Psychology of Women Quarterly, 30 (2006), 276–290. Blackwell Publishing, Inc. Printed in the USA. Copyright C 2006 Division 35, American Psychological Association. 0361-6843/06

“YOU CAN’T HUSTLE ALL YOUR LIFE”: AN EXPLORATORY INVESTIGATION OF THE EXIT PROCESS AMONG STREET-LEVEL PROSTITUTED WOMEN

Rochelle L. Dalla University of Nebraska–Lincoln

Between 1998 and 1999, 43 street-level prostituted women were interviewed regarding their developmental experiences, including prostitution entry, maintenance, and exit attempts. Three years later, 18 of the original 43 participants were located and interviewed. This exploratory follow-up investigation focused on the women’s life experiences between the two points of contact, with emphasis on sex-industry exit attempts. Five women had maintained their exit efforts and had not returned to prostitution, nine had returned to both prostitution and drug use, and one had returned to prostitution only. Three additional women had violated parole and been reincarcerated. Themes evident among those who were able to stay out of prostitution and refrain from substance use are compared to those whose exit attempts had not been successful. Suggestions for intervention and outreach are presented, as are directions for future work.

Prostitution activities and the contexts in which prostituted 1994), chemical dependence typically motivates contin- women work and survive are far from homogenous. Com- ued involvement (Flowers, 1998; Inciardi, Lockwood, & pared to other prostitution venues, such as escort services, Pottieger, 1993). street-level sex work is much more dangerous, with less Leaving the sex industry is a process, not an event monetary return (Maher, 1996; Miller, 1993). The past (M˚ansson & Hedin, 1999; Williamson & Folaron, 2003). decade has witnessed an explosion of research documenting Understanding reasons for entering and maintaining pros- why and how women become involved in street-level pros- titution involvement, as well as the exit process, is neces- titution. Drug abuse (Potterat, Rothenberg, Muth, Darrow, sary for critically evaluating intervention efforts aimed at & Phillips-Plummer, 1998), childhood victimization (Dalla, this unique population (M˚ansson & Hedin, 1999). Yet, few 2003; Earls, 1990; McClanahan, McClelland, Abram, & studies have directly assessed women’s exit attempts. The Teplin, 1999), runaway behavior (Nandon, Koverola, & current investigation was intended to address this gap in Schludermann, 1998; Seng, 1989; Simons & Whitbeck, the literature by examining developmental processes asso- 1991), and economic necessity (Hardman, 1997) are pre- ciated with the entry-exit-reentry cycle; the study focused cursors to prostitution entry. Data have also been gar- on identifying factors that promote and challenge efforts at nered exploring the social milieu surrounding the game1 leaving the game. of street-level sex work. Although drug use as an ad- Three previous studies have examined sex-industry exit diction, rather than a recreational activity, often ensues attempts; only one of the three focused exclusively on street- after prostitution entry (Dalla, 2000; Graham & Wish, level prostituted women. Williamson and Folaron (2003) interviewed 21 women involved (or formerly involved) in street-level prostitution. They describe a five-stage pro- cess model, from prostitution entrance to exit, including Rochelle L. Dalla, Family and Consumer Sciences, University of enticement into the lifestyle, learning the lifestyle, living Nebraska–Lincoln. the lifestyle and trusting in the game, caught up in the This research was partially supported by grants from the Foun- lifestyle, and leaving—or taking stock and getting out. Tak- dation for the Scientific Study of Sexuality (FSSS) (#01-003) and the University of Nebraska–Lincoln Layman Trust Funds (#26- ing stock and getting out is characterized by cognitive ap- 6227-0033). praisal, emotional adjustment, and behavioral change. The Address correspondence and reprint requests to: Rochelle L. authors write, “It is the sum total of daily hassles, acute Dalla, Family and Consumer Sciences, University of Nebraska– traumas, and chronic conditions that precipitate a woman’s Lincoln (Omaha campus), ASH 102, Omaha, NE 68182-0214. decision to exit prostitution” (p. 283). Institutional pres- E-mail: [email protected] sure, largely from law enforcement and child protective

276 Exit Processes 277 services, also influence exit decisions. However, lacking per- therefore reasonable to assume that different exit strategies sonal desire to quit, “...outside restrictive measures are only exist between women involved in street-level versus other temporary” (p. 283). Williamson and Folaron (2003) note types of sex work. further that exiting is not necessarily permanent because A second limitation of the previously mentioned studies reentrance will likely occur in the absence of support. Fi- was that they utilized cross-sectional research methodolo- nancial hardship is a primary factor in a woman’s decision gies and thus, developmental processes were difficult to ex- to reenter the game. amine. For instance, recall that M˚ansson and Hedin (1999) Two other studies offer additional insight. The com- divided their 23 participants into three groups. Women in mercial sex industry in Thailand has recently received the third group (i.e., those who developed a marginal exis- considerable attention, largely due to a severe HIV epi- tence) appeared at greatest risk of prostitution reentry, thus demic attributed to prostitution (Schwartlander, Stanecki, requiring special services. However, lacking follow-up data, & Brown, 1999). In one such investigation, Manopaiboon it would be premature to develop services for one group as- and colleagues (2003) interviewed 42 Thai sex workers to sumed to be at high risk for reentry, just as it would be determine factors facilitating or inhibiting their ability to premature to assume that the others (i.e., those who transi- leave the industry. Only 1 of the 42 had never quit sex tioned into work or structured treatment) were not at risk work, 25 had quit and reentered at least once, and 16 quit of returning to prostitution. Moreover, one might reason- and never returned. Factors influencing the women’s de- ably assume that the primary factors that trigger reentry by cisions to remain in or leave sex work included the de- women who transition into roles involving work or study or velopment of new relationships, fear of HIV/AIDS, and who enter structured treatment would differ from those economics. Of the three reasons, economics was “...the motivating reentry by women in the marginal existence main reason for initiating, remaining in, or returning to group. Cross-sectional studies preclude analysis of change sex work” (Manopaiboon et al., 2003, p. 48). Given that over time. Because exiting prostitution often involves nu- few employment options (e.g., farmer, laborer) exist for merous entry-exit-reentry cycles, follow-up studies are nec- women in northern Thailand, the participants’ families of- essary to understand fully the exit process, including the ten supported their daughters’ prostitution involvement. experiences and events that propel women out of prostitu- “[Participants] did not feel that they would be stigmatized tion and back in following exit attempts. because of their former career as a sex worker...they had Follow-up data on street-level prostituted women are done the work out of economic necessity and their commu- difficult to obtain, largely because the population is elusive nity accepted that” (p. 48). Importantly, the sex workers in and transient. Maintaining contact with prostituted women this study were involved in prostitution venues other than across time presents enormous challenges that render qual- street-level prostitution (e.g., karaoke bars, massage par- ity long-term work very difficult. In the present study, I built lors), which may account for the visibly absent mention of on previous work with prostituted women to examine the either drug use or violent victimization. exit-reentry process. Between 1998 and 1999, intensive in- Finally, in a Swedish investigation, M˚ansson and Hedin terviews were conducted with 43 street-level prostituted (1999) interviewed 23 women who were or had been in- women. This previous research was intended to document volved in the sex industry. Although many were street-level developmental processes with particular attention on pros- prostituted women, participants involved in various types of titution entry and continued involvement. Results of this sex work (e.g., escort services) were also included. M˚ansson work have been published highlighting intergenerational and Hedin (1999) identified two types of “break-aways”: familial processes (Dalla, 2003), life in the game (Dalla, those that happened quickly by women loosely associated 2002), and violence associated with street-level prostitu- with the sex industry and those that occurred gradually af- tion (Dalla, Xia, & Kennedy, 2003). The current study was ter years of exploitation. Based on the women’s break-away a follow-up investigation that further explored developmen- experiences, participants were divided into three groups: tal experiences of street-level prostituted women, with em- (a) those who transitioned directly into a new role involving phases on exit strategies and successes. The goals of the work or study, (b) those who entered structured treatment investigation were to: (a) document the street-level entry- (e.g., detox), and (c) those who developed a marginal exis- exit-reentry process, (b) identify factors which contribute tence with high risk for prostitution reentry. to reentry following exit, and (c) identify factors which pro- Although valuable for beginning dialogue on a particu- mote continued success among women able to remain free larly vulnerable female population, several limitations are of the game for a significant amount of time. inherent in the prior studies that examined the prostitu- tion exit process. First, two of the three studies (those in Thailand and Sweden) included participants involved METHOD in a variety of different types of prostitution. Only the Participant Recruitment work of Williamson and Folaron (2003) focused exclusively on street-level prostituted women. Street-level sex work is Eighteen women composed the follow-up sample (repre- qualitatively different from other forms of prostitution. It is senting 42% of the original 43 participants). The 18 women 278 DALLA were located between 2001 and 2002, approximately 3 years Participants engaged in an in-depth, audio-recorded inter- after the initial interviews of 1998 and 1999. They were lo- view. The interviews were semi-structured to elicit informa- cated using a variety of strategies similar to those used for tion across a broad range of issues, including prostitution en- participant recruitment during the first wave of data col- try and continued involvement, drug use, relationships with lection. First, the director of the Hope Center2,aninter- significant others (children, partners, and family members), vention program designed to assist prostituted individuals, residence and employment patterns, community services was contacted. She in turn contacted several of the original and assistance, and future goals. Interviews were structured participants who had maintained communication with the to emphasize those content areas or themes that emerged Center; nine individuals interested in participating in the as most significant during the initial interviews of 1998 and follow-up interview then contacted me. Second, I returned 1999. A series of open-ended questions within each of these to the maximum-security women’s prison where 14 individ- content areas was created prior to data collection. I began uals had been interviewed initially (1998 to1999). Three of each interview by asking participants to describe significant the original 14 had been released from prison since they developments in their lives since the initial interview. Fur- were initially interviewed and then reincarcerated. All 3 ther questions were asked regarding what each participant agreed to participate. The parole officers of 7 other women deemed as “significant developments” in her life. As the in- were also contacted and 1 additional participant was found. terviews continued, I asked questions within each content The 5 remaining women were located through word-of- area mentioned above. The list of predetermined questions mouth. remained in a folder, so as to keep the interviews as infor- At the time of the follow-up interviews, participants mal as possible throughout the process. As the interviews ranged in age from 33 to 59 years (M = 41 years). Most culminated, the list of questions was scanned to ensure that were Black (n = 10) or non-Hispanic White (n = 5). Many all content areas had been addressed adequately. (n = 7) were divorced and the majority (n = 17) had chil- The amount of time spent discussing each content area dren. Only 7 of the 49 children lived with their mothers. and the ordering of questions varied depending on each par- The average age at which the women had entered the sex ticipant’s life situation and developmental experiences over industry was 20.7 (range = 11 to 31 years) and all but one the past several years. Interviews were conducted in private reported current or prior chemical addiction. Substance locations, such as participants’ homes or rooms in shelters. dependence preceded prostitution entry for less than half Participants were compensated $35 for their time, except (41%; n = 7). for the prison inmates, who were restricted from receiving Statistical comparisons on key demographic variables any form of compensation. After all data were collected, were made between the 18 women who were located at the audio-recorded interviews were transcribed verbatim both data collection points (1998–1999 and 2001–2002) and by trained, graduate-level research assistants (RAs). the 25 women who participated in the initial investigation but who could not be located for a follow-up interview. Chi- square tests were used to examine race, marital status, and Data Analyses use of drugs; Mann Whitney t tests allowed for comparisons This investigation was intended to explore the exit process, on age, age of entry into prostitution, years involved in the with attention devoted to experiences and events that pro- sex industry, number of children, and years of education. mote or inhibit exit success. To this end, the 18 partici- Several significant differences emerged. First, the women pants were divided based on whether they had remained who participated at both data collection points were sig- free of prostitution, drugs, and other criminal activity in χ 2 = = = nificantly more likely to be single ( 3.6, df 1, p the previous 3 years. Two groups emerged. Five women χ 2 = = = .06) and African American ( 3.7, df 1, p .05) com- had successfully avoided prostitution, drug use, and other pared to the others, who were more often married and Euro forms of illegality. The remaining 13 women had experi- American. Additionally, those who could not be located for enced significant setbacks in their exit attempts. Nine had = a follow-up interview were younger (M 30.3 years versus returned to both prostitution and illicit drug use, one had = =− 37.6 years, SD 6.4; Z 3.22; p< .001) with fewer years returned to prostitution only, and three others had vio- = spent in the sex industry (M 8.8 years versus 15.2 years, lated parole and been reincarcerated after brief returns to = =− SD 7.1; Z 2.24; p< .02) compared to the 18 who the outside world. Thus, at both points of contact, three were located twice. The groups were not significantly differ- women were located and interviewed while serving prison ent on number of children, years of education, or drug use. terms. All three described extensive involvement with the Table 1 provides complete demographic information for the legal system for a variety of offenses, including prostitution, 25 women who were interviewed only once (column one), shoplifting, forgery, assault, and possession and distribution and for the 18 women available at both the first interview of controlled substances. (column two) and at follow-up (column three). Data from the two groups were then analyzed separately using Thematic Analysis (Aronson, 1994; Taylor & Bog- Data Collection dan, 1984). The process began with documentation of all I personally collected all data. The procedures and goals patterns of experience (e.g., relationships with significant of the investigation were explained to each participant. others). Patterns of experience described by the women, Exit Processes 279

Table 1 Demographic Comparisons: Original Sample Time 1 and Subsample Times 1 and 2 ∗ Time 1 Time 1 (Subsample) Time 2 (Subsample) (n = 25) (n = 18) (n = 18)

Age Mean 30.3 37.6 41 Mode 21 34 36 Range 19–42 30–56 33–59 Race/ethnicity (n) African American 8 10 10 Euro-American 15 5 5 Native American 2 3 3 Marital status (n) Never married 16 6 5 Married 5 5 2 Divorced/separated 3/1 6/1 7/4 Residence (n) Shelter 7 7 2 Friends 2 1 0 Prison/jail 11 5 7 Partner/husband 2 4 3 Alone/with children 3 1 6 Education Mean 10 yrs. 11.7 yrs. 11.7 yrs. Range 7th -2yr. coll. 9th -2yr. coll. 9th -2yrs. coll. GED (n)779 Mothers (n)211717 Total children 56a 49 49b Mean 2.7 2.8 2.8 Range 1–5 1–7 1–8 Child(ren)’s residence (n) Mother 6 3 7 Father 7 12 11 Grandparent/aunt 5/8 5/3 3/1 Foster Care/adopted 13/8 11/3 1/8 On own 6 10 13 Otherc 32 5 Prostitution Age at entry Mean 18.4 20.7 20.7 Mode 18 18 18 Range 13–31 11–31 11–31 Time in sex industryd Mean 8.8 yrs. 14.8 yrs. 16.4 yrs. Range 6 mos. - 25 yrs. 1 yr. - 44 yrs. 2 yrs. - 47 yrs. Drugse (n) Drug abusef (n)231717 Pre-prostitution 8 7 7 Concurrent 5 3 3 Post-prostitution 10 7 7

∗These are the 25 women interviewed at Time 1 who could not be located at Time 2. aDoes not include total number of pregnancies; several reported miscarriages and aborted fetuses. bBarb had another child (her eighth) and Talisha lost a child (i.e., murdered) between Times 1 and 2. Thus, the total number of children remained the same despite the range change. cIncludes individuals who are living in mental health facilities, incarcerated, or homeless. dIncludes street-work, nightclub dancing, and other forms of prostitution (e.g., escort services). eDrugs of choice include crack cocaine, methamphetamines, alcohol, and heroin. fSubstance addiction or abuse was determined by the women themselves and not based on clinical criteria. 