A comparison of psychosocial barriers among welfare recipients: implications for drug treatment.

Implementation of Temporary Assistance for Needy Families (TANF) presents welfare recipients with time-limited benefits and work requirements. However, it is estimated that over 140,000 welfare recipients meet the DSM-IV criteria for "drug dependence". In this study, samples of chronic drug using and non-drug using female TANF recipients were compared with regard to: current employment, psychological functioning, self-perceived employment skills, barriers to employment, and need for help in seeking employment. It was found that non-drug using study participants were significantly more likely to be employed and reported significantly higher self-perceived work skills than users. Chronic users reported significantly greater barriers to seeking employment.     

Female drug users and the welfare system: a qualitative exploration

In the United States, much of the public views welfare recipients negatively, as unmotivated, as lazy, as chronic drug users, and as exploiters of the system. Yet, despite a large body of sociological literature regarding welfare recipients and their stigmatized social position, there exists a dearth of information from the individuals themselves, most notably from those engaged in drug use. That is, the voices of welfare recipients are largely absent from published sociological research. The link between drug use and public assistance is seen frequently as absolute, though the reasons for this relationship are chiefly unknown. In this paper we present a qualitative analysis that allows for new understandings of the welfare system and of the lives of the female drug users who are publicly seen as unworthy of assistance. Our in-depth interviews demonstrate that welfare dependency and drug use are symptoms of the women's societal position, largely resulting from barriers including a lack of education, few job skills, the absence of employment and affordable child care, and restricted geographic mobility. Furthermore, the respondents identify no correlation between their status as welfare recipients and their drug use. By focusing on poverty and drug use as social problems, we negate prevailing narratives while providing concrete suggestions for improving the lives of individuals in need, including those we interviewed.     

Predictors of employment in substance-using male and female welfare recipients

This study examined predictors of employment among substance-using men and women enrolled in welfare-to-work programs. Participants were 394 welfare applicants assigned to either coordinated care management or usual care for treatment services and job training and followed up for 1 year to track employment outcomes. Common barriers to work were assessed at baseline in four key domains: disabilities, situational barriers, labor capital, and motivation. Results indicated substantial gender differences in the number and profile of work barriers. Among men, work experience and job motivation were the only significant predictors of employment; among women, multiple factors from each barrier domain predicted job acquisition even when controlling for all other significant predictors. Findings suggest that welfare-to-work programs should emphasize job training and job seeking during the early stages of welfare interventions for men and for many women.     

Older and sicker: Changing mortality of drug users in treatment in the North West of England

BackgroundThe study examines the age at which drug users die and ascertains whether there is a significant difference in the causes of death (‘drug related’ versus ‘non-drug related’) according to age.MethodsDetails of people reported to the North West of England's National Drug Treatment Monitoring System as dying (years 2003/2004–2007/2008) were matched by the Office for National Statistics to death notifications to identify the cause and date of death. Spearman's rank correlation was performed on median age at death by year. Mantel–Haenszel statistics tested the association between age and type of death, adjusted for year.ResultsCauses of death were ascertained for 504 people. Median age at death increased significantly from 36.46 in 2003/2004 to 41.38 in 2007/2008. The odds of a person aged 40 and over dying from a non-drug related death were 3.27 the odds of a person aged less than 40 dying from a non-drug related death.ConclusionCurrent focus on drug related deaths detracts attention from other causes; in particular, the types of death which disproportionately affect older drug users. Ongoing debates about reintegration into society and employment presuppose that drug users are of working age and are healthy enough to work.     

Impulsivity, risk taking and recreational 'ecstasy' (MDMA) use

The present study investigated characteristics of recreational drug users, especially 'ecstasy' (MDMA) users, in 254 undergraduates. All participants completed a drug history questionnaire (DHQ), the impulsiveness venturesomeness and empathy questionnaire, a novel risk-taking task (Bets16), and 59 also completed the tri-dimensional personality questionnaire (TPQ). DHQ responses allocated participants to five groups: non-drug controls, cannabis users, polydrug (no ecstasy) users, low (<20 occasions) ecstasy users and high (>20 occasions) ecstasy users. Eighteen percent of the sample had used ecstasy and of the ecstasy users, only one had not used other substances. A larger proportion of high ecstasy users had also used amphetamines, cocaine and LSD in comparison to the low ecstasy and non-ecstasy polydrug users. High ecstasy users typically took significantly more ecstasy tablets compared with low ecstasy users. Impulsiveness, venturesomeness and novelty seeking behaviour increased from the non-drug users to high ecstasy users. Ecstasy users (low and high) and polydrug (non-ecstasy) users had higher levels of impulsivity, venturesomeness and novelty seeking behaviour compared with non-drug users. Furthermore, high ecstasy users scored higher on the Bets16 risk-taking measure than non-drug users, cannabis users and low ecstasy users. The findings are discussed in relation to: (i) the possibility that increased impulsivity pre-dated drug use; and (ii) the possible link between impulsivity and the putative serotonergic neurotoxicity of ecstasy.     

