No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Drug testing and mandatory treatment for welfare recipients
Abstract
One province in Canada, Ontario, is considering the use of drug tests for welfare recipients. Those with positive tests could be required to receive treatment and abstain from drug use or risk losing their benefits. Several experts from the Centre for Addiction and Mental Health (CAMH) reviewed the scientific strengths and weaknesses of this proposal. Strengths included possible increases in employment and reduced drug use among welfare recipients; however, the group concluded that drug testing of welfare recipients or removal of welfare benefits for people who refuse treatment or relapse is not advisable for several reasons. Drug testing cannot be used to determine substance abuse or dependence, could undermine the client case manager relationship and could be legally challenged as a violation of human rights. Other drawbacks of conditional welfare include possible negative societal consequences (i.e. increased crime and health problems) and disruptions to the treatment population. The whole process is expensive and will likely result in a very marginal increase in employment because drug dependence is not a major barrier to employment.
... A simple example of one determinant of health -access to clean water -is salutary given the well-documented relationship between the absence of safe water sources and significant injection-related harm, general health including dental health, and self-esteem [90][91][92]. Another example is limitations placed on people who use drugs to access poverty-eliminating programs through the application of so-called 'welfare conditionality' [93][94][95]. In terms of the cultural determinants of health, a growing body of scholarship and activism recognises the relationships between drug related harms and dispossession, colonisation with its intergenerational legacies, racism, and the loss of cultural identity [31,96,97]. ...
Support for a human rights framework for drug policy has been growing for some years. This year, the UNODC published a chapter in the World Drug Report focussed on the right to health. In this paper, we draw attention to the conceptualisation of the right to health for people who use drugs. While one essential element is access to appropriate, high quality, and affordable healthcare, this needs to occur hand-in-hand with two other central components of the right to health – the right to conditions that promote health (the social, economic, legal, commercial, and cultural determinants of health) and the right to meaningful participation in healthcare decisions and in health policy. We consider these three components of a right to health against the current international drug control regime. More specifically we point to how the three drug conventions (1966 as amended 1972, 1971 and 1988) make explicit mention of the right to health. In this way, we argue that duties to respect, protect and provide the right to health for people who use drugs accrue through being a signatory to the drug conventions. Given that there does not appear to be international appetite to abandon the current treaties, and notwithstanding the strong impression that they reinforce a criminalisation approach to people who use drugs, the work herein may afford another avenue for effective advocacy about the right to health.
... 44, 45 The study's a review of the research evidence concluded that drug use is not a major barrier to employment for welfare recipients. 46 The authors of the Florida study caution that a disproportionate emphasis on drug use as a barrier to employment could be ineffective if other major barriers, such as physical and mental health problems, lack of job skills, and lack of transportation, are ignored. It should be noted that few drug testing proposals include substance abuse treatment components, making deterrence the primary mechanism through which decreased drug use or increased employment could result. ...
In the years since welfare reform transformed federal cash assistance for the poor into to the time-limited, work-focused Temporary Assistance for Needy Families (TANF) Program, the issue of substance abuse among welfare recipients has arisen periodically as a policy and programmatic concern. This Issue Brief examines recent State and federal legislative proposals to require drug tests as a condition of TANF program eligibility. The paper discusses the prevalence of substance abuse among TANF recipients, how states typically address substance abuse in their welfare programs, the variety of drug testing proposals now under discussion in states, and legal and practical issues raised by drug testing proposals.
... As well, it is worth considering that some jurisdictions have rates that adjust to local cost of living whereas others do not, meaning that high urban housing prices might make rates even less sufficient. Moreover, some jurisdictions have rigorous requirements to access and maintain access such as demonstrated job searching or drug testing (MacDonald et al. 2001). Therefore, several factors will influence sufficiency of income supports such as: family make-up, age, community of residence, cause of need (and the temporary or permanent nature of this cause), requirements to maintain access to income, and policies regarding earning a partial income while receiving assistance. ...
Homelessness is often considered to be an outcome of individual behaviours and shortcomings, or individual conditions. However, research has demonstrated that there are several policy factors that are strong predictors of homelessness at state or national levels. In fact, policies from sectors as various as the justice system, health system, income supports, and housing can all create the context in which people find themselves de-housed. This chapter will explore homelessness as a “fusion policy problem”, meaning that problems across a variety of policy areas fuse together to create this particular social ill. The chapter focuses on the U.S., Canada, and Finland as examples, although the concept holds true internationally. A variety of particularly concerning policies is presented across different public systems, and proposed reforms to each of the policies are presented from within the research literature. Ultimately, this chapter presents considerations for how we can prevent and end homelessness at a structural rather than individual level.
