Changes brought about by the welfare reform law gave states wide latitude to design programs to help low-income people attain self-sufficiency. States could developed innovative programming for hard-to-employ welfare populations, including those with substance use disorders with screening and better integration of needed ancillary services (i.e., medical care, child care, help with housing and transportation). Or states could create a punitive atmosphere at welfare offices that may drastically reduce the number of low-income Americans with substance use disorders who receive public aid, and treatment programs dependent on public funds may face a resulting loss of revenue. Research on substance use disorders in the context of welfare reform primarily focused on four questions:
- What is the prevalence of substance use and substance use disorders among Temporary Assistance to Needy Families (TANF) recipients?
- To what extent are substance use disorders and co-occurring problems a barrier to employability?
- Can screening strategies in welfare settings successfully identify and refer clients to substance abuse treatment?
- What types of services do these clients need to attain self-sufficiency?
This article reviews findings on these questions and offers suggestions for how these findings can inform policy and future research.