CSAT Publications -- TAP 25, The Impact of Substance Abuse Treatment on Employment Outcomes Among AFDC Clients in Washington State
Substance abuse continues to have a significant adverse effect on the health and well-being of millions of Americans.1-3 Questions about substance abuse, its behavioral impacts, and the effects of substance abuse treatment have recently been given new urgency by welfare reforms enacted by Congress in the last 4 years. Box I-1. The AFDC Program 4 The AFDC program was created over 60 years ago as a Federal-State program to provide support to low-income families with needy children-defined by the AFDC program as "children deprived of parental support or care because their father or mother is absent from the home continuously, is incapacitated, is deceased, or is unemployed."
Under the Social Security Act, States were required to provide cash assistance to all AFDC-eligible families. Working within Federal limitations, the States administered the AFDC program, established State income levels below which families qualified for assistance, and set the benefit levels for eligible families. By 1992, 13.6 million individuals, including 9 million children, were receiving AFDC assistance nationwide; and total program costs (administration plus benefit payments) had reached almost $25 billion.In 1996, Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act (Public Law 104-193) in an effort to move people off welfare and to establish strong incentives to work. The new law replaced the Aid to Families With Dependent Children (AFDC) program with Federal block grants to States to provide temporary assistance to needy families (TANF) and imposed a 5-year lifetime limit on welfare payments to families with a minor child.*
A key assumption underlying the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 is that welfare recipients can become employed and thus, over time, can move successfully from welfare dependency to economic self-sufficiency. In the short time the law has been in effect, welfare rolls have shrunk to an unexpected degree under highly favorable U.S. labor market conditions. Whether welfare recipients will be able to sustain employment and earn enough to support themselves and their families over the long run, however, remains unclear.
*States may exempt up to 20 percent of there welfare caseload from the 5-year limit.
Obtaining a job and achieving economic self-sufficiency may be especially difficult for welfare recipients with substance abuse problems. At a minimum, the rehabilitation needs of these individuals will have to be addressed. The Personal Responsibility and Work Opportunity Reconciliation Act allows States to use TANF funds to treat substance abuse if such treatment is a component of a State's work-readiness program for welfare recipients.
Substance abuse is a multidimensional problem, and the relationship between substance abuse and welfare dependency is unclear. Some studies have reported that substance abuse prevalence rates among AFDC recipients are higher than the rates among the general population.6-8 However, other studies have found that the substance abuse prevalence rates among AFDC recipients and the general population are similar. One recent national study, for example, found that AFDC recipients had prevalence rates for substance abuse/dependence and drug abuse/dependence of about 4-12 percent and 3-6 percent, respectively-similar to the rates among the general population.9
The prevalence of substance abuse also has been found to vary among subpopulations of the welfare population. In one northern California county, for example, Schmidt and colleagues8 found the prevalence of substance abuse was much higher among general assistance recipients than among AFDC recipients. These investigators found no strong direct link between substance abuse and welfare dependency among AFDC recipients over the 6-year period of their analysis. Other investigators, however, have found a link between substance abuse and welfare dependency.10-12 Several studies-including large-scale longitudinal analyses13,14 and other studies15-17-have concluded that substance abuse treatment has a positive effect on employment outcomes among substance abusers. This finding has also been reported in studies among indigent clients in Washington State.18-20
Unfortunately, little is known about the effects of substance abuse treatment on employment outcomes for welfare recipients with substance abuse problems. A better understanding is critical if States are to address the special treatment and vocational needs of this vulnerable population.
The primary purpose of this study was to assess the effect of substance abuse treatment on employment outcomes and earnings among a sample of 5,664 AFDC clients admitted to treatment in Washington State from July 1994 to June 1996. Four major questions were investigated:
* What was the general pattern of employment and earnings among these AFDC recipients before and after substance abuse treatment?
* What was the level of welfare payments to these AFDC recipients before and after substance abuse treatment?
* What was the effect of substance abuse treatment on these AFDC clients' employment outcomes, when holding constant other factors such as age, gender, education, and prior treatment?
* Did an AFDC client's time on welfare (number of quarters in which the client received cash grants) prior to substance abuse treatment affect the client's employment outcomes?
It is important to bear in mind that the primary goal of substance abuse treatment is rehabilitation, not employment. Moreover, successful substance abuse treatment is but one of many factors that affects whether an AFDC client will find and hold a job and earn income. Because most of the 5,664 AFDC clients analyzed in this study were single women with relatively little education, little or no formal work history, and one or more children, it is generally unrealistic to expect these individuals to achieve substantial gains in earnings following substance abuse treatment. The second purpose of the study was to illustrate the potential utility of State computer databases for tracking client outcomes and conducting timely evaluation research. Implementation of broad health and social welfare initiatives such as TANF and the Children's Health Insurance Program has created an increased need for timely treatment outcomes studies and related analyses. Few States have the resources or time to conduct studies involving large-scale primary data collection. Such studies may take years to complete; the delay may yield findings that are outstripped by the rapid changes in policy and programs occurring in most States. An alternative approach, illustrated by this study, is to analyze data from State administrative computer databases to track outcomes among substance abuse clients and to perform timely evaluation research.
For further information, contact the CSAT staff
at 240-276-2750.
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