280 DALLA but not initially identified as primary areas of interest, such requirements, regained custody of her two sons, and they as religion and mental health, were also catalogued at this lived together in a transitional housing unit. Yolanda had stage. The next step involved identifying information re- graduated from a treatment program, lived alone in an lated to already classified patterns. This step is critical be- apartment, and was employed full-time at a dye manufac- cause individuals frequently elaborate on particular events turing plant. She attended school part-time and had reg- or issues at multiple points throughout the course of an ular contact with her two children. Kiley was employed interview. For instance, nearly all of the participants de- full-time as a sales coordinator, had recently purchased her scribed the influence of significant others in their lives. Re- first home, had regained custody of her oldest child (her lationships with significant others was identified as a theme youngest two had been adopted), and was attending school and all patterns of experience related to important peo- part-time. Rachel was married to her long-time partner, liv- ple in these women’s lives were catalogued. Importantly, ing in an apartment, working full-time, and shared custody relationships with significant others were described differ- of her two children. Among the five women, Marlee’s sit- ently between those whose exit attempts were successful uation had changed the least between the first and second and those whose attempts were not successful. Those whose interviews. She was still married, living with her husband, exits had been successful spoke frequently about relation- and working full-time. However, her stepdaughter was no ship renewal; those who had returned to prostitution or drug longer living in her home. use emphasized relationship loss. In the next phase of data analyses, related patterns are combined and catalogued into Decisions to Exit subthemes, or patterns within the larger themes. Several The five women described significant events culminating in subthemes were identified. For example, women whose ex- their decisions to exit the sex industry. Four of the five re- its had not been successful spoke frequently about relation- ported that “hitting bottom” motivated their commitments ship loss, including loss of both long-term and new or antic- to the exit process. Yolanda and Kiley hit bottom when ipated relationships. These patterns were classified as sub- they were viciously attacked by clients; neither thought she themes within the larger theme. A graduate-level RA and I would survive. Yolanda sought immediate help through a coded all the data. When coding discrepancies arose, origi- 12-month residential drug and mental health treatment fa- nal transcripts were reexamined until coding agreement was cility. Although the attack on Kiley did not propel immediate reached. action, it did initiate the exit process. She recalled, “I just got tired. I started going to detox more frequently. Then, RESULTS the last time [at detox], it just happened like that [snaps fingers]. I just reached out and asked if there was a bed in Among the 18 women who completed a follow-up inter- long-term care.” view, only 5 had remained free of prostitution and drug use. Amy described hitting bottom when she lost custody of Themes that emerged as prominent in influencing their exit her children due to her addiction to crack cocaine. How- successes are described below, with background informa- ever, she did not immediately enter treatment; her initial tion presented first to contextualize their life situations. response to losing her children was denial and increased drug use. Still, within 6 months she was participating in an in-house treatment program. “CPS [Child Protective Ser- The Road to Recovery vices] made me,” she stated. “They said ‘you have to go Background to treatment to get your kids back.’” Rachel also described hitting bottom. She was sentenced to prison for 4 years on When originally interviewed in 1998 or 1999, Amy3, Kiley, multiple drug and solicitation charges. “As much as I hate Marlee, Yolanda, and Rachel had not engaged in prostitu- to say it,” she remarked, “something good comes out of tion activities for an average of 3.1 years (range = 3 months something bad. Prison did save my life. It really did. I was to 8 years). At that point in time, the five indicated that they out there killin’ myself.” At the time of her imprisonment, had entered the sex industry at an average age of 23 years Rachel had a $500/day addiction to crack cocaine and had (range = 18 to 31 years); they had been involved in prosti- nearly overdosed on three separate occasions. tution for an average of 9 years (range = 1 year to 16 years). Unlike the others, Marlee exited largely due to the de- Four reported having been chemically addicted. Also, at the clining economic viability of street-level prostitution. For initial point of contact, Amy, Yolanda, and Kiley were living years, street-level sex work had been a lucrative endeavor in shelters, Rachel was imprisoned, and Marlee lived with for Marlee and her husband4. However, the widespread her husband in a home they owned. Four of the five (all but use of crack cocaine by prostituted women had signifi- Marlee) had biological children, but none retained custody. cantly altered the street-level prostitution economy. Marlee In contrast, Marlee’s stepdaughter lived in her home. Only explained: Amy and Marlee were employed. When interviewed in 2001 or 2002, four reported signif- The girls out there now are not like we used to be. icant life changes. Amy had completed all state-mandated They’re out there for drugs. That’s why the business Exit Processes 281

is so bad. It’s not even worth it. They’re crack heads you put me in your life.’” She continued, “He was kinda like and will do anything for a little bit of money...they’re a counselor. He was not only a parole officer but a friend. not real ones [prostitutes]. He made a difference in my life.” Formal services, including professional residential treat- In addition to economic changes, Marlee’s stepdaughter ment, safe housing, and individual and group counseling moved into her home. The incident impacted many areas were described as particularly important during the initial of her life. She noted: exit phase. Although Marlee did not receive formal services, I stopped doing a lot of things because of my step- she and the other four women were in agreement that indi- daughter being here with me. How can I tell a child viduals ultimately determined the outcome of their own exit “you need to go to school, get a good education, go attempts. Marlee concluded, “If you wanna be nothin’ all to college, get a good job” when she’s looking at you your life, I guess that’s what you’re gonna be.” In addition to saying “well you don’t work—and we don’t live bad,” formal support and personal choice, informal support from you know? We was showin’ her there’s another way to significant others who denounced life in the game was fur- do this [make a living]. ther mentioned as essential for long-term abeyance. It is important to note that Amy, Kiley, and Rachel had all Significant Relationships/Emotional Attachments attempted to exit at earlier points in their lives. Moreover, it is impossible to say whether any of the five will return to The five women who exited prostitution received substan- prostitution or use drugs in the future. Nonetheless, they tial support from informal network members. Given their had successfully avoided the sex industry, substance use, varied life circumstances, sources of informal support dif- and criminal activity for a significant amount of time5. Four fered markedly between them. main themes emerged as significant in their ability to exit. Family and partners. Rachel and Marlee noted that Formal Support Services family members, including parents and siblings, had been vital to their exiting. Marlee explained, “It was easy for me to Formal support services were critical during the initial get off the streets because of my mother. I wasn’t raised to exit stage. With the exception of Marlee, residential treat- be a hooker, I had a beautiful mom—she never smoked, ment and continued professional services provided neces- drank, or anything. So I lost myself for awhile, but I’m sary support at a crossroads in these women’s lives. For back!” Aside from biological kin, Marlee and Rachel noted instance, after being raped by two men, Yolanda went to that their husbands were their most critical sources of emo- great lengths to find residential treatment. Because services tional support. Both women had been involved in prostitu- were not available in her community, she moved to a city tion with their husbands. Marlee’s husband had been her 300 miles away to obtain residential care. She also received pimp; together they worked the streets for nearly a decade. group and individual counseling through the Hope Center. Importantly, they exited the sex industry together. In a sim- She conveyed her belief that “Counseling is key. Counsel- ilar vein, Rachel’s husband was a former client and was a ing teaches you to think for yourself. Your counselor is not heroin and crack addict. They met 5 years prior to her incar- there to think for you—but to give you the tools to think for ceration; crack use was a daily routine for both. However, yourself.” during Rachel’s imprisonment he stopped using drugs and Kiley and Amy also entered residential treatment. Kiley’s wanted the same for Rachel. He gave her an ultimatum: treatment lasted 6 months and Amy’s was twice as long. him or the game. She chose him and commented, “He is Kiley participated in AA (Alcoholics Anonymous) and NA my biggest support. He has strength that’s unbelievable.” (Narcotics Anonymous), and both women received indi- In contrast, Yolanda, Kiley, and Amy reported that they vidual and group counseling through the Hope Center. In were physically and emotionally cut off (Klein & White, addition, after Amy regained custody of her sons, the three 1996) from their extended families due to severe and sus- attended family therapy. Like the others, Rachel also took tained childhood abuse (see Dalla, 2003). “Family” for advantage of formal services. While imprisoned, she en- these three included their children and church groups only. rolled in every class that was offered. The teacher of the Moreover, all three described apprehension about roman- substance abuse class “... was excellent—she made a big tic, intimate relationships and general distrust of men. Kiley impact on my life...I’d like to thank her, you know?” After believed avoiding men was critical to escaping prostitution. her release, Rachel entered a 4-month residential work- She noted: release program and excelled in her weekly AA and NA meetings: “It got to where I was talkin’ more than anybody It is important to be in touch with yourself and be else at the meetings ...and they asked me to start chairin’ relationship free, from men especially. They [coun- the meetings!” Rachel also reported to a parole officer who selors] suggest going through recovery relationship played a valuable role in her successful exit. She explained, free, and I firmly believe that. It takes a lot of energy “He tells you what you need to hear, not what you want to to go through recovery... and men will manipulate hear. He told me, ‘I didn’t ask to be brought into your life, you. 282 DALLA

