TO REFORM WELFARE, TREAT DRUG ABUSE

The welfare reform bills passed by the House and reported out of the Senate
Finance Committee consign most of the women and children remaining on
welfare to a cruel Catch-22: forcing them off the rolls without giving them
the tools they need to stand on their own feet.

We have come a long way since 1968, when Lyndon Johnson called the welfare
system in America "outmoded and in need of a major change" and pressed
Congress to create "a work incentive program, incentives for earning, day
care for children, [and] child and maternal health services." With such
reforms finally put in place a quarter century later, we have reduced the
number of women and children on welfare from a peak of more than 14 million
in 1994 to 5.3 million last year.

But in the process, the character of the welfare population has
fundamentally changed. In 1994 at least half the mothers (largely
temporarily unemployed) and children on welfare were there for less than a
year. Moving and keeping them off public assistance in a booming economy
was relatively easy.

Now comes the hard part: Today the bulk of mothers on welfare -- perhaps
most -- are drug and alcohol abusers and addicts, often suffering from
serious mental illness and other ailments. Most have been on welfare for
several years. Moreover, women in the 1994 welfare population had an
average of two children; those now on the rolls have an average of four
children.

The National Center on Addiction and Substance Abuse at Columbia University
(CASA) has been testing CASAWORKS for Families, a demonstration program
involving 700 such women at seven sites (one each in California, Oklahoma,
Maryland, Missouri, North Carolina, Tennessee and New York). The program
provides integrated services such as treatment; literacy, job and parenting
skills training; mental health and medical care; and assistance with
housing and employment.

CASAWORKS women are representative of the mothers with substance abuse
problems remaining on welfare. On average, they have been heavy drinkers
for five years and illegal drug users for eight. Most have been abused: 70
percent physically and 51 percent sexually. Seven of 10 suffer from
depression and almost a third have attempted suicide. Three-fourths of
these women have children younger than 6 and a third have children with
serious medical, learning and behavioral problems. All confront the
problems of poverty, such as inadequate housing, homelessness and despair.

The administration bill passed by the House would provide just three months
for substance abuse treatment and training for these women before they
could be pushed off the rolls. The Senate committee bill, only marginally
better, would provide six months. These women need at least a year, perhaps
two, of concentrated substance abuse treatment and literacy, job and
parenting skills training. With such help, and with their benefits
conditioned on staying in treatment, a significant number will achieve
economic self-sufficiency and become responsible parents.

Preliminary evaluation of women in the program at the end of the first year
is encouraging. Eighty percent have not used any illicit drug and 78
percent have not done any heavy drinking in the past month. At entry, only
16 percent were working part or full time; at the end of the first year,
that figure had jumped to 41 percent, and the average amount earned had
climbed from $50 a week to $250.

The next round of welfare reform should not be an unrealistic exercise in
self-congratulation by members of Congress, serving up more of the same and
ignoring the salient differences and greater vulnerability of the
population remaining on the rolls. To offer these women a few months of
treatment is a penny-wise, pound-foolish gesture that denies them the
ability to become taxpaying workers and responsible parents and condemns
them and their children to more years of dependency, ill health and crime
with enormous public costs.

Several states, among them California, New Jersey, North Carolina,
Tennessee and New York, are struggling to make the investment required to
help these families by providing such treatment and training. Others are
likely to follow if the president and Congress put resources behind their
rhetoric -- and give these woman a decent chance to be self-sufficient.

The writer is president of the National Center on Addiction and Substance
Abuse at Columbia University. He was secretary of health, education and
welfare from 1977 to 1979.