Moving Substance-Abusing Women from Welfare to Work Author(s): Lisa R. Metsch, Clyde B. McCoy, Michael Miller, Heather McAnany, Margaret Pereyra Source: Journal of Public Health Policy, Vol. 20, No. 1 (1999), pp. 36-55 Published by: Palgrave Macmillan Journals Stable URL: http://www.jstor.org/stable/3343258 Accessed: 10/06/2009 05:45 Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at http://www.jstor.org/page/info/about/policies/terms.jsp. JSTOR's Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at http://www.jstor.org/action/showPublisher?publisherCode=pal. Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission. JSTOR is a not-for-profit organization founded in 1995 to build trusted digital archives for scholarship. We work with the scholarly community to preserve their work and the materials they rely upon, and to build a common research platform that promotes the discovery and use of these resources. For more information about JSTOR, please contact [email protected].

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Moving Substance-AbusingWomen from Welfare to Work LISA R. METSCH, CLYDE B. McCOY, MICHAEL MILLER, HEATHER McANANY, MARGARET PEREYRA

and

INTRODUCTION

UBSTANCE abuse and welfare reform are among 365 days

5.226 7.49z 5-356

1.333

Is555 .02z5

zo.480 36.o85 z7.971

Logistic Regression Model Predicting Working (Table 4) Multivariate analysis shows that a high school education, participation in the Village's aftercare program, and treatment duration of more than a year were independently related to work status. Women with a high school education were five times more likely to be working than those who did not graduate. Women who participated in the Village's aftercare program were seven times more likely to be working. Women who were in treatment for more than a year were five times more likely to be working. DISCUSSION

This study sought to investigate the work situations of low-income women who had participated in substance-abusetreatment in Miami, Florida. As welfare reform becomes a reality, studies examining predictors of moving women from welfare to work are needed to inform policy and decision making. In particular,studies of substance-abusing women with children are critical, given that substance abuse has been identified in previous research studies as a consistent barrierto gaining and maintaining employment (6). Research studies have shown that women substance-abuserscompared to men tend to have lower educational levels, fewer job skills, and limited employment experience (33). Furthermore, studies have shown that women, in contrast to their male counterparts, are more likely to have histories of physical and sexual abuse (34), neglect, low self-esteem, and inadequate coping skills (35), a host of medical and psychiatric disorders (36), limited parental skills, and encountered domestic violence in their lifetime (34). Substance-abusingwomen also are faced with limited treatment and rehabilitation options for substance abuse and vocational training, making them one of the most difficult populations to reintegrate into the employment sector.

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Findingsfrom the presentstudy are consistentwith the aforementioned literature.Of the ioo women studied,only zo were currently working and 54 were not looking for a job. This work situation, although dismal, needs to be viewed both in light of the individual and demographiccharacteristicsof our target population and the societalrealitythat these women face when reachingout to the communityto findemployment.The druguse and demographicprofileof our populationindicatesthat at the time of the interviewnearly40 percentof women reportedsome substanceuse and over one-fifthof the women reportedhavingusedcrackcocainein the past thirtydays. Almosthalf of the samplehad not completedhigh school and only six percenthad been employedat the time of admissionto the treatment program.Furthermore,these women are part of a hard-to-treatpopulation having treatmenthistorieswith an averageof 2.7 treatment episodesbeforeenrollment.Thesedemographicand druguse characteristicswere compoundedwith long historiesof physicaland sexual abuse. A history of sexual abuse was reportedby one-thirdof the respondentsand a history of incest was reportedby i8 percent.A clear recognitionof these social backgroundand emotionaldifficulties is importantin understandingmechanismsthat may interfere with vocational functioning and gaining employment (6).

