Welfare reform and substance abuse treatment for welfare recipients.

Studies presented in this paper were supported by funding from the National Institute on Drug Abuse (grant 5–RO1–DA12256), the Administration for Children and Families, and the Robert Wood Johnson Foundation. The 1996 welfare reform law replaced the existing entitlement to cash welfare with a transitional program of temporary aid that has employment as its primary goal. Among the key provisions of the welfare reform legislation were mandatory time limits on benefits and work requirements for all recipients, including those with substance use disorders. Changes brought about by the welfare reform law have important implications for the organization of substance abuse services and the well-being of disadvan­ taged children whose parents have substance use disorders. The overall effect of welfare reform could be positive. It gives States wide latitude to design programs to help low-income people attain self-sufficiency and has increased interest in developing innovative programming for hardto-employ welfare populations, including those with substance use disorders (Berlin 2001). This interest could lead to increased funding for treatment, new services such as screening, better integration of needed ancillary services (i.e., medical care, child care, help with housing and transportation), and more account­ ability for outcomes on the part of programs and gov­ ernment systems. Conversely, welfare reform may have a profoundly negative impact on low-income people with substance use disorders and the programs that serve them. The policy of sanctioning welfare recipients for failure to comply with new welfare regulations and a punitive atmosphere at welfare offices may drastically reduce the number of low-income Americans with sub­ stance use disorders who receive public aid, and treatment programs dependent on public funds may face a result­ ing loss of revenue. Research on substance use disorders in the context of welfare reform has primarily focused on four questions: