Rehabilitating the Exploited with Dual Disorder Treatment

By Meghan Vivo

There are a lot of reasons people resort to prostitution, but drugs and alcohol are often the primary motivator. People who are addicted to drugs or alcohol may turn to a life of prostitution in search of fast money to fund their drug habit. Those who are involved in prostitution may turn to drugs or alcohol to escape the reality of their lifestyle and cope with the trauma and abuse they encounter.

Addiction and prostitution often go hand in hand, yet very few programs exist to help men and women stuck in a lifestyle of prostitution. In most communities, these individuals end up in jail without any attempts at rehabilitation.

But this is not the case in Pittsburgh. Thanks to a collaborative effort between Cove Forge Outpatient Recovery Center, local police, and the district attorney and courts in Allegheny County, individuals convicted of prostitution are sentenced to one year of probation and participation in a unique program called PRIDE, rather than being sent to prison.


The PRIDE program (or Program for the Re-Integration, Development and Empowerment of Exploited Individuals) works with men and women of all ages who have engaged in various types of prostitution, including escort services, strip bars, massage parlors, Internet services and street prostitution.

When individuals are first assigned to the PRIDE program, they are sometimes resistant to receiving help. Thus, the first challenge is getting them engaged in the treatment process.

“Education is key because it helps these individuals realize that there’s another way,” said Johnna Zacharias, the PRIDE program coordinator. “From there, it’s about building trust by always following through on what you say and never making a promise you can’t keep.”

Individuals participate in the PRIDE program as long as it takes to successfully complete all group sessions, graduate from drug rehab at Cove Forge/White Deer Run and get involved in work or school. The program is self-paced, and usually lasts between nine months and two years.

A Unique Population with Complex Needs

Individuals who have engaged in prostitution have complex needs. The significant trauma they have experienced makes them reluctant to change, accept help or trust others. Because they are likely to have been betrayed repeatedly by virtually everyone they ever trusted, many former prostitutes are guarded, defensive and living in survival mode.

“When they come to us, they have been so beaten down,” said Zacharias. “They often have intense feelings of inadequacy; they are addicted, mentally ill and sometimes homeless. They don’t trust anyone, which is understandable because everyone in their lives has betrayed them – in some cases, even their own parents and siblings.”

In addition to trauma, many who fall victim to prostitution struggle with substance abuse and mental illness, which can be exacerbated by exposure to street life, lack of education, unemployment, homelessness, criminality, and physical, emotional and sexual abuse. The result is a complex person who has built up layers of defense mechanisms and is often resistant to treatment.

Integrated Treatment for Dual Disorders

Research has shown that dual disorders require integrated treatment that addresses all diagnoses simultaneously. For this reason, individuals in the PRIDE program undergo holistic dual disorder treatment for both their addictions and prostitution, as well as any co-occurring mental health disorders. They participate in drug treatment in the morning and prostitution-specific groups in the afternoon.

The addiction treatment program at Cove Forge/White Deer Run offers individuals in the PRIDE program care at all levels, from outpatient to inpatient to partial hospitalization, though inpatient drug rehab is usually necessary. White Deer Run has a large network of addiction treatment programs, so the patients in the PRIDE program have the opportunity to receive treatment at any number of rehab facilities.

For example, pregnant women can undergo drug rehab at the Bowling Green Brandywine facility in Kennett Square, Pa., and individuals can transition back into daily life at White Deer Run’s halfway house in Johnstown, Pa.

A Compassionate Approach to Trauma, Abuse and Post-Traumatic Stress

Rather than being judged for their choices, the PRIDE program approaches patients with compassion using a post-traumatic stress model. Participants attend support groups that address the lifestyle of prostitution and the problems associated with that lifestyle, including trauma, trust issues and interpersonal conflict. They also attend group therapy sessions designed to help them understand the history of prostitution and their own motivations for turning to the lifestyle.

“We don’t view our patients as criminals or blame them for their choices,” explained Zacharias. “Many are victims of vicious rapes, domestic violence or sexual abuse as children. We can’t even fathom the things they’ve seen – stabbings, shooting, rapes. There’s no judgment here.”

As part of treatment, Zacharias invites outside speakers, including the local rape crisis center and law enforcement personnel, to educate the patients about legal issues, coping skills, women’s health and other topics. Patients receive free HIV and hepatitis C testing, and consultations with medical staff about sexually transmitted diseases and related issues. PRIDE also has a clothing closet where participants can get clean clothes and hygiene supplies.

To help patients reintegrate into society, the program provides vocational rehab and consultations with an employment specialist who helps them look for jobs or go back to school, and offers advice on resume-writing, job interviews, and handling questions about their criminal record and prison time.

Putting an End to the Exploitation

There are a lot of misperceptions about prostitution. Prostitution happens in every community, and is not a lifestyle that most people choose because they “love sex” or are savvy businesspeople. Though many mistakenly believe that prostitution is a “victimless” crime, the staff at PRIDE knows better.

“Prostitution turns women into a product,” said Zacharias. “What people forget is we’re talking about human beings.”

Fortunately, the PRIDE program is making a real difference in the lives of people who have been exploited, and word is spreading fast. Women on the street know about the PRIDE program and know it’s a safe place where they won’t be turned away. Of more than 70 individuals who have successfully graduated from the program, only three have been re-sentenced. Those who need to come back for additional treatment are welcomed with open arms.

“We give everyone several chances,” Zacharias noted. “Thirty to 40 years of betrayal sometimes can’t be erased in just a few months.”

While Zacharias has many hopes for the graduates of the PRIDE program, her primary goal is for them to become strong and independent so they never have to rely on anyone in that manner again.

“I want them to understand the impact prostitution has on their mind, body and spirit, and to never resort to that kind of behavior again,” she said. “My biggest hope is to see them emerge from their cocoon and be able to fly on their own.”