摘要：Objectives. We explored changing relations between substance use, welfare receipt, and substance-abuse treatment among low-income mothers before and after welfare reform. Methods. We examined annual data from mothers aged 18 to 49 years in the 1990–2001 National Household Survey of Drug Abuse and the 2002 National Survey of Drug Use and Health. Logistic regression was used to examine determinants of treatment receipt. Results. Among low-income, substance-using mothers, the proportion receiving cash assistance declined from 54% in 1996 to 38% in 2001. The decline was much smaller (37% to 31%) among low-income mothers who did not use illicit substances. Low-income, substance-using mothers who received cash assistance were much more likely than other low-income, substance-using mothers to receive treatment services. Among 2002 National Survey of Drug Use and Health respondents deemed “in need” of substance-abuse treatment, welfare recipients were significantly more likely than nonrecipients to receive such services (adjusted odds ratio=2.31; P <.05). Controlling for other factors, welfare receipt was associated with higher prevalence of illicit drug use. Such use declined among both welfare recipients and other mothers between 1990 and 2001. Conclusions. Welfare is a major access point to identify and serve low-income mothers with substance-use disorders, but it reaches a smaller proportion of illicit drug users than it did prereform. Declining welfare receipt among low-income mothers with substance abuse disorders poses a new challenge in serving this population. During the 1996 welfare reform debate, many policymakers and analysts worried that the proposed legislation would harm low-income mothers who used illicit drugs, and would have even more profound effects on those dependent on these substances or on alcohol. 1 , 2 We examined these issues, focusing on 3 specific concerns: (1) trends in illicit drug use by welfare recipients (and nonrecipients) over the period that includes the 1996 reforms, (2) trends in welfare receipt by illicit drug users (and nonusers) over the same period, and (3) treatment receipt among welfare recipients (and others) after welfare reform. First, we extended previous trend analyses on the reported prevalence of illicit substance use among welfare recipients and other low-income mothers, before and after the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) with data from the 1990–2001 National Household Survey of Drug Abuse (NHSDA) and its successor, the National Survey of Drug Use and Health (NSDUH). Second, we examined the relation between welfare receipt and participation in substance-abuse treatment among mothers aged 18 to 49 years in the 2002 NSDUH. Third, we examined the prevalence of substance-use-related symptoms among low-income mothers who did not satisfy substance abuse or dependence criteria, but who may have experienced some difficulties that they attributed to substance use.