All three described years of experience with dysfunc- She then described a specific encounter with a former client tional relationships. They admittedly lacked role models of by saying: strong partnerships and were uncertain about the likeli- There is this one guy named Jerry. He came by [place hood of ever developing and maintaining healthy, intimate of work] one day and asked me if I still worked [pros- relationships with men. tituted] part-time. I said, “No Jerry, I don’t think God would approve of that.” He said, “I didn’t think so.” Children. Participants discussed their children fre- And I haven’t heard from him since. quently throughout the interviews. Amy and Rachel, in par- ticular, reported that the desire to be a better parent was She continued, “I don’t see many [old playmates] but I am significant to their exiting success. Rachel explained that not afraid to face these people of the past.” Rachel, too, parenting and involvement in the game cannot coexist. She had sporadic contact with former clients while working as stated, “[Before], I had them physically, not mentally. I was a waitress. She explained: not there, ya know? They’d sit out in the living room and There was this guy that kept comin’ in there that was a I’d stick my arm in the bathroom door and get shot up with trick of mine. ...He would step on my feet “Hi baby” a needle.” She continued, and make little remarks. I couldn’t do it. I would ac- Iamtrying to be the mother I was supposed to be tually ask the other waitresses to take his table. all along. The main reason I have stayed straight is—I Rachel noted further: look at my kids. I know the kind of person I was before I started on crack, and I’m not bragging—but I was When I used to hunt for my [drug] dealers I couldn’t a hell of a woman. I lost my self-respect. When I lost find ’em for nothin’. But when I got out of prison the my kids I lost my self-respect. I lost everything. first two weeks I ran into every dealer in town ...I told ’em I was straight and to put the word out. Since deciding to exit, the parent–child relationship had changed dramatically for Amy as well. At the time of our Marlee and Kiley described similar encounters. None second interview, she and her children had been reunited initiated contact with old playmates and if chance en- and living together for nearly 3 years, but the transition was counters occurred, they described interacting but avoiding difficult. Amy commented: prolonged conversation. They indicated further, however, that they were not “afraid” of former acquaintances. In- I was afraid that everything I was doing was wrong, stead, they intimated that they were far enough removed and if I got a little bit angry they [sons] would say from the game that its lure had diminished. Yolanda’s sit- “that’s old behavior”—that I was returning to my old uation was unique in that she moved to a new city after behavior. Because when I was using, I got mad a whole deciding to exit. She believed the move was critical to her lot [emphasis included]. So they were scared of my exit success and remarked: “I had a fresh new start in a new going back to “old behaviors.” town. And I set up boundaries.” It took time and concerted effort, but eventually Amy was able to regain her children’s trust. She explained: Economics and Employment I went to all my meetings, and when I told them “I will The ability to legally earn a living wage is paramount to be back in an hour” I was back in an hour. Because they sustained withdrawal from the sex industry. If one cannot af- didn’t trust me. I think they were afraid to come home ford the basic necessities of life, illegal schemes and income- because I never showed them any security. They had generating ventures abound—particularly for women with a lot of fears. We did a lot of therapy. connections to the street subculture and its pervasive drug trade. That said, employment was discussed frequently Old playmates. In addition to describing efforts to throughout the interviews. Despite extended absences maintain and strengthen relationships with certain network from the job market, all five secured legal employment. members (i.e., family, partners, children) these five women Participants’ first jobs typically included entry-level work also described distancing themselves from others—namely, (e.g., factory, fast food) that evolved into higher-paying old playmates. For instance, when asked about former ac- and status positions. For instance, when originally inter- quaintances, Amy remarked, viewed, Amy worked in the fast-food industry; when inter- viewed 3 years later, she managed a gas station. Despite Every once in awhile I believe that God will have no prior training, she proudly noted being hired for the someone stop in the gas station [her place of employ- position because she was persistent and a fast learner. ment] and I will be there and it is either to show me Kiley, too, had experienced benefits of work commitment. what it will be like if I go back out there [on the streets] In 3 years she had earned enough money to buy her first or to show them what their future could be like if they home, whereas in the not-too-distant past she had been in would get God in their lives. debt by thousands of dollars. Similarly, Rachel frequently Exit Processes 283 worked 14-hour days and proudly described her parole of- hooking, I used to stand outside this church and just ficer’s reaction: cry. I saw a guy one time going to the church, I said “Would you pray for me? I really don’t want to do this, He started seein’ my paycheck stubs where I’d have but I don’t know how to get out of it. I’m not strong so many hours and he says, “Well how in the ...how enough.” come you’re doin’ that? Habba dabba.” And I said, “Isn’t that what you want?” “Yeah, but don’t burn After her release from prison, she found God again and yourself out.” And I said, “Just let me do what I gotta reported, do.” I’m not a Bible thumper—but I look at my kids, I look Economic viability not only allowed for daily subsistence, at my husband, I look at where I was and I’ve got God but also appeared to promote self-confidence. For instance, so much in my life right now. I couldn’t do it without Yolanda noted being “hired on the spot” after completing Him. I really couldn’t. an application and taking a test. She was hired as a recep- ... Amy described a similar journey and attributed equal tionist, “ but they couldn’t keep me busy. So now I run credit to God for her ability to exit prostitution. She was their hydro-berg machine and several other machines.” She introduced to religion through a co-resident at a treatment continued, “Yeah, I’m developing skills. It feels good.” Like facility; an interaction between them had a profound im- Rachel, it was not unusual for her to work long days and pact. She explained: earn overtime. Employment opportunities appeared par- ticularly significant during the initial exit stage for Yolanda I was always talking about my kids and wondering if and Kiley, both of whom lacked extensive informal sup- they were okay and blah, blah, blah and she told me port. Kiley explained, “I was paying off my bills instead “You need to give your kids to God because you can’t of getting high.” Likewise, Yolanda replaced her addiction take care of them. You never did take care of them.” “by working.” All four women appeared to thrive on their And it was sad, but it was true. I learned I had to focus work-related responsibilities, skill development, and ability on myself and my recovery. In order for me to be a to demonstrate competence and reliability; their employ- whole person, I had to recover first. ment records were a source of pride. When interviewed in 2001, Amy’s entire support system was In contrast, because prostitution had been lucrative for comprised of friends from church. Marlee, the transition to legal employment was financially Similarly, after exiting the industry, Marlee described disappointing. She explained, sporadic church involvement at her husband’s urging, fol- It was kinda difficult when I started back [legal work]. lowed by steady attendance, and then regular participation I used to look at a check and would be like, “Uh—I in Bible study and prayer meetings. She explained, can’t believe this is what won out [over prostitution]!” I used to want a lot of money. Money does not make But now, I thank God for the little checks I get. you happy. I remember one time I had $6,000 in cash She explained the sheer practically of legal employment: and all my bills were paid. I was sitting in the bathtub crying. I didn’t understand then why I was crying, but Before, I just lived day by day, didn’t think about the there was a void in my life. It was God. future. And here it is I’m just starting to work—and keep in mind just about ready to retire. You can’t hus- Kiley and Yolanda were equally