The Washington PostDemocracy Dies in Darkness

States want drug tests for welfare recipients. That’s a terrible idea.

Laura Fritz, 27, with her daughter, Adalade Goudeseune, applies for government aid for food and rent at the Jefferson Action Center in Lakewood, Colo. (Kristen Wyatt/AP)

Many forms of public assistance have not kept pace with the rising poverty during the great recession. This quiet human failure has proved particularly acute with Temporary Assistance to Needy Families (TANF) — our nation’s cash assistance system for poor single mothers and their children.

Here in Illinois, for example, the number of TANF-recipient families dropped by 84 percent between 1997 and 2011. Our state TANF rolls remain stuck at 30,000 families per month, markedly below what they were in 2006 before the great recession struck. Of course, the trend is national. As I’ve noted here before, the percentage of low-income children receiving cash assistance has plummeted. Despite what you might hear on the radio, folding federal disability programs into the mix doesn’t change this reality.

TANF benefits are quite low. That’s most obvious in the deep-red states. Mississippi’s maximum monthly cash benefit for a family of three is $170. Illinois’ $432 maximum monthly benefit is better, but only marginally. According to the Center on Budget and Policy Priorities, the combined value of TANF and food stamps allows Illinois families to reach 60 percent of the federal poverty line.

Given such realities, legislators across the country should be exploring how to address serious unmet needs among millions of families in a tough economy. Instead, in many state capitals, precisely the opposite conversation is going on.

A surprising number of states are pondering one extremely bad idea: suspicionless, population-based screening of welfare recipients for illicit drug use. Such proposals periodically reappear, despite an almost complete lack of evidence that they accomplish very much.

This month, the Michigan House approved such a measure. The news story from the Associated Press explains:

Legislation requiring some form of drug testing or screening for welfare recipients has been proposed in at least 29 states this year, according to the National Conference of State Legislatures. Measures have passed in eight states.

It’s especially ironic that Michigan is pondering that legislation, since that state was the site of a previous, spectacularly unsuccessful drug testing effort 13 years ago.

Between 1999 and 2005, I and my co-authors published a series of papers that explored drug use among welfare recipients. We examined Michigan-specific longitudinal data from the Women’s Employment Study (WES). We also examined nationally representative trend data from the hilariously misnamed National Household Survey on Drug Abuse (NHSDA) and the National Survey of Drug Use and Health (NSDUH).

The latter two surveys are not ideal. Surveys that properly explore substance use disorders are poor at capturing socioeconomic variables such as welfare receipt. Meanwhile, well-designed economic surveys tend to be poor at capturing data related to substance use. I wish the NSDUH and NHSDA  included better methodologies to verify respondents' self-reports.

Despite survey limitations, the data conveyed the basic story. Drug and alcohol disorders were genuine issues in the welfare population, but these disorders were not widespread. Moreover, screening in the absence of specific suspicion was not an operationally wise strategy for identifying or serving women who have a drug-related problem.

Roughly one-fifth of TANF recipients reported using some illicit substance, typically marijuana, over the past year. Use was more common among welfare recipients than  within the general population, but it was still a bounded problem. Even among women who reported recent illicit substance use, depression, physical health problems and limited education were actually more common barriers to self-sufficiency and social functioning.

Depending on the year and the sample, roughly one-tenth of TANF recipients reported some actual substance use disorder, which were most frequently associated with alcohol. Illicit drug use had also markedly declined since the early 1990s. Most welfare recipients who reported illicit substance use were casual marijuana users who didn’t meet screening criteria for marijuana (or other substance use) disorders. Ironically, chemical testing technologies were most sensitive in identifying marijuana users who rarely needed specialty addiction services.

Given these patterns, we concluded that poorly implemented screening policies had the potential to flood already stretched child protection and drug treatment systems with women who didn’t need to be there, diverting resources from others in more serious need.

That’s where I left things roughly eight years ago.

Yet it’s been awhile since I’ve examined the data. Meanwhile, reporters keep calling about it. Drug use patterns have changed. The TANF rolls have declined. Things might be different. So when an advocacy group called last week, I decided to download the most recent, 2011 data from the National Survey of Drug Use and Health to take a fresh look.

Within the data, I focused on the most pertinent group for welfare policy: unmarried women between the ages 18 and 49 who live with children in their homes. I further narrowed the sample to those with family incomes below 200 percent of the federal poverty line. To gain some context, I compared drug-use patterns among women who reported that their families had received welfare assistance for at least one month in the previous year with unmarried women who fit the same age and income criteria but reported no receipt of welfare aid. [1]

In addition to capturing substance use, NSDUH is especially useful because it applies screening criteria for actual disorders, operationalized as abuse or dependence following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

The concept of abuse captures a range of behaviors in which recurrent, poorly controlled substance use results in a failure to fulfill major obligations, induces behaviors that endanger self or others, or places the individual in legal difficulties.

The concept of dependence operationalizes commonsense notions of physiological addiction: A person needs increasing amounts of a substance to become intoxicated or achieve a desired effect; a person suffers withdrawal symptoms (or begins to consume a substance to relieve or avoid these symptoms); a person is making persistent and unsuccessful efforts to control or reduce her substance use.

The DSM’s specific criteria and framing are always controversial. The above distinctions are important. One can be a weekly drinker or occasional marijuana user and have no adverse life consequences or physiological harms from that use. But even casual use bears watching for any number of reasons. It still does not meet the usual criteria for referral to specialty addiction treatment, however, which are based on an abuse or dependence diagnosis.

The 2011 NSDUH data proved uncannily similar to what we had found before. Some 22.3 percent percent of 2011 welfare recipients reported illicit substance use in the previous year. About half of these users reported only marijuana use. Presumably, authorities want to drug-test to identify people who are using drugs illicitly or suffering from drug abuse or dependence. Only 3.6 percent of welfare recipients satisfied screening criteria for these disorders. Alcohol disorders -- unaddressed by most illicit-drug testing policies -- were more than twice as common, accounting for about 8.6 percent of welfare recipients, with overlap between these latter two groups.

Welfare recipients were slightly more likely than the comparison-group of other low-income single women to report illicit substance use and accompanying disorders. These differences were rarely statistically significant.

However one runs the numbers, illicit drug use disorders are not common among welfare recipients. Other physical and mental health problems are far more prevalent. Yet these less-moralized concerns receive much less attention from legislators or the general public. Twenty-five percent of welfare recipients in the Michigan Women’s Employment Study met criteria for major depression, for example. Forty-seven percent reported transportation difficulties. Nineteen percent had a physical health problem.

I’m actually a big believer in drug testing — when done as part of a careful intervention when someone has specific drug-related concerns. Such testing can be valuable, for example, in monitoring a parent who has a drug problem that leads her to neglect her children, when someone fails to meet basic program requirements, when someone’s drug problems lead her into legal difficulties.

But let’s be real. Much of the conversation about drug testing of welfare recipients reflects nasty stereotypes with flimsy empirical validity. It strains credulity to believe that we’d demand hair or urine samples from a more influential set seeking public help. It’s tough to be a single mom living on a few hundred dollars a month, Medicaid and food stamps. These women deserve better than they are getting.

[1] I accounted for the weighted and stratified nature of the NSDUH data. I’m happy to share the program output with interested readers.

Harold Pollack is the Helen Ross professor at the School of Social Service Administration and co-director of the Crime Lab at the University of Chicago. He is a nonresident fellow of the Century Foundation.