FamilyWorks: Substance Abuse Treatment and Welfare Reform

Article excerpt

The National Center on Addiction and Substance Abuse at Columbia University is developing an intervention strategy tailored to meet the needs of substance-abusing mothers receiving cash assistance.

The author would like to acknowledge several people involved in the development of the FamilyWorks model: Mary Nakashian, The National Center on Addiction and Substance Abuse at Columbia University vice president and director of program demonstration, who had the vision and tenacity to join substance abuse and welfare reform in one study; the FamilyWorks research team - Paula Kleinman, Herbert D. Kleber, Audra Keitt, Jennifer Begasse, and Patrick Durning; the FamilyWorks advisory panel - Barbara Blum, Sheila Blume, Jerri Bryant, Rubie Coles, Maria Del Valle, Lynda Fox, Carmen Nazario, Marguerite Saunders, Jose Szapocznik, and Eileen Wolkstein; the women receiving cash assistance who shared their ideas, concerns, and opinions; the treatment centers, training programs, staff, policymakers, and researchers across the country who generously gave us their time, feedback, and insight; and The Robert Wood Johnson Foundation, for providing the planning grant to develop FamilyWorks.

The qualities, characteristics, and circumstances that facilitate women's transition from welfare to work are absent or dramatically diminished among the substance-abusing population. (In this article, substances are defined as alcohol and other drugs.) As states struggle to meet the requirements of Temporary Assistance for Needy Families (TANF), they will increasingly be faced with the need to move this hard-to-serve population into work. As time goes on, more and more of the clients in states' caseloads will have multiple, complex, and long-term problems that prevent them from getting and keeping jobs.

The National Center on Addiction and Substance Abuse at Columbia University (CASA) was awarded a planning grant from The Robert Wood Johnson Foundation to determine the information that is known about substance-abusing welfare recipients and to suggest an intervention strategy tailored to meet their needs. CASA's research has led it to two powerful conclusions:

1. Poverty, addiction, and violence are locked together in a self-perpetuating relationship in which cause and effect are virtually indistinguishable. Violence, which pervades the lives of both poor and addicted individuals, is especially present for women in this population.

2. Employment plays a critical role in helping women move away from addiction, poverty, and abuse.(1)

These interlocking sets of concerns are rarely dealt with as dynamic systems. Violence, for example, is typically not addressed by substance abuse treatment or job training programs in any substantive way. Furthermore, most substance abuse treatment programs do not pay sufficient attention to the employment needs of their clients, and most job training programs are ill-equipped to deal with substance abuse problems.

Many women date the onset of their substance abuse to a specific traumatic event (for example, incest, rape, sexual or physical abuse, sudden physical illness, an accident, a disruption in family life, or the emergence of repressed memories concerning these events).(2) Women's reasons for use onset differ from those of men. Women also have distinct risk factors and different motivations, patterns, and morbidity of substance abuse. Women exhibit different symptoms as well and require distinctive approaches to recovery. Historically, however, substance abuse treatment programs for women have been designed based on effective treatment programs for men.(3)

FamilyWorks, CASA's research demonstration project, will respond to the special needs of low-income mothers who are substance abusers. There has been little prior research on the best way to treat substance abuse in women,(4) and CASA hopes that FamilyWorks will demonstrate how states can serve this population more appropriately and effectively. …