invested in their church tle all your life. What are you gonna do when you get communities; both attended services regularly and partic- too old, you know? You can’t draw Social Security. ipated in Bible study groups. Yolanda was also an active I don’t have really anything in Social Security and member of church choir and “praise team.” I’m 40 years old! So I’m really mad at myself about The most prominent and consistent theme to emerge that. during data analysis with these women centered around the church. As their time out of the sex industry continued, The Church Community reliance on their church communities for inspiration and support increased and use of formal services slowly dimin- All five women described, at length and spontaneously, be- ished. lief in a higher power and the importance of organized re- ligion in their successful exits. All also described spiritual Summary journeys that began slowly but gained steady momentum. During the initial exit period, four of the five women took ex- Rachel, Amy, and Marlee reported childhood introductions tensive advantage of a variety of professional services (e.g., to religion, but only as adults did belief in a higher power residential treatment, AA/NA, counseling/therapy). Use of become central in their lives. Rachel noted, formal support was, generally speaking, intense during the The religious seed was planted a long time ago. My initial year of the exit process. With time and increased mom used to take me to church. Then, while I was confidence, reliance on informal support increased and use 284 DALLA of formal services lessened. Importantly, these women had a “preacher’s wife.” During the follow-up interview, she severed ties with old playmates; maintaining sobriety and said, freedom from the sex industry demanded this. Moreover, their informal networks consisted of people who would not I thought at the time [1999] that my life and every- tolerate life in the game. Loss, or threatened loss, of those thing was going great. I was clean. I felt good about significant relationships, whether with partners or children, myself. I felt good about my life. My kids felt good was central to exit success. Additionally, they described de- about me, my family, everybody. And I was in love. veloping new support systems and connections to conven- However, within months of program discharge, her part- tional society as they increasingly immersed themselves in ner began using drugs again and then turned violent. Sharia various church groups. All described being impacted by a sought refuge with her sister, an active drug addict. Several higher power. In addition, although employment was nec- days later, she was using again, and prostitution soon en- essary, it also appeared to fill a void, particularly during the sued. Sharia stated, “There’sa lot of things that you shouldn’t initial exit stage for those whose informal support systems do during recovery that I did do because I thought I could were sparse. The work arena provided a context in which handle this. But anything small can get you back to relapse.” these women obtained new skills and received recognition Similarly, during the initial exit stage Trina, Char, and for their abilities and commitment. They reported that their Lettie began new relationships, all of which ended in feel- lives were dull, comparatively speaking; their time was spent ings of disappointment and worthlessness. Char, for exam- at work, attending religious services, or at home alone or ple, explained how she “...met a man” before completing with family. Still, they were content—a feeling impossible treatment through the Hope Center. He was a user, “So I to capture when immersed in the game. Rachel’s statement, did what he did.” When asked what could have prevented “I wouldn’t change my life right now for a million dollars,” her from relapsing, she commented, “Some man who loved applied to all five women. me,” and then continued, “I thought he did but I must be crazy.” At the time of our follow-up interview, Char was mar- The Entry-Exit-Reentry Cycle Continues ried to a physically abusive man who forced her to prostitute for drug money. Background Like Marlee and Rachel, Lettie too was married to a As noted earlier, 13 women had attempted to exit the street- man well aware of her prostitution and drug involvement. level sex industry, but experienced significant setbacks re- In distinct contrast from Marlee and Rachel, however, her sulting in continued prostitution involvement, drug use, or partner was not a source of support and her marriage was imprisonment. Analysis of follow-up interview data with failing. She explained: these women revealed developmental trajectories and ex- We are still together, but not really [they were sep- periences that differed substantially from the five women arated]. He has a lot of dysfunctions... .Hebrings whose exits had been successful. Themes that emerged as me down. If there is a cliff and I am about to jump most prominent in their return to prostitution, drug use, or he will say, “No, go over there where you can jump prison are described below. higher. Jump where it is higher and then you’ll hit those rocks.” Significant Relationships and Emotional Attachments Eleven of the 13 women (8 who returned to both prosti- She explained her relapse with the following: tution and drug use and 3 who had been reincarcerated I fell in love with this guy [not her husband]. I felt after parole violations) described events precipitating their “Oh my God, he really likes me” and then for a single return to old behaviors. Relationship loss emerged as a key no show [he failed to show up] I took that to heart theme, and further analysis revealed two subthemes: loss and thought I must be dirty—I must not be worthy of new or anticipated relationships and loss of long-term, of being loved. enduring relationships. Drugs created the perfect escape, and prostitution provided Loss of new or anticipated relationships. Unlike Kiley, an environment where she was accepted, where she be- who heeded the advice of her counselors to remain “rela- longed. She stated: “I know certain places that I can go tionship free” during treatment, four women began new re- and get money because those people still like me. I know lationships with male partners within the initial exit period. I can just go there and get money and all I have to do is All four described reentry into prostitution and drug use as lay on my back.” Lettie’s desire to fit in and belong was not precipitated by the cessation of those relationships. Sharia’s unique. In subtle ways, Char, Sharia, and Trina described situation is illustrative. She was involved in professional similar desires, and all invested hope in the development of treatment and was nearing graduation when originally new, intimate relationships as realizations of those desires. interviewed. However, she became involved with a fellow Relationship failure and subsequent feelings of rejection treatment participant, a minister, and dreamt of becoming triggered their return to old behaviors. Exit Processes 285

Loss of long-term relationships. Seven others, includ- inspiration or support. Likewise, Jackie’s 13-year marriage ing the 3 who violated parole, also described relationship ended several months after she was initially interviewed. loss. Contrary to the loss of new or anticipated relationships, Furthermore, her grandmother, the one person she felt however, these women spoke at length of the loss of long- close to, had died. She explained “...and I just didn’t care term, enduring relationships with male partners, children, about nothin’ no more because I had just lost my grandma. and other family members. Marti is a case in point. When My grandma was like my best friend, you know?” originally interviewed, she was living with her ex-husband Although death did not separate Bridget and Barb (and had been for 25 years, despite divorcing a decade ear- from their children, the parent–child bond was nonethe- lier). He was her sole source of companionship and only less threatened. When originally interviewed, both women friend. Months after the interview in 1998, he died, and were doing exceptionally well. They were living in struc- Marti was forced to sell their home. The cumulative losses tured settings, attending the Hope Center, and free of triggered an immediate urge to escape loneliness and se- prostitution and drugs. Barb was pregnant with her sev- vere depression. The result was drug relapse and a return enth child (her other six were in foster care or with their to prostitution. fathers), attending prenatal classes for the first time, and Four others also experienced the death of loved ones in determined to be a good mother. Bridget believed she and the 3 years spanning the original and follow-up interviews. her ex-husband would reunite and together raise their 4- For Talisha, the death was particularly devastating; her 18- month-old daughter. However, when interviewed 3 years year-old son had been murdered. The trauma compounded later, both women reported that they had returned to the when she turned to her husband for support and learned game. Bridget recalled the day she returned to drug use he was using crack cocaine. She explained, with the following: “I was upset, lonely, hurt, angry, and I was fed up.” Her ex-husband, she explained, denied her Crises like this [son’s death] and it was really hard for visitation with her daughter and was seeking legal action to me to deal with. I had a nervous breakdown and he bar further contact between them. She reacted with famil- [husband] wasn’t there to help me. He was out on the iar self-destructive behaviors involving crack cocaine and streets ...I’m trying to save him and I