Supporting the habit: income generation activities of frequent crack users compared with frequent users of other hard drugs.

US Federal sentencing guidelines punish possession of crack cocaine very differently from powder cocaine, based partially upon the assumption that crack users engage more frequently in criminal behavior to pay for their habit. This article analyzed frequent users (those who have used at least 15 of the last 30 days) of crack with subgroups of less frequent hard drug users in terms of various income generation activities reported during the past 30 days. The sample consists of 602 African-Americans who were current (in past 30 days) users or sellers of cocaine powder, crack, and heroin. They were carefully recruited from randomly selected blocks in the Central Harlem area of New York City and interviewed extensively in 1998-1999. Their IGAs were classified into six categories. Compared with not-frequent (less than 15 days) hard drug users, frequent crack and multiple hard drug users were equally likely to be involved in drug distribution activities, but were significantly less likely to have full-time jobs, part-time jobs, aid to families with dependent children or welfare support. They had much higher odds ratios for non-drug related illegal (theft mainly) income generation activities and sex work among women. Often, gender and birth cohort variables had higher odds ratios with specific income generation activities than the frequent use of the primary drug(s). This evidence suggests that very frequent crack users have been stigmatized by, are largely excluded from, and perform very marginal economic roles in the legal economic system (jobs and welfare), the illegal economic system, and even in the hard drug distribution system.     

Methamphetamine use among Australian workers and its implications for prevention

Introduction and Aims. Little attention has been directed to the use of methamphetamine among Australian workers. To address this, a study was conducted that examined drug consumption patterns of the Australian work-force. Design and Method. A secondary analysis of the 2004 National Drug Strategy Household Survey (NDSHS) data was undertaken that focused on methamphetamine use among those in paid employment. Results. Methamphetamine use in the past 12 months was reported by 4.0% of workers compared to 2.2% of respondents not in the paid work-force. A larger proportion of male (4.8%) than female workers (3.0%) used methamphetamine. The highest prevalence occurred among 18 - 29-year-old workers (11.2%; males: 12.6%; females: 9.4%), and among workers in hospitality (9.5%), construction (5.4%) and transport (5.4%) industries and among tradespeople (6.5%). Significantly more methamphetamine users reported absenteeism compared to users of other illicit drugs and non-drug users. Among respondents reporting methamphetamine use, 13.4% reported absenteeism due to illicit drug use, while 56.8% reported absenteeism due to any illness or injury. Significantly more methamphetamine users (32.9%) reported going to work under the influence than users of other illicit drugs. Compared to users of other illicit drugs, methamphetamine users were also significantly more likely to drive a car, operate heavy machinery or abuse someone while under the influence. Discussion and Conclusions. The specific details of the profile of workers using methamphetamine and the impact it has on work performance allows for the development of targeted interventions and tailored prevention strategies previously not possible. [Roche AM, Pidd K, Bywood P, Freeman F. Methamphetamine use among Australian workers and its implications for prevention. Drug Alcohol Rev 2008;27:334-341]     

Scholastic attainment and employment of drug users in Singapore

A study of the educational and employment aspects of drug use, which was carried out in 1980 in Singapore, included 100 drug users randomly selected from those who had been, because of drug addiction, registered for treatment and rehabilitation by some major voluntary organizations dealing with drug abuse problems, and 100 non-users individually matched for sex, approximate age, ethnic group, education and neighbourhood. The respondents were interviewed on the basis of a questionnaire designed to collect data for this study. Data on 11 items of the questionnaire were available in official records which were used to check the truthfulness of the responses of the drug users. The agreement between the two sources of data ranged from 83 to 100 per cent. The drug users were found to have significantly lower levels of educational attainment and poorer scholastic results than the non-users. Similarly, significantly more drug users than non-users had a lower career status, higher instability in employment and greater job dissatisfaction. The author suggests that educational and vocational guidance, counselling service, welfare schemes and in-service training should cater to this group of people.     

