Substance use contributes to trafficking risk in complex ways. For many, substance use precedes experiences of being trafficked or commercially sexually exploited, often in an effort to cope with prior trauma.  Exploiters may utilize access to alcohol and drugs to recruit and entrap substance-using youth. Youth with significant substance dependence may be vulnerable to, and even initiate themselves, exchanges of sex for access to substances. Even youth without prior significant substance use may use alcohol and drugs to cope with the experiences of being trafficked/exploited. Some exploiters specifically foster substance use and addiction as a means of establishing dependence upon them as suppliers, and to enhance control and compliance, with the youth incurring “debt” that they must “work” to pay off. Even after exploitation/ trafficking, survivors may use alcohol or drugs in an effort to cope with their past  trauma and trafficking experiences, which may exacerbate risk of re-exploitation and other harms.

It is noted also that caregiver substance use and dependence is a related risk factor children. Caregivers with significant substance dependence may exchange sex acts with their children for alcohol and drugs or money to purchase alcohol or drugs. Less directly, caregiver substance use may contribute to neglect, out-of-home placement, inadequate supervision and other risk factors for T/CSEC.

Familial trafficking involves the intentional or unwitting exploitation of children by individuals who are responsible for the care, safety, and trust that is foundational to how society understands and defines the family. Methods used to control or sustain involvement of children in familial trafficking include psychological, physical, and/or sexual abuse. In fact, multiple studies demonstrate significant psychological and physical harm, and high levels of clinical need. Some ways that family members initiate trafficking include:

• Family members not otherwise engaged in trafficking allowing traffickers to exploit their children for sex or labor in exchange for drugs, money, or something else of value. Traffickers may fraudulently promise jobs or other opportunities for caregivers or their children and instead force the children into domestic servitude, commercial sex, strip club involvement, or production of child sexual abuse materials (formerly called, ‘child pornography’), etc.
• Family members exploiting/trafficking their own children and potentially others.
• Caregivers providing inadequate supervision leaving children/youth vulnerable to those who exploit them.

Immigrant, undocumented and refugee children are vulnerable to trafficking, especially when they are unaccompanied by or separation from a parent or guardian. Factors prompting migration may elevate the risk of exploitation, including poverty and violence in the community or within the home, armed conflict and prominent gang activity in the area. During transit, economic deprivation, breakdown of family and social structures, imbalance in power relations and dependence on traffickers and/or smugglers to cross borders render children at risk for trafficking. Unknown physical surroundings, fear of law enforcement, social isolation, and food insecurity compound the risk. In the destination country, additional factors contribute to increased vulnerability to trafficking and exploitation including the social and physical structure of refugee camps and other housing situations (e.g., over-crowding, deprivation, inadequate supervision). Limited knowledge of legal rights within the new country, distrust of authorities, and language barriers further add to the vulnerability.

Youth who identify as LGBTQ+ are disproportionately impacted by a wide variety of traumatic experiences including abuse and neglect, harassment, and family rejection, all of which place them at risk for trafficking. LGBTQ+ youth who lack family support or safe shelter are vulnerable to traffickers who are seeking to exploit their needs for housing, food, and social connections. LGBTQ+ youth are at especially disproportionate risk for sex trafficking and sexual exploitation. In fact, even among runaway/homeless youth, LGBTQ+ youth experience commercial sexual exploitation at greater rates than their heterosexual cisgender counterparts.*

Youth facing housing and employment discrimination related to their actual or perceived gender identity or sexual orientation may feel they have no choice but to exchange sex acts for items and conditions necessary for survival like shelter or food, as well gender affirming-medical needs. Also, the lack of LGBTQ+ affirming and inclusive schools, health- care, legal and criminal justice systems, and other critical social services increase isolation and create barriers for youth to access support.

*Covenant House (2016). Labor and Sex Trafficking Among Homeless Youth: A Ten-City Executive Summary. New Orleans, Louisiana: Loyola University.

Economic factors and poverty appear to be important elements of trafficking vulnerability.

Economic factors constrain opportunities, undermine educational attainment, impact community values and norms, and otherwise profoundly contribute to trafficking victimization. Individuals with limited opportunities to meet basic needs and/or expectations to provide monetarily for their loved ones (e.g., runaway/homeless youth, youth with impaired parents, siblings in need, young children) are especially at risk. Similarly, parents facing severe financial distress may be vulnerable to manipulation by traffickers and unknowingly allow their children to enter into high-risk situations, or may be even more fully complicit in the trafficking of their child in an effort to help the family survive.

