Since welfare reform was launched in the United States in 1996, the welfare rolls have been slashed dramatically. They were down 38 percent by the end of 1998 alone. Many observers, however, suspecting that the best candidates for the workforce have already been tapped, wonder how much further the rolls can be pared.

In other words: How many of those still receiving welfare benefits suffer from psychiatric problems or engage in illegal drug use—factors that could well keep them from being employable? Harold Pollack, an assistant professor of health management and policy at the University of Michigan in Ann Arbor, and his colleagues, set up a study to find out. It was funded by the Robert Wood Johnson Foundation and the National Institute of Mental Health. The results, which they reported at the annual meeting of the American Public Health Association in Chicago in November, suggest that whereas serious drug abuse is fairly limited among welfare recipients, psychiatric problems are rampant.

Pollack and his colleagues analyzed data from the 1994 and 1995 National Household Surveys of Drug Abuse since they are the only national surveys that include information on substance abuse, psychiatric disorders, and welfare receipt. The surveys, which were conducted by the National Institute on Drug Abuse, included some 2,700 single mothers at least 18 years of age living with at least one minor child. Residents of single-room hotels and homeless persons were also included. All survey participants were asked whether they had received income from welfare during the previous year; whether they used illegal drugs and, if so, what kind; and whether they suffered from symptoms that would indicate they had a major depression or suffered from panic attack, agoraphobia, or generalized anxiety disorder.

Almost a third of those surveyed—31 percent—reported having received welfare checks during the previous year. Of the welfare recipients, 21 percent reported using illegal drugs (compared with 13 percent of nonrecipients); 10 percent reported using illegal drugs other than marijuana (compared with 7 percent of nonrecipients), and 5 percent reported using cocaine or crack (compared with 3 percent among nonrecipients). Moreover, almost 20 percent of the welfare recipients appeared to have at least one of the four psychiatric disorders (compared with 13 percent of nonrecipients). Major depression appeared to be the most prevalent, followed by panic attack or agoraphobia, then generalized anxiety disorder.

These results suggest how easing people off welfare should be handled, Pollack and his team believe. For example, welfare programs should focus on identifying the small group of serious drug abusers and then attempt to get them successfully treated rather than focus on the larger group of occasional users, since it is undoubtedly the former who are more unemployable.

For another, if extensive psychiatric screening and treatment services were incorporated into welfare-to-work programs, more welfare recipients would probably become employable than is presently the case. Existing "training programs tend not to address mental and behavioral health concerns," Pollack and his colleagues point out.

An article written by Pollock and his colleagues on their study, titled "Welfare Reform, Substance Use, and Mental Health," is posted on the Web at <www.ssw.umich.edu/poverty/pubs.html>.