... The Prime Minister described the measures as a 'policy that is based on love', intended to 'make a change in people's lives so they were not taking drugs, so they were not destroying their lives, so they were not destroying the lives of their families, so they were not making themselves unemployable' (Turnbull 2017). Yet the measures run counter to local and international evidence that drug-testing strategies are unlikely to produce these effects (Arthur 2017; Australian National Council on Drugs 2013; Covert 2015; Macdonald et al. 2001; Royal Australasian College of Physicians 2017; Whiteford 2017a; Wincup 2014), focusing instead on ensuring 'that taxpayers' money is not being used to fund drug addictions' (Australian Government 2017a, p. 3). In this case, the symbolic value of the policy -which reinforces the 'battler versus bludger' welfare narrative -appears to trump cost-benefit analysis, data and experience of what works to achieve meaningful change in this arena. ...
The Australian Government announced in its 2017 budget that it would trial random drug-testing of recipients of the Newstart Allowance and Youth Allowance in three locations from January 2018. The Prime Minister described it as a policy ‘based on love’, but that sentiment is hard to find in the policy rhetoric, which situates it in a suite of measures designed to ‘ensure taxpayers’ money is not being used to fund drug addictions which are creating significant barriers to employment'. The policy may make it harder for people to buy drugs with their welfare payments, through income management, but research suggests it will not help them overcome addiction and its costs will exceed any savings it generates in income support. Furthermore, the policy perpetuates ‘medicalisation’ of the problem of long-term unemployment by suggesting it stems from deficiencies in individuals that can be ‘treated’, despite evidence to the contrary. Finally, the policy claims to close loopholes in enforcement of mutual obligation requirements without addressing structural weaknesses in the welfare-to-work model. Each of these issues will pose challenges for those charged with implementing the policy.
... Testing may also take place within the criminal justice system (Macdonald et al., 2001), such as arrest referral schemes, probation, medico-legal situations, coroners' cases, prison medical services and secure units (Magura & Kang, 1996;Mieczkowski et al., 1991;Rosay et al., 2007) and in the drug-driving context. Testing may be used within the criminal justice system, for the detection of persons who have recently used drugs, to monitor and deter further illicit drug use, to assess level of intoxication, to estimate risk and to estimate national and local drug use trends (Wish, 1990;Singleton, 2008). ...
Biological testing procedures for substance use are extensively used for a variety of purposes, and there has been an increase in the number and types of testing procedures available in recent years. The emergence of recreational drug use as the norm rather than the exception has proved challenging for laboratory services who may have to adapt to a different range of substances from the more traditional biological screening and testing
methods used previously.
... However, in compulsory detention centers drug users receive treatments regularly, even though treatments vary across centers [6] and the treatment efficacy has been frequently questioned [7,9]. Moreover, there is evidence showing that mandatory treatment can produce positive outcomes [10]. ...
Background
Compulsory drug detention is the most frequent way to control drug use in China; however, it has often been criticized. This qualitative study aimed to investigate abstinence self-efficacy and its sources of drug users in a compulsory male drug detention center in Shanghai, China, and the attitudes of the drug users to this form of rehabilitation. Methods
Thirty-six participants were interviewed (semi-structured, in depth) about their history of drug use and rehabilitation, self-evaluation of addiction, motivations to abstain, plans for the future and attitudes toward rehabilitation. A thematic analysis was undertaken of the transcripts with responses to interview questions being coded for content. ResultsTwo main types of self-efficacy were found – “overconfidence” (n = 16) and “helplessness” (n = 17). Overconfident participants underestimated their levels of addiction, overestimated their self-control and held external motivations and attributions. In contrast, helpless participants overestimated their levels of addiction, underestimated their self-control and had internal motivations and attributions. Compared to overconfident participants, helpless participants had more relapse history, and were more inclined to interpret relapse as a failure and attribute relapse to themselves. More helpless participants were abandoned by their family members, and received blame from the family members instead of encouragement, but their family members motivated them to abstain. Helpless participants experienced more negative emotions and had worse physical status. They said compulsory detention was a strong support for them and was the most effective way to abstain; while overconfident participants said compulsory detention was not necessary and not useful. Conclusion
It is important to increase the motivation of overconfident drug users and the perceived control of helpless drug users. Compulsory drug detention has strengths in supporting drug users who feel helpless to resist drug use. Adjustments and improvements of compulsory drug detention are suggested.
... For instance, the 1997 Ontario Works Act requires people who apply for financial and employment assistance to undergo a screening test for substance addiction (ServiceOntario e-laws, 2010). The purpose of this regulation was to ensure that people received treatment to abstain from drugs so they can get off welfare and back into the labour force (Macdonald et al., 2001). However, the prevalence of substance use among people applying for welfare is comparable to substance use among people not on welfare (CAMH, 2000). ...
