Drug testing and mandatory treatment for welfare recipients

International Journal of Drug Policy 12 (2001) 249–257

Policy analysis

Drug testing and mandatory treatment for welfarerecipients�

Scott Macdonald a,*, Christine Bois b, Bruna Brands c, Diane Dempsey d,Patricia Erickson c, David Marsh c, Stephen Meredith c, Martin Shain c,

Wayne Skinner c, Angelina Chiu e

a Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, London, Ont., Canada M6G 4X8b Centre for Addiction and Mental Health, 547 Upper Dwyer Hill Road, R.R. c4, Almonte, Ont., Canada K0A 1A0

c Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ont., Canada M6J 1H4d Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ont., Canada M6J 1H4

e Centre for Addiction and Mental health, 265 North Front Street, Ste. 411, Sarnia, Ont., Canada N7T 7X1

Received 1 November 2000; accepted 30 May 2001

Abstract

One province in Canada, Ontario, is considering the use of drug tests for welfare recipients. Those with positivetests could be required to receive treatment and abstain from drug use or risk losing their benefits. Several expertsfrom the Centre for Addiction and Mental Health (CAMH) reviewed the scientific strengths and weaknesses of thisproposal. Strengths included possible increases in employment and reduced drug use among welfare recipients;however, the group concluded that drug testing of welfare recipients or removal of welfare benefits for people whorefuse treatment or relapse is not advisable for several reasons. Drug testing cannot be used to determine substanceabuse or dependence, could undermine the client case manager relationship and could be legally challenged as aviolation of human rights. Other drawbacks of conditional welfare include possible negative societal consequences(i.e. increased crime and health problems) and disruptions to the treatment population. The whole process isexpensive and will likely result in a very marginal increase in employment because drug dependence is not a majorbarrier to employment. © 2001 Elsevier Science B.V. All rights reserved.

Keywords: Drug testing; Treatment; Abstinence

www.elsevier.com/locate/drugpo

� The views expressed in this paper are those of the authors and do not necessarily reflect the view of the Centre for Addictionand Mental Health.

* Corresponding author. Tel.: +1-519-858-5000; fax: +1-519-858-5199.E-mail address: [email protected] (S. Macdonald).

0955-3959/01/$ - see front matter © 2001 Elsevier Science B.V. All rights reserved.

PII: S 0955 -3959 (01 )00094 -9

S. Macdonald et al. / International Journal of Drug Policy 12 (2001) 249–257250

Background

History of drug testing and mandatorytreatment

Drug testing through urinalysis was firstused on military personnel returning from theVietnam War and on people receiving treat-ment for drug abuse problems. Since then,drug testing has been used on a wide varietyof populations, including convicts, parents,children, pregnant women, and employees.Drug testing for employees has been rational-ized in part in the United States because 70%of people who use drugs are employed (Officeof National Drug Control Policy, 1990).Drug testing is most prevalent in the UnitedStates, where drug enforcement and punish-ment are primary strategies to address druguse in society. In Canada, where preventionand treatment are emphasized to a greaterextent than the United States, drug testing isless common and some types of testing havebeen successfully challenged in the courts(Erickson and Haans, 2001).

Mandatory treatment, also called construc-tive confrontation, was first introduced inworkplaces in the 1940s. Mandatory treat-ment involves the application of negativeconsequences to people who do not acceptsubstance abuse treatment. In the first pro-grams, employees with alcohol problems wereidentified by supervisors and required to re-ceive substance abuse treatment or face possi-ble dismissal if they refused treatment. Sincethen, practices have changed as employersnow only identify work performance prob-lems (not alcohol or other drug problems perse) of employees and can not dismiss em-ployees if they do not seek treatment. Today,most Canadian companies focus more onvoluntary treatment than supervisor referrals(see Macdonald and Wells (1994) for a moredetailed description).

