Emma Smith, Research Associate at King’s College London and study lead, said:

“Our review highlights that people working in the sex industry need substance use treatment services that truly reflect their realities. This requires flexible, non-judgmental support that addresses substance use alongside broader health, housing, and safety needs.

“Importantly, these services should be co-designed with those with lived experience, ensuring they are not only accessible but genuinely affirming and supportive.”

Jennifer Riley, CEO of Bristol charity One25 and a member of the team who conducted the review, said:

“One25 recognises that mainstream substance use treatment services often fail women involved in street sex work. This review highlights the urgent need to centre their voices in shaping services that break down barriers and provide holistic, trauma-informed support.

“When meaningful change happens, this kind of life-changing support is possible.”