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
- 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
Outcomes from an Enhanced Substance Abuse Treatment Package: CASAWORKS for
Thomas McLellan, Ph.D., Treatment Research Institute, University
- Twelve months after enrolling in CASAWORKS, 75% of the women
were abstinent from alcohol and illegal drugs compared to 26% when they started
- 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
- 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
- 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
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.