... Few examples of implementation of mandatory policies and forms of action in the health care setup include mandatory psychiatric admission and treatment in the US, mandatory Treatment of Tuberculosis patients in Russia , mandatory admission and treatment of drug and alcohol abusers in Canada and mandatory isolation and treatment of HIV infected in Cuba. The main justifi cations in all the four cases were that the mandate of the health system to protect health of the public is greater than the mandate to benefi t an incompetent patient18192021. ...
The HIV/AIDS pandemic has raised a number of ethical dilemmas and considerations of
peculiar nature. The issue around HIV testing policies of pregnant women has currently
gained an increasing interest; whether it is ethical to let a pregnant woman make a decision to forego HIV testing to the extent of refusing test and treatment at the potential
expense of the life of the would-be-born child versus mandating HIV testing in all pregnant
women.
HIV testing of pregnant women is an important entry point to benefit from PMTCT. It is
reported that a significant number of women decline HIV testing and fail short of benefiting
from the program for various reasons. Because of this, there is an urgent need to look
for ways of maximising the number of pregnant women being tested for HIV to the extent
that all are tested in areas of high HIV prevalence such as Sub-Saharan Africa. To ensure
this the available options include an ‘opt-out testing approach’ versus ‘mandatory testing’.
Mandatory testing has gained much attention recently and there is an ongoing dialogue
on the relevance of mandatory HIV testing in pregnant women. Is such an interceptive
approach worth considering?
The objective of this paper is to assess the ethical issues around HIV testing in pregnant
women with more critical focus on mandatory HIV testing, using mainly the Capability
Approach for further elaboration and deliberation. The Capability Approach, apart from
utilitarian, liberal and communitarian perspectives, is used for elaboration and ethical
deliberation. The capabilities and functionings of women are very important in the understanding of the status of vulnerable groups like women of the developing world. Even
though in utilitarian terms, mandatory HIV testing of all women coming for a prenatal
care is assumed to be of maximum effects, this is yet practically unproved assumption
which has rather problematic ethical issues that need due reconsideration. Informed-consent and counselling should not be skipped in such emotionally engaging and psychologically affecting test. Providing HIV testing in a forced and coercive way can work rather negatively against the effectiveness of the PMTCT program; women will loose confidence in the health care system, they shy away from services and there results big uncertainty about the subsequent cooperation of the women in the rest of the PMTCT interventions i.e. compliance to treatment, breast feeding options and medical follow-up. This will put the practical effectiveness of the approach in to question. There is rather a need to analyse the capabilities that women have in decision making in important and sensitive issues. The analysis is of more importance for women who have a vulnerable position socially, biologically, intellectually and economically; which is the case in the Sub-Saharan Africa. Due emphasis needs to be given for the decision making capabilities of women and the factors playing determinant role in their decision making. With out addressing their capability coercion will have dire effects. Acknowledging this fact, any kind of maximisation of HIV testing intake needs careful thought and ethical analysis before implementation because of the nature of the test and the interplay of factors in determining the effectiveness of such an approach. In this regard an ‘opt-out’ strategy of testing gives a better position for pregnant women to act based on their capabilities.
... Specifically, those with positive tests could be required to receive treatment and abstain from substance use or risk losing their benefits. However, this proposal is not supported by evidence and may produce increases in crime, health problems and other social costs [14]. Our results also highlight the importance of interventions in preventing the potential variability in demand for the SU due to the dates of welfare payments. ...
In British Columbia (BC), the Ministry of Human Resources issues welfare cheques to eligible recipients monthly on the last Wednesday of each month. Previous studies have indicated that there are significant increases in hospital admission, ED admission, 911 calls and deaths shortly after the distribution of the monthly welfare cheques. The objective of this analysis was to rigorously examine the impact of welfare cheque issue dates on admission to the Sobering Unit (SU), a service for the publicly intoxicated, in Vancouver, Canada. Data on 1234 consecutive admissions to the SU over a 7-month period were assessed, and the average number of daily admissions on each of the 7 days of the welfare cheque issue week and similar weekdays in other weeks were compared. A Wilcoxon rank-sum test was performed for the comparisons. Our results showed that there were significant increases in the number of admissions on the 3 days starting with "Welfare Wednesday" compared to the similar weekdays in other weeks (Welfare Wednesday vs. other Wednesdays: 8.7 vs. 5.1, p = 0.02; Welfare Thursdays vs. other Thursdays: 9.6 vs. 5.3, p = 0.02; Welfare Fridays vs. other Fridays: 8.6 vs. 5.7, p = 0.04). The demonstrated impact of welfare cheque issue dates is an important consideration for the re-design, staffing and resource allocation of services for withdrawal management and potentially for other services offered to this population.
