Predictors of Risky Sexual Behaviors Among Female Adolescents and Young Adults Seeking Withdrawal Management Treatment: A Lifestyle-routine Activities Theory Approach

Objectives: This study examines prevalence and predictors of risky sexual behaviors (RSBs) among female adolescents and young adults admitted to withdrawal management treatment (WM) for substance use disorders (SUD), a critical point where addressing co-occurring risk behaviors could considerably enhance treatment outcomes and recovery. Utilizing lifestyle-routine activities theory (LRAT), we aimed to identify vulnerability factors contributing to sexual victimization. Methods: A 1:1 sample (n = 194; 45%) was drawn from all admissions over 5 years to the sole national acute WM unit serving females aged 13-34. Data were collected through clinical intake interviews and standardized questionnaires, assessing substance use, mental health, social context, and risky sexual experiences. Results: Sexual victimization and RSBs (eg, unprotected or transactional sex) were highly prevalent, with 89% reporting experiencing sexual assault and 84.9% engaging in at least one recent RSB. Notably, 28% reported participating in 6-7 RSB types. Significant RSB predictors included earlier SUD diagnosis, poor mental health, limited social support, and strained parental relationships. SUD severity (β = 0.15, P = 0.042), peer drug use (β = 0.31, P < 0.001), and living on the street (β = 0.15, P = 0.048) significantly increased the likelihood of multiple RSBs. Conclusions: Findings underscore the importance of integrated, trauma-informed approaches in SUD treatment among young females. The complex interplay between trauma exposure, substance use, and RSBs, influenced by environmental factors, necessitates comprehensive treatment strategies encompassing these co-occurring risk domains simultaneously. LRAT offers a valuable framework for understanding how disrupted environments and diminished protective factors contribute to vulnerability. Implementing tailored, trauma-informed care may enhance recovery while addressing broader public health implications.