The public health community is just beginning to understand the inherent connections between substance abuse, sexual abuse and prostitution. Someone who is suffering from one of these issues will be more likely to suffer from another, if not both of the other issues. In other words, they are mutually enforcing. We know from experience by outreaching to those who suffer from substance abuse or who have been prostituted that we will reach survivors of sexual violence. This program bridges gaps in current services and leads to a holistic approach for victims of sexual abuse who have been prostituted and dealing with substance abuse issues.

Research shows that there is a strong connection between sexual violence and substance abuse. According to the Center for Substance Abuse Treatment, between 41 and 74 percent of women in treatment for substance abuse disclose a history of either child or adult sexual violence. Within some programs, at least half of the women receiving treatment have been battered or raped and most have been emotionally abused. Studies also show that rape victims are six times more likely to use cocaine and ten times more likely than non-victims to use hard drugs. The reasons for this high level of substance abuse among survivors of sexual violence include both a desire to forget or deny the violence and the use of a substance to numb feelings of guilt, fear and anger that result from a rape. The result is a pattern of self-medication that can often lead to addiction.

In addition, women dealing with substance abuse problems may put themselves at a higher risk for assault because of impaired judgments and their increased vulnerability during drug or alcohol use. Memory problems associated with substance abuse can make reporting and prosecution difficult. In addition, a victim might be unwilling to report a sexual assault when they are under the influence of illegal substances. Under Massachusetts law, a person cannot give consent to sexual intercourse if he/she is under the influence of drugs or alcohol, however it is difficult for survivors to prove their level of incapacitation during an assault.

Furthermore, there is also a strong correlation between substance abuse and prostitution. If drugs and alcohol are a survivor's way of coping with previous sexual assaults, she may have to prostitute herself to support her addiction. However, as the researcher, Maureen Norton-Hawk states in her article found in the March/April 2002 edition of the Sexual Assault Report, drug use and prostitution have a complex relationship. In her study done in 1998 and 1999 at the Suffolk County House of Corrections, she showed that 68% of the women were prostituted in order to support their drug habit and 80% of subjects report that regular drug use led them to become prostituted.

Prostitution personally affects many women's lives. The National Task Force on Prostitution suggests that over one million people, or 1% of women living in America, have been prostituted in the United States. While men are also prostitutes, 70% are female. In addition, violence is a major issue for women who are prostituted. In some cases, a situation in which a sexual act is performed in exchange for drugs can easily turn into a rape. This same study by the National Task Force on Prostitution showed that 58% of women have been verbally assaulted by a customer, 32% have had a customer attempt to rape them and 26% have been raped.

Due to the limited understanding within the legal community about sexual violence, a survivor who is prostituted could be easily dismissed as "not being a real victim" or her assault could be viewed as merely an "occupational hazard". This lack of support and judgmental attitude can create a dangerous cycle. The survivor could further abuse substances in order to cope with the disbelief about her assault by the legal system. In addition, women who are prostituted are hesitant to access rape crisis services because of fears of law enforcement.

We have found that specifically in Lowell, there is a large substance abuse and prostituting community. According to MassSNAPP, Lowell is in the highest 20% of towns in Massachusetts containing risk factors for substance abuse. The Lowell police department shows 1,166 narcotics violations since January 2000 and 115 arrests for prostitution.

In the past seven months, Rape Crisis Services of Greater Lowell staff has provided twenty-eight psycho-educational presentations to clients in our community. Through presentations at detoxification facilities, recovery homes, day programs and court mandated treatment programs, we have reached 272 clients. In addition, eight staff presentations have been conducted for a total of 37 staff members and included information on rape trauma syndrome, our services and appropriate referral information. Goodwill Industries, Tewksbury Detoxification Center, Renaissance Club, Lowell House Recovery Home, Sheehan Women's Program, and The Middlesex D.U.I.L. Program have all participated in these psycho-educational support groups and/or staff presentations.

We received approximately 56 disclosures of sexual violence from clients who participated in psycho-educational groups or group training. The disclosures have included: incest, child sexual assault, adult and child rape, date rape, rape while prostituting and drug-facilitated sexual assault. In groups with nine or fewer members, 40% of group members disclosed a history of at least one incident of sexual violence. Within that 40% of group members, 82% disclosed more than one incidence of sexual violence during their lifetime. In addition, all prostitution disclosures were preceded by a rape disclosure.