Breaking the cycle of dependency: dual diagnosis and AFDC families

This paper proposes that a comprehensive, long-term program with a case-management focus will produce better outcomes and be more cost-effective than the current approach to managing the illnesses of women on Temporary Assistance for Needy Families (or TANF, formerly known as AFDC) who are afflicted with both drug dependency and mental illness, i.e. a dual diagnosis. It is proposed that this comprehensive approach would diminish the generational cycle of substance abuse, dysfunction (including violence), and dependence on public support, which is too often the pattern in single-parent homes where the mother has been dually diagnosed. For our purposes, dual diagnosis is defined as any mental health diagnosis using the DSM-IV criteria coexisting with a diagnosis of substance abuse, whether licit or illicit. Current drug policy, particularly as it applies to those with a dual diagnosis, has an emphasis on criminal justice system solutions. It is extremely expensive (incarceration alone is variously estimated as costing $25,000 to $45,000 per year per person), and does little to treat, prevent, or consequently, reduce the problem. The model design discussed in this article provides for comprehensive treatment and support services to women with a dual diagnosis receiving TANF. Its goal is to help break the family cycle of system dependency. The article hypothesizes that if a well-designed program evaluation is implemented, it will demonstrate savings in reduced health care, criminal justice, and social service costs.