ended up using street-level prostitution. with him. Barb’s situation was similar in that fear of losing her chil- Money obtained from prostitution allowed Talisha to main- dren triggered an immediate need to escape; drug use and tain a chemically induced oblivion. prostitution ensued. When interviewed in 2001, Barb had All three women who violated parole and returned eight children but retained custody of the youngest two to prison had also experienced the deaths of significant only. She described how, 2 years earlier, an accumulation of others between the two data collection points. To illus- stressful events resulted in a “nervous breakdown” and she trate, 2 weeks after being released from prison in 1999, “started to crack up.” Barb’s sister intervened and removed Georgette’s “mother” (i.e., her biological grandmother) had her two children. “It was the first time in over 4 years” that died. Like Marti, Georgette was forced to sell the only home she was not able to care for her children. The incident trig- she had ever known. She explained, “I’ve never really been gered guilt and remorse for losing custody of her older six out on my own ...I lost everything out of my life, every- children. She had vowed, she explained, to be a better par- thing that I grew up with had just been wiped out.” Bryn ent to the youngest two than she had been with the others. and Jackie described similar experiences. Bryn’s father had After her children were gone, she went to a bar with every died not long after our initial interview. Further, her 19-year intention of picking up a “date.” “I figured,” she explained, marriage had ended and her relationship with her three “I was just going to be on the street [prostituting]. I didn’t children was severely strained. “That [relationship with her have any idea what was going to happen after that. I felt like children] hurts me more than anything. My kids are grown. I had already failed at everything, so whatever happens—I They were 4 and 1 when I started doing time, and now deserve.” they’re 18, 14, and 11.” Still, like Rachel, Bryn believed there were benefits to prison and explained, Old playmates. Moreover, in contrast to the five women whose exits had been successful, these 13 women had not The way men treat their women, degrade them, let- severed ties with old playmates. It was not uncommon for ting them know they are a piece of shit—he is getting them to describe continued relationships with people in- it through your mind that you can’t have anybody else volved in drug use, prostitution, or other forms of illegal ac- because no one else wants you. A lot of men, includ- tivity. In some instances, they actually pursued relationships ing mine, do that to women. To come up here [prison] with former acquaintances who often tempted their return and do some time is good for women to actually learn to old behaviors. To illustrate, Sharia knew her sister was what is going on. Out there, they go straight to the actively using crack cocaine; she nonetheless moved into drugs. her sister’s home rather than seek shelter elsewhere when Her comment clearly indicates that, despite 19 years with her engagement ended. Likewise, Char and Trina began the same man, Bryn’s marriage was not a strong source of new relationships with men known to be drug users. That 286 DALLA these women mimicked the behavior of those comprising through the Hope Center. Six had participated in various their informal networks is not surprising. structured, residential programs and 8 had attended AA or NA. Chancey participated in all of these in addition to Economics and Employment sexual addicts anonymous and an obsessive-compulsive dis- order group. Moreover, all of the incarcerated women took Among those wanting to work, securing legal employment advantage of programs and classes within the prison sys- did not appear to be problematic. In fact, since the original tem. However, unlike Rachel, who valued the educational interviews, 11 of the 13 women had been legally employed. courses offered in prison, these courses seemed to be of lit- Two clear distinctions emerged in how these women de- tle value to these women. Bryn commented, “I have taken scribed income-generating ventures, compared to the five almost every class they can offer me here [in prison] twice, who had been successful in their exit attempts. First, a clear three, four times ...none of those classes can tell me how lack of job stability or commitment was evident. It was not Iamgoing to do my life.” unusual for participants to describe working several differ- Unlike those whose exits were successful, these 13 ent jobs in numerous agencies within brief spans of time. women did not “work” their programs or fully utilize ser- They described quitting their jobs and moving on to new vices offered. Indeed, seven stopped using formal services places of employment for a variety of reasons: They did not prior to, or concurrent with, their relapses. Lettie stopped like the work, they were not “getting enough hours,” or the attending the Hope Center after returning to the game location was inconvenient. Three women had never sought because “I didn’t want to disappoint them.” And Sharia permanent employment, but instead chose to work for tem- noted that, despite having a “really good” probation offi- 6 porary agencies .Thus, their employment at any one place cer, she “...wasn’t ready to stop using drugs. So I lied to was limited to a few days only. Finally, 2 of the 11 who had her and avoided her and I stopped seeing her.” Likewise, been employed had been fired for theft. Trina stated, “I wasn’t ready [to quit]. I wasn’t trying to deal The second economic-related distinction between these with my issues. I wasn’t saying ‘I am through,’ nor was I women and those who had remained prostitution-free in- staying focused. I was not determined.” volved their frequent use of illegal, criminal acts to obtain Several also described frustration with services received. ... money quickly. Sharia reported stealing merchandise “ at Four explained how the continuously changing staff at var- expensive stores, like Dillard’s” and then reselling those ious service agencies left them lacking stable, consistent items to acquaintances. She explained: “I’d leave the tags on care providers. Frequent turnover compromised the qual- so they’d know how much the clothes were,” and continued, ity of services. Three others explained that professional help “I would get what people wanted. They would give me their for prostituted women, specifically, was not available. Two lists.” She might steal $500 worth of clothing, for instance, women refused to see counselors because they were afraid and then resell those items at half price. Georgette manu- of the consequences of revealing details of their lives to factured a similar scheme and three others simply resorted professionals. Barb explained: “I am not going to risk los- to stealing merchandise for themselves or forging checks if ing my kids over something stupid like that [talking to a they could not afford desired items. Relatedly, four women counselor].” She was afraid of arrest or Child Protective either returned to the game between the first and second Services involvement if she admitted the circumstances of interviews, or reported that they would return in the fu- her life to professional support providers. Finally, Char was ture if finances became tight. Patti commented that money asked if she would seek formal assistance again, to which earned from hustling was simply “too good to give up.” She she replied, “No, they [programs] don’t work anymore.” would not “...pass up no money, no kinda way.” And Lettie similarly explained that prostitution Mental Health ...is just too easy. You try to ask somebody to give you some money to buy milk and eggs for your kids None of the five women whose exits had been successful and they will say, “I didn’t have those kids for you. You mentioned emotional or mental health problems during our need to get a job. But, we can go in the back room, interviews. In sharp contrast, discussions of mental health okay baby?” That is a fact. A man will find money for a difficulties emerged frequently among women whose ex- blow-job quicker than he will a pair of shoes for your its had not been successful. Specifically, 7 of the 13 (54%) kids. That is a fact...He is gonna find some money who had returned to prostitution or drug use reported that for that. they had been diagnosed with some form of mental illness (e.g., bipolar disorder, clinical depression, obsessive com- pulsive disorder). Three reported a long history of mental Formal Support Services health problems; one had received electro-shock treatment Twelve of the 13 women (all but Patti) had been involved and two had been institutionalized. Moreover, Chancey, with some form of professional intervention in the time pe- who identified herself as a “sex addict,” believed her return riod spanning the original and follow-up interviews. In fact, to the sex industry resulted from mental health problems 7ofthe 13 had received individual and group counseling and a medication mishap: Exit Processes 287

