As of , 11 states imposed the TANF ban on all drug felons, 26 states and the District of Columbia had modified the ban to impose it only under certain conditions, and 13 states had opted out entirely. Common modifications to the ban include to apply it only to persons whose drug felonies involve drug manufacture, distribution, or trafficking; to place time limits on the ban; or to exempt individuals who complete substance abuse treatment.
While some states opted out or modified the drug felon ban early, other state modifications are relatively recent. Seven states enacted legislation to modify or eliminate the TANF drug felon ban between and States have struggled to decide whether substance abuse in the context of the TANF program should be addressed as a public health issue, a criminal issue, a social issue, or a moral issue.
Prior to welfare reform, few States made efforts to identify whether clients had alcohol or other drug abuse problems. That changed under welfare reform as employment and self sufficiency became primary program goals. In a survey at the time TANF was first implemented, States identified screening for substance abuse as one of their top challenges related to assessing the job readiness of TANF clients.
Many states already conduct substance abuse screening and assessment either as part of their TANF intake processes or at some point later, such as after an unsuccessful job search or if a beneficiary quickly loses an initial job. These efforts are intended to determine whether substance abuse presents a barrier to employment. States use various screening and assessment approaches within their TANF programs and vary in their efforts to link program participants who have substance abuse disorders with substance abuse treatment.
The most commonly used screening approaches are question and answer instruments which are designed to detect evidence of alcohol and illicit drug abuse and dependence, such as the Substance Abuse Subtle Screening Inventory SASSI , which has been shown to be reasonably accurate in detecting problem substance use, including alcohol abuse, in a variety of populations.
However, TANF programs typically identify and refer far fewer clients to treatment than would be expected based on prevalence rates. These proposals vary in their content on many dimensions. Of those actually enacted, a broad, suspicionless drug testing program in Michigan had operated briefly in before being suspended by the courts.
Suspicionless testing refers to programs that test either everyone or a random subset without having reason to believe that the individuals tested have used illicit drugs.
Arizona has been testing TANF recipients for whom they have reason to suspect substance abuse i. Missouri will be testing current beneficiaries for cause, [16] while the Florida program requires suspicionless testing of all applicants.
Legislative proposals on drug testing vary widely. Some focus on punishment and cost savings and would deny benefits to individuals who test positive without efforts to provide substance abuse treatment, without opportunities for benefits to continue for children, and without procedural safeguards to ensure the reliability of positive results.
Proposals in this category include bills introduced in Kentucky and Oregon see Appendix A for details. Others are oriented toward identifying clients who need substance abuse treatment in order to achieve employment and self sufficiency goals.
Such proposals, including bills in Connecticut, Illinois and New York, would require substance abuse evaluation and treatment as a consequence of testing positive. Still others include provisions related to child well-being, requiring that childrens benefits be paid to a third party who will ensure benefits are spent to meet the childrens needs. Positive drug tests are intended to identify whether an individual has used specific substances recently.
The most common tests detect five specific drugs amphetamines, cocaine, marijuana, opiates and phencyclidine PCP ; tests for additional drugs are also available at additional expense. They function by detecting in the tested individuals bodily fluids or tissues e. How long a substance may be detected depends on how quickly the body fully metabolizes the substance.
Urine drug tests, which are the least expensive and most frequently used form of drug test, can generally detect marijuana use within the past week; cocaine, heroin and other hard drugs used within the past two days; and alcohol use within the past several hours though alcohol is not often included in drug screens.
Drug tests cannot measure frequency of use, nor do they indicate the severity of impairment or whether an individual has a substance use disorder that requires treatment.
In addition, without medical review and confirmation testing on initial positive results, [20] urine screens also cannot distinguish between the illicit use of street drugs and the legitimate use of certain prescription and over-the-counter drugs.
For instance, a drug test cannot distinguish between prescribed Tylenol with codeine and illicit opiates. Improper testing procedures and mishandling of samples can also produce inaccurate results.
Drug testing has significant limitations in its ability to identify welfare recipients with substance abuse problems. One study concluded that drug tests would misclassify, either positively or negatively, more cash assistance recipients than it would accurately identify as having a substance abuse problem in need of intervention.
Estimates for false negatives included those who abuse alcohol or other substances not detected by the most commonly used drug tests and those whose most recent use was not within the short window within which metabolites are detectable by urine screens.
False positive results included users whose legitimate prescription drug use would be detected, persons with medical conditions e. Testing of hair rather than urine is often promoted because it is less invasive and can detect drug use over longer time periods. Hair tests cannot detect very recent drug use but do detect use that has occurred between approximately 10 and 90 days prior to the test depending on the length of the hair.
In addition to being more expensive than urine testing, however, hair testing raises several important concerns. As compared with urine drug tests, hair testing may more frequently result in positive results because of external i. Hair treatments, such as coloring or straightening, can also affect the results of hair tests, making it more difficult to detect drug use. In addition, hair testing is not used in some Federal criminal justice proceedings because there is some evidence that naturally dark hair e.