Taking a multi-disciplinary perspective (including public health, sociology, criminology, and political science amongst others) and using examples from across the globe, this book provides a detailed understanding of the complex and highly contested nature of drug policy, drug policy making, and the theoretical perspectives that inform the study of drug policy. It draws on four different theoretical perspectives: evidence-informed policy, policy process theories, democratic theory, and post-structural policy analysis.
The use of and trade in illegal drugs are a global phenomenon. It is viewed by governments as a significant social, legal, and health problem that shows no signs of abating. The key questions explored throughout this book are what governments and other bodies of social regulation should do about illicit drugs, including drug policies aimed at improving health and reducing harm, drug laws and regulation, and the role of research and values in policy development. Seeing policy formation as dynamic iterative interactions between actors, ideas, institutions, and networks of policy advocates, the book explores how policy problems are constructed and policy solutions selected, and how these processes intersect with research evidence and values. This then animates the call to democratise drug policy and bring about inclusive meaningful participation in policy development in order to provide the opportunity for better, more effective, and value-aligned drug policies. This book will be of great interest to students and scholars of drug policy from a number of disciplines, including public health, sociology, criminology, and political science.
Is mandatory drug testing for welfare recipients morally justifiable? This article argues that none of the three justifications typically offered in support of drug testing—that is, paternalist, contractualist, and harm-based justifications—are normatively persuasive. On the one hand, I claim that these normative justifications do not warrant the violation of welfare recipients’ privacy. That is, I argue that they fail to make the case that the benefits of drug testing outweigh its costs in terms of welfare recipients’ privacy. On the other hand, I argue that even if we accept any of these normative justifications for drug testing, current background conditions in the US make the implementation of this policy unfair in practice. First, the enforcement of drug testing can strengthen existing injustices. Second, under current circumstances, drug testing policies are likely to engender moral obligations which cannot be fulfilled.
United Kingdom government policy to increase social security claimants' entry to the labour market through conditions attached to unemployed, sickness and incapacity benefits now includes additional measures to activate particular groups such as lone parents and drug users. The latter are a prime target because of their high level of dependency on benefits and because social security rules are seen as having the potential to modify the behaviour of individuals with a lifestyle regarded as being at odds with the moral obligations of citizenship and incompatible with the government's realization of its wider economic and social goals. There are strict procedures for the identification of drug-user claimants, enabling additional conditions to be attached to their benefit rights. This article discusses the general trend in benefit reform towards increased conditionality and evaluates the reforms affecting drug users, considering human rights and other implications. It concludes by reflecting on the status of conditional rights to social security as social rights.
Canada is an egalitarian society committed to accessible and comprehensive health care. Although there has been a tendency to assume that its various social welfare programs have improved health conditions for lower income citizens, Canada's record in ensuring health equality remains poorer than expected (Humphries and van Doorslaer, 2000; Wasylenki, 2001). The Canadian Health Act stipulates that all residents of Canada are to have access to medically necessary hospital and physician services based on need and not the ability to pay. However, for marginalized groups such as drug users and the homeless, structural barriers to better health remain. This paper examines the health care needs and experiences of 30 women who were heavily involved in the street life of crack and prostitution in Toronto. Through their ready access to local drop-in clinics and nearby hospitals, the women reported generally positive experiences with the health care system. The study concludes that the women experienced many of the health problems that typify homeless, poorly housed and economically marginalized groups. Both positive and negative experiences with the health care system, and structural barriers that hamper its full utilization, are identified.
In Ontario, those dependent on substances are no longer eligible for welfare payments based on an addiction disability. While the impact of this program has not been assessed, evidence from a similar policy shift in the USA suggests deleterious effects on the health and social functioning of about half of those who lose this form of social support. A review of the research on the chronic-illness view of addiction, the fostering of stigma by exclusionary social policies, and the negative effects on mental health and homeless status associated with the loss of welfare benefits leads to the conclusion that this is an ill-advised policy for Ontario. Its continuation there, and its extension to other provinces, is not recommended.
Background: Recently enacted federal legislation targeted at curbing perceived abuses of cash benefits for former Supplemental Security Income beneficiaries for drug addiction and/or alcoholism (DAA P,.005; 95% confidence interval, 1.615.7) and of having 2 or more comorbid psychiatric disorders (odds ratio, 6.9; P,.005; 95% confidence interval, 1.9-24.7). Conclusions: Those who have lost DAA consequently, helping these cases make the transition from government assistance to sustained employment is increasingly difficult.
