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Policy Brief: Substance Abuse & Welfare Reform

Introduction:
The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) changed the nature, purpose, and financing of public aid. PRWORA ended a 60-year-old federal entitlement, Aid to Families with Dependent Children (AFDC), replacing it with the transitional program, Temporary Assistance to Needy Families (TANF) (Weaver, 2000). The goals and implementation of TANF are now being re-explored.

PRWORA brought many uncertainties about its potential impact on low-income mothers who misuse alcohol, prescription medication, or illicit drugs. At welfare reform’s passage, the prevalence of substance use disorders among recipients was largely unknown. Many advocates, administrators, and researchers feared that substance use disorders were widespread and that such disorders would prevent many recipients from complying with TANF requirements. As described below, our own research and that of others established that such disorders are less common among TANF recipients than initially was feared. Nonetheless, more than a decade after PRWORA’s passage, the identification, assessment, and treatment of recipients with these disorders continue to raise policy challenges.

Policy Implications:
Substance abuse and dependence are relatively uncommon but raise important problems for some TANF recipients.

For policymakers, a key challenge is to balance the need to encourage self-sufficiency with the need to address the varied and challenging circumstances facing TANF recipients with substance use disorders. Recipients facing the most serious barriers are unlikely to quickly obtain and retain employment. Many require multiple services (Meara and Greenfield, 2008). Treatment outcomes should address substance use, other health and personal problems, employability, welfare recidivism and family and housing stability. Some will face sanctions due to non-compliance with work requirements or other TANF obligations.

Policymakers must consider how best to combine work requirements and other obligations with the need to provide TANF recipients with access to an appropriate range of services. Although work and treatment are sometimes considered in mutual opposition in policy discussion, the development of work skills is an important goal of many treatment interventions. Some treatment interventions also provide support and monitoring to help clients be successful in subsequent job roles begun during the latter stages of treatment. Such services are likely to be especially important for TANF recipients, although the peer-review research base is limited regarding the effectiveness and cost-effectiveness of such efforts. Recession raises additional challenges. Welfare reform was initially implemented during a time of general prosperity, low unemployment, and high state and local tax revenues. Many current and former cash aid recipients were thus able to obtain paid employment. The labor market in 2009 is distinctly less favorable. At the same time, many states face unusual fiscal constraints in financing health and social services. The current peer-review literature does not directly address these concerns.

For state and local TANF administrators, the most pressing challenges concern the effective execution of broadly supported but administratively difficult interventions: screening, assessment, referral, and case management. Local welfare offices need the resources and expertise to screen, assess and refer individuals experiencing substance use disorders. Best-practice models such as incorporating intensive case management into the screening process are emerging to accomplish these tasks. Many TANF programs do not now effectively identify and serve TANF recipients with substance use disorders.

Finally, the changing nature of public aid requires policymakers to consider needs of low-income families who do not receive TANF cash aid. In the wake of welfare reform, TANF receipt has declined among all low-income families, including those headed by parents with substance use disorders. States and localities must therefore strengthen outreach and treatment referral services for low-income families who do not receive TANF cash aid.


Results:

  • Over different years, in many different surveys, approximately 20 percent of TANF recipients report that they have used an illicit drug at least once in the past year. Read more

  • The prevalence of self-reported illicit drug use among welfare recipients has remained relatively stable post-reform, and remains below observed prevalences of the early 1990s. Read more

  • Approximately 4 percent of TANF recipients reported illicit substance abuse or dependence. Approximately 4.3 percent of TANF recipients reported alcohol abuse or dependence. Read more

  • AFDC/TANF receipt has declined as rapidly among low-income mothers who report recent substance use as among the broader population of low-income mothers. Read more

  • Low-income women who are not working, are TANF-sanctioned, or are experiencing housing instability are more likely than others to report substance use disorders. Read more

  • Substance use is associated with increased duration (and cycling) of TANF receipt. Read more

  • Substance use is only one of many barriers to well-being and social performance among low-income mothers and often co-occurs with other significant barriers such as psychiatric disorders. Read more

  • Some former welfare recipients have failed to find stable employment and may spend prolonged periods without work and cash welfare. These women are more likely to have used illegal drugs or meet the diagnostic screening criteria for alcohol dependence. Read more

  • Screening and assessment of substance use disorders remain central administrative challenges, with great variation across service sites. Read more

  • Specialized screening and case management appear promising in identifying substance use disorders in welfare offices and integrating them into substance abuse treatment. Read more

  • Work conditions, relationships between welfare workers and clients, and the stigma surrounding substance use influence the success of screening, assessment, and intervention. Read more

  • TANF receipt may facilitate treatment entry among women with substance use disorders. Read more

  • Comprehensive services for women and children may improve treatment outcomes. Read more

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