Research Problem
In the United States, the issue of sex trafficking has recently come to the forefront of public debate. While there are no hard statistics on the prevalence of this phenomenon, it is very clear that women who find themselves in this underground market have exceptionally high rates of early mortality: 204 deaths per 10,000 sex workers (Bowen & Bungay, 2015). While the “world’s oldest profession” has been glamorized in the United States media, namely through feature films such as Pretty Woman (1990), the lives of these women are typically violent, brutal, and abbreviated.

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Given such horrific working conditions, it is hard to imagine that anyone would choose such a path for themselves. Indeed, multiple studies demonstrate that a high proportion of sex workers in the United States are addicted to multiple substances. In some cases, the women entered the sex work profession out of a desire to support an expensive drug habit; in other cases, their traffickers provide sex workers with drugs in order to keep them dependent and compliant. Further, sex workers often exhibit signs of mental illness, and this is also a factor in their participation in prostitution.

Research Question
Will a program that focuses on substance abuse and mental health decrease alcohol and drug use and decrease depression among women survivors of prostitution?

Theoretical Consideration
In considering the best manner in which to examine women’s lived experiences of prostitution, there are multiple theoretical issues that arise. The first is that many women who are survivors of prostitution are hesitant to speak of their experiences, due to the stigma attached to this profession. Further, former prostitutes often live in fear that if they speak openly about their experiences as a sex worker, they will be subject to retaliation from their former traffickers (Milkovitz, 2016). Also, the issue of substance use disorder and mental health issues among former sex workers presents a theoretical conundrum: did these women have a pre-existing substance use disorder or a mood disorder that motivated them to seek this line of work, or did the profession itself propel them into drug addiction and depression?

Research Hypothesis
Hypothesis
The hypothesis of this study is that a treatment program that addresses substance use disorders and mental health issues will indeed decrease substance use and depression among this population. However, one consideration to take into mind is that substance use disorder has an exceptionally high rate of relapse.

Data Collection
For this particular study, the method of data collection will be quantitative in scope. Given the secretive and illicit nature of the sex trade, a reliably qualtitative study would be impossible, as members of this cohort are typically hesitant to speak about their experiences, or to provide empirically reliable information. Thus, most of the data for this study will be gathered from secondary sources, such as data gathered by sex trafficking research groups and through scholarly literature that discusses the phenomenon of sex trafficking within the United States.

The data that is collected will be assessed for two primary results: the rate of recovery from substance use disorder that former sex workers who have been treated exhibit, as well as the prevalence of symptoms of Major Depressive Disorder. As substance use disorder is often a chronic, lifelong condition with high rates of relapse, this study will define “recovery” as one year or longer of continuous abstinence from substances of abuse, which includes alcohol.

External and Internal Validity
In a study of former sex workers who are afflicted with substance use disorder, there will inevitably be issues with validity, both external and internal. For instance, due to the fact that the former sex workers were intoxicated during their days in the sex trade, much of the data they provide will be skewed, as substance use treatment centers are often revolving doors in which clients repeatedly leave against medical orders.

Another issue that arises with regards to external and internal validity is the fact that many of the research subjects are difficult to reliably “track.” Many of these women will relapse shortly after release from their treatment programs, and will almost certainly return to prostitution (Farlow, 2003). Further, it can be very difficult to extricate the symptoms of a major mood disorder such as depression from the effects of any substances of abuse. Often, responsible health care providers will refrain from providing a diagnosis of mental illness until a former substance user has refrained from use for a period of one year.

Ethical Issues
The main ethical issue in this study arises from retrieving data from substance use treatment centers, who may be hesitant to reveal such information. Another issues arises from the confidentiality of these clients. Also, the subjects may be unreliable narrators.

Research Relevance
While there are now a plethora of research studies regarding the efficacy of substance use disorder treatment for former sex workers, this study will make a unique contribution by examining its effectiveness in relation to the symptoms associated with depression. Also, the study will examine the relationship between substance use disorder and entry into the field of sex work. Finally, this study will highlight the extremely exploitative nature of the sex industry.

Conclusion
The issue of sex trafficking in the United States is one that baffles many law enforcement officials, and mental health professionals alike. While the workers appear to enter the profession willingly, the fact remains that many of them are held in bondage to their drug addictions (Hotaling, Burris, Johnson, Bird & Melbye, 2008). Hopefully, this study will help to ascertain if treatment programs are effective in eliminating substance use disorder and symptoms of Major Depressive Disorder among this population.

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