One study has examined the specific limitations of drug testing welfare recipients. A pilot test of a drug testing regime for welfare recipients in Florida concluded in that drug testing did not produce reliable estimates of the level of drug use among TANF recipients.
Studies have also found recipients drug use is largely unrelated to welfare exits, [27] long welfare stays, repeat welfare use or the length of time spent on welfare, [28] and is of only minor relevance in predicting employment success among welfare recipients. That is, drug users were discouraged from participating in the TANF program and those who found employment reduced their recreational use of illicit drugs. It should be noted, however, that the research base is weak and the few existing studies have not used rigorous methodologies.
House of Representatives and Senate. The many current legislative proposals differ on their features and are summarized in Appendix A. Features that differ widely among the bills include the following:. The legislative proposals identified differ in the populations that would be subject to drug testing. Of the bills, 50 State bills plus the two congressional bills would require that applicants be tested, 35 State bills would require suspicionless testing of current recipients, and an additional 26 would test current recipients for cause.
In addition, while nearly all bills focus on testing adult applicants or recipients, a small minority of State bills would require youth aged 13 or older be tested and proposed legislation in one State would require that all benefit recipients, including children under 12, be tested.
Consequences for a positive test vary. Most commonly, 55 bills would automatically deny benefits to those testing positive for varying lengths of time from 90 days to several years , while 24 either require substance abuse evaluation and treatment or provide referral to services. For States providing treatment or referral services, some bills allow benefits to continue during treatment and many allow for earlier reapplication upon completion of treatment.
About one-third of State bills provide for children and other family members to continue to receive the benefit usually paid to a third party if. In addition, while not mentioned in the statutory language, news reports regarding the implementation of Floridas new TANF drug testing law indicate that parents testing positive will be reported to the States child abuse hotline. Fewer of the legislative proposals include procedural safeguards to protect against false positive results or the use of drug testing data for purposes unrelated to the TANF program: 24 allow for retesting, 13 note that results may not be used for criminal prosecution, and 12 would allow for administrative hearings or appeals.
Eleven bills would require recipients to pay for the costs of testing, although some States would reimburse those who test negative. Drug testing is a common pre-employment condition among private employers. Testing by the government has resulted in Constitutional challenges the most recent one involves a challenge to Florida state law.
Courts have upheld the legality of drug testing by government agencies for individuals in sensitive positions and when public safety is involved, as well as for persons involved in accidents on the job and for certain public school students.
Testing when there are specific reasons to suspect drug use is also allowed. However, courts have struck down suspicionless drug testing requirements when they have determined there is no real public safety issue.
Michigans program of suspicionless drug testing of TANF recipients was suspended by the courts after operating only a few weeks, and Floridas recently implemented policy of testing applicants is the subject of a pending challenge. The primary issue in the Florida challenge is whether such testing violates the Constitutions Fourth Amendment prohibition against unreasonable searches and seizures, which prevents the indiscriminate searching of individuals.
Plaintiffs argue that since suspicionless testing involves no reasonable cause to suspect the individuals tested and courts have definitively ruled that drug tests constitute searches, suspicionless testing should not be allowed under the Fourth Amendment.
Also at issue in some disputes in this area is the adequacy of due process protections provided to persons for whom a positive drug test results in the suspension of benefits. The Fifth and Fourteenth Amendments require that the government make available safeguards to prevent an individual from being deprived of property through arbitrary processes or results.
In the context of drug testing, due process typically includes assuring that drug tests are processed by reputable, certified labs that conform to federal specifications, conducting more accurate confirmatory tests when initial results are positive, and having positive results reviewed by a Medical Review Officer who can determine whether the results may be due to legally obtained prescription drugs or medical conditions that may influence test results.
Drug testing by government agencies as a condition of eligibility for public benefits is an area of active litigation. The estimated cost of drug testing TANF applicants and recipients varies by State and proposed law, depending on the proposed number of individuals who would be tested and the range of activities for which costs were estimated.
Aggregate cost estimates of proposed welfare drug testing legislation were identified for twelve States see Appendix C for details. Other estimates include the cost of increasing staff to monitor or administer the tests, as in Maryland and Missouri. Idahos estimate includes the cost of making programming changes to the States information system. Floridas law and Alabamas proposal require the applicant or recipient to pay for the up-front costs of the drug test, though both would reimburse those who test negative.
Most estimates do not incorporate costs relating to increased substance abuse treatment utilization or to increased child welfare interventions.
None of the State cost estimates identified for this paper showed net savings resulting from proposed drug testing programs, though these are all legislative cost estimates rather than rigorous cost-benefit analyses. Also, none of the State cost estimates identified described anticipated unit costs of drug testing programs. Cost Savings. Those who would fail the test, do not comply with the test, or are deterred from applying knowing they would be tested would help decrease the public assistance rolls.