Using a new survey of a representative sample of single mothers who were welfare recipients in an urban Michigan county, the authors explore how certain employment barriers, often ignored by previous welfare researchers and policy makers, constrain these single mothers' employability.
The results the authors present show that welfare recipients in the sample have unusually high levels of some barriers to work, such as physical and mental health problems, domestic violence, and lack of transportation, but relatively low levels of other barriers, such as drug or alcohol dependence and lack of understanding work norms. The authors also show that most recipients have multiple barriers and that the number of barriers is strongly and negatively associated with employment status. In addition, the authors find that an expanded regression model that includes these barriers is a significantly better predictor of employment than is a model that only includes variables traditionally measured, such as education, work experience and welfare history. The authors conclude with a discussion of the implications of these results for understanding the employment and post-welfare experiences of single mothers and for reforming welfare-to-work policies.
A meta-analysis of the efficacy of remediation with drinking/driving offenders included 215 independent evaluations identified through a comprehensive literature search. Study characteristics, including dimensions of methodological quality were coded using scales and protocols developed by expert panels. Better methodological quality (as indicated by group equivalence) was associated with smaller effect size and less variation in effect size. Among studies with adequate methods (as determined empirically through examination of effect size variation with quality), the average effect of remediation on drinking/driving recidivism was an 8-9% reduction over no remediation. A similar effect size was found for alcohol involved crashes. However, licensing actions tended to be associated with reduction in occurrence of non-alcohol events (e.g. non-alcohol crashes). Exploratory regression analysis and confirmatory within study analysis suggested that combinations of modalities--in particular those including education, psychotherapy/counseling and follow-up contact/probation--were more effective than other evaluated modes for reducing drinking/driving recidivism. Treatment effects are probably underestimated in the literature due to overemphasis on education as a treatment for all offenders and drinking/driving recidivism as the most frequent measure of outcome. Limitations of the primary literature and future research needs are discussed.
As interest increases in employment-related drug testing, the technologies and the interpretive skills of analysts continue to evolve. Although recent literature indicates that significant refinements and modifications to drug testing technology have been made, the complexity of drug effects is so great that many problems exist in interpretation of the test results. The most frequent problems that confront the toxicology laboratory relate to developing technology that can determine how much and when the drug was taken, how long after use the tests are capable of showing positive results, the causes and rates of false positives and false negatives, and how tests can be “beaten” by employees. These problems will be discussed in this chapter, and the various laboratory procedures that are used to combat these problems will be examined.
Recently enacted federal legislation targeted at curbing perceived abuses of cash benefits for former Supplemental Security Income beneficiaries for drug addiction and/or alcoholism (DA&A) may be creating a residual population that is too seriously impaired to work owing to psychiatric and substance use disorders.
Data in this report were derived from 1-year follow-up interviews of 204 randomly selected DA&A beneficiaries in Chicago who were initially interviewed between January 1997 and March 1997, immediately following their termination in the Supplemental Security Income DA&A program. Information on subjects' work and benefits status were collected along with DSM-III-R psychiatric and substance use disorder diagnostic information. Urine specimens were also collected and tested for recent use of marijuana, cocaine, opiates, phencyclidine, amphetamines, and methadone.
Twenty-six percent had a past-year severe mental illness while 34% met the DSM-III-R criteria for drug dependence. Illegal drug use was also prevalent with about 50% of the sample testing positive for marijuana, cocaine, or opiates. Compared with those working and earning at least $500 a month, unemployed or underemployed subjects who had lost all federal benefits had a much greater likelihood of being dependent on drugs (odds ratio, 5.0; P<.005; 95% confidence interval, 1.6-15.7) and of having 2 or more comorbid psychiatric disorders (odds ratio, 6.9; P<.005; 95% confidence interval, 1.9-24.7).
Those who have lost DA&A disability benefits and who continue to be unemployed or underemployed have elevated rates of drug dependence and psychiatric comorbidities; consequently, helping these cases make the transition from government assistance to sustained employment is increasingly difficult.
Reform has transformed traditional entitlement to cash welfare under Aid to Families with Dependent Children (AFDC) into a transitional program known as Temporary Assistance to Needy Families (TANF). Because of the new work requirements and the time-limited nature of assistance, policy makers are increasingly confronted with what to do when welfare recipients do not effectively make the transition from welfare to work. Increasingly, the language of public health is being used to determine who is "employable" and who is not. Thus renewed attention is being focused on the individual characteristics of participants themselves, particularly specific diagnoses that might reduce employability. This article focuses on substance abuse and mental health problems among single mothers and examines their relationship to welfare receipt. We analyze data from the 1994 and 1995 National Household Survey of Drug Abuse (NHSDA) and find that 19 percent of welfare recipients meet the criteria for a DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, third edition revised) psychiatric diagnosis. About the same percentage have used illicit drugs during the previous year. Logistic regression results indicate that mental and behavioral health problems that are significant barriers to self-sufficiency are increasingly important in this era of time-limited benefits.