I was put on some psychotropic medication which prostitution, with particular attention to delineating key fac- did a number on me ...it made me paranoid and I tors or experiences that challenge exit success. To this end, became obsessed with sex. I was thinking about sex comprehensive data were collected allowing for the lives of all the time ...I couldn’t get my mind off of it. 18 prostituted women to be contextualized through time. The value of this work is twofold. First, long-term research When asked if she would return to the game she stated, “It with street-level prostituted women is rare; information depends on what medication I’m on.” Still, Chancey was gained provides a basis for new avenues of scholarship with more fortunate than the other six women with diagnosable similarly vulnerable female populations. Second, because mental illnesses. At the time of the follow-up interviews, two distinct groups emerged, comparison between those she was the only one receiving professional mental health who had maintained their exits and those whose attempts treatment. had been less successful was possible. Three common themes emerged as influential for all Summary of the women, regardless of whether they maintained their Relationships with significant others were frequently dis- exit attempts, including the significance of relationships and cussed in interviews with the women who were unable to emotional attachments, formal support and professional maintain their exit attempts. In discussing their significant services, and economics and employment. It is interesting relationships, themes of loss or abandonment, largely due to to note that these same three themes were influential for all death or feelings of rejection, surfaced frequently. In fact, 11 women, yet the way the exited and nonexited women expe- of the 13 described how their return to drugs, prostitution, rienced each differed a great deal. Among those whose exits or other criminal behavior was immediately preceded by had not been successful, experiences with significant others stressful events or painful experiences with significant oth- centered around issues of relationship loss and disconnect ers. Relationships with male partners and children were par- rather than renewal and maintenance. Also, in direct op- ticularly problematic. In addition to experiencing the loss position to the women who had successfully exited, many of significant relationships, these women frequently noted who returned to old behaviors reported maintaining contact maintaining contact with or developing new relationships with old playmates. Thus, in addition to experiencing emo- with people who would tempt their return to prostitution, tional trauma of relationship loss or rejection, their informal drug use, or other criminal behavior. networks often consisted of individuals actively involved in Employment, or other means of earning income, also various illegal endeavors, including prostitution and drug emerged as a key theme in interviews with these women, trafficking. and nearly all had been legally employed at some time be- Moreover, unlike Marlee, who focused on long-term fi- tween the two points of contact. Even so, none described nancial well-being, or the other successful four who per- approaching employment as an opportunity to develop spe- ceived employment positions as opportunities to obtain cialized skills or to learn a trade. Their employment histories skills and demonstrate competence, those who returned were sporadic and characterized by frequent job hopping. to old behaviors expressed limited patience with, or com- Further, some appeared to prefer the ready cash associated mitment to, legal employment. Short-term financial gain, with illegal ventures to legal employment. None, however, rather than hard work and diligence, largely character- mentioned problems in finding legal employment. Also sig- ized their approach. Not surprisingly, illegal ventures often nificant was the finding that 7 of the 13 women had been ensued. diagnosed with a mental health illness and that only one was Additional distinctions surfaced as well. Specifically, de- receiving treatment. Finally, one might speculate that for- spite the consistency with which religion and spiritual re- mal services were unavailable to these women or that they birth were described by the 5 whose exits were successful, lacked access to professional intervention services. How- only 2 of the 13 who had not maintained their exits alluded ever, such was not the case. Twelve of the 13 sought as- to religion, God, or spirituality in any form. Moreover, inter- sistance through a variety of community and professional views with the 13 who had not successfully exited revealed services between the original and follow-up interviews, in- a theme of mental health difficulties, which was not evident cluding AA, NA, and individual and group counseling. Some among the 5 who successfully exited. Perhaps mental health had participated in residential treatment programs for sub- issues were not discussed by those women able to maintain stance abusers. In fact, the formal support services available their prostitution exits because none had experienced prob- to and used by these women are quite similar to, and in some lems in this area, or had experienced problems to such a mi- instances the same as, those available to and used by their nor degree that they played little role in their ability to exit. “exited” peers. On the other hand, perhaps some of the five had, indeed, experienced mental health difficulties, but received enough professional help so that their exit efforts were not jeopar- DISCUSSION dized. Unfortunately, data needed to probe this issue fur- The goal of this investigation was to explore the exit process ther were not collected. However, the available information among women attempting to leave the game of street-level indicates that a need for professional mental health services 288 DALLA exists among street-level prostituted women. It is important to prostitution, drug use, or criminal activity would result to point out that I did not initiate discussion of mental health in some (i.e., Bryn, Sharia) being placed in the preparation with any of the participants. Fifty-four percent of those who or action stages, and others (i.e., Char, Patti) being placed returned to prostitution, drugs, or other criminal behav- in the precontemplative or contemplative stages. Develop- ior spontaneously mentioned experience with diagnosable ment of a new model that addresses the unique compo- mental illnesses during the interview process. Additional nents of the prostitution exit process while incorporating studies of the incidence and type of mental illness among aspects of the stages of change model could prove valuable prostituted women would prove valuable for developing for service delivery. Development of such a model could intervention strategies aimed at this unique population of be used to identify key points of intervention within critical women. life areas informed by a woman’s readiness to change. For In a related vein, nearly all of the women (n = 16) example, the data suggest that the initial stages of the exit described involvement with formal support agencies (e.g., process, what might be interpreted as the preparation stage, residential treatment, NA, AA, the Hope Center). Still, as- requires safe residence away from old playmates, structured sociation with or use of such services was not sufficient professional drug treatment, and mental health assessment to sustain lasting behavioral change; personal commitment and treatment. With time, movement into the action stage was key. The women who successfully exited prostitution would necessitate additional forms of supports, including took it upon themselves to obtain knowledge, internalize development or renewal of healthy emotional attachments information, and then apply newly acquired tools to their to informal networks (e.g., church groups and family) and own lives. Their unsuccessful peers described instead an emphasizing reintegration and incorporation into the larger expectation that others were responsible for “fixing” their community. Development of employment skills and assis- life situations or, more commonly, they described being un- tance with economic support for legal employment would committed to making the necessary changes required in also be integrated in the action stage. The maintenance their lives to maintain exit pursuits. stage would consist of ongoing individual and group coun- The Stages of Change Model developed as a framework seling, mentoring, and monitoring to identify and address for understanding an individual’s readiness to change addic- person-specific “triggers” or challenges facing the women tive behaviors (Prochaska, DiClemente, & Norcross, 1992) in their unique life contexts. is relevant for understanding the street-level prostitution Importantly, however, models specific to the prostitution exit process. Working with individuals with addictive be- exit process must be created with individual differences in haviors, Prochaska and colleagues identified five stages of mind. To illustrate, the five women who were able to main- change experienced by their clients. In the precontempla- tain their exit attempts varied considerably with regard to tive stage, individuals are not aware of their problem and age, race, amount of time spent in the sex industry, fam- further, have no plans to change their behaviors any time ily composition, and chemical addiction. Moreover, the one in the foreseeable future. Only at the insistence of others participant who appeared to make the easiest transition out would individuals seek help during this stage. In the con- of the industry, requiring the least amount of formal as- templative stage, individuals are consciously aware of their sistance, was the one who had been immersed in the sex problem behaviors but have not made a commitment to ad- industry for the longest period of time and was the only one dress them. Individuals in this stage are considering behav- with a pimp. Her case history defies M˚ansson and Hedin’s ior changes, but it may be a long time before action is taken. (1999) conclusion regarding two types of break-aways. She Individuals in the next stage, preparation, have begun to was