Specialized Screening Approaches Can Substantially Increase the Identification of Substance Abuse Problems Among Welfare Recipients. Discussion


Overall, results of this report suggest that a generic approach to screening in welfare settings  one that relies primarily on caseworkers administering paper and pencil measures as part of benefit eligibility determination  is useful in identifying a small percent of substance abusers. Similar results have been reported in other states (Nakashian & Moore, 2000). At the same time, findings suggest that specialized screening programs can substantially increase identification rates. The key elements of this approach are the use of trained staff to conduct interviews on groups who are at high-risk for having a substance abuse problem. Interviews focused on establishing rapport as well encouraging self-disclosure through careful questioning. In addition, it is important to address issues of privacy and confidentiality. Findings also indicate that high-risk groups may have a high prevalence of substance abuse problems: about one-third to one-half of recipients in the specialized screening programs appeared to have a problem. Findings that 49% of sanctioned clients interviewed met criteria for a substance use disorder is notable because it suggests that the prevalence of substance abuse among clients failing at work activities may be especially high.

It is also important to note study limitations. This study did not employ an experimental design. Thus, although findings are promising, causal inferences about the effectiveness of specialized screening approaches have not been established. In addition, findings that 49% of sanctioned clients met criteria for a substance use disorder were based on those clients (24% of those sanctioned) who attempted to cure their sanction. Rates of substance abuse among those not responding to the sanction letter may be higher or lower. In addition, many factors contribute to the low rates of identification of substance abuse among welfare recipients. It is beyond the scope of this report to discuss these factors or other promising solutions. However, a broader analysis of this problem is presented in an excellent report published by the Center for Substance Abuse Treatment (Nakashian & Moore, 2000).