Proportions of welfare recipients using, abusing, or dependent on alcohol or illicit drugs are consistent with proportions of both the adult U.S. population and adults who do not receive welfare, report National Institute on Alcohol Abuse and Alcoholism researchers in the November American Journal of Public Health.
However, certain age, gender, and ethnic characteristics of the general population group with alcohol or drug problems do not hold true for the welfare group with such problems, according to authors Bridget F. Grant, Ph.D., Ph.D., and Deborah A. Dawson, Ph.D., of NIAAA's Division of Biometry and Epidemiology. These differences help to identify segments of the welfare population that may be appropriate targets for alcohol and drug abuse interventions, suggest the authors.
"NIAAA's National Longitudinal Alcohol Epidemiologic Survey (NLAES) shows that alcohol and illicit drug indicators are far less prevalent among persons on public assistance than has been suggested by either the findings of less authoritative research or some public policy debates," said NIAAA Director Enoch Gordis, M.D. "This exemplifies anew the need for sound science to guide health policy deliberations."
Data for today's report were collected as part of the 1992 NLAES designed by NIAAA and conducted by the Bureau of the Census. Responses are from in-person interviews with a single resident aged 18 years or older in each of 48,862 households within the contiguous United States and the District of Columbia. NLAES is the "gold standard" for estimating the prevalence of adult alcohol and other drug use disorders, in part because survey questions reflect the stringent diagnostic criteria for those disorders as syndromes according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The NLAES questions are based on diagnostic criteria in the current edition known as DSM-IV.
Earlier NIAAA reports from the 1992 NLAES include estimates for the general population prevalence of alcohol abuse and alcohol dependence syndrome (February 1995) and subgroup variations in U.S. drinking patterns (July 1995) among others. Single copies of today's publication and the earlier reports are available from NIAAA.
For today's report, NLAES respondents were asked whether they had received assistance under Aid to Families with Dependent Children (AFDC), the Special Supplemental Food Program for Women, Infants, and Children (WIC), the Supplemental Security Income (SSI) program, Medicaid, or the Food Stamps program during the month prior to the interview. Although the NLAES design does not account for homeless persons, those under 18 years, persons residing in institutions, multiple welfare recipients in a single household, and multiple program payments to a single individual during the prior year, the survey produced estimates of the number of adults covered under each welfare program that are similar to those from the 1992 Current Population Survey and program statistics of the administering Federal agencies.
Drs. Grant and Dawson found the 1992 prevalence of alcohol abuse and/or dependence among welfare recipients (which ranged from 4.3 to 8.2 percent across the five welfare programs) and drug abuse and/or dependence (which ranged from 1.3 to 3.6 across the programs) comparable to general population rates for alcohol abuse and/or dependence (7.4 percent) and other drug abuse and/or dependence (1.5 percent). Similarly, the proportion of welfare recipients who are heavy drinkers (6.4 to 13.8 percent across programs) was comparable to 14.5 percent in the general population, and the proportion of welfare recipients who use other drugs (3.8 to 9.8 across programs) was comparable to 5.0 in the general population. The welfare rates also were similar to non-welfare rates of alcohol abuse and/or dependence (7.5 percent), drug abuse and/or dependence (1.5 percent), heavy drinking (14.8 percent), and any drug use (5.1 percent).
The general and welfare populations demonstrated somewhat different gender, ethnic, and age patterns in the proportions of individuals who use, abuse, or are dependent on alcohol or other drugs. For example, in the general population, rates for all alcohol and drug problem indicators are substantially higher among men than women; in the welfare population, no gender differences were found for drug problem indicators, nor were alcohol problem indicators higher among men than women in the AFDC program. Similarly, while the general population prevalence of all alcohol and drug problem indicators is higher for non-Blacks than blacks, rates of heavy drinking, drug use, and alcohol and/or drug abuse and dependence were not significantly different between Black and non-Black recipients of each welfare program.
Among the welfare recipients with alcohol and other drug problems, the authors report differences according to welfare program type. For example, heavy drinking, any drug use, and alcohol and other drug abuse and/or dependence were significantly greater among 25- through 34-year-old recipients of AFDC and Food Stamps, than among recipients 35 years and older, and among 30- through 54-year-old SSI and Medicaid recipients than among those 55 years and older. WIC recipients did not demonstrate a similar age differential.
Additional analyses will be required to understand the observed age, gender, and ethnicity differentials of the alcohol and drug problem indicators. However, targeted education programs, screening efforts, and provisions for treatment could be incorporated into existing welfare programs, just as AFDC participants now receive training and employment services and WIC participants receive nutrition education.
To schedule author interviews, telephone NIAAA's Scientific Communications Branch (301/443-3860). Past press releases, full-text alcohol research publications, and additional information are available at NIAAA's World Wide Web site--http://www.niaaa.nih.gov.
A component of the National Institutes of Health, NIAAA is the nation's lead agency for biomedical and behavioral alcohol research.