Systemicbarriersalso can interferewith gainingemployment.Our findingsindicatethat almost all of the non-workingwomen reported barriersto findinga job. The most frequentlycited barriersincluded absenceof childcare,currentinvolvementin illegalactivities,and the unavailabilityof jobs. Child care, the most commonlyreportedbarrier,is a problemfor all workingwomen, but even more so for substance-abusingwomen or women in recoverybecausethe majorityof jobs obtained do not offer child care, do not provide sufficient incometo affordchild care, and often have inflexiblework schedules which do not allow for child care arrangementsto be made (I4,37). VariablesAssociatedwith WorkStatus Severalvariableswere associatedwith respondentsbeing currently employedat the time of the studyinterview.First,havingreceivedjob trainingand havinga highereducationwere associatedwith current work status.Personswho reportedhavinga resumeor job interviewing skills or at least a high school educationwere more likely to be working than those without these job-seekingfacilitators.As noted

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by Kates (38), welfare recipients who continue their education and participate in job training programs that provide job skills are more likely to make a successful move from welfare to work. Second, being drug free, including no recent alcohol use, crack use or any other drug use, was associated with current work status. That is, non-drug users were more likely to work compared to their drugusing counterparts. Drug use impacts work status, both with regard to amount of time spent seeking and purchasing drugs and then recovering from its effects. New welfare reform policies may be exacerbating this association, particularly with the role of drug testing in welfare reform. Employers are increasinglyrequiringjob applicants to undergo drug testing, and therefore even drug abusers who may be able to function acceptably at work may find themselves

unemployable(9). Third, respondents who successfully completed the Village program as demonstrated through their graduation, length of stay, or participation in aftercare were more likely to be working at the time of the study interview compared to their non-completing counterparts. This is consistent with other studies (z8) which have indicated that drug treatment is associated with reduced drug use and criminal justice involvement, and increased employability. It is important to note, however, that many of the studies which examined outcomes comparing employment rates at admission to post-treatment do not specifically examine welfare recipients. The fourth variable associated with current work status indicates that respondents reporting close relations with friends were more likely to be working than those not reporting such close relationships. In contrast, close relations with family members were not related to work status. To explain these findings, it is important to recognize that many drug abusers in recovery come from dysfunctional families that may have facilitated their entry into or maintenance of drug use. In contrast, the close relations with friends may be reflective of new friends met after completing drug treatment that facilitate their abstinence from drugs and functional recovery in the community. Furthermore, close friends may be able to provide social support such as child care and transportation which also helps in gaining and maintaining employment.

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MultivariateModel which Included ThreePredictorsof CurrentWork Resultsof the multivariateanalysesindicatethat threevariableswere independentlyassociatedwith currentwork status-high school education, longer durationin treatment,and participationin aftercare. Each of these variablesindependentlyand collectivelyhighlightthe importanceof the need for communitiesto assist substance-abusing women in gaining and maintainingemployment,and, in particular, highlightthe criticalrole of comprehensivedrugtreatmentprograms in movingwomen from welfareto work. First,providingthe opportunity for a high school educationis one of the primaryresponsibilities of our nation to each of its citizens.Yet, relativeto nationalpolicy, we need to ask whose responsibilityit is to ensure that every individualis equippedwith the basic educationand skills necessary to becomegainfullyemployed.Data fromour studydemonstratefailures somewherewithin our social system, as only half of our study samplereportedhavinga high school education.Most jobs that pay salariesabovethe povertylevelrequireat least a high school diploma. In our study,those with a high school educationwere five times as likely to be working as women who did not have a high school education. For this predictor,it is importantto recognizethat residential drug abuse treatmentprovides a window of opportunityto enroll women in General EquivalencyDiploma (GED) classes and help them obtain a high school education. Complementaryto the need for more education is the need for longer-termtreatment.Treatmentdurationof more than 12 months was found to be a predictorof work status. Shorterterm treatment programs, especially those less than one month, provide limited opportunitiesto addressthe physiologicalaspects of addiction,not withstandingthe social, behavioral,and other needs of the client, particularlythose relatedto the vocationaland functionalaspectsof full recovery.This also relatesto the third predictorof work status, namelyparticipationin aftercare,which indicatesthe need for continued support in the recoveryprocess, even in gaining and maintainingemployment.It is duringthe aftercarephaseof treatmentthat individualscan continueto increasetheirsocial and employableskills andreceiveassistancein breakingdown barriersthathavetraditionally preventedthemfromgainingandmaintainingsuccessfulemployment.