Mass drug testing of welfare recipients isnot currently being conducted in any otherprovince in Canada. In Nova Scotia, parentswith a history of addiction may be subject tomandatory drug testing, which can be or-dered through the courts (Fraser, 1998).Drug testing of welfare recipients has beenconducted in some jurisdictions of the UnitedStates, but the most thorough evaluation wasdone in Oregon (Kirby et al., 1999). In Ore-gon, drug tests can be ordered for selectedrecipients, and the need for treatment is iden-tified by three means: (1) validated drugscreening tests, (2) through observation bythe case manager, and (3) failure by therecipient to comply with an agreed employ-ment plan. Drug testing is sometimes used forclients who deny a problem and refuse refer-ral to treatment when a problem appears tobe obvious. Mass drug testing of welfarerecipients was considered in Oregon but wasrejected due to costs, lack of utility and thepotential to undermine the relationship be-tween the client and the case manager. Aswell, drug testing is not uniformly adminis-tered in each of Oregon’s 15 districts and onedistrict refused to do any testing. Little evi-dence is available from other jurisdictions onthe costs and benefits of this policy.

The use of drug testing and mandatorytreatment for welfare recipients in a NorthAmerican jurisdiction

During the 1999 provincial election in On-tario, Canada, the Conservative government(which was re-elected) indicated it would in-troduce legislation that would requiremandatory drug testing and treatment of wel-fare recipients (Ontario Progressive Conser-vatives, 1999). The purpose of the testing isdescribed in the pre-election document enti-tled ‘Blueprint’ as follows: ‘‘It’s commonsense – you can’t get off welfare and hold a

S. Macdonald et al. / International Journal of Drug Policy 12 (2001) 249–257 251

job if you’re addicted to drugs. That’s whywe’ll provide mandatory treatment for wel-fare recipients who use drugs. We’ll helpthem get off drugs, off welfare and back ontheir feet again. Those who refuse treatmentor who won’t take tests on request will losetheir benefits.’’

After its re-election, the Ontario govern-ment unveiled, on November 14, 2000, its‘Drug Treatment Consultation Plan’ its initialstep in developing the policy and supportinglegislation. Although the policy has not beenspecified in detail, it appeared to include thefollowing components as conditions of receiv-ing welfare: (1) mandatory drug testing, (2)treatment, and (3) abstinence from drugs.This statement accompanying the announce-ment of the Consultation Plan on the govern-ment website was unequivocal: ‘Individualswho refuse treatment or who won’t take testson request will be ineligible for a welfarecheque’ (Ministry of Community and SocialServices, 2000).

The Policy Review and Development Com-mittee at CAMH decided that the strengthsand weaknesses of this policy proposalshould be addressed with the ultimate intentto develop a position paper by the Centrewith supporting scientific documentation.Committee members were chosen on the ba-sis of their expertise in various aspects of thecontent of the proposal. These areas includeddrug testing, welfare issues, client issues,treatment, policy and the disciplines of epi-demiology, criminology, pharmacology andjurisprudence. The group met on several oc-casions and individuals drafted sections ofthis paper based on their areas of expertise.

The resulting paper reviewed the scientificstrengths and limitations of drug testing andmandatory treatment for welfare recipientsand is presented here. Issues related to moralaspects of the proposal or to political prefer-ences are not addressed. Rather, the major

scientific and practical issues related to drugtesting of welfare recipients are reviewed. Anupdate on the paper’s impact on the policyprocess in Ontario is also included.

Three main terms are used in relation toconsumption of drugs and alcohol. Substanceuse refers to use of either alcohol or drugsthat does not pose serious physical, psycho-logical or social problems. Substance abuserefers to drug use that leads to adverse phys-ical, psychological or social consequences.Substance dependence or addiction refers toprolonged high levels of drug use, resulting inloss of control over one’s use, impaired func-tioning and significant adverse physical andpsychological consequences.

Strengths of mandatory drug testing andtreatment

In this section, the primary strengths of theproposal for drug testing of welfare recipientsare outlined. It should be noted that nosupporting evidence was provided in the gov-ernment proposal itself, it simply assertedthat, ‘our goal is to remove barriers to em-ployment and help those in trouble beat theodds’ (Ministry of Community and SocialServices, 2000).

Effects of treatment on employability

Generally, people that receive treatmentfor substance abuse have higher rates of em-ployment after treatment than before treat-ment (Center for Substance Abuse Treat-ment, 1997). Some studies which show highrates of both substance abuse and mentalhealth problems have concluded that ‘appro-priate treatment is likely to improve eco-nomic outcomes among affected welfareclients’ (Jayakody et al., 2000). Therefore,requiring welfare recipients to obtain treat-


ment may lead to subsequent improved ratesof employment among this group.

