Things are looking up for Lynette, a recovering alcoholic in Hoisington, Kan.
The divorced mother of two is celebrating a year of "being clean." And she's just gotten a part-time, minimum-wage job at a grocery store. For now, Lynette will still receive government assistance. But she's hoping to work her way up to full-time employment - and financial independence.
The key to her success: the Women's Recovery Center, a drug-treatment facility that lets women bring their children. "My treatment was paid for, and they had day care," says Lynette, who declines to give her last name.
Lynette's experience demonstrates what some states are learning as they embark on the national drive to put welfare recipients to work: substance-abuse problems must be addressed if a person has any hope of finding and keeping a job.
That conclusion may seem obvious, but experts on drug abuse report that very few states are making that link adequately in their new welfare-to-work programs.
"It's a very neglected issue," says Nancy Young of Children and Family Futures in Irvine, Calif., who has studied the states' welfare reforms. Under the old system that allowed states to conduct test programs in welfare reform, only two states - Kansas and Oregon - had pilot programs that dealt specifically with substance abuse, Dr. Young says.
The need for treatment
Of the roughly 4 million adults receiving welfare in the United States, a significant number use drugs and alcohol in ways that impair their ability to work and care for their children. The US Public Health Service puts the figure at 16 percent, while other estimates range as high as 39 percent.
On top of that, 90 percent of adults on welfare are women, and so it becomes crucial to design substance-abuse programs that are oriented to women, experts say. Some women have been physically abused and need substance-abuse treatment that is nonconfrontational, they say. And many need care for their kids.
But nationally, there's a serious shortage of publicly funded treatment slots for substance abusers. And with a national mandate to put welfare recipients to work in two years, and a five-year lifetime cap on benefits, states are being pressured to move welfare recipients to the head of the line for drug treatment.
Federal legislation proposed by Sens. John Chafee (R) of Rhode Island and John Rockefeller (D) of West Virginia would require parents of children who are clients of child protective services to get priority status for substance-abuse treatment.
In Kansas, there's no wait for drug-abuse treatment, and the new Kansas Works welfare-to-work program has put treatment counselors right in the welfare offices, where applicants can be screened for substance abuse and referred for treatment. Caseworkers then monitor the outcome.
But in Virginia, counties face a shortage of treatment slots for substance abusers, so welfare recipients must compete with many other groups for those slots.
There's the welfare agency that wants its clients to be treated first, to boost those clients' employment prospects. Then there are the parents and spouses of abusers who have been using their own resources to keep their family-members afloat while they wait for a treatment slot.
"That's one of the real dilemmas," says Richard Kunkel, director of substance-abuse programs in Fairfax County, Va., where he currently has 96 people waiting for a long-term care program with about 60 beds.
In addition, the court system has people in jail - not on welfare, but costing the taxpayer money nonetheless - who are waiting to go into drug treatment. In some cases, for example, parole boards will grant a person parole only if he or she goes into a drug-treatment program upon release. This helps ensure the person's habit doesn't return. If no treatment slots are available, the person stays in prison. "Do you just keep occupying that jail bed because the people on public assistance keep hopping to the top of the list?" Mr. Kunkel asks.
A question of values
At the root of the link between welfare and substance abuse lies a question of values that substance-abuse experts say was not adequately addressed during the debate on welfare reform. As a society, we are now increasingly holding people responsible for their behavior. If people behave irresponsibly - by abusing drugs or alcohol, for example - they should lose their public assistance and their children, some public figures argue.
But experts on substance abuse counter that some people have a predisposition to abuse drugs or alcohol, and need public support - not just sanctions - to overcome their problems.
Some public officials are frustrated by an aspect of welfare reform that takes benefits away from people convicted of drug felonies. In Fairfax County, Kunkel is now beginning to see the effects of this. Some of the people in his treatment programs are losing monthly cash assistance that was used to buy incidentals, such as toiletries. Even if it's a matter of $40 a month per person, he says, "we don't have that in our budget."
Another law that is frustrating some public-health advocates is called the Contract With America Advancement Act, which ends disability payments, called Supplemental Security Income, to people whose disability is caused by alcohol or drug abuse. The result, advocates argue, could be increased homelessness.
How States Handle The Drugs Factor
Some states are beginning to establish programs for welfare recipients who abuse drugs or alcohol. A sample of approaches follows.
Kansas: Screens all welfare applicants for drug and alcohol use. Those people who test positive are referred for treatment and then monitored closely.
Oregon: Provides orientation on drug issues for staff of welfare offices, including training on how to screen for substance abuse. The welfare agency contracts with local treatment centers, and clients found to have substance-abuse problems must undergo treatment. A recipient who fails to follow through may lose welfare benefits.
Delaware: With federal permission, the state uses Social Security funds for alcohol and drug treatment. This money funds joint teams from Child Protective Services and an alcohol- and drug-abuse program to provide treatment to parents whose children might otherwise be placed in foster care.
Michigan: Enrolls all welfare clients who have alcohol or drug problems in employment-training or employment programs. But the jobs programs are not supposed to interfere with drug or alcohol treatment.
Source: Drug Strategies, Washington, and Children and Family Futures, Irvine, Calif.