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Study Limitations Various limitations in this study must be noted when considering these data. First, the sample size of Ioo respondents may have resulted in a limited ability to capture some relationships that may have existed but were not observed due to the small sample size. Second, our data on work status and drug use are based on the participants' self-reports, a limitation of most studies of chronic drug abusers. Third, the cross-sectional design of our study may limit our ability to describe the processes by which study respondents moved in and out of employment since being discharged from treatment. Implications for WelfareReform Policy and Needed Interventions Despite these limitations, the present findings address critical issues of welfare reform, particularly among efforts to move substanceusing women from welfare to work. As shown by the above data, the women in our study lead very difficult lives as they try to balance the demands of maintaining their sobriety, child care, and working in a labor market that has traditionally been very difficult for unskilled and semi-skilled workers (39,40). Sixty percent of the zo women who reported working in the past 30 days showed incomes that were below the poverty level. National policy needs to recognize that moving individuals from welfare to work requires attention to the conditions and status at that particular moment in time. Certain populations, such as the drugabusing women in our study, might require attention in greater intensity and longer in duration to bring them to a level where they require no welfare assistance. Policy makers must recognize the potential value of long-term societal gain outweighing the short term capital expenses, not even to speak of the restoration of self-esteem and quality of life for women and, equally important, for their children and hopefully generations to come. Our data suggest that as welfare reform becomes a reality, continuing support of various types is needed to assist substance-abusing women in gaining and maintaining employment. What is currently available is not enough. On the positive side, the data indicate the value of longer-termresidential treatment as a means to accomplishing much that is needed in this population. Drug treatment could provide increasing opportunities for improving education and the other skills required as well

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as linking women to other ancillaryservicessuch as housing, child care, and transportation,in addition to providing sponsors, role models, and professionalsthat can continueto supportand monitor their full recoveryand integrationinto the community. Policy makers need to thoughtfully consider program goals in funding drug treatment. If the goal is not merely abstinence or decreasein criminalinvolvement,but ratherproductiveliving, then we must be cautious in moving to a managed-care model that emphasizes shorter durations of treatment. This study demonstrates that longer terms of treatment are more likely to result in work (productive) status. Whether this can be done with extended lengths of time in treatment utilizing a greater range of modalities (outpatient, weekly classes) as stepdowns from residential treatment is not known from this study, but could be the basis for future research. However, what we do know is that if we rush to brief treatment with this population, we sacrifice the goal we sought to achieve in the first place. A challenge to our society is the decision as to whether to pay now or pay more later. Without the requisite attention, it is not only unfair but ineffective to expect that vulnerable and disadvantaged populations will integrate themselves into the workforce. The quicker and more effective the integration, the sooner public assistance will no longer be necessary. Unless we conclude that there are throw-away populations, then we either pay for corrective programs or "correctional" facilities. Can we truly conclude that correctional facilities are even the most cost-saving way, without considering even quality of life issues? These difficult national decisions speak to the quality of a nation and its ability to sustain its citizens' quality of life. In conclusion, there is a great need for further research studies and the development, implementation and evaluation of community-wide interventions to help women make a successful transition from welfare to work. It would seem most reasonable and prudent to base future policy decisions on sound empirical research exploring conditions, characteristics, and determinants of moving substance abusers from welfare to work and solid evaluation of appropriately designed programs.

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ABSTRACT Substance abuse and welfare reform are among the nation's highest priorities, and research that examines linkages between the two is of extreme importance to both government policy and the community. Welfare reform will have serious implications for substance abusers as well as for the various professionals who treat them and work to move their clients into functional recovery and self-sufficiency. Within the context of welfare reform and the special needs of substance-abusing populations, the present study examines current welfare status, work status, and barriers and facilitators to gaining and maintaining employment among Ioo low income women who participated in a long-term residential substance-abuse treatment program in Miami, Florida. Participants completed a face-to-face interview to assess a detailed employment history and current sources of income as well as the Addiction Severity Index. Results indicate that completers of the treatment program were more likely to be working post-discharge than non-completers. Similarly, the longer the length of stay in the program, the more likely the client was to be working post-discharge. Multivariate analysis indicates a high-school education, participation in the treatment center's aftercare program, and treatment duration of more than one year were independently related to work status. These data suggest that as welfare reform becomes a reality, continuing support of various types, particularly drug treatment, is needed to assist substance-abusing women in gaining and maintaining employment.