The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses. JAMA. 2000;284:1689-1695.
Reform has transformed traditional entitlement to cash welfare under Aid to Families with Dependent Children (AFDC) into a transitional program known as Temporary Assistance to Needy Families (TANF). Because of the new work requirements and the time-limited nature of assistance, policy makers are increasingly confronted with what to do when welfare recipients do not effectively make the transition from welfare to work. Increasingly, the language of public health is being used to determine who is“ employable” and who is not. Thus renewed attention is being focused on the individual characteristics of participants themselves, particularly specific diagnoses that might reduce employability. This article focuses on substance abuse and mental health problems among single mothers and examines their relationship to welfare receipt. We analyze data from the 1994 and 1995 National House-hold Survey of Drug Abuse (NHSDA) and find that 19 percent of welfare recipients meet the criteria for a DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, third edition revised) psychiatric diagnosis. About the same percentage have used illicit drugs during the previous year. Logistic regression results indicate that mental and behavioral health problems that are significant barriers to self-sufficiency are increasingly important in this era of time-limited benefits.
This paper presents an update on the progress and barriers to harm reduction for cocaine users, with proposed new directions, since the overview of Erickson [Erickson Patricia G. Prospects of harm reduction for psychostimulants. In: Nick Heather et al., editors. Psychoactive Drugs and Harm Reduction: From Faith to Science. London: Whurr, 1993, pp. 184–210.]. Though not without challenges, various approaches for opiate use, ecstasy and cannabis—even alcohol and tobacco—have all advanced significantly throughout the 1990s [Erickson Patricia G, Riley Diane, Cheung Yuet W, O’Hare Pat, editors. Harm Reduction: A New Direction for Drug Policies and Programs. Toronto: University of Toronto Press, 1997.]. Compared to these drugs, initiatives for cocaine have been relatively few and far between. We use Zinberg’s organizational framework of drug, set and setting to summarize the available literature on the various expressions of harm reduction around cocaine. It is argued that it is the interaction of these components—that is the social context of use—rather than any one pharmacological feature that shapes the nature of cocaine problems. In particular, there is promise for harm reducing approaches to cocaine in a focus on the social environmental setting of cocaine use and access, applying the concept of community social capital.
Draws on the experiences of Oregon, where welfare offices have addressed alcohol and drug problems since 1992, to help states develop ways to include treatment in a work-oriented welfare environment. Key factors for success include strong leadership at the state level as well as collaboration and communication between the existing welfare and alcohol and drug treatment systems.
On December 31, 1996, the U.S. Congress officially ended its funding of the Social Security Administration's program of supplemental security income (SSI) and social security disability income (SSDI) cash and Medicaid benefits for drug addiction and alcoholism (DA&A). This social policy change is part of the U.S. Congress welfare reform, which will impact more than 26,000 Illinois residents, thousands in Cook County alone. Our study seeks to illuminate the meaning of these benefits to a group of approximately 40 former Cook County recipients. We explored the utility and meaning of the cash and Medicaid benefits to at least three types of recipients (Good Citizens, Hustlers, and Lost Souls) that emerged from a series of focus groups. Our paper studies the differences between the three types of recipients in their use of cash (e.g., from paying for housing and living essentials to purchasing drugs) and Medicaid (e.g., medications and drug treatment) benefits. Findings and conclusions also generate important insights into how recent social policy changes impact the drug-using community and produce new health and social problems for both the former recipients and society-at-large.
