Drug addiction is one of those subjects that people are not comfortable talking about. Society regards alcohol and drug users & addicts as lazy, irresponsible people who make poor choices and therefore deserve the bad things that happen to them. Some families go to great lengths to hide their members who have addictions and are perceived to be “bringing down the family name”. Many politicians have seen their careers come undone because of long-ago substance abuse allegations.
Historically, people see substance abuse as some kind of moral failing, rather than as a legitimate medical health concern. Addiction is not something to be treated, it is something to be ashamed of. This stigma results in people not getting the help they need, and in many cases, falling into a never-ending cycle of addiction.
If those people also happen to be poor, their problems are amplified by social assumptions that the poverty has resulted from the drug abuse (when in some cases, it is the reverse that is true). We see examples of these assumptions regularly in our everyday lives. We buy food for homeless people instead of giving them the change in our pockets “because they would only spend money on alcohol”. We conclude that a disheveled man on the street with wild eyes and shaking hands is suffering from delirium tremens instead of considering that maybe he is ill and cannot afford his medication. When we see someone passed out on the sidewalk, we jump to the conclusion that this person has passed out from too much drinking before we think of the possibility of a medical emergency.
With these attitudes so deeply ingrained in our social fabric, it is perhaps not surprising that in some parts of the world, governments have started to turn to drug testing. Not the random drug testing you may be familiar with from the professional or athletic world, but rather, drug testing dependent social assistance. Supporters of this move claim that governments are saving tax dollars by denying welfare payments to people who would use the money to support their addictions. Opponents claim that not only does drug testing welfare applicants not save taxpayer money, it actually ends up costing the taxpayer more. Moreover, it does a great deal of damage to two groups of people who are already vulnerable: low-income individuals and families, and people suffering from substance abuse disorders.
Where is welfare drug testing done?
In the United States, thirteen states currently require applicants and repeat recipients of various social assistance programs to undergo drug screening in order to receive their social assistance or unemployment benefits. In Canada, the Ontario government has occasionally talked about plans to implement a drug testing program, but so far, this has not come to fruition. Drug tests are not a condition of eligibility in Europe, but trials have been proposed in Australia.
How do the drug testing programs work?
In its original form, the drug testing program worked exactly the way its title suggests: social assistance program applicants would be required to submit a urine or hair sample for drug testing in order to determine eligibility for payments. If they refused the testing, or if they tested positive for a controlled substance, they could have their payments denied, and they would be ineligible to reapply for a period of time. Repeat “offenders” could be permanently banned from receiving payments.
In Florida, the drug testing laws were in place for four months before being paused by a court injunction. A legal challenge that had been mounted made the claim that “suspicionless testing” – compelling welfare recipients to undergo a drug test without any concrete reason to suspect that they were actually using illicit drugs – was in violation of human rights laws, since it constituted a search without cause.
In response to this, several states tweaked their programs by introducing a questionnaire called SASSI (Substance Abuse Subtle Screening Inventory). The yes-or-no style questions are designed to assess the probability of the individual having a substance use disorder. If an applicant “fails” this test, reasonable suspicion of drug use is deemed to be present, and the applicant is required to undergo the drug test.
How effective are the welfare drug testing programs?
The short answer is “not very”.
During the four months for which Florida performed drug tests on social assistance program applicants, over 4,000 people were tested. Of these, just 2.6% tested positive. According to CLASP, a non-profit organization that is advancing policy solutions for low-income people, Florida’s drug-testing law cost the state around $1 million (including the cost of the court challenge).
In the thirteen states that require drug screening or testing for the TANF (temporary assistance for needy families) program, out of 260,000 people tested, a mere 338 tested positive for a controlled substance – a percentage of positive tests that is so low that is has no statistical meaning.
Is SASSI an accurate predictor of substance abuse?
