Welfare feeling
disease‘s burden
September 28, 1999
Rolls swell with those affected by alcoholism
By Eric Newhouse
Tribune Projects Editor
Alcoholism plagues at least half of Montana‘s 4,650 welfare families — and could cost taxpayers up to $11 million a year, social workers estimate.
There are no exact figures, because many alcoholics and their families don‘t admit they have a problem. Estimates are based on the educated guesses of caseworkers, who deal with the symptoms daily.
Kim Brown of the state Department of Public Health and Human Services in Helena said social workers estimate 40 percent to 60 percent of their cases involve alcohol abuse.
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"I suspect that alcohol is involved in at least 50 percent of the cases I see," Linda Franz of the state public assistance office in Great Falls said.
Three years ago, there were probably the same number of alcoholics on the welfare rolls, but the percentage doubled as the caseload was halved under welfare reform, she said.
In fiscal 1999, which ended June 30, an average 5,344 Montana families received cash assistance averaging $2.07 million each month.
By August, that had dropped to 4,650 cases totaling $1.84 million.
In some welfare cases, the alcoholism is obvious, admitted and documented.
Carol Solis, another Great Falls caseworker, remembers a woman who has been very open about her battle with the bottle over the past decade.
"She‘s a single woman who couldn‘t cope, so she left her child with her parents so she could go explore and find herself," Solis said. "She has done a lot of treatment: inpatient, outpatient, religious, whatever.
"But she constantly finds a job bartending, and she finds men who are abusive," Solis said. "She starts drinking again to mask the pain, then the babies have to go back to grandma and grandpa again."
By now, Solis said, this woman is at a point where there‘s no sense in putting her in treatment again. She knows it all, she just can‘t apply it to her own life.
"I see her begin to get herself together, get looking good, a glow in her cheeks, radiant hair," she said, "but then she leaves treatment and is back within six weeks, dull hair and eyes, sallow skin, saying ‘It just didn‘t work again.‘
"And this is a beautiful, intelligent woman who isn‘t even 30 yet," Solis said. "People have no idea the power of alcohol."
But most families aren‘t so open about their problems, which makes them harder, and more costly, to help.
"They have to address their alcoholism before we can work on anything else to make them self-sufficient," Franz said.
She had a client — ironically, one who used to work with troubled kids — who denied being an alcoholic, but who couldn‘t keep the appointments for his own self-help programs.
"Over and over again, he didn‘t follow through," Franz said. "He was facing his second sanction until he recently asked us to close his case because he planned to move.
"I suspect we were getting close to something he didn‘t want to admit, so he planned to go somewhere that people don‘t know about him," she said. "But his case notes will follow him anywhere he goes in the state."
Not only do alcoholics need help, but also their families.
Caseworkers must work on self-esteem, financial management and anger control, and often have to deal with the aftermath of domestic violence, before they can do anything with job-training skills that can lead to employment.
"We have to use a lot more community resources, and it takes much more of our time," Franz said.
"Even though our caseloads are going down, we have to work a lot harder with the people we have left," she said.
Foster care
Alcohol costs taxpayers in several ways. In addition to cash assistance to families with children, some alcoholics without families receive food stamps and many children have to be removed from alcoholic households for their own safety.
"Alcohol is a big part of the reason our foster care caseloads are soaring," Great Falls caseworker Carol Solis said. "Parents are frustrated, can‘t cope and turn to drink."
Montana usually has between 2,000 and 2,200 children in foster care on any given day, said Shirley Tiernan, chief of the family services bureau for the state human services department.
"Alcohol use is a big factor in children being removed from their homes," she said. "Most of our foster care cases are related to alcohol abuse."
Nationally, Tiernan said, more than 50 percent of foster child placements result from excessive parental drinking.
"That may not mean alcohol dependency," she added. "It may mean that the parents were drunk and there was no one to take care of the children. They may get them back in a couple of days when they sober up, then keep them for a couple of months until they get drunk again.
"There are an awful lot of binge drinkers," said Tiernan.
The cost of foster care in Montana was $13.4 million in fiscal 1998, increasing to $14.3 million last year.
Food stamps
Some single alcoholics qualify for food stamps, but they aren‘t a majority of the caseload by any means, according to two local caseworkers.
"There‘s not a lot we do for single people in Montana unless they‘re elderly, blind or disabled," said Sharon Hansen, who supervises about 225 clients eligible for nursing home care, Medicaid or food stamps.
Under the new regulations, alcoholism alone isn‘t considered a medical disability. Consequences of heavy drinking — liver or brain damage, for example — can qualify an alcoholic for a disability and permanent food stamps.
Without a disability, however, able-bodied adults can only get three months worth of food stamps in a three-year period.
"Many alcoholics and drug addicts fall under these rules, end up disqualified from receiving food stamp benefits (after three months) and move on to other areas or somehow survive on the street," caseworker Linda Godak said.
She believes the rule is too harsh for alcoholics because it doesn‘t give them enough time to deal with their problems.
But alcoholism isn‘t always easy to spot, she said.
"I haven‘t had to turn many of them away because they show up drunk," she said. "They usually get themselves cleaned up before they come in to see me."
Godak can verify about 35 alcoholics among her 250 cases — about 14 percent of her workload.
That may not be a complete number, "but it‘s all I can prove," she said.
State officials have difficulty tracking down the number of people in Montana who have been certified as disabled because of alcoholism.
Changing the rules left a lot of people high and dry, said Hansen.
It doesn‘t make sense to delay benefits for an alcoholic until the illness has created serious medical consequences, Godak said.
"You can pay now or pay later," she said. "I believe you‘re inflicting more duress and pain than if this country would just address the problem right at the beginning."
National picture
Several years ago, this country began to realize it was creating a class of people — more than three generations deep in many places — who knew no other lifestyle than welfare checks.
University of California-San Diego sociologist David P. Phillips analyzed nearly 32 million electronic death certificates over a 15-year period, from 1973 to 1988, and concluded earlier this year that the welfare lifestyle can be fatal.
He found an average of 4,320 more deaths in the first week of every month than the last week of the preceding month, which he attributed to alcoholics and addicts overdosing after spending their first-of-the-month government checks on drink and drugs.
The study "really highlights the extraordinary toll of substance abuse," Lisa Najavits, a professor of psychology at Harvard Medical School told The Associated Press.
Once welfare reform was enacted, the focus for caseworkers changed, from merely certifying eligibility to encouraging welfare recipients develop job skills and find employment.
"Five years ago, I wasn‘t in the middle of people‘s lives the way I am now," Solis said. "It takes more time, it takes more effort, and it takes more of my heart."
In 1995, the National Center on Addiction and Substance Abuse at Columbia University estimated that the federal government spent $11.5 billion treating just the consequences of alcoholism in its entitlement programs such as Medicare, Social Security, Aid to Families with Dependent children and Food Stamps.
States spent another $1.4 billion, it estimated.
"In 1995, $60.3 billion, or nearly one in five dollars the federal government spends on all health care entitlements, will be spent to treat illness and conditions attributable to tobacco, alcohol and other drugs," said the center. "This amount is three times as much as the federal government will spend on AFDC, and more than the combined total of AFDC and food stamps."
Since welfare reform, welfare cases dropped from 14.1 million when he took office in 1993 to just 7.3 million earlier this year.
That worked out to 2.7 percent of the population receiving cash assistance, the smallest percentage since Lyndon B. Johnson was president. In 1967, the figure was 2.5 percent.
But America mirrors the problem in Montana: Those left on the welfare rolls are the least hirable, the ones with the greatest problems.
And two ominous deadlines approach.
The first is a three-year limit on the length of time a welfare recipient can receive benefits. Many are approaching that first deadline now.
The second is a two year-extension of that limit, which would be granted if the welfare recipient does at least 20 hours a week of community service.
After that, though, recipients no longer are eligible for welfare unless they live in an area where there are extraordinarily few jobs — like Indian reservations, for example.
"I‘d like to believe that at the end of that five years, our clients will be self-sufficient or those who are still in the system will have been determined to be disabled," Solis said. "But I know that‘s unrealistic, so really, I don‘t want to think about it.
"But it really means that I have to find a way to make all my clients self-sufficient before they hit the end of the road," she said
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