Cognitive function and mood in MDMA/THC users, THC users and non-drug using controls

Repeated ecstasy (MDMA) use is reported to impair cognition and cause increased feelings of depression and anxiety. Yet, many relevant studies have failed to control for use of drugs other than MDMA, especially marijuana (THC). To address these confounding effects we compared behavioural performance of 11 MDMA/THC users, 15 THC users and 15 non-drug users matched for age and intellect. We tested the hypothesis that reported feelings of depression and anxiety and cognitive impairment (memory, executive function and decision making) are more severe in MDMA/THC users than in THC users. MDMA/THC users reported more intense feelings of depression and anxiety than THC users and non-drug users. Memory function was impaired in both groups of drug users. MDMA/THC users showed slower psychomotor speed and less mental flexibility than non-drug users. THC users exhibited less mental flexibility and performed worse on the decision making task compared to non-drug users but these functions were similar to those in MDMA/THC users. It was concluded that MDMA use is associated with increased feelings of depression and anxiety compared to THC users and non-drug users. THC users were impaired in some cognitive abilities to the same degree as MDMA/THC users, suggesting that some cognitive impairment attributed to MDMA is more likely due to concurrent THC use.     

Work and the journey to recovery: Exploring the implications of welfare reform for methadone maintenance clients

BackgroundAn emphasis on welfare reform has been a shared concern of recent UK governments, with the project of transforming the provision of welfare gathering pace over the past six years. Replicating active labour market policies pursued across the globe, successive governments have used welfare-to-work programmes as mechanisms to address worklessness. Since 2008, problem drug users (PDUs) have been added to a list of groups for whom intervention is deemed necessary to encourage, enable, and sometimes coerce them into paid employment. This approach is underpinned by three beliefs relating to paid work: it sustains recovery, has a transformative potential and should be the primary duty of the responsible citizen.Using policy developments in the UK as a case study, the article explores the implications for methadone maintenance clients of connecting drug policy (premised on the belief that work is central to recovery) with welfare policy (which at present is preoccupied with reducing worklessness).MethodsA critical analysis of policy documents, including drug strategies, Green and White papers and welfare reform legislation, alongside a review of relevant academic literature.ResultsThe ‘work first’ approach which underpins current labour market activation policies in the UK and elsewhere is insufficiently flexible to accommodate the diverse needs of PDUs in recovery, and is particularly particular problematic when combined with a ‘social deficit’ model which concentrates on individual rather than structural barriers to employability. The use of payment-by-results mechanisms to provide employment services, coupled with the use of sanctions for those who do not engage, is likely to be particularly problematic for methadone maintenance clients.ConclusionWelfare reform in the UK is likely to undermine the recovery of methadone maintenance clients. Further research is urgently needed to explore its impact on this sub-group of PDUs, alongside comparative studies to determine best practice in integrating drug and welfare policies.     

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. METHOD: 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.     

Addicted to the ‘life of methamphetamine’: Perceived barriers to sustained methamphetamine recovery

Aims: This qualitative study explores and characterises barriers to methamphetamine recovery that emerge from users discussing anonymously their challenges in an online discussion forum. Methods: Anonymous letters and stories (N?=?202), which were submitted to an online support forum for methamphetamine users and their loved ones, were analysed in Dedoose software using grounded theory methodology. Findings: Six perceived barriers emerged from the narratives, which were categorised as internal or external. The first three perceived barriers – low self-efficacy, conflicting thoughts about methamphetamine use, and side effects of withdrawal – were related to internal barriers, and the other three perceived barriers – escaping the drug environment, friends and family prevented recovery, and inadequate drug rehabilitation programmes – were related to external barriers. Conclusions: Methamphetamine users participating in an online discussion forum faced many internal and external barriers that impeded their recovery. These identified barriers were remarkably similar to barriers reported by users seeking treatment in conventional settings or recruited from drug networks, which suggests that methamphetamine users, in general, use multiple methods to assist with recovery and face many common barriers. Developing behavioural interventions that include online components may help remove some of the barriers and improve methamphetamine recovery.     