These savings, particularly savings from deterrence, are difficult to measure. However, none of the legislative costs estimates we identified estimated net savings as a result of the proposed drug testing programs.
This provision would decrease the potential savings of drug screening in that State since only savings from the adults benefits would be realized.
Child Well-Being. Few proposals suggest child well-being improvements as a result of drug testing, though provisions for protective payees for childrens benefits are intended to ensure funds are spent on childrens needs. Proposals that sanction families by definition reduce the income available to the family and may therefore decrease child well-being.
It is clear that our constitution — and common sense — would object to the random drug testing of this large group of people, making the drug testing of an equally absurd category of people — welfare recipients — unconstitutional as well.
It is very possible that random drug testing schemes for welfare recipients will run afoul of these state-specific protections as well. Howard, F. DuPont, Teresa G. Campbell and Jacqueline J. Brinkley Smithers Inst. Random drug testing of welfare recipients is scientifically and medically unsound: Welfare recipients are no more likely to use drugs than the rest of the population.
According to a study by the National Institute of Alcohol Abuse and Alcoholism, differences between the proportion of welfare and non-welfare recipients using illegal drugs are statistically insignificant. CAMH believes that there was little benefit to testing and that the stigma associated with testing impacted those on welfare negatively. Additionally, when possible, services were tailored to women by referring clients to treatment programs that had female therapists, women-only groups, and child care.
CWF was a demonstration program testing an intensive intervention for TANF women with substance use problems in 10 counties around the country Morgenstern et al. CWF offered client-level case management and fostered interagency coordination to ensure that clients had access to ancillary services. The study did not employ a control group, but researchers conducted a rigorous evaluation of CWF with women receiving treatment at 10 sites.
An independent evaluation of this demonstration project produced promising findings McLellan et al. Women had high rates of retention 51 percent were still in treatment 6 months after beginning treatment and received substantial amounts of ancillary services.
Followup at 12 months showed that the women had significant and meaningful reductions in substance use 78 percent reported no heavy alcohol use in the previous 6 months , increases in employment 41 percent were employed at least part-time at the month followup , and decreases in welfare dependency. Although this was not a randomized clinical trial, results indicate that integrated care programs may be effective for addressing the multiple needs of substance-abusing women on welfare.
However, such programs require careful attention to the coordination of services across agencies as well as other implementation issues. Women meeting criteria for substance dependence were identified in welfare offices and randomly assigned to receive either ICM or UC. ICM was designed to assist in engaging and retaining clients in care, assessing and linking clients to ancillary services including employment training, and providing long-term monitoring and continuity of care.
In addition, ICM clients received incentives for attending substance abuse treatment. A total of clients were randomly assigned to receive ICM or UC, and 96 percent of clients were followed for 15 months after intake.
Results are promising, indicating that ICM more than doubled the rates of engagement and retention in substance abuse treatment 42 percent versus 18 percent , and nearly twice as many ICM clients as UC clients were completely abstinent at 15 months 43 percent versus 26 percent Morgenstern et al.
However, the ICM clients showed no differences in employment outcomes at 15 months in comparison with women who received standard care Morgenstern et al. CASASARD was a well-designed, well-implemented, rigorously evaluated, randomized clinical trial, and although findings suggest that ICM can improve outcomes for these difficult-to-treat women, implementation of the full model, especially employment training, is critical to success. Overall, best estimates suggest that 8 to 20 percent of women on TANF have a substance use problem that probably interferes with their functioning Metsch and Pollack Women with substance use disorders experience substantially more barriers to employment and are less likely to become employed and more likely to be sanctioned and lose welfare benefits.
Screening procedures are being used in many States to identify TANF recipients with substance use disorders, but findings to date suggest that screening identifies only a minority of those with substance use disorders. Evidence from a rigorous random assignment study indicates that more intensive interventions can yield better treatment engagement rates and substance use outcomes. Overall, available research supports policies that have identified TANF recipients with substance use disorders as part of a group of hard-to-employ HtE recipients who require more intensive services than the typical brief training programs followed by work assignments that most welfare settings offer.
However, substantially more research is needed to provide critical answers to the questions posed at the beginning of this article regarding an evaluation of the broad impact of welfare reform on disadvantaged mothers with substance use problems.
Given the funding constraints and particular challenges associated with conducting this type of research, it is critical to find new ways for substance abuse health services researchers to collaborate with State and Federal welfare agencies on this agenda.
Overall, Federal and State governments face important questions regarding the handling of HtE welfare recipients: What services are effective in helping HtE recipients move toward self-sufficiency? Can States afford to provide these services? And what are the consequences, both human and economic, when such families are removed from the welfare roles?
Further research is urgently needed to inform policy in this area. Berlin, G.
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