Children and adolescents who have experienced sex trafficking often have very high rates of involvement in multiple child-serving systems, especially child welfare (e.g., Child Protective Services, foster care) and juvenile justice. The trafficking risk associated with child welfare involvement is sometimes related to the traumatic experiences (child sexual abuse, child physical abuse, neglect) that may have precipitated a child’s or adolescent’s entry into the system. Often it is related to, and compounded by, experiences that occur because of their involvement in child welfare, such as housing instability, foster care placement, disruptions in education, and continued experiences of maltreatment. Foster care in particular, especially multiple placements and earlier placement in congregate care vs. single family homes, appears to increase trafficking risk.*

While, initial placement is often a result of early experiences of abuse and neglect that contribute to trafficking vulnerability, there also appears to be experiences while in care that potentially exacerbate vulnerability, including degrading of a youth’s self-worth, erosion of their belief or expectation that others will care for them, and the monetization of their care. Perpetrators, both traffickers and buyers, will often target children who are not getting their basic needs met (including those for love and belonging) because they assume they will be easier to manipulate and control. Justice systems were once the primary systems that served youth with histories of being sex trafficked because youth would be arrested for “prostitution.” While there are some states that still charge minors with prostitution, other states have shifted to match federal laws recognizing victims of child sex trafficking as victims of child abuse. With this recognition, the child welfare system is increasingly becoming the intended primary system to serve children and youth who have experienced child sex trafficking. Even with this shift, youth are still vulnerable to contact with law enforcement, probation systems, and the juvenile court. This is often due to factors related to their exploitive situations (e.g., substance abuse, coercion to commit crimes, traumatic stress reactions, and homelessness) that lead to increased interaction with law enforcement and the justice system.

* Dierkhising, C. B. & Ackerman-Brimberg, M. (2020). CSE Research to Action Brief Translating Research to Policy and Practice to Support Youth Impacted by Commercial Sexual Exploitation (CSE). National Center for Youth Law: California State University, Los Angeles.

Although people of all races and ethnicities are trafficked, youth of color are identified as being trafficked at disproportionate rates compared to White, non-Hispanic youth. This is likely due to intersecting economic, educational, community, and societal factors and embedded racism, and structural inequality in multiple systems (e.g., juvenile justice, child welfare, and education). In the United States, Black, Native American, Asian American and Pacific Islander youth are especially vulnerable to sex trafficking due to the particular histories of oppression and exploitation, including the sexualization, objectification, and fetishization of women and girls of color. Sexual stereotypes persist in the present day with specific implications in the commercial sex market. Biases that attribute greater physical, emotional, and sexual maturation and less need for protection and support to youth of color furthers the harm and increases their vulnerability to trafficking.

* Dierkhising, C. B. & Ackerman-Brimberg, M. (2020). CSE Research to Action Brief Translating Research to Policy and Practice to Support Youth Impacted by Commercial Sexual Exploitation (CSE). National Center for Youth Law: California State University, Los Angeles.

Youth who leave home or placement without caregiver permission, are often rejected by caregivers, forced to leave, or unwelcome in their homes. Due to this, LGBTQ+ youth who are homeless may be especially vulnerable to being trafficked. Youth who are homeless often experience several risk factors increasing their vulnerability for trafficking prior to and while being homeless. That is, exposure to trauma and other stressors (e.g., poverty, abuse or neglect, violence in the home or the community, conflicted or lack of social and family relationships, disrupted education, and substance abuse) are common precipitants and consequences of trafficking. These experiences may also contribute to low self-esteem, problems with trust, depression, anxiety, and other social-emotional issues that increase vulnerability to trafficking. In particular, youth experiencing homelessness or housing instability often have unmet basic needs such as food, clothing, safety, shelter, money, or access to other resources or things of value with restricted options for securing these basic needs and resources.Youth with unstable housing or experiencing homelessness may feel they have no choice but to exchange sex acts for items and conditions necessary for survival like shelter or food. This is referred to as “survival sex.” They may not perceive their situation to be one of exploitation, but instead view it as engaging in voluntary acts that meet their needs and preserve their independence and freedom. However, under the age of 18, any exchange of sex acts for goods, is child sex trafficking. Likewise, youth are at high risk of labor trafficking and exploitation. Due to youth’s needs and vulnerabilities, they may view those who seek to manipulate them as “friends,” benefactors, or intimate partners, as well as a source of help, support, or care. It is important for professionals, caregivers, and youth alike to be educated on the increased vulnerability to trafficking for youth who are homeless or absent from placement, especially if periods of homelessness or absence from placement are prolonged or repetitive, in order to inform prevention, identification, and intervention.