Examined how employee assistance programs (EAPs), health promotion programs (HPPs), and drug testing programs have changed since 1988. 647 of the original 1,056 human resource managers from workplaces with 50 or more employees answered the same survey questions 4 yrs later. The percentage of workplaces with EAPs increased from 16.1% to 32.0%. There were trends to provide only self-referral routes for treatment and to use external, private contracted services. Growth occurred for practically all types of HPPs. While EAPs and HPPs are recognized as beneficial to workers' psychological and physical health, less agreement exists as to whether the use of drug testing programs is beneficial to employees in addressing drug problems. However, it was found that about 4% of work sites had drug testing programs in 1993, compared with about 1% with such programs in 1988. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reviews estimates of workplace drug use (WDU) from employer, treatment samples, and general surveys, and from 15 studies that report rates for more general population surveys. Findings indicate that prevalence estimates of WDU that are inferred or extrapolated from rates of general drug use among national or community samples or employees are unreliable, inaccurate, and misleading. The best estimates are from general samples from nations, the community, or specific occupations. Based on data from more population representative general samples, 3 conclusions are drawn: Prevalence estimates of WDU, according to employee reports, range from predominantly modest to moderate; use of drugs or being high on the job is more common among men than women; and the highest rate of WDU seems to be among young adults. Data show little justification for the widespread concern if not hysteria regarding the use of drugs during working hours. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Client ambivalence is a key stumbling block to therapeutic efforts toward constructive change. Motivational interviewing—a nonauthoritative approach to helping people to free up their own motivations and resources—is a powerful technique for overcoming ambivalence and helping clients to get "unstuck." The first full presentation of this powerful technique for practitioners, this volume is written by the psychologists who introduced and have been developing motivational interviewing since the early 1980s.
In Part I, the authors review the conceptual and research background from which motivational interviewing was derived. The concept of ambivalence, or dilemma of change, is examined and the critical conditions necessary for change are delineated. Other features include concise summaries of research on successful strategies for motivating change and on the impact of brief but well-executed interventions for addictive behaviors.
Part II constitutes a practical introduction to the what, why, and how of motivational interviewing. . . . Chapters define the guiding principles of motivational interviewing and examine specific strategies for building motivation and strengthening commitment for change.
Rounding out the volume, Part III brings together contributions from international experts describing their work with motivational interviewing in a broad range of populations from general medical patients, couples, and young people, to heroin addicts, alcoholics, sex offenders, and people at risk for HIV [human immunodeficiency virus] infection. Their programs span the spectrum from community prevention to the treatment of chronic dependence.
All professionals whose work involves therapeutic engagement with such individuals—psychologists, addictions counselors, social workers, probations officers, physicians, and nurses—will find both enlightenment and proven strategies for effecting therapeutic change. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper presents national estimates of heavy drinking, drug use, and alcohol and drug abuse and/or dependence among recipients of selected welfare programs.
Data from the 1992 National Longitudinal Alcohol Epidemiologic Survey were analyzed.
The percentages of welfare recipients using, abusing, or dependent on alcohol or drugs were relatively small and consistent with the general US population and those not receiving welfare benefits.
Although a minority of welfare recipients have alcohol or drug problems, substance abuse prevention and treatment services are needed among high-risk subgroups.
In Nova Scotia Canada, governmental authorities expressed concern in the late 1980s about the adverse effects of drug use by parents on the welfare of their children. Since 1991, parents with a history of drug abuse may be required to submit to urine drug and alcohol testing when ordered by the Family Courts of this province. The objective of this paper is to present this drug testing program and the results of drug testing on 125 clients from 1994-1996. Urine specimens were collected in the parents' residence by a nurse and transferred directly to the laboratory by the collector or a courier. Specimens were screened by immunoassay and TLC followed by GC-MS confirmation. Results were sent directly to the social worker. In the 3,613 urine specimens analyzed, 50.2% of specimens were negative, 45.6% were positive for one or more drug/metabolite and 4.2% of specimens were dilute (creatinine < 25 mg/dL). The distribution of positive results were: cannabinoids (11.5%), cocaine metabolite (5.0%), benzodiazepines (14.5%), codeine/morphine (7.1%), codeine (6.6%), diphenhydramine (2.2%) and ethyl alcohol (1.6%). Drug testing has been considered a success by these agencies since testing provides an objective indication of recent drug use and the overall prevalence of drug use in this drug abusing population has reduced from 100% to < 50%.
The purpose of this study was to determine the effectiveness of an Employee Assistance Program (EAP) in terms of selected work performance indicators and treatment outcomes. Three primary data sources were utilized: a questionnaire administered to EAP users, reports from EAP counsellors on treatment diagnoses and outcomes, and employee records on absenteeism and other performance criteria over a five year time period. On the whole, EAP clients reported very favourable outcomes regarding the quality of services and improved well being, and the counsellors reported successful treatment outcomes. However, employee records on performance outcomes indicated that EAP clients had higher rates of problems before, during and after treatment, compared to a matched control group. Additionally, rates of sick days significantly increased from before to after treatment among EAP users.
Modes of adaptation to termination of the SSI/DI Addiction Disability Hustlers, good citizens, and lost souls
- P Goldstein
- T L Anderson
- I Schyb
- J Swartz
Goldstein P, Anderson TL, Schyb I, Swartz J. Modes
of adaptation to termination of the SSI/DI Addiction Disability Hustlers, good citizens, and lost
souls. Advances in Medical Sociology 2000;7:215 -38.