The Encyclopedia of Mental Disorders states that the SASSI screening questionnaire can determine with 94% accuracy that an individual has a substance use disorder. While this number is high, there is limited independent research to verify it. Even if this is an accurate number, the SASSI Institute itself says that use of the questionnaire for screening welfare applicants could be problematic from a legal standpoint. Employers are not allowed to eliminate job applicants on the basis of their SASSI scores, since this is in contravention of the Americans with Disabilities Act (ADA). It is conceivable that a court of law will come to the same finding with regard to welfare recipients.
Is welfare drug testing harmful?
One of the biggest problems with welfare drug testing is that it is based on the assumption that people who are addicted to drugs or alcohol are acting out of choice. Nobody who has a glass of wine or a puff of a marijuana joint intends to become addicted. Substance use disorders are just that – disorders. They are legitimate physical and mental health concerns, and they should be treated as such. People with drug and alcohol addictions should be helped, not stigmatized.
A second major flaw with welfare drug testing programs is that they imply a link between addiction and poverty that does not exist. There is a perception that people with addictions are unemployed layabouts who go to rough neighbourhoods to get their “fixes”. The reality is that substance abuse does not discriminate. Many people with addictions have jobs, homes and families. In fact, studies show that alcoholism is more prominent among wealthier, more educated people than it is among low-income earners with less education. While opioid addiction seems to be higher in low-income communities, this could be a result of a lack of education, meaning that people take medications prescribed by their doctors, without understanding the risks.
There are some basic flaws in welfare drug testing laws that makes them inherently unfair.
A drug test fails to identify substance abuse
All a drug test can do is detect the presence of a substance at a single point in time. It cannot determine when the individual actually used the drug: most drugs can be detected in the urine for up to four days after a single use, and some tests will return a positive result up to a month after prolonged use has ended.
Another thing the test cannot do is actually determine whether someone has a substance use disorder. Testing positive for a drug is not the same as needing treatment. This determination can only be made by the individual, along with family members, close friends and medical professionals.
Legal substances can yield positive results
5-10% of positive drug tests are thought to result from legitimate use of painkillers, antihistamines and a number of other prescription and over-the-counter medications. This raises the possibility that the number of welfare applicants who actually have controlled substances in their system at the time of testing is even smaller than the statistics tell us.
Drug testing can leave families worse off
People receiving welfare have a genuine need for it. They use the money to feed their families, keep a roof over their heads, and pay their utility bills. In many cases, families receiving social assistance are not able to meet all of these financial obligations. They have to choose which bill to not pay, or at what time of the day they can eat the one meal they can afford to have. A lot of welfare recipients do have jobs, but they are paid so poorly that they still need welfare assistance for themselves and their families.
Drug testing often leaves families worse off than they were to begin with, because some states do it at the applicant’s expense. While those who test negative for controlled substances save their money, and are given full refunds, they may incur late fees on bills that went past dues as a result of the drug test. Applicants who test positive for controlled substances have to pay for the testing cost, leaving them with less money for their families. What’s worse in that in some states, such as North Carolina, people who test positive are forced to enter drug treatment programs at their own expense.
This leads to a whole host of problems, the biggest of which is that people on social assistance have few financial resources as it is, and it is needlessly cruel to force them to pay for a program that they may not even need.
Another issue is that the denial of social assistance following a positive drug test can have a knock-on effect on the other members of the same family receiving benefits. Most states with welfare drug testing programs have laws that protect children from losing their benefits if a parents either tests positive or refuses to be tested. Many parents may not realize this, though, and they may refrain from applying for their children’s benefits because they believe they would be declined.
Being addicted to drugs or alcohol is hard.
Being caught in a cycle of poverty is hard.
When drug testing is used to determine eligibility for social assistance, both groups – the poverty-stricken and the addicted – are further marginalized. It is inhumane to subject poor people to drug tests just because they’re poor, and it is inhumane to block someone’s access to social assistance just because that person suffers from an addiction.
Money that is currently being used or slated for mandatory drug testing would be better used if it were channeled toward correctly identifying people who need treatment for substance abuse problems, and then giving them the help they need.
Photo credit: Marco Verch. This picture has a Creative Commons attribution license.