Characteristics of individuals screening positive for substance use in a welfare setting: implications for welfare and substance-use disorders treatment systems.
OBJECTIVE
This study examined barriers to employability, motivation to abstain from substances and to work, and involvement in multiple service systems among male and female welfare applicants with alcohol- and drug-use problems.


METHODS
A representative sample (N= 1,431) of all persons applying for public assistance who screened positive for substance involvement over a 2-year period in a large urban county were recruited in welfare offices. Legal, education, general health, mental health, employment, housing, and child welfare barriers to employability were assessed, as were readiness to abstain from substance use and readiness to work.


RESULTS
Only 1 in 20 participants reported no barrier other than substance use, whereas 70% reported at least two other barriers and 40% reported three or more. Moreover, 70% of participants experienced at least one additional barrier classified as "severe" and 30% experienced two or more. The number and type of barriers differed by gender. Latent class analysis revealed four main barriers-plus-readiness profiles among participants: (1) multiple barriers, (2) work experienced, (3) criminal justice, and (4) unstable housing.


CONCLUSIONS
Findings suggest that comprehensive coordination among social service systems is needed to address the complex problems of low-income Americans with substance-use disorders. Classifying applicants based on barriers and readiness is a promising approach to developing innovative welfare programs to serve the diverse needs of men and women with substance-related problems.
Morgenstern
Jon
J
The National Center on Addiction and Substance Abuse at Columbia University, New York, New York 10032, USA. jm977@columbia.edu
Hogue
Aaron
A
Dasaro
Christopher
C
Kuerbis
Alexis
A
Dauber
Sarah
S
D000328:Adult; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data; D015897:Comorbidity; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D006305:Health Status Indicators; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009042:Motivation; D020380:Needs Assessment; D009519:New York City; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011632:Public Assistance / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012050:Rehabilitation, Vocational; D015406:Single Parent / Q000706:statistics & numerical data; D012946:Social Welfare / Q000706:statistics & numerical data*; D015813:Substance Abuse Detection / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D014505:Urban Population / Q000706:statistics & numerical data
D013287:Illicit Drugs; D008691:Methadone