able to exit smoothly and develop a new identity and make small changes in their behaviors and have intentions lifestyle, but could hardly be defined as “... loosely asso- of making additional, perhaps larger, changes in the near ciated with the sex industry” (p. 69). Several factors con- future. The action stage often follows and is reached when tributed to her relatively seamless exit: She had never been individuals successfully change their behavior. If change chemically addicted, street-level prostitution was no longer persists for more than 6 months, individuals have entered lucrative, and, perhaps most importantly, she exited with the maintenance stage. During this stage, the ultimate goal her husband and had a strong informal support network is to maintain behavioral and attitudinal changes. (e.g., family, church group) that did not condone criminal This model appears to have broad applicability. Hood activity. and Johnson (2002) concur, noting, “These same stages of Despite this exception to the break-away experiences change pertain to clients with a wide variety of problems” identified by M˚ansson and Hedin (1999), other aspects of (p. 70). When examined in relation to the women who par- their work parallels results obtained here. Specifically, they ticipated in this investigation, the model informs the exit identified traumatic (e.g., life-threatening experiences) and process. To illustrate, due to their extended absences from positive (e.g., falling in love, having a child) events as fac- the sex industry for more than 6 months, the five whose exits tors motivating the exit process. In this investigation, sim- had been successful through time could readily be identi- ilar events were described by those who had maintained fied as fitting within the maintenance stage. Further, exam- their exits in this investigation. Importantly, the influence ination of the model in relation to those who had returned of significant relationships on the exit process was noted not Exit Processes 289 only by M˚ansson and Hedin (1999), but also by Manopai- and people (e.g., parole officers) might explain the diffi- boon et al. (2003) and Williamson and Folaron (2003). The culty in locating them. On the other hand, it is also possible data presented in this study, coupled with work revealed that the younger women, who were newer to the streets, by these researchers, clearly speaks to the central role of had returned to the game and not yet resurfaced or come relationship loss and relationship renewal in the exit pro- to the attention of intervention agencies. In other words, cess. Further development of this concept could greatly some of the 25 women who could not be located may have enhance theory creation or modification and potentially been actively involved in the game but maintaining very low aid intervention strategies. Assisting women in developing profiles. new informal systems of support or recovering from the Further, it is possible that the married women transi- emotional loss of significant others appears central for exit tioned out of the industry more easily than their single peers, success. thus making them more difficult to locate for a follow-up Furthermore, it is important to note that leaving the sex interview. That is, one might assume that having a mar- industry rests, at least in part, on having the ability to legally riage partner promotes the exit process, with formation of support oneself. Still, working minimum-wage jobs with lit- new roles and identities, thus explaining my inability to find tle room for growth and that require and teach few trans- these women after 3 years. Racial disparities between those ferable skills may prompt a return to old behaviors in an who could and could not be located for a second interview attempt to earn “fast cash.” Employable skills and job train- present additional complexity and raise additional questions ing would be components of an ideal intervention program. about the exit process. It is unclear why African American Moreover, one of the most interesting, yet surprising, find- women would be more easily located at the second point ings of this study involved the central role of religion (and in- of contact, particularly given that the original sample of 43 tegration within religious communities) among those whose consisted of more Euro American (n = 20) than African exits were successful. No other study involving prostituted American (n = 18) women. women could be located that addressed, or even alluded to, Although speculation of the meaning of biases due to age, this issue. The door is certainly open for continued explo- industry tenure, marital status, and race for the exit process ration of the role of religion in the exit process. is possible, definitive answers cannot be made at this junc- ture. Future investigations with larger samples would pro- vide valuable data to inform the present field of knowledge Limitations and Future Directions and, by extension, practice and intervention efforts. Sug- Several limitations, particularly in relation to sample repre- gested strategies for maintaining sample size through time sentation, must be kept in mind when interpreting results. are to (a) obtain contact information on participants’ clos- First, this investigation focused exclusively on street-level est kin or primary sources of formal support (e.g., specific prostituted women. These women differ substantially from shelters) during the initial data collection and (b) arrange those involved in other sex-industry venues. Information for follow-up data to be collected more frequently. presented should therefore be interpreted within context; Future studies aimed at theoretical development and generalizations to women involved in other types of sex model building to identify critical service needs at vari- work (e.g., call girl services) must be made with caution. ous points in the exit process are warranted. Street-level Future studies that comparatively analyze the exit process prostituted women are embedded within unique social, between women involved in different types of prostitution historical, and political contexts. Continued longitudinal would be useful. Thus, services should be tailored to the work designed to critically examine the developmental tra- specific needs of prostituted women, and these needs will jectories of prostituted individuals for purposes of theory likely differ substantially based on the type of prostitution development and testing would provide valuable data for in which each is involved. effectively intervening on behalf of those caught in the Moreover, this investigation is limited due to sample size. entry-exit-reentry cycle. Only 18 of the original 43 women were located for a follow- up interview, and biases inherent in the sample’s compo- Conclusion sition may further limit transferability of results. Specifi- cally, compared to the 25 women who were interviewed only It was discouraging to learn that only 5 of the 18 (27%) once, the 18 who participated at both data collection points women located for this study had maintained their exit ef- were older, had been involved in the sex industry for a sig- forts for a significant amount of time. Still, one must re- nificantly longer amount of time, and were more likely to be member that although 13 returned to old behaviors, this single and African American. Perhaps the younger women, does not mean that their exit attempts were not valuable with fewer years invested in prostitution and subsequently or that progress was not made. Leaving the street-level sex fewer connections to the game, found it easier to transi- industry is a process, often involving numerous exit-reentry tion into new roles and identities, as the work of M˚ansson cycles, and thus “success” is a vague term and difficult to and Hedin (1999) would suggest. If such is the case, their define. It is likely that each time a woman attempts to exit, severance of ties with formal agencies (e.g., Hope Center) she becomes a little stronger, a little more confident, and 290 DALLA a little more committed to making a permanent lifestyle Flowers, R. B. (1998). The prostitution of women and girls. Jef- change. Certainly, to some degree, development of these ferson, NC: McFarland. attributes qualifies as “success.” Even though she may re- Graham, N., & Wish, E. D. (1994). Drug use among female ar- turn to the sex industry after attempting to leave, perhaps restees: Onset, patterns, and relationships to prostitution. her next exit will be her last. The exit process is clearly Journal of Drug Issues, 24(2), 315–329. Hardman, K. (1997). A social work group for prostituted women complex and the challenges significant, but change is pos- with children. Social Work with Groups, 20(1), 19–31. sible, as evidenced by Marlee, Kiley, Amy, Yolanda, and Hood, A. 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Leaving ble and in which their clients attempt to obtain sexual services sex work: barriers, facilitating factors and consequences for as cheaply as possible. Some also use the term to denote that female sex workers in northern Thailand. AIDS Care, 15, street-walkers “play with” (i.e., risk) their lives. 39–52. 2. This is not the actual name of the program. M˚ansson, S. A., & Hedin, U. C. (1999). Breaking the Matthew 3. All names are pseudonyms. effect on women leaving prostitution. International Journal 4. Marlee’s husband had also been her pimp for the majority of of Social Welfare, 8, 67–77. the time she was involved in the street-level sex industry. McClanahan, S. F., McClelland, G. M., Abram, K. M., & Teplin, 5. About 6 years in total, as they had been out of the game an L. A. (1999). 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