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CHAPTER 14
DISCUSSION
About half of states have implemented some type of screening program in welfare settings to detect substance use problems (Legal Action Center, 2001). This is the first study to systematically examine the characteristics and service needs of women screening positive who also meet criteria for a substance dependence diagnosis. Overall, substance abusing women reported moderate to severe substance use problems of a long standing nature and were assessed as requiring intensive substance abuse treatment. In addition, they reported high rates of co-occurring problems in the areas of employment, mental health, domestic violence, child welfare involvement, legal, and basic needs. Substance abusing women differed significantly from their non-affected counterparts in being older, spending more time on welfare, and having more co-occurring problems. These differences were not only statistically significant, but substantial in magnitude. In many cases, the rates of co-occurring problems were 2-3 times as great among substance abusers.
Relationship to Findings in Other Studies
Findings that substance abusing women on TANF experience high rates of co-occurring problems are consistent with the limited number of studies that have been conducted in this area. McLellan and colleagues (2001) found a very similar pattern of co-occurring problems in a sample of 760 substance abusing women on TANF entering treatment at 10 sites in a national treatment demonstration project for this population. Statewide studies of TANF recipients in New Jersey, South Carolina, and Connecticut found that substance abusing women had significantly higher rates of mental health, health, employment, legal, and family problems than other recipients (Kasten et al., 2001; Klein et al. 1999; Schottenfeld et al., 2000). The magnitude of the differences reported in the Klein et al. study were similar to those reported here.Women in the non-affected sample also reported experiencing a variety of barriers to employment. Prevalence rates of behavioral health problems were lower in this sample than those reported in other studies of TANF populations (e.g., Chandler & Meisel, 2001; Danziger et al., 2000). These differences are likely due to differences in sample composition. Most barrier studies do not report findings for substance abusers compared to those without a substance use disorder. In addition in this study, the non-affected group did not have a substance use disorder in the past five years. Excluding women with even minor substance use problems likely contributed to lower rates of behavioral health problems like depression and domestic violence.
Limitations
Findings on substance abusers are limited by the study design which assessed women identified using screening procedures in one urban county in the Northeast. Findings do not automatically generalize to all TANF recipients with substance dependence. In addition, a primary exclusion criteria in this study was seeking or being treated in a methadone maintenance program. Thus, findings do not apply to this group. We are examining problem profiles of women in methadone maintenance treatment.
As indicated above, findings on barriers occurring in the non-affected group are not easily comparable to those of other studies, because of the unique selection criteria that excluded even minor substance use problems. In addition, women were excluded from the study if they were deferred from a work activity for a medical reason. Thus, rates of medical problems in both the substance abuse and non-affected samples are likely to be lower than in studies that report on the entire welfare caseload. In addition, high rates of refusal in recruiting non-affected women also raise some questions about the representativeness of this group.
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