Mandatory treatment

There is some evidence in the literaturethat mandatory treatment can produce posi-tive outcomes in terms of substance abuse.For example, employees who are on the vergeof losing their jobs due to performance prob-lems related to substance abuse have shownimprovements when offered treatment (Mac-donald et al., 1997). Similarly, court diversionprograms where driving under the influenceof alcohol offenders have been offered treat-ment have produced better results than pun-ishment (Wells-Parker et al., 1995).

Treatment enrollment, treatment complianceand treatment completion

Mandating clients to attend treatment as acondition of receiving social assistance wouldlikely increase the number of drug and alco-hol users who enroll in treatment programs.Rates of treatment compliance and comple-tion also could be expected to increase forthose who enroll under these circumstances.

Limitations of mandatory testing andtreatment

The magnitude of drug use problems

The prevalence of drug use in general andparticularly within the welfare population isrelevant in terms of possible need for sub-stance abuse interventions for those receivingwelfare in Ontario. Data on the prevalence ofsubstance use are based on self-reports fromtelephone surveys, which likely underestimatetrue prevalence. Alcohol is the most com-monly used drug, with about 80% of Ontario

adults drinking in the past year. In contrast,the 1998 survey of Ontario adults indicatedthat 8.6% used cannabis and 4.6% used co-caine in the past year (Adlaf et al., 1999).Non-medicinal use of opiates is much lesscommon, being reported by less than 1% ofthe population.

Little information is available on the pro-portion of Ontario welfare recipients that useor abuse drugs or alcohol. Research in theUnited States generally shows that rates ofuse and abuse among the welfare populationare comparable to those not receivingbenefits (Grant and Dawson, 1996), althoughelevated rates of substance abuse problemsamong women on welfare have been found insome studies (Centre on Addiction and Sub-stance Abuse, 1994). An Ontario study foundthat those on subsidized housing had lowerrates of substance use than those withoutsubsidized housing (Boyle et al., 1990).

The research evidence does not clearly in-dicate that the welfare population has highlyelevated rates of substance use problems. Aswell, the fairly low prevalence of drug use issuggestive that the magnitude of substanceuse problems, with the exception of alcohol,is not large. The proposed policy will targetonly a small percent of welfare recipients whoare illicit drug users.

Barriers to employability

Another question of importance is whethersubstance use and abuse represents a seriousbarrier to employment. Studies have shownthat about 70% of drug users are employed,and ironically, this fact has been instrumentalin the adoption of drug testing in the work-place to fight the war on drugs (Office ofNational Drug Control Policy, 1990). Severesubstance abuse or dependence, as evidencedby improved employment rates after treat-ment, likely impedes employability. However,


the preponderance of the research evidenceindicates drug use is not a major barrier toemployment. Furthermore, many factorssuch as physical and mental health problems,lack of job skills, perceived discrimination,and lack of transportation are major barriersfor employment (Danziger et al., 1999). Adisproportionate emphasis on drug use as afactor for not obtaining employment couldbe ineffective if these other factors are notaddressed as well.

Limitations of drug tests

Urinalysis can only be used to determinewhether drug metabolites are present in theurine. The tests can not measure impairment(i.e. deteriorated performance), abuse or de-pendence. Drug tests are generally conductedto detect five classes of drug metabolites:cannabis, cocaine, opiates, phencyclidine-re-lated compounds and amphetamine-relatedcompounds (Kapur, 1994). Since differentdrugs are eliminated from the body at differ-ent rates, drug tests can detect use of somedrugs more readily than others. For example,cannabis use can be detected if it was used aslong ago as 3 weeks before the test, whereascocaine use can only be detected if use oc-curred within a few days before the test.Other substances, such as sedatives, alcohol,hallucinogens and solvents, which have thepotential to affect employability, are not rou-tinely included in standard drug tests or aredifficult to detect. Drug tests do not addressthe full range of drugs that could interferewith performance or employability, and donot detect the drug most likely to cause workproblems, namely alcohol.

The need for clinical assessments

Since the tests can not be used to distin-guish substance abuse or dependence from

occasional use, comprehensive clinical assess-ments are still needed to diagnose the pres-ence of a substance use disorder. Aspreviously mentioned, most people who usedrugs are gainfully employed. A comprehen-sive assessment should include a thoroughsubstance use history, a full psychosocial his-tory and a medical examination (and associ-ated tests) to determine if there are signs ofillness or compromised functioning thatmight be related to substance use. Collateralinformation from key informants (family,friends) is useful for verifying client self-re-ports. Confidentiality and the absence of ad-verse consequences also improve the accuracyof self-reports (Donovan and Martlatt, 1988).

