Editor's Note: This article was presented at the Stockholm enforcement, courts, prisons and jails to help combat

ombat pros-
Criminology Symposium, June / 7, 2006, in Stockholm, Sweden. titution.^ However, the current enforcement of prostitution
laws appears to create a revolving door phenomenon. Typi-

P
rostitution is a social issue of desperate impor-
tance both in the U.S. and internationally. Prostitu- pimps, customers and traffickers often remain free because
tion fuels a literal slave trade. The U.S. State
Department's Bureau of Public Affairs estimates
that 600,000 to 800.000 individuals, up to 50 percent of
whom are children, are trafficked across international
borders annually. According to the Swedish Ministry of
Industry. Employment and Communications. "International
trafficking in human beings could not flourish but for the
existence of local prostitution markets for men who are
willing and able to buy and sell women and children for
sexual exploitation."'
In all areas of the U.S., except four or five counties in
Nevada, prostitution is illegal. The U.S. government adopt-
ed a position against legalized prostitution in a December
2002 National Security Presidential Directive. The criminal
justice system devotes tremendous resources to law
cally it is women and children who are arrested, while
of difficulties in meeting the burden of proof in the courts.
Women are often incarcerated on misdemeanor prostitu-
tion chtirges, released and rearrested on the same charges.
The high costs of law enforcement have motivated some
to suggest decriminalizing prostitution. Proponents of
decriminalization also support the myth that prostitution is
a "victimless crime." The criminal justice communit>' must
therefore make it clear that prostitution is costly to society
in other ways as well. For example, prostitution has been
demonstrated to be detrimental to public health.^ But more
important, in light of current research, it is preposterous to
suggest that prostitutes themselves are not victims. In field
research in nine countries, it was found that up to
68 percent of women in prostitution met the criteria for
post-traumatic stress disorder; this is the same range as

