Substance Abuse Research Demonstration (CASASARD) | CASAColumbia

CASASARD: Intensive Case Management for Substance-Dependent Women Receiving Temporary Assistance for Needy Families

CASASARD: Intensive Case Management for Substance-Dependent Women Receiving Temporary Assistance for Needy Families

Published: January 2009

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Background

CASASARDSM was a 10-year welfare demonstration program for mothers with drug addiction in New Jersey. It was designed to:

  • Get women engaged in treatment and employment services
  • Help them become sober
  • Help them successfully move to stable employment

Methods

CASASARDSM used an innovative intensive case management approach to provide services for these women and compared it to the standard care approach that focused on employment first, screening and referral. 302 participants were randomly assigned to each model (161 to intensive case management and 141 to standard care). Participants came from Essex county (including Newark) and Atlantic County (including Atlantic City) in New Jersey.

Results

The study found that while women in the CASASARDSM demonstration program who received standard care appeared to gain employment faster than those who received intensive case management, they were not able to sustain those jobs over time. Compared to women who received standard care, the women who received the intensive case management approach:

  • Received more time and services from their caseworkers
  • Achieved rates 3 times as great of initiation, engagement and retention in outpatient substance abuse treatment
  • Were almost twice as likely to be completely abstinent at the 12 and 24 month follow-ups
  • Were more than twice as likely to be employed full-time at the end of 2 years

Past CASAColumbia research has found that for each unemployed female welfare recipient with a substance use disorder who became substance-free and self-supporting, the economic benefit to society was about $48,000 annually in avoided welfare, health care and criminal justice costs, and contribution to the economy in employment. In New Jersey alone, this could amount to economic benefits of as much as $35 million per year.

The demonstration program and its results were also documented in a corresponding article, “Improving 24-Month Abstinence and Employment Outcomes for Substance-Dependent Women Receiving Temporary Assistance for Needy Families With Intensive Case Management,” published in the February 2009 issue of the American Journal of Public Health (AJPH).

Recommendations

CASASARDSM is the first major system level test of the chronic disease management approach to addiction. Based on its success, the CASAColumbia white paper recommended that:

  • All states adopt this intensive case management approach for women welfare recipients with substance use disorders
  • Local and state agencies increase efforts to collaborate and coordinate services that support intensive case management
  • The federal government support intensive case management through regulatory change and funding
  • Federal and state officials educate policymakers and welfare and other service caseworkers on the disease of addiction and benefits of treatment

A Note on the Language
In 2012, CASAColumbia stopped using words like “drug abuse”/“drug abuser” because the terms are imprecise and have negative connotations. Instead, we now distinguish between “addiction” (clinical criteria for the disease) and “risky use” (use of addictive substances in ways that increase the risk of harm but do not meet criteria for addiction). Some reports and other publications published prior to 2012 still contain this language.

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