Welfare Reform and Substance Abuse Treatment for Welfare Recipients

The 1996 welfare reform law replaced the existing entitlement to cash welfare with a transitional program of temporary aid that has employment as its primary goal. Among the key provisions of the welfare reform legislation were mandatory time limits on benefits and work requirements for all recipients, including those with substance use disorders. Changes brought about by the welfare reform law have important implications for the organization of substance abuse services and the well-being of disadvantaged children whose parents have substance use disorders. The overall effect of welfare reform could be positive. It gives States wide latitude to design programs to help low-income people attain self-sufficiency and has increased interest in developing innovative programming for hard-to-employ welfare populations, including those with substance use disorders (Berlin 2001). This interest could lead to increased funding for treatment, new services such as screening, better integration of needed ancillary services (i. e., medical care, child care, help with housing and transportation), and more accountability for outcomes on the part of programs and government systems. Conversely, welfare reform may have a profoundly negative impact on low-income people with substance use disorders and the programs that serve them. The policy of sanctioning welfare recipients for failure to comply with new welfare regulations and a punitive atmosphere at welfare offices may drastically reduce the number of low-income Americans with substance use disorders who receive public aid, and treatment programs dependent on public funds may face a resulting loss of revenue. Research on substance use disorders in the context of welfare reform has primarily focused on four questions: 1. What is the prevalence of substance use and substance use disorders among Temporary Assistance to Needy Families (TANF) recipients? 2. To what extent are substance use disorders and co-occurring problems a barrier to employability? 3. Can screening strategies in welfare settings successfully identify and refer clients to substance abuse treatment? 4. What types of services do these clients need to attain self-sufficiency? This article reviews findings on these questions and offers suggestions for how these findings can inform policy and future research. Prevalence of Substance Abuse in Welfare Populations Prevalence rates for substance use problems among TANF recipients vary widely depending on study methodology and on how problem use is defined. Most recent studies cite survey data that relies exclusively on administrative data or self-reports of substance use (Jayakody et al. 2000), both of which are likely to underestimate the true prevalence of substance use disorders (Metsch and Pollack 2005). Data from the 1998 National Household Survey on Drug Abuse (NHSDA) indicate that in the previous year 7.5 percent of TANF recipients were alcohol dependent and 4.5 percent were dependent on illicit drugs (Pollack et al. 2002). According to other studies using self-report data, 6 to 10 percent of TANF recipients were dependent on either alcohol or other drugs (Jayakody et al. 2000; Schmidt et al. 1998; Chandler and Meisel 2000; Grant and Dawson 1996). It is more difficult to determine the prevalence of problem users who are not dependent. Overall prevalence data obtained from numerous waves of the NHSDA and the more recent National Survey on Drug Use and Health (NSDUH) suggest that illicit substance use was about twice as common among female welfare recipients as among other women with dependent children who did not receive public assistance (Jayakody et al. 2000; Pollack et al. 2002). Data from the 2002 NSDUH show that about 22 percent of female welfare recipients used illicit drugs at least once in the year before the survey (Pollack et al. 2002). The exclusive reliance on self-report data is a serious limitation of these findings. …