Variations in the effects of different drugs

The pharmacological properties, addictiveand long term harmful effects vary consider-ably among the drug classes that are tested.For example, cannabis is not highly addictiveand use will usually not affect employability.In contrast, cocaine is more addictive andlong term use could interfere with one’s em-ployability, although most people who usecocaine do not become dependent (Ericksonand Cheung, 1999). Also, most people whouse drugs do not use them at work (New-comb, 1994).

Negati�e consequences of conditional welfarebenefits

Providing welfare on the condition thatclients are drug free or participate in a treat-ment program could result in negative soci-etal consequences, such as increased crimeand social problems. A qualitative study inChicago that examined the impact of elimi-nating disability benefits, is useful for under-standing the likely societal consequences(Goldstein et al., 2000). The researchers con-


ducted a focus group with 40 individuals whohad been receiving disability benefits for drugaddiction and alcoholism and lost them whenthese conditions were disallowed in federalwelfare programs. While some people (the‘good citizens’) went back to work, others(the ‘hustlers’) increased their criminal activi-ties. Those who suffered the most, labelledthe ‘lost souls,’ had pre-existing physical andmental disabilities. This latter group becamea larger burden on the health system as manyof them became sicker. It is clear that elimi-nating welfare payments has a differentialeffect, as not all recipients are the same intheir ability to adapt and to function in thecommunity.

Another quantitative study in the Chicagoarea provided additional evidence of harmfulimpact of this policy on particularly vulnera-ble groups (Swartz et al., 2000). Over 200randomly selected individuals who had beenbeneficiaries of a drug addiction and alco-holism disability plan were interviewed imme-diately after its termination and 1 year later.The results showed that unemployed individ-uals had elevated rates of drug dependenceand psychiatric co-morbidities, making theirtransition to sustained employment extremelydifficult. The investigators concluded that thepolicy of denying welfare benefits to previousrecipients ‘may be creating a residual popula-tion that is too seriously impaired to workowing to psychiatric and substance use disor-ders’ (Swartz et al., 2000:701).

Other considerations relate to the treat-ment process itself under coerced conditions.Clients who have no desire to change theirbehavior may be disruptive to the treatmentprocess and undermine the efficacy of treat-ment for other individuals. This is particu-larly the case where therapy is offered on amilieu or group basis, which could have anegative effect on treatment participation andcompletion of non-mandated clients in theseprograms.

About 40–60% of substance users have atleast one relapse in the first year after com-pleting treatment (McLellan et al., 2000). Apolicy that demands abstinence from drugs asa condition of receiving welfare likely will notbe effective because relapse is so common.Rather, such a policy may result in negativesocietal consequences as described above.

Disruption to the client and case managerrelationship

Case managers for welfare recipients canbe instrumental in assisting clients to obtainemployment. Case managers are generallymost effective when they build a trustingrelationship with the client. Drug testing hasthe potential to undermine this relationshipby creating an adversarial environment,which could be counterproductive to the jointgoal of obtaining employment.

Legal issues

Drug testing and mandatory treatment ofwelfare recipients could be challenged on le-gal grounds in some jurisdictions. For exam-ple, under the Ontario Human Rights code,alcohol and drug dependence is considered ahandicap and a perceived alcohol dependencemight be considered a handicap as well (Nor-ton, 1999). Failure to provide welfare benefitson the basis of substance abuse may consti-tute discrimination. Also, a legal challengeagainst both mandatory drug testing andmandatory treatment might succeed underCanada’s constitutional statement of rights,the Canadian Charter of Rights andFreedoms.

Cost issues

Various financial costs will be incurred toimplement the proposed drug testing and


mandatory treatment program. Increasedcosts are associated with conducting drugtests, increased clinical assessments and in-creased substance abuse treatment. The totalcosts increase as a function of the number ofpeople who test positive.

When drug testing is implemented, proce-dural safeguards are necessary to ensure ac-curate findings but are costly. The processmust be rigorous and adhere to widely recog-nized forensic standards, including properqualifications of the staff, collection of urinesamples under direct observation, chain ofcustody, documentation and regular inspec-tions (Kapur, 1994). As well, a medical re-view officer, who must be able to discuss andinterpret positive test results with the client,should review positive results. All positivetest results must be re-confirmed by moreadvanced and costly methods, usually gaschromatography and mass spectrometry.