68 — October 2009 Corrections Today

treatment-seeking combat veterans and victims of state-
organized torture.' Other manifestations include depres-
sion, anxiety, bipolar disorders and eating disorders,
Women who have been exposed to long periods of prosti-
tution activities reveal other symptoms, including cutting,
psychological abreaction and psychotic episodes. Even
under circumstances where women have worked in legal
brothels, there are mental health consequences consistent
with any oUier form of prostitution. Reasons for this are spec-
ulative, but it is hypothesized that repetitive prostitution
activity coincides with reliance on dissociative coping mech-
anisms that serve to compress these experiences and in turn
leads to crippling psychological symptoms, as earlier
described.^
The Women's Recovery Center
Volunteers of America (VOA), founded in 1896, provides
social services, housing, nursing homes and correctional
services and has a presence in 38 states in the U.S. in 1984,
the organization established a privately operated jail
for women In St. Paul, Minn. After observing repetitive jail
commitments of women for prostitution offenses, VOA
conducted an informal study of 12 inmates with long-term
involvement in prostitution. Each inmate had cumulatively
served four to six years of jail time through repetitive com-
mitments. This translated into a cumulative jail time cost
of $80,000 to $120,000, with a likelihood of additional costs
in the future. Each individual self-identified a chemical
addiction with repeated and failed attempts at convention-
al chemical dependency treatment. In each case, there was
a prior history of sexual abuse and a desire to get out of
prostitution. With these facts. Volunteers of America began
marketing an idea of developing an alternative residential
recovery center to serve as a court diversion or a volun-
tary post-incarceration option.
The 1999 session of the Minnesota Legislature granted
funding for Volunteers of America to develop the Women's
Recovery Center, which would offer an integrated, gender-
specific treatment program. The center admitted its first
October 2009 Corrections Today — 69
 clients in February 2000. The mission of the Women's Recov-
ery Center is treatment, not research, and while its results
cannot prove the efficacy of its treatment model with rigor,
all the gathered data suggest it is a success.
Development of Treatment Model
A small panel of prostitution "survivors" was assembled.
They expressed frustration both with the lack of treatment
and that the treatment provided by conventional thera-
pists failed to take into account the complete cuntext
of prostitution. They described an ideal program that
would include chemical dependency treatment, mental
health treatment with emphasis on sexual trauma, and a cog-
nitive/teaching program of expanded life choices.
Chemical dependency. At the time, new thinking was
beginning to emerge regarding chemical dependency treat-
ment for women that was integrated with the treatment of
anxiety, depression and related psychiatric/emotional
conditions. Paramount in this thinking was the influence of
the Wellesley College Stone Center.'' Studies in the use of
the relational model became the gender-specific model
adopted by the program. The model acknowledges the
relational nature of women in general that historically has
been "pathologized" in comparison with the traditional
male self-centered orientation. However, the centrality of
women's relationships, as seen in the relational model of
treatment for chemical dependency and trauma, is seen as
a strength and key to recovery.
Sexual trauma/mental health. In addition to physical
health consequences, women who have been victimized by
prostitution typically have experienced trauma through
physical violence, sexual violence and incest, sometimes
beginning at a very young age. Through testing after admis-
sion, it was observed that as many as 70 percent to 75
percent of women had been preliminarily diagnosed with
post-traumatic stress disorder. This observation was found
to be consistent with women who are forced into prostitu-
tion. When women have left periods of incarceration, they
often relapse into drug usage and further prostitution in
part to escape the pain of mental health issues. In selected
cases, post-traumatic stress disorder is addre.çsed through
the use of eye movement desensitization and reprocessing
(EMDR), which is a cognitive/neurological approach
toward symptom relief. It targets trauma and specific trau-
matic experiences that are identified and reprocessed at a
neurological level and accessed through bilateral stimula-
tion employing light, auditory tones, tapping or other types
of tactile stimulation.' At the Women's Recovery Center,
the EMDR experience is accessed by a clinician through a
back and forth hand motion. In between "sets" of this eye
stimulation exercises, the clinician communicates verbally
with the client in an effort to reprocess a traumatic experi-
ence. This technique is used in conjunction with other
mental health protocols that address incidents or patterns
of sexual and physical trauma.
Expanded life choices. Many women in prostitution
have experienced a confined existence, handicapped by
limited social networks, community support plans and
knowledge of the availability of outside community
resources. To address tliis, Expanded Uíe Clioices, devel-
70 — October 2009 Corrections Today
oped by Range Technical College." became the third part of
the recovery program. Expanded Life Choices is designed
to emphasize broadening perspectives on choices such as
housing, reproductive health, vocational choices, communi-
cation, problem-solving and goal-setting. Through this
program, women are able to achieve healthy supportive tran-
sitional housing with support services upon completion.
Another dimension is the development of a sense of spiritual-
ity, though not directly related to an organized religion.
Women engaged in prostitution have had such substantial
histories of all forms of abuse that they tend to have a dis-
torted (or no) sense of life purpose. This kind of spiritual
dimension transcends the other treatment components, yet
plays an intricate part of the recovery process.
All three aspects of treatment are vital and must be inte-
grated; Education and training toward another lifestyle fails
absent chemical dependency treatment because drug
addiction cannot typically be supported by a straight job.
Chemical dependency treatment that does not address sex-
uai trauma fails because drugs may be used as an escape
from emotional pain. And mental health treatment fails if
the hard realities of drug addiction and economic survival
are not also addressed. Successful recovery represents a
three-legged stool that will topple if any leg is missing.
Treatment Outcome
The Women's Recovery Center admitted its first clients on
Feb. 21, 20Ü0. By Sept. 1. 2003, 152 clients had been dis-
charged. Of these, 26 resided for 10 days or fewer and there-
fore did not receive significant exposure to the program. In
fact, a few in this sample left the program within the first 24
hours, likely because they were not prepared for the rigors of
treatment, which for many represent a variety of fears includ-
ing resistance to personal disclosure. Additionally, Minnesota
public iissistance guidelines at the time disallowed duplicate
treatment exposures within a period of two years; the criteri-
on for qualifying as a treatment exposure was 14 days of resi-
dency. Therefore, clients who stayed past 14 days stayed
with the knowledge that they would not receive another
chajice at treatment funding within two years. The aggregate
statistics presented herein pertain to the 126 clients in resi-
dence for 11 days or more.
Client Characteristics
Clients reported data about themselves upon admission
to the program. From this self-reported data clients provided
the following informatit>n;
Race. Clients were predominantly black and white,
with minor representation of Asian, Native American and
Hispanic heritage (see Table 1).
Housing. A total of 95 individuals (76 percent) lacked any
permanent housing. For example, 40 (32 percent) came
directly from correctional institutions white 22 (18 percent)
reported coming directly in from the street. Others variously
reported coming from shelters and treatment centers, and
two clients reported living in their cars.
Table 1. Racial Characteristics of Client Population

Race Residents New Conviction % New Prostitution/Drug %

Post-Discharge Conviction Post-
Discharge
Black 64 8 12.5 6 9.4
White 41 Î3 31.7 6 14.6
Indian or Native 11 4 36.4 2 18.2
American
Multiracial 7 0 0.0 0 0.0
Asian/Pacific 2 0 0.0 0 0.0
Islander
Hispanic or 1 0 0.0 0 0.0
Latina

Poverty. Forty-five individuals (36 percent) reported
rarely or never having money for basic necessities. Addi-
tionally. 52 (40 percent) reported having enough food
either rarely/never or less than half the time.
Addiction, treatment and mental health. Seventy-four
(59 percent) reported that they are or have been addicted
to alcohol, and 124 (98 percent) reported that they were or
had been addicted to drugs. The median reported age of
first drug use was 13, and the median reported age of first
intoxication was 14. Clients reported having been in previ-
ous treatment a median of 4.0 times and an average of 4.8
times.
A total of 85 (67 percent) reported having received pro-
fessional help for mental health problems. Including 74
receiving one-to-one counseling, 59 receiving treatment in a
support group, 45 receiving treatment in a hospital and 24
receiving treatment in an institution.
Prostitution. Among 103 clients stating an age of first
involvement in prostitution, the median age was 18, and
the average was 20.3. Among 100 clients stating a length of
involvement in prostitution, the median was 11 years, and
the average was 12.0 years. A total of 87 of 103 (84 percent)
reported having been paid with drugs.