Drug testing methods and interpretations of test results Drug testing in the workplace Integrating alcohol and drug treatment into a work-oriented
- B Kapur
- G Kirby
- L Pavetti
- J Kauff
- Tapognia
Kapur B. Drug testing methods and interpretations of test results. In: Macdonald S, Roman P, editors. Drug testing in the workplace. New York: Plenum Press, 1994. Kirby G, Pavetti L, Kauff J, Tapognia J. Integrating alcohol and drug treatment into a work-oriented
Blueprint: Mike Harris' plan to keep Ontario on the right track
- Conservatives Ontario Progressive
Ontario Progressive Conservatives. Blueprint: Mike
Harris' plan to keep Ontario on the right track. (at
//www.mikeharrispc.com), April 1999.
Ontario drug monitor 1998: alcohol, tobacco and illicit drug use, 1997-1998. CAMH Research Document Series No 4. Toronto: Centre for Addiction and Mental Health
- E M Adlaf
- A Paglia
- A Ialomiteanu
Adlaf EM, Paglia A, Ialomiteanu A. Ontario drug
monitor 1998: alcohol, tobacco and illicit drug use,
1997-1998. CAMH Research Document Series No
4. Toronto: Centre for Addiction and Mental
Health, 1999.
Building a Drug-Free Workforce
Office of National Drug Control Policy. Building a
Drug-Free Workforce. Washington, DC, 1990.
- Norton K Ontario
Norton K. Ontario Human Rights Commissioner. Letter to the Minister of Community and Social Services, July 27 1997.
Substance use among adolescents and young adults: prevalence, socio-demographic correlates, associated problems and familial aggregation, Working Paper No 2. Toronto: Ontario Ministry of Health
- M H Boyle
- P Szatmari
- D R Offord
- K Merikangus
Boyle MH, Szatmari P, Offord DR, Merikangus, K.
Substance use among adolescents and young adults:
prevalence, socio-demographic correlates, associated problems and familial aggregation, Working
Paper No 2. Toronto: Ontario Ministry of Health,
1990.
Position Statement on Mandatory Drug Testing and Treatment of Welfare Recipients
- Addiction Centre
- Mental Health
Centre for Addiction and Mental Health. Position
Statement on Mandatory Drug Testing and Treatment of Welfare Recipients. //www.camh.net/ Dec
11, 2001.
Another modest proposal
Another modest proposal. Editorial. Canadian Medical
Association Journal Jan 09, 2001; 164 (1): 5.
Integrating alcohol and drug treatment into a work-oriented welfare program: lessons from Oregon
- G Kirby
- L Pavetti
- J Kauff
- J Tapognia
Kirby G, Pavetti L, Kauff J, Tapognia J. Integrating
alcohol and drug treatment into a work-oriented
welfare program: lessons from Oregon. Mathematica Policy Research Inc., 1999.
Centre on Addiction and Substance Abuse. Substance Abuse and Women on Welfare. Columbia University, 1994. Center for Substance Abuse Treatment. Substance Abuse and Mental Health Services Administration
- M H Boyle
- P Szatmari
- D R Offord
- K Merikangus
Boyle MH, Szatmari P, Offord DR, Merikangus, K.
Substance use among adolescents and young adults:
prevalence, socio-demographic correlates, associated problems and familial aggregation, Working
Paper No 2. Toronto: Ontario Ministry of Health,
1990.
Another modest proposal. Editorial. Canadian Medical
Association Journal Jan 09, 2001; 164 (1): 5.
Centre for Addiction and Mental Health. Position
Statement on Mandatory Drug Testing and Treatment of Welfare Recipients. //www.camh.net/ Dec
11, 2001.
Centre on Addiction and Substance Abuse. Substance
Abuse and Women on Welfare. Columbia University, 1994.
Center for Substance Abuse Treatment. Substance
Abuse and Mental Health Services Administration.
'The National Treatment Improvement Evaluation
Study,' 1997.
Ministry of Community and Social Services. Harris Government Unveils Drug Treatment Consultation Plan
- W R Miller
- S Rollnick
Miller WR, Rollnick S. Motivational interviewing:
preparing people to change addictive behavior. New
York: Guilford, 1991.
Ministry of Community and Social Services. Harris
Government Unveils Drug Treatment Consultation
Plan. //www.gov.on.ca/ Nov 14, 2000.
Modes of adaptation to termination of the SSI/DI Addiction Disability Hustlers, good citizens, and lost souls
- Goldstein
Final results from a meta-analysis of remedial interventions with drink/drive offenders
- Wells-Parker