Broadly, resilience is “the achievement of positive adaptation” in the face of “significant” threats or adversities. Definitions of resilience and prevailing resilience theory have evolved over time, from resilience as a fixed personality trait to the current conceptualization of resilience as a dynamic, multisystem process. ĭespite this disparity between WWUD-SS and the general population, little research has focused on modifiable factors to improve mental health in this population, such as resilience. These exposures, independently and synergistically, heighten the risk for mental distress, overdose, and HIV acquisition. For WWUD-SS, economic precarity is common, as is the threat of arrest and incarceration as a result of the criminalization of sex work and controlled substances, particularly in the USA. Globally, women who use drugs and sell sex (WWUD-SS) bear a high mental health burden, that includes rates of depression (estimated at 29–82%) and post-traumatic stress disorder (PTSD, estimated at 13–68%) much higher than the general female population, and significant exposure to chronic and severe stressors such as violence and stigma that can heighten psychological distress. Improving connections to community resources may be a targeted way to strengthen external resilience, as are policies addressing structural vulnerabilities for marginalized communities. Focus on internal resilience alone offers an incomplete picture of the construct in drug-using populations. Internalized stigma, reflecting the larger society’s stigmatized views of drug use, sex work, and poverty, left WWUD-SS eschewing help from outside sources. WWUD-SS’ ability to exercise external resilience may be undercut by experiencing structural vulnerabilities and competition for material resources that create transactional relationships and diminish the perceived value of social support. ConclusionsĮxternal resilience appears limited among WWUD-SS and shaped by the social and economic contexts of a street-involved life. Resource utilization was rare, and “self-medication” through substance use was common absent other perceived options for help. Participants also distinguished between transactional relationships (help is contingent upon receiving something in return) versus genuine (non-transactional or altruistic) support, including the role of family members who do and do not use drugs. Participants described reluctance to ask for support and often felt resigned to address problems alone. Participants were a median age of 37 years, 50% identified as Black, and 50% reported currently injecting drugs. WWUD-SS were queried about recent difficult experiences with a focus on how they did or did not use social support or formal resources (e.g., clinic, crisis hotline) in response. WWUD-SS ( N = 18) enrolled in an ongoing cohort study were purposively sampled for age, race, and recruitment location and participated in semi-structured, in-depth interviews aimed to elucidate external resilience (i.e., social support and resource utilization). This study aims to fill a gap in the literature by characterizing external resilience among WWUD-SS and understanding the ways that socio-structural vulnerabilities (e.g., poverty, stigma) and substance use shape external resilience. Further, substance use is often viewed as antithetical to resilience despite populations like women who use drugs and sell sex (WWUD-SS) surviving significant hardships.

Yet it is often narrowly defined by only its internal qualities (e.g., adaptability, hardiness) and overlooks its external qualities (e.g., supportive relationships, navigating one’s environment). Resilience is a commonly used construct in substance use and mental health research.

Qualitative social work journal