Youth who have disabilities (e.g., physical, intellectual, developmental, or a combination) are at increased risk for experiencing a range of traumatic experiences including being vulnerable to trafficking. They may be especially vulnerable because of the social discrimination and stigma they face regarding their disability. There are many reasons why youth with intellectual disabilities may be more vulnerable to being trafficked, including lack of understanding of what is and is not exploitation. These disabilities may also limit a youth’s ability to assertively refuse the propositions or directions of others and to report abusive situations. An inability to assess risk and to be overly trusting and engage in relationships in which they are sexually or financially exploited. Youth with disabilities may lead more isolated lives, sometimes restricted to their caregivers and service providers (e.g. physical therapist, staff at a recreational or vocational training center). Due to this isolation and restriction, they may desire autonomy, friendship, and human connection outside of their support system. This may heighten vulnerability to exploitation of all kinds and make them especially vulnerable to manipulation by a trafficker who gives the appearance of friendship or relationship. Traffickers may also seek out victims with disabilities to gain access to their public benefits such as Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits. Youth with disabilities may be submissive to their caregivers and comply with their caregivers’ wishes because they are dependent upon them. This dependency on others may lend itself to youth being at risk of being compliant and submissive to traffickers and their demands. Youth who have disabilities may have difficulties with communication and/or speech. They may be unable to speak clearly or require communication devices or interpreters to make their needs known. This may affect their ability to get help and report any abuse they are experiencing and could require them to depend on their trafficker for interpretation of their needs. In some cases, youth may not be believed by family, friends, or even authorities when they report their abuse and exploitation. This is especially true for young people with disabilities that affect intellectual, cognitive, or communication functions or those with mental health diagnoses. Specifically regarding sex trafficking vulnerability, often others do not see youth with intellectual disabilities as sexual beings, and, as a result, they are often uninformed about concepts on sexual health including consent. Some youth who have disabilities depend on caregivers for intimate care and bodily cleaning or have had medical procedures that involve aftercare with physical touching. As a result, youth can become desensitized to touch and/or may be unsure about what appropriate touch is and whether they have the right to object to and report unwanted touch, sexual abuse, and sexual acts.

There are significant educational and economic impacts experienced by youth who have been or are being trafficked. Many youth experience the school environment negatively, both academically and socially/interpersonally.

While being trafficked, school attendance and performance is often additionally impacted as some youth may cease attendance altogether, especially if being moved geographically by traffickers, and fall substantially behind their peers in grade level. Other youth may continue to attend school while being trafficked but performance and learning may be impacted by significant sleep disruption and fatigue, malnourishment, and inattentiveness.

After youth are identified as having been exploited through trafficking, educational supports and services are often a key priority in service planning. However, as trafficked youth attempt to re-engage in traditional school settings following identification and intervention, they may:

• Struggle as a result of their histories of disrupted attendance and academic performance
• Experience (continued) trauma-related difficulties with attention and concentration
• Face challenges related to feelings of disconnection from peer culture and traditional setting, concerns of shame and judgment, and/or bullying by peers.

Conversely, some youth will thrive in traditional school settings, especially if they are able to attend regularly, and are appropriately supported and adequately assessed to determine educational, learning, and intellectual abilities. Others may thrive in non-traditional or alternative educational programs.

Trafficking has significant long-term educational and economic impacts on survivors:

• Lower rates of high school graduation and college attainment, restricted opportunities to develop vocational and life skills. This restricts achievement, limits economic mobility and employment opportunities, and further contributes to risk of trafficking re-victimization.
• Limited employment and career pathways specifically due to criminal records – a felony conviction, especially, can impact licensure in many fields and may undermine hiring in any position requiring a criminal background check, including military service. (Even though youth are now less likely to be charged with prostitution as a result of legal reforms, they may have other criminal charges while being trafficked.)

