Substance Misuse Profiles of Adults in Families Receiving Temporary Assistance for Needy Families (TANF) Benefits: Findings from a National Sample

Background/Purpose: Adults in families receiving Temporary Assistance for Needy Families (TANF) assistance, mostly caregivers of children, are two times more likely to have a substance use disorder than non-TANF counterparts. Substance misuse by adults in TANF families raise major public health concerns not only for users but also for children for its adverse effects on their developmental outcomes (e.g., early onset of substance use and use disorders, cognitive development delay, mental health disorders). However, evidence is limited about substance misuse patterns and comorbid mental health problems among adults on TANF programs, which is essential to inform substance use prevention and treatment efforts.

Methods: Data were derived from the 2015-2018 National Survey on Drug Use and Health, a nationally-representative sample of non-institutionalized U.S. civilians aged 18 or older. Our analytic sample was restricted to 3,589 adults (1,140 men and 2,449 women) in families who have ever received TANF cash assistance for at least one month within a year from the time of survey. As measures of substance misuse, we examined past-year marijuana use, cocaine/crack use, heroin use, prescription pain reliever (e.g., Hydrocodone, Oxycodone, Vicodin) misuse, and any prescription psychotherapeutics (sedatives, stimulants, and tranquilizers) misuse as well as past-month binge drinking. Also, dichotomous measures of past-year substance use disorders and major depressive episodes (MDE) in consistent with the DSM-IV criteria were examined. The statistical analyses were conducted in two phases. First, we conducted a latent class analysis to identify adult subgroups in TANF families based on their involvement in substance misuse in the past year. Starting from a one-class model, we generated a series of models by adding one additional class until the best-fitting model was obtained. Then, multinomial logistic regression models were used to test significance of the associations between the substance misuse group classification and substance use disorders/mental health correlates.

Results: A four-class solution was the best-fitting model of the data, suggesting four distinct groups: Low Risk (Class 1, 81.4%), Marijuana and Alcohol misuse (Class 2, 12.7%), Polysubstance misuse (Class 3, 2.1%), and Prescription Pain Reliever and Alcohol misuse (Class 4, 3.8%). The Marijuana & Alcohol misuse (Class 2) and Polysubstance misuse (Class 3) groups shared similarities in some sociodemographic characteristics (e.g., never-married status, young adulthood [aged 18-34], current marijuana use), but the Polysubstance misuse (Class 3) group reported greater rates of cocaine/crack (60%), heroin (22.4%), and psychotherapeutics (43.4%) misuse. Of the three identified at-risk groups, the Polysubstance misuse (Class 3) and Prescription Pain Reliever and Alcohol misuse (Class 4) groups were more likely to experience substance use disorders and MDE compared to the Low Risk (Class 1) group.

Conclusions and Implications: Despite their higher involvement in substance misuse, over 80% of adults in TANF families showed low substance misuse risks. While effective screening is needed to identify adult populations who misuse substances, more attention needs to be paid to adequate treatment for unique substance abuse and mental health needs for promoting drug abstinence among those who meet the Polysubstance misuse and Prescription Pain Reliever and Alcohol Misuse group characteristics.