Does Drug Testing the Poor Do Anything to Reduce Addiction?

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In one of the most emailed articles this week on TIME.com, legal columnist Adam Cohen questions the constitutionality and financial benefit of a new Florida law that requires welfare applicants to take a drug test for eligibility. The legal issues aside, I would also ask, Is this a policy that promotes health or reduces addiction?

There’s no evidence that simple drug testing actually reduces rates of drug use. For example, studies on school testing programs find no differences in drug use between schools that test for drugs and schools that do not. There is even some evidence that drug testing reduces students’ feelings of “school connectedness,” a sense of belonging and being cared for at school, which is itself linked with lower drug-use rates.

Testing is not always a net negative: In carefully controlled probation programs for drug offenders, which offer immediate sanctions for positive tests and free access to treatment, drug testing can be helpful. It can also be useful in some addiction treatment settings.

But simply testing people and then cutting off their only source of financial support for a year and not even offering access to treatment, as the Florida law requires, is unlikely to save the state money or reduce rates of addiction.

“There is little evidence that drug screening, in the absence of specific justification, of [welfare] and [unemployment] recipients will promote self-sufficiency or improve services for the relatively small subgroup with substance use disorders,” says Harold Pollack, professor of public policy at the University of Chicago.

Although poor people do have higher rates of addiction than the general population, because they also have higher rates of trauma, mental illness and unemployment (factors that each dramatically increase addiction risk), the vast majority of poor drug users are nonetheless not addicts. One study found that just 4% of people receiving welfare were addicted to illegal drugs.

Consider the case of a single mother who is not a drug addict, but tests positive for marijuana, when she seeks welfare assistance. She is denied welfare. Now you have a woman who doesn’t need addiction treatment, with no financial support for herself or her child for a year.

That puts the child at greater risk of homelessness and at greater risk of being placed into foster care, if the mother can’t afford proper care. Foster care costs at least $10,000 a year per child, not to mention its emotional costs which, ironically, would increase both the mother’s and child’s future risks of drug addiction. Any savings accrued by withholding the welfare check would immediately be erased here.

And if the woman is required to attend a drug-treatment program to get benefits or to secure the return of her child, that adds another $4,000 in state costs, at a minimum. It also takes a treatment slot away from someone who may actually have needed it, potentially increasing crime, prison costs and medical costs for health problems that go untreated during active addiction.

But even when you don’t consider the worst-case scenario, drug testing welfare applicants makes no sense. Cohen reported:

Several studies, including a 1996 report from the National Institute on Alcohol Abuse and Alcoholism, have found that there is no significant difference in the rate of illegal-drug use by welfare applicants and other people. Another study found that 70% of illegal-drug users between the age of 18 and 49 are employed full time.

Drug-testing laws are often touted as a way of saving tax dollars, but the facts are once again not quite as presented. Idaho recently commissioned a study of the likely financial impact of drug testing its welfare applicants. The study found that the costs were likely to exceed any money saved.

That happens to be Florida’s experience so far. A Florida television station, WFTV, reported that of the first 40 applicants tested, only two came up positive, and one of those was appealing. The state stands to save less than $240 a month if it denies benefits to the two applicants, but it had to pay $1,140 to the applicants who tested negative. The state will also have to spend considerably more to defend the policy in court.

Drug testing welfare recipients may sound like a good idea on paper, but in practice it is expensive, wasteful and counterproductive — at least if the goal is reducing addiction. Of course, if the goal is stigmatizing and shaming people in need, it’s quite effective.

Maia Szalavitz is a health writer for TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland‘s Facebook page and on Twitter at @TIMEHealthland.

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