As previously indicated, clinical assess-ments are still needed for those who testpositive in order to determine whether treat-ment is required. These assessments alongwith a possible need for increased capacity oftreatment for clients with substance abuseproblems will produce additional costs to thehealth care system.

Implementation of mandatory drug testingfor welfare recipients would be a costly en-deavor. If the costs of additional technicaland expert fees attached only to positive re-sults are averaged over all samples collected,a conservative estimate of cost would be$40–60 per sample. Estimating conserva-tively, if as many as 2–3% of samples arepositive (which would be a higher rate thanoften seen in workplace testing) the cost perpositive sample would be in excess of $2000.In considering these cost estimates, it is im-portant to bear in mind that not all individu-als who test positive for substance use willhave problematic substance use requiring

treatment. Therefore, the cost per individualappropriately referred into treatment will beeven higher.

Conclusion

Drug testing through urine analysis haslimited utility in terms of determining theneed for treatment and increasing employ-ability of welfare recipients. The tests can notbe used to determine substance abuse or de-pendence and do not address the full range ofdrugs that could interfere with employabilityor employment performance. Clinical assess-ments are still required to assess substancedependence problems. Furthermore, drugtesting could undermine the client and casemanager relationship, be legally challengedand is costly.

There is some evidence that substanceabuse treatment can increase employabilityfor those with alcohol or drug problems;however, the issue of mandatory treatmenthas drawbacks, such as potential negativesocietal consequences, disruptions to thetreatment population and additional financialcosts. Conditional welfare, based on absti-nence from drugs, has similar drawbacks.Moreover, the denial of benefits to those withsubstance abuse problems may produce in-creases in crime, health problems and othersocietal costs, and be subject to expensivelegal court challenges.

In conclusion, these authors do not believethat either drug testing of welfare recipientsor removal of welfare benefits for people whorefuse treatment or experience relapse is ad-visable. Individuals who use drugs shouldhave the same access to welfare benefits asother residents, irrespective of whether theyneed or receive treatment. Substance abusetreatment should be available to welfare re-cipients and other socially disadvantaged in-


dividuals on a voluntary basis. The need fortreatment should be determined through clin-ical assessments and a strategy for treatmentshould be agreed upon jointly by the clientand case manager.

Update (March, 2001)

An earlier version of the above text wasposted on the CAMH website. It was accom-panied by a position statement approved bythe senior management of CAMH thatclearly stated its non-support of the policy ofmandatory drug testing and treatment forwelfare recipients. In addition to highlightingthe evidence from the position paper, CAMHadded, ‘such an approach would also serve toperpetuate the stigma associated with povertyand addiction.’ Improved access to morebroad based social supports (e.g. housing,skills training, and child care) and improvedaccess to trained case workers where appro-priate, was presented as a more desirableapproach (CAMH website, Dec. 11, 2000).This quick response, within 1 month of thegovernment’s announcement, was possiblebecause the working group had already pre-pared and circulated an earlier version of thisbackground paper.

Subsequently, the paper reached a wideaudience, and was cited both in the mediaand by organizations opposing the govern-ment scheme. These included an editorial inthe Canadian Medical Association journalwhich castigated the proposal in a Swiftianmanner, suggesting that the Ontario govern-ment’s next step would surely be to ‘persuadethe poor to redress their debt to society byselling their children as food’ (CanadianMedical Association Journal, 2001). As well,various unions, social justice and anti-poverty groups, legal clinics and harm reduc-tion activists have formed a coalition against

the proposal (Coalition Against MandatoryDrug Testing and Treatment, 2001), basedmuch of the substance of their opposition onthe CAMH documents. Thus, while the fateof the proposed plan to drug test welfarerecipients in Ontario remains in doubt, thepaper reproduced here provides an importantexample of policy advocacy. It demonstratesthe way in which a scientific literature review,from a well known organization, dissemi-nated widely in the community, can con-tribute to the drug policy process.

Acknowledgements

The authors are indebted to KrystinaWalco for helpful comments on earlier ver-sions of this paper.

References

Adlaf EM, Paglia A, Ialomiteanu A. Ontario drugmonitor 1998: alcohol, tobacco and illicit drug use,1997–1998. CAMH Research Document Series No4. Toronto: Centre for Addiction and MentalHealth, 1999.

