Key Research Findings

Substance Abuse Trends among Welfare Recipients
Harold A. Pollack, Ph.D., University of Michigan

• Although almost 20 percent of welfare recipients report recent use of some illicit drug during the year, only a small minority satisfies internationally accepted diagnostic criteria for drug or alcohol dependence.
• Illicit drug use and dependence are more common among women receiving welfare than among women who do not. Drug use is a risk factor for welfare receipt, even after controlling for race, educational attainment, region and other factors.
• Alcohol dependence also appears more prevalent among women receiving welfare than among those who do not, though this effect is smaller and more ambiguous than is the case for drugs.
• The prevalence of illicit drug use among welfare recipients nationally declined between 1990 and 1998, although recipients are more likely than non-recipients to use drugs.
• Psychiatric disorders, especially major depression and post-traumatic stress disorder, are more prevalent than illicit drug dependence among welfare recipients. States should screen, assess, and refer to treatment those welfare applicants and recipients who have a broad range of mental health and substance abuse problems that hinder the transition from welfare to work.

The Relationship of Substance Abuse to Welfare Reform: Barriers to Work Among a Population of Substance Abusing Women on TANF
Marjorie A. Gutman, Ph.D., Treatment Research Institute, University of Pennsylvania

• Domestic violence and other family conflicts, childcare, transportation, mental health problems and other chronic potential barriers to work are intertwined with substance abuse.
• Substance abusing women on Temporary Assistance to Needy Families (TANF) exhibited an average of 6 barriers (plus substance abuse as the seventh barrier) to work compared to an average of 4 for the general TANF group.
• The most common barriers to work among substance abusing women were: low work experience (81%), low educational level (48%), low job skills (65%), lack of transportation (88%) and generalized anxiety disorder (49%).
• The total number of barriers to work, regardless of what they were, was significantly related to employment at 12 months after entry into the study. 47% of women with 1-3 barriers were employed at least half-time at 12 months into the study, 28% of women with 4-6 barriers were employed at least half-time at 12 months into the study, and only 19% of women with 7 or more barriers were employed at least half time at 12 months into the study.
• Special attention should be directed toward substance abusing women on TANF since this group tends to have more numerous and complex problems that serve as barriers to employment than their non-substance abusing counterparts.

Outcomes from an Enhanced Substance Abuse Treatment Package: CASAWORKS for Families Program
Thomas McLellan, Ph.D., Treatment Research Institute, University of Pennsylvania

• Twelve months after enrolling in CASAWORKS, 75% of the women were abstinent from alcohol and illegal drugs compared to 26% when they started the program.
• Participants who did not report abstinence, reported significant reductions in number of days of heavy drinking and of illegal drug use.
• 40% of the women were employed at least half time after 12 months compared to 16% when they enrolled in the program, and only 13% were still receiving TANF.
• Some improvements were shown in domestic violence and basic needs (childcare and housing) although not statistically significant.
• No improvements were shown in medical or psychiatric status of these women.
• Women in CASAWORKS stayed in treatment for an average of 7 months; typically, 50% of the individuals in substance abuse treatment drop out within the first month.

New Jersey Study on TANF Women
Jon Morgenstern, Ph.D., National Center on Addiction and Substance Abuse (CASA) at Columbia University

• Substance dependent TANF women experience many more barriers to employability than those without a substance abuse disorder and thus are less likely to become employed.
• 84% of these women had been involved at some point with child protective services and 38% were currently involved with child protective services.
• Children of substance abusing TANF women appear at grave risk for adverse outcomes because of high rates of child welfare involvement, domestic violence and lack of family cohesion.
• Findings from the NJ study indicated that adolescent children of substance abusers were engaging in significantly more high-risk behaviors than those in the non-affected group.
• Screening and assessment appears to be a successful strategy for facilitating treatment entry. About 65% of TANF women who completed an assessment subsequently entered treatment.
• Intensive case management more than doubled the rate of attendance in substance abuse treatment among TANF recipients in a study conducted in New Jersey.
• Research suggests that developing new models that integrate substance abuse treatment and employment training, rather than providing them in separate programs may be especially beneficial in improving welfare outcomes. One year after entering CASAWORKS, women reported significantly increased rates of employment, decreased welfare dependency, and decreased substance use.

Moving Drug Treatment Participants from Welfare to Work:The Florida Study
Lisa Metsch, Ph.D., University of Miami School of Medicine

• The proportion of substance abuse treatment participants who made the transition from welfare to work increased over 300% during the study period from 1994 to 1999.
• Almost one-third of substance abuse treatment participants had moved from welfare to work by 1998-99, compared to 15% of those who did not receive treatment.
• Treatment completion and length of stay in treatment was associated with moving from welfare to work and residential treatment (compared to other drug treatments) was associated with positive employment outcomes.
• Women who lose their employment and welfare benefits may be engaging in illegal activities to support themselves and their children.
• While wages earned by substance abusing women who successfully transition from welfare to work are low, women who successfully complete substance abuse treatment have higher wages than those who do not.

Policy Relevancy of Research Findings
Sheldon Danziger, Ph.D., University of Michigan

• Consistent with public concerns, substance use and dependence are more common among women receiving welfare than among women who do not. However, only a small percentage of recipients meet diagnostic screening criteria for substance dependence.
• Welfare recipients have more barriers to employment, such as labor market problems and health, mental health and substance abuse problems, than women in general; substance abusing welfare recipients have more labor market, health and other barriers than recipients who do not abuse substances. As the number of barriers increase, the probability of making a successful transition from welfare to work decreases substantially.
• Although treatment will not be successful for all substance abusers, many will benefit from treatment. Those women who stay in treatment for 7 to 12 months have more success in leaving welfare for work than those who spend less time in treatment. Programs that combine substance abuse treatment with the provision of job skills seem particularly promising. This suggests that reauthorization should consider giving states more flexibility to define which activities meet work requirements.
• Model programs have demonstrated that welfare offices can successfully screen and assess recipients for substance abuse problems and refer them for treatment. However, very few states have implemented these kinds of screening/assessment/referral services. This suggests that reauthorization should encourage states to incorporate these services into their programs.
• The experience of the past 5 years has documented that, in a booming economy, many recipients can find jobs-- the employment of current and former welfare recipients increased substantially from the mid- to the late-1990s. However, the percentage of current and former recipients who worked in any month never exceeded 70 percent. Even women with few barriers to employment are unlikely to work 40 hours per week year round (2000 hours) during an economic boom. Women with substance abuse problems and other barriers to employment are unlikely to work full-time, full-year. Many will not find jobs that offer 40 hours of work per week; others will have difficulty working in every week during the year. These women are likely to get and lose several jobs during the year, with spells of unemployment between jobs.