Neuroendocrine and subjective responses to pharmacological challenge with citalopram: a controlled study in male and female ecstasy/MDMA users

Despite evidence that +/-3,4-methylenedioxymethamphetamine (MDMA; 'ecstasy') causes persistent alterations to the serotonergic system of animals, evidence for long-term neurological effects of ecstasy/MDMA in humans remains equivocal. The current study assessed serotonin functioning of nine male and 11 female recreational ecstasy polydrug users by measuring neuroendocrine (prolactin, cortisol) responses to pharmacological challenge with the selective serotonin reuptake inhibitor citalopram, compared with nine male and five female cannabis polydrug users and 11 male and 11 female non-drug using controls. A single-blind, randomised, placebo-controlled design was used. Subjective responses, other substance use, mood, personality traits and demographic variables were measured to control for potentially confounding variables. There were no significant differences between ecstasy polydrug users, cannabis polydrug users and non-drug using controls in neuroendocrine or subjective responses to serotonergic challenge, and there were no sex by drug group interactions. There was no relationship between extent of ecstasy use and neuroendocrine functioning, alone or in combination with potential confounding variables. Subjective responses to the pharmacological challenge (nausea, tremor, dry mouth), novelty seeking and lifetime dose of alcohol were the only variables that contributed to one or more of the neuroendocrine outcome variables. These data do not support the premise that recreational ecstasy/MDMA use results in measurable impairment of serotonergic control of endocrine activity.     

Barriers to formal drug abuse treatment in the rural south: a preliminary ethnographic assessment

This article describes barriers to obtaining drug abuse treatment in the rural South using qualitative interviews conducted with 86 illicit stimulant users recruited in rural Arkansas and Kentucky between 2003 and 2005. Fifty-nine (69.0%) of the interviewees had never entered drug abuse treatment. Sixteen (19.0%) participants reported current perceived need for treatment, while seven (8%) were ambivalent about seeking it. Interview data suggest five interrelated categories of barriers to accessing drug abuse treatment: (1) geographical, (2) organizational, (3) economic, (4) social, and (5) psychological. The study findings can inform further examination of rural treatment barriers and have important implications for developing strategies to overcome these obstacles.     

Barriers to employability among substance dependent and nonsubstance-affected women on federal welfare: implications for program design

OBJECTIVE: This study examined barriers to employability among women meeting criteria for a substance dependence disorder who were identified by routine screening conducted in welfare offices. The characteristics of these women were compared to other women on welfare who did not have a substance use disorder. METHOD: A sample of 214 substance dependent women on federal welfare were recruited to participate in a substance use disorders welfare demonstration project. An additional 69 nonsubstance-affected women on welfare served as a comparison sample. All participants were assessed in welfare settings through a standardized battery of measures. RESULTS: Substance dependent women reported moderate to severe substance use problems. They also reported significantly higher rates than the women with no substance use disorder of other barriers such as domestic violence, mental health problems, legal problems, child welfare investigations and fewer job skills. CONCLUSIONS: Findings raise questions about the likely effectiveness of existing welfare reform services in addressing the needs of substance dependent women.     

Recreational ecstasy/MDMA and other drug users from the UK and Italy: psychiatric symptoms and psychobiological problems

RATIONALE: Recreational drug use is increasingly widespread amongst young people, but there are concerns that psychoactive drugs may be associated with psychiatric symptoms or psychobiological problems. OBJECTIVES: To assess the psychiatric health status of a large, non-clinical sample of young adults from Italy and the UK, and relate it to their use of ecstasy/MDMA and other recreational drugs. METHODS: The UEL Recreational Drug Use Questionnaire was completed by 768 young people (mean age 21.7 years) from four European cities. The subjects comprised 150 non-drug users, 185 alcohol/tobacco users, 97 cannabis and alcohol/tobacco users, 102 illicit polydrug but not ecstasy users, 115 light (<20 times) ecstasy polydrug users, and 119 heavy (>20 times) ecstasy polydrug users. The unpaid volunteers completed the SCL-90 self-rating inventory for psychiatric symptoms when off drug, with 30 additional questions covering positive moods and life experiences. RESULTS: Heavy ecstasy polydrug users reported significantly higher scores than non-drug users on several SCL-90 factors, including phobic anxiety, obsessive-compulsive behaviour, anxiety, psychoticism, somatisation, and significantly higher rates of 'loss of sex interest or pleasure'. Self-rated symptom scores increased in line with greater drug use, so that polydrug users who had never taken ecstasy also reported a variety of psychobiological impairments. In contrast, positive moods and life experiences were broadly similar across subgroups. CONCLUSIONS: The recreational use of ecstasy/MDMA is associated with a range of psychiatric symptoms and psychobiological problems. However, these problems are not specific to ecstasy users but are also evident in other recreational polydrug users.     

