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Article Excerpt
In the United States, public policies related to poverty relief have long been shaped by an ideological distinction between a "deserving" and an "undeserving" poor (Katz 1989). Poor people with substance use problems have generally been considered among the latter, although the strength of the linkage between substance abuse and undeservingness has waxed and waned over time. During periods of relatively weak linkage--politically liberal in the U.S. context--poor people with substance use problems have tended to receive more public aid and support than in periods of strong linkage under conservative regimes (Katz 1986 and 1993). After several decades of relatively liberal policies, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) marked a definitive return to a more conservative orientation. Known as "welfare reform," PRWORA reinforced the notion that public aid was a specific benefit for the deserving poor rather than a universal entitlement for all.
A distinctive feature of PRWORA was that it empowered the welfare system to address clients' alcohol and drug problems as barriers to labor market participation. In the welfare system prior to PRWORA, the Aid to Families with Dependent Children (AFDC) program, only a handful of states even routinely evaluated program participants for addiction problems (United States Office of the Inspector General 1990). AFDC provided few services for clients with alcohol or drug problems, and welfare workers infrequently viewed substance abusers as a particularly important or deserving clientele. Under AFDC, welfare workers often feared that addressing a client's drinking or drug problem might imply victim blaming, viewed addiction as outside their scope of expertise, and found working with addicted clients to be distasteful and challenging (Lawson 1994; Rush and Timney 1983; Schmidt 1990; see also Schmidt, Weisner, and Wiley 1998). The entitlement approach separated individual difficulties such as addiction from the social problem of poverty; welfare workers were not to "treat" the poor. Consequently, workers seldom even noted substance abuse problems in clients' case records, fearing that it might raise suspicions of discrimination. Nevertheless, substance abuse problems still intruded on worker-client relationships, often when workers came to believe that clients were using cash aid to purchase alcohol or drugs. Individual workers sometimes used their discretion to resolve what they perceived to be a moral dilemma inherent in the entitlement system: They developed strategies to pass troublesome substance-abusing clients on to other public programs, or they defined addicted recipients as "employable" and allowed them to sink or swim in the department's standard work and job search programs (Schmidt 1990).
Another distinctive feature of welfare reform was its emphasis on culture change in the welfare system and among welfare clients. In other aid programs, such as Social Security Disability Insurance, the new conservatism resulted in the termination of aid to people with substance dependency (Hunt and Baumohl 2003). The public debate surrounding welfare reform also questioned policies of offering clients open-ended cash entitlements (Shaner, Eckman, Roberts, Wilkins, Tucker, Tsuang, and Mintz 1995; United States General Accounting Office 1994; United States Office of the Inspector General 1994). However, federal and state reforms emphasized the need to create a new culture of self-sufficiency and accountability among clients, one that meted out aid to clients who sought work and addressed personal barriers to employment. Welfare reform also embraced principles of federalism and devolution of authority that empowered and encouraged local welfare offices to directly address clients' substance abuse problems--along with other formerly "personal" problems--that might stand as barriers to employment (Hays 2003). This broad shift in philosophy spawned new programs throughout the country for the screening and treatment referral of aid recipients and empowered welfare workers to reduce or deny aid to clients who failed to comply with prescribed addiction treatment (Jayakody, Danziger, and Pollack 2000; United States General Accounting Office 1998).
In these respects, welfare reform sought to change the culture and organization of public aid in the U.S. In this paper, we examine one aspect of this complex change: welfare workers' reports of how the new welfare system has affected their relationship with clients who have substance use problems. We used semistructured interviews with workers in a large California county to provide an in-depth case study of this dimension of reform. This county had served as the site for a previous study examining workers' attitudes toward substance abuse in the pre-reform welfare system (Schmidt 1990). Before collecting data for this study, we hypothesized that welfare reform would provide workers with powerful tools--including new opportunities to identify substance abusers, time limits on aid receipt, and work mandates--for acting on negative feelings toward substance-abusing clients. We expected to find that workers' views of substance abuse had remained negative, and that changes in the culture and organization of the welfare system afforded them new opportunities to directly, and potentially negatively, impact the lives of substance-abusing clients generally considered "undeserving" of assistance. The aim of this paper is to assess the plausibility of this expectation and better understand the potential consequences of welfare reform, and similar policies, for clients with substance use problems.
Case studies of changes in the management of substance abuse by welfare agencies provide a valuable perspective on the potential success of welfare reform and implementation. Substance-abusing clients have long been a special challenge to local agencies. As a result of reform, welfare line workers can potentially enact and create policies that disenfranchise "problematic" clients through unofficial practices and the use of personal discretion (Brodkin 1997; see also Browne, Browne, McLaughlin, and Wagner 1987; Feldstein, Wickizer, and Wheeler 1988; Levin, Glasser, and Roberts 1984; Lipsky 1980; Prottas 1981; Ridgely, Goldman, and Willenbring 1990; Schmidt 1989; Schmidt and Weisner 1993; Scott 1982 and 1985). Welfare reform's policy of devolution and its high public and political visibility (Rogers-Dillon 1999; Rogers-Dillon and Skrentny 1999) place even greater importance on understanding workers' views (Hagen and Owens-Manley 2002; Hagen and Wang 1993; Meyers, Riccucci, and Lurie 2001; Meyers, Glaser, and MacDonald 1998). Examining workers' attitudes toward welfare reform policies that impact substance abusers is particularly important (see also Sandfort, Kalil, and Gottschalk 1999). These clients constitute an especially vulnerable population within the welfare caseload that has historically had difficulty maintaining access to welfare system benefits (Schmidt, Dohan, Wiley, and Zabkiewicz 2002; Schmidt, Weisner, and Wiley 1998).
Methods
Setting
We conducted this study in a large county in northern California, starting in 2001. When we began research for this project, the study county had implemented all policies required under PRWORA in its California Work Opportunity and Responsibility to Kids (CalWORKS) program, California's version of Temporary Assistant to Needy Families (TANF), the reformed AFDC program. TANF required California counties to implement rules regarding time limits, work requirements, and the availability of substance abuse treatment. Counties, however, had discretion over how to provide services related to clients' needs. Several years prior to instituting TANF, the study county implemented a number of policies that came to mirror federal guidelines: time limits on cash aid receipt, welfare-to-work requirements, and provision of supportive services in its locally administered and funded General Assistance (GA) program. Welfare reform policies were thus stably in place when we entered the field.
We analyzed the views of workers in both TANF and GA. The programs were different programmatically (we discuss this below), and applicants and recipients of TANF and of GA differed considerably in the study county (see also Schmidt, Dohan, Wiley, and Zabkiewicz 2002; Schmidt, Weisner, and Wiley 1998). TANF households included dependents; the modal recipient was a young single mother with children. Substance abuse problems were relatively uncommon. The average length of aid receipt in TANF was less than one...
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