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 Table 2. Outcomes One Year Post-Discharge by Age
Age Residents New Conviction
19 to 31 40 10
32 to 37 42 7 16.7
38 to 54 44 8 18.2
Clients reported a range of prostitution activities, most
prominently listing "street," and including stripping, escort,
brothels and participation in ixjrnography (see Table 2). Of
103 clients, 23 had been transported to other cities. 28 to
other states and three to other countries for prostitution.
Criminal history. A total of i 16 (92 percent) self-reported
prior convictions, wliile 106 (84 percent) self-reported prior
incarceration.
Post-Treatment Outcomes
In September 2004, after four years of operation. Volun-
teers of America researched computerized records located in
a centra] database managed by the Minnesota Department of
Safety, Bureau of Criminal Apprehension. This database is
considered official public record and is the best source of
conviction data representing all courts in Minnesota. A
search was conducted for new criminal convictions among
women treated by the Women's Recovery Center in the
yecU" following their release. The conviction statistics were
compiled for all 126 women released from the Women's
Recovery Center by Sept. 1, 2003, allowing for at least one
year in the community post treatment. Twenty percent of the
group received a new conviction of any kind, while 11 per-
cent received a new conviction for drugs or prostitution.
There is a slight correlation between age and conviction
rates, with those under the age of 32 showing somewhat
higher overall conviction rates. However, this age group
does not show any higher drug/prostitution conviction rate
than the other groups despite the fact that this is consid-
ered an age group more at risk for criminal activity consis-
tent with age (see Table 2).
Analysis
The results are particularly striking in light of informa-
tion self-reported by the women residing at the Women's
Recovery Center. The successes were not merely easy
cases. Of the study subjects, 92 percent reported prior con-
victions; 84 percent reported prior incarcerations; 98 per-
cent reported having been addicted to drugs, particularly
crack cocaine; and 81 percent reported having used crack
cocaine in the six months prior to treatment. The women
had participated in a median of four (presumably unsuc-
cessful) prior treatment programs, with a slight positive
correlation between the number of prior treatments and
the conviction rate after leaving.
Criminal justice costs devoted to what may be a social
problem are substantial and indeed misplaced. Considering
further that control of prostitution appears to be an ongo-
ing struggle, the contemporary solutions now applied are
misdirected. Innovations such as the Women's Recovery
72 — October 2009 Corrections Today
% New Prostitution/Drug Conviction %
25.0 5 12.5
5 11.9
4 9.1
Center may provide better outcomes and circumvent the
necessity of using the criminal justice system as a method
of management or control. The recovery model used at the
Women's Recovery Center emphasizes recovery of self,
which serves as a direct contradiction to the imprisonment
of self under the umbrella of prostitution and trafficking.
An integrated, gender-specific treatment model is more
likely to be effective than conventional or no treatment meth-
ods at helping women escape prostitution. While the data
from the Women s Recovery Center does not constitute
rigorous research. It is strongly suggestive of the direction
future research should take. Future studies must fill tbe
current gap in assessing the effectiveness of various treat-
ment programs and it is expected that such research will
bear out the worth of the VOA model.
ENDNOTES
' Swedish Ministry of Industry, Employment, and Communications.
2004. Fad stieel: Prostitution and trafficking in women. Article
#N4aO4. Stockholm, Sweden.
Pearl, J. 1987. The highest paying customers: America's cities and
the costs of prostitution control. The Hastings Law ./ournal,
38(4):43-59.
" Parriott, R. 1994. Health experiences of women used in prostitu-
tion. Unpublished paper. Available at www.angelfire.com/mn/fjc/
healthex2.htnil.
'' Farley, M.. A. Cotton, J. Lynne, S. Zumbeck, F. Spiwak, M.E. Reyes,
D. Alvarez and U. Sezgin. 2003. Prostitution and trafficking in nine
countries: An update on violence and posttraumatic stress disorder.
Joumal of Trauma Practice, 2(3/4);33-74; and Farley, M. (Ed.). 2003.
Prostitution, trafficking, and traumatic stress. New York: Haworth
Press.
Parriott, R. 1994.
'' Wellesley Centers for Women. 2001. Wellesley relational model
instrument development. Weliesley College. Available at
www.wcwonline.org/content/view/896/299/.
^ EMDR Institute Inc. 2004. A brief description ufEMDR. Watsonville,
Calif. Available at http://emdr.com/briefdes.htm.
Nemancik, T., M. Primozich and K. McQuillam. 1992. Expanded
Ufe choices. Hibbing. Minn.: Range Technical College.
William F. Nelson is director of Correctional Services for
Volunteers of America of Minnesota. In partnership with
a PBS affiliate, Nelson directed a documentary about
the Women's Recovery Center treatment model called
Prostitution: Beyond the Myths. He can be contacted at
bnelson@voamn.org.
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