Barriers to use of Needle and Syringe Programmes in a high drug use area of Sydney,New South Wales

Objective:Most surveillance of injecting drug users (IDUs) in Australia is done with samples of participants drawn from those who attend Needle and Syringe Programmes (NSPs). We investigated the barriers and preferences to NSP access of a group of IDUs who do not use NSPs as their primary source of injecting equipment from a defined geographical area in Sydney, which has been estimated to house the highest number of IDUs in Australia.Method:A cross-sectional, interviewer-administered questionnaire was completed by 294 participants, most of whom were recruited through the personal and extended networks of peer interviewers. Participants were considered in two groups: those who did not use NSPs (non-NSP users) and those who used NSPs infrequently (infrequent NSP users).Results:Infrequent NSP users were more likely than non-NSP users to report reasons of convenience and NSP operation as barriers to access. Non-NSP users reported barriers related to lack of awareness of NSPs and that they did not need to access NSPs. Fixed locations and vending machines were most frequently endorsed by both groups as the “best way” to distribute injecting equipment. However, issues of stigma and maintaining anonymity were concerns for participants in both groups. Compared to non-NSP users, infrequent users were more likely to reside in areas with a large drug user population, obtain safe injecting information from health workers, have injected drugs for longer, have injected alone, have been tested for blood borne viruses, report greater connectedness to drug user networks and be less concerned about contacting NSP staff.Conclusion:Understanding the preferences of IDU, including those who do not attend NSP, is central to providing health services which meet their needs and in developing hepatitis C prevention programmes which reach this target group. The effects of stigma on the health care choices of IDUs must be recognised in planning developments in NSP service, or alternatives to NSPs.     

Substance Use Disorders and Employability Among Welfare Recipients

The 2006 welfare reform legislation (Deficit Reduction Act of 2005) imposed more stringent work requirements and defined the amount of time cash assistance recipients are allowed to be exempted from the work requirement because of substance use treatment. As there is little empirical literature on the employability of substance users, it is difficult to know whether it is realistic to expect individuals with substance use disorders to meet the increased work requirement. Based on a comprehensive evaluation of nearly 9,000 substance-misusing welfare recipients from 2001 to 2007, University Behavioral Associates (UBA) Comprehensive Services Model program in Bronx, New York, found that 60% of recipients were not exempted from the work requirement owing to substance misuse at the outset, and an additional 24% were found nonexempt after 3 months of intensive outpatient treatment coupled with case management, resulting in a total of 84% of the UBA clients not being exempted from the work requirement because of substance misuse by Day 90. UBA also found that 25% of substance-misusing clients were able to obtain employment, and most successfully retained those jobs over the course of 6 months. These findings are discussed in relation to the new law's work requirements and the issue of the employability of substance misusers. Finally, the value of case management in serving this hard-to-engage population is discussed.     

Drug use and barriers to use of health care services.

This paper examines barriers to health care utilization and the correlates associated with these barriers. As part of a larger study of health services utilization, the study sample of 1085 including injection drug users, other chronic users of heroin or cocaine, and a demographically similar group who had used neither heroin nor cocaine, was selected based on the criterion of not having received health care for at least one health problem within the previous 12 months. Both categories of chronic drug users were more likely than non-users not to want health care treatment and to put off seeking needed health care.     

Factors related to psychosocial barriers to drug treatment among Chinese drug users

Although substance abuse treatment has been considerably scaled up in China, impediments to accessing these services remain among drug users. The authors examine the primary psychosocial barriers to drug treatment in this population and evaluate factors associated with these barriers. Barriers to accessing drug treatment were measured using the Barriers to Treatment Inventory (BTI). A Structural Equation Model was used to examine whether the internal barriers were associated with treatment history and frequent methamphetamine use as well as how demographic characteristics influence such barriers. We found four primary factors of internal barriers to drug treatment – absence of problem, negative social support, fear of treatment, and privacy concerns – to fit well. Demographic factors, notably age and employment status, indirectly influence barriers to treatment via other factors. Frequency of methamphetamine use and drug treatment history are directly associated with the absence of problem and negative social support dimensions of the BTI, and it is through these pathways that demographic factors such as age and employment status shape barriers to treatment. The findings indicate that perceived absence of a problem and negative social support are the barriers most influenced by the personal domains of Chinese drug users' lives. Efforts to engage drug users in China about drug treatment options may consider how these barriers are differentially perceived in order to effectively reach this population.