Although reform efforts have resulted in significant advancements, trafficked youth may nevertheless experience a range of legal impacts, including:

• In some states and local jurisdictions, minors continue to be arrested and incarcerated for prostitution
• Even if not charged with prostitution, youth may be charged with other crimes (sometimes in an effort by law enforcement and judges to detain youth for their own safety)
• Experiences of harassment from peers, adults, or law enforcement
• Employment-related impacts of a criminal record, as well as social, physical, and relational impacts (contrary to common belief, juvenile records are not sealed)
• Loss of autonomy and basic freedoms as a result of incarceration
• Separation from children
• Deportation

Given the breadth and severity of trauma and adversities often experienced prior to and while being trafficked, youth may experience a range of mental health-related symptoms and difficulties, including:

• Having trouble paying attention or concentrating
• Being easily irritated or angered
• Having trouble falling asleep or sleeping too much, nightmares
• Experiencing dissociation
• Getting upset when things happen that remind them of traumatic events (trauma reminders)
• Having difficulty with emotional identification, expression, and regulation
• Experiencing intrusive thoughts about their experiences while being trafficked and other traumatic experiences(s)
• Avoiding thinking or talking about upsetting their experiences, including trafficking
• Having low self-esteem
• Alterations in ability to relate with others
• Dealing with self-blame, guilt, and shame
• Having problems initiating and sustaining healthy relationships
• Dealing with depression
• Experiencing anxiety
• Engaging in substance use or having dependence problems
• Experiencing suicidal thoughts and engaging in self-injurious behaviors
• Changes in sense of self
• Alterations in the way they view the world

There are a number of physical health and medical impacts that may be experienced by youth who have been trafficked. Traffickers may prevent a youth from seeking medical care until a condition or concern  keeps them from being able to work for the trafficker. Traffickers may also control a youth’s identification, immigration or health insurance documents, thus controlling their access to care.

• Physical violence may result in contusions, lacerations, burns, broken bones, internal injuries, concussions, and other forms of head injury. There may be resultant scarring, branding, and disfiguration, as well as functional limitations.
• Neglect and poor nutrition may result in malnourishment, new medical illness or disease, complications due to or exacerbation of pre-existing chronic medical conditions (e.g. diabetes, asthma) and untreated injuries.
• Sexual contact may result in sexually transmitted infections (STIs) and HIV/AIDS. Untreated STIs lead to various health problems including immune suppression, cancer, or liver damage/failure, pelvic inflammatory disease, which can lead to infertility and ectopic pregnancy.
• Unwanted pregnancy may result in forced or elective abortion, miscarriage, maternal complications (teens are at especially high risk) and fetal/newborn complications.
• Sexual assault can lead to genital and/or anal trauma and rarely, more severe internal injury. It can also lead to other injuries found with sexual assault such as contusions and concussions.
• Dental complications due to physical violence, inadequate dental hygiene.
• Substance use problems and medical complications of substance use problems
• Forced tattoos or branding
• Chronic pain and/or fatigue

Experiences of sex trafficking and sexual assault (that sometimes also co-occur with labor trafficking) may have profound impacts on the sexual health and wellbeing of youth. This includes:

• Experiences and understanding of healthy sexual relationships, including capacity to trust and expectations of mutuality and non-exploitation
• Problems with sexual function and experience of pleasure
• Lasting reproductive health challenges
• Fears and concerns regarding acceptance of current and future sex partners

For more on sexual health, click here.

Experiences of trafficking can have profound impacts on a youth’s social development and interpersonal relationships.

• Loss of trust in others
• Challenges in understanding of healthy relationships free of exploitation, coercion, and harm
• Concerns about future romantic and sexual relationships
• Isolation and disconnection from peers and caring adults, often resulting in continued association with others still being exploited, with whom they experience belonging free of judgment and stigmas

Trafficking experiences can have profound impacts on a youth’s spiritual well-being - their sense of connection to others, place in the world, belief in a benign or benevolent spiritual presence larger than themselves, purpose or meaning in life. Because trafficking, by its nature, involves exploitation, harm, and exposure to depravity, it can be difficult to maintain a balanced perspective on humanity, hope for the future, and belief in human good.