Substance Abuse and Welfare Reform

Reform has transformed traditional entitlement to cash welfare under Aid to Families with Dependent Children (AFDC) into a transitional program known as Temporary Assistance to Needy Families (TANF). Because of the new work requirements and the time-limited nature of assistance, policy makers are increasingly confronted with what to do when welfare recipients do not effectively make the transition from welfare to work. Increasingly, the language of public health is being used to determine who is "employable" and who is not. Thus renewed attention is being focused on the individual characteristics of participants themselves, particularly specific diagnoses that might reduce employability. This article focuses on substance abuse and mental health problems among single mothers and examines their relationship to welfare receipt. We analyze data from the 1994 and 1995 National Household Survey of Drug Abuse (NHSDA) and find that 19 percent of welfare recipients meet the criteria for a DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, third edition revised) psychiatric diagnosis. About the same percentage have used illicit drugs during the previous year. Logistic regression results indicate that mental and behavioral health problems that are significant barriers to self-sufficiency are increasingly important in this era of time-limited benefits.

Investigated the effects of early motherhood on academic and behavioral outcomes for children born to early child bearers. The authors used newly available data from the National Longitudinal Survey of Youth for thier study. The authors found that early motherhood's strong negative correlation with children's test scores and positive correlation with children's grade repetition is almost entirely explained by prebirth individual and family background factors of teen mothers themselves. However, early childbearing is associated indirectly with reduced children's test scores through its linkage to family size. The authors found a different pattern in predicting fighting, truancy, early sexual activity, and other problem behaviors among adolescent and young adult offspring. For these behaviors, maternal age at first birth remains an important risk factor even after controlling for a wide range of background factors and maternal characteristics. These results highlight the diverse pathways through which teen parenting might influence subsequent child well-being and social performance.

Substance abuse and dependence are among the most common psychiatric disorders among pregnant and parenting women. These disorders among welfare recipients have attracted special concern. Chemical testing has been proposed to identify illicit drug use in this population. This analysis scrutinizes the potential value of drug testing, using recent data from the Women's Employment Study and the National Household Survey of Drug Abuse. One-fifth of recipients reported illicit substance use during the previous year. However, less than 5% satisfied diagnostic screening criteria for illicit drug dependence. Most recipients with psychiatric disorders or alcohol dependence reported no recent illicit drug use, and, thus, would not be detected through chemical tests. Although illicit drug users are rarely dependent, many face barriers to self-sufficiency. Screening and assessment programs should distinguish use from dependence, and should also identify alcohol dependence and psychiatric disorders. States should provide a range of treatment services to address these concerns.

Substance use by welfare recipients is frequently mentioned as a barrier to well-being and social performance. This article uses nationally representative cross-sectional data and Michigan-specific panel data to summarize trends in substance use among AFDC/TANF recipients. It also examines the prevalence of substance dependence within the welfare population. Although almost 20 percent of welfare recipients report recent use of some illicit drug during the year, few satisfy criteria for drug or alcohol dependence as indicated by the short-form Composite International Diagnostic Interview. The article concludes by considering policy responses to substance use disorders following welfare reform.

Men and women under correctional supervision may be the most challenging population of public health concern. Prison inmates, parolees, and probationers experience prevalent infectious disease including HIV and hepatitis C. Many supervised individuals have significant mental or behavioral health problems that require clinical intervention. The U.S. correctional population is also rapidly growing, and now includes more than 5 million men and women. Concerns about quality, accessibility, and cost of correctional care have prompted calls for managed care models in this population. This paper reviews pertinent experiences within Medicaid managed care and suggests four interconnected strategies--outreach, discharge planning, entitlement security, and case management--to improve the quality and efficiency of correctional care.

The 1996 welfare reform made extended welfare stays more difficult. One of the most notable provisions was the 60-month lifetime limit on cash benefits through the Temporary Assistance to Needy Families (TANF) program. This study investigated the personal characteristics associated with accumulating more months on TANF. Using four waves of data from the Women's Employment Study, we examined factors surrounding receipt at varying levels: low (less than 20 months), medium (20 to 39 months), and high (40 to 60 months). Medium and high accumulation groups had many factors in common relative to the low group. However, demographic variables, such as the presence of a partner and number of children, mattered more in determining whether someone would accumulate a relatively low as opposed to medium amount of time on TANF. For the high accumulation group, the presence of human capital problems, as well as persistent personal and family challenges, such as child and maternal health problems and domestic violence, greatly increased the likelihood of a longer stay.