Boyle MH, Szatmari P, Offord DR, Merikangus, K.Substance use among adolescents and young adults:prevalence, socio-demographic correlates, associ-ated problems and familial aggregation, WorkingPaper No 2. Toronto: Ontario Ministry of Health,1990.

Canadian Medical Association Journal (2001). Anothermodest proposal. Editorial. Janurary 09,2001;164(1):5.

Centre on Addiction and Substance Abuse. SubstanceAbuse and Women on Welfare. Columbia Univer-sity, 1994.

Center for Substance Abuse Treatment. SubstanceAbuse and Mental Health Services Administration.‘The National Treatment Improvement EvaluationStudy,’ 1997.

Coalition Against Mandatory Drug Testing and Treat-ment. Statement of Unity: Code Yellow. Toronto,Mar 2001.


Danziger S, Corcoran M, Heflin C, Kalil A, Levine J,Rosen D, et al. Barriers to the Employment ofWelfare Recipients, Poverty Research and TrainingCentre, University of Michigan, July 1999.

Donovan DM, Marlatt GA, editors. Assessment ofaddictive behaviors. New York: Guilford, 1988.

Erickson PG, Cheung YW. Harm reduction amongcocaine users: reflections on individual interventionand community social capital. International Journalof Drug Policy 1999;10:235–46.

Erickson PG, Haans DL. Drug War, Canadian Style.In: Gerber J, Jensen E, editors. Drug War, Ameri-can Style. New York: Garland 2001; 121–147.

Fraser AD. Urine drug testing for social service agen-cies in Nova Scotia, Canada. Journal of ForensicSciences 1998;43(1):194–6.

Goldstein P, Anderson TL, Schyb I, Swartz J. Modesof adaptation to termination of the SSI/DI Addic-tion Disability Hustlers, good citizens, and lostsouls. Advances in Medical Sociology 2000;7:215–38.

Grant BF, Dawson DA. Alcohol and drug use, abuse,and dependence among welfare recipients. Ameri-can Journal of Public Health 1996;86(10):1450–4.

Jayakody R, Danziger S, Pollack H. Welfare reform,substance use and mental health. Journal of HealthPolitics, Policy and Law 2000;25:623–51.

Kapur B. Drug testing methods and interpretations oftest results. In: Macdonald S, Roman P, editors.Drug testing in the workplace. New York: PlenumPress, 1994.

Kirby G, Pavetti L, Kauff J, Tapognia J. Integratingalcohol and drug treatment into a work-orientedwelfare program: lessons from Oregon. Mathemat-ica Policy Research Inc., 1999.

Macdonald S, Wells S. The prevalence and characteris-tics of employee assistance, health promotion anddrug-testing programs in Ontario. Employee assis-tance quarterly 1994;10(1):25–60.

Macdonald S, Lothian S, Wells S. Evaluation of anemployee assistance program at a transportationcompany. Evaluation and program planning1997;20(4):495–505.

McLellan A, Lewis D, O’Brian C, Kleber H. Drugdependence, a chronic medical illness. Journal ofAmerican Medical Association 2000;284(13):1689–95.

Ministry of Community and Social Services. HarrisGovernment Unveils Drug Treatment ConsultationPlan. //www.gov.on.ca/ Nov 14, 2000.

Newcomb M. The prevalence of alcohol and other druguse on the job: cause for concern or irrationalhysteria? Journal of Drug Issues 1994;24:403–16.

Norton K. Ontario Human Rights Commissioner. Let-ter to the Minister of Community and Social Ser-vices, July 27 1997.

Office of National Drug Control Policy. Building aDrug-Free Workforce. Washington, DC, 1990.

Ontario Progressive Conservatives. Blueprint: MikeHarris’ plan to keep Ontario on the right track. (at//www.mikeharrispc.com), April 1999.

Swartz JA, Lurigio AJ, Goldstein P. Severe mentalillness and substance use disorders among formersupplemental security income beneficiaries for drugaddiction and alcoholism. Archives of General Psy-chiatry 2000;57:701–7.

Wells-Parker E, Banger-Drowns R, McMillen R,Williams M. Final results from a meta-analysis ofremedial interventions with drink/drive offenders.Addiction 1995;90:907–26.

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Drug testing and mandatory treatment for welfare recipients