Neurochemically informed network control theory reveals energetic dysregulation of altered brain state dynamics in obsessive-compulsive disorder.

Drug-related risks and harms are experienced differently across populations, shaped by intersecting forces such as the marginalization of individual identities (e.g. racism, sexism, homophobia and transphobia), structural inequities (poverty, public policies), and physical environments (neighborhoods, service access) []. These interconnected factors are often magnified among individuals with lived experience of sexual exploitation [–]. Although the strength of the correlation between exploitation and substance use is unknown, studies have shown that both cisgender and transgender women who use drugs report a high lifetime prevalence of gender-based violence of all types [, ], while a recent study using data from emergency departments found that individuals identified as having experienced sex trafficking had higher rates of substance use disorder (SUD) than labor trafficking survivors and those who have not been trafficked []. The co-occurrence of being a survivor of exploitation and having a SUD can complicate service provision to survivors [], making it necessary to understand how this population experiences broader service systems. Individuals who have experienced exploitation and use drugs often have unique mental and physical health needs stemming from complex trauma. Addressing these needs requires rigorous evaluation of integrated treatments for survivors as well as the development of innovative treatment approaches and complementary programs, including peer support and harm reduction-oriented services [, ]. Indeed, the intersectional marginalization and complex barriers faced by this group necessitates an anti-carceral and anti-oppressive orientation to service provision to counter pervasive stigma and systemic discrimination. In recognizing the value of the perspectives of those with lived experience, it is important to consider survivors’ perceptions of how to enhance such services. This study aims to examine multi-level barriers to services for survivors of exploitation who use drugs and interrogate sources of power and oppression through the intersectional risk environment framework. We used qualitative interviews with 17 individuals who had experienced exploitation and self-defined problematic substance use in a Midwestern US state, to answer the following questions: