By Amanda Michelle Gomez

In 2017, states spent more than $490,000 to drug-test 2,541 people who had applied for Temporary Assistance for Needy Families (TANF) benefits, which yielded just 301 positive tests.

While the costs for these programs has dropped somewhat over the past three years, the number of positive tests has also declined.

This year, ThinkProgress also asked states to provide the questionnaires used to determine whether there is “reasonable suspicion” that their applicants/recipients are abusing drugs. The five states that didn’t provide this information said they license a copyrighted questionnaire from a for-profit company that prohibits disclosure of the questions.

The screening method is deeply flawed. The questions typically ask people to volunteer information about their own illegal drug use, and the questions vary widely between states. The vast majority in all but one state still tested negative, even after they were given screening questions, raising serious questions about the efficacy of these screening processes.

“This is not an academic survey and it’s not a clinical tool that I’m doing for somebody at a treatment facility,” said University of Chicago professor, Dr. Harold Pollack, who’s studied drug testing in public assistance for more than a decade. “It’s a series of intrusive questions that I’m asking someone who is in economic need and has approached a public agency looking for assistance.”

The screening questions are asked arbitrarily and out of context, said Pollack. “I think there’s definitely an appropriate context in which I would ask someone these types of questions,” said Pollack. “If your children are showing up to school in dirty clothes and the school social worker starts looking into it, there’s a point where I would totally give someone a set of screening questions about substance use disorders… If someone shows up because don’t have enough money for food, it just strikes me as a real punitive moralistic thing that is not evidence-based.”

Five states use Substance Abuse Subtle Screening Inventory (SASSI) from the for-profit SASSI Institute, which has published screening tools since 1988. The screening results, the company said in a statement, “do not provide evidence that an individual is using or abusing a controlled substance… A diagnostic interview is necessary to determine for which substances, if any, the client has a substance use disorder.” The institute also said that “[t]o use the SASSI to discriminate against individuals, such as disqualifying job applicants or to deny public assistance, violates the purpose of the SASSI and is a violation of the Americans with Disabilities Act.” Still, the company licenses its questionnaire to states for precisely this purpose.

But even screeners like Wisconsin’s that have been well-studied and validated by the federal government, typically exclude alcohol so “the notion that this is being driven by concern about the recipients does not seem well-founded,” said Wendy Cervantes, senior policy analyst at the Center for Law and Social Policy. “If the goal is to actually identify addiction issues that are interfering with people’s life functioning, alcohol is [as] likely to be the problem as any other drug.”

Drug testing is one of those bad policy ideas that never seems to die. In fact, the Trump administration and Republican lawmakers are trying to mandate drug testing in other public programs like Medicaid and the Supplemental Nutrition Assistance Program (SNAP).

According to the National Conference of State Legislatures, no new states have added requirements in the past year, although bills have been introduced in Hawaii, Illinois, Iowa, Massachusetts, Minnesota, Nebraska, New York, Rhode Island, South Carolina, and Vermont in that time.

But data and expert testimony show lawmakers are wrong when they claim drug testing ensures no one’s taking advantage of government assistance or that it enables addiction treatment. It’s clear this policy only stigmatizes people who are in an already vulnerable situation.

“Substance use disorder is less common than people think in the welfare population,” Pollack told ThinkProgress. “If you wanted to really find someone with an alcohol disorder, you can go right outside a football stadium in Arizona, Saturday morning… But we don’t do that in large part because we treat people who are seeking public benefits different and in a less respectful way.”

Since a 2014 appeals court ruling struck down Florida’s unconstitutional universal drug testing requirement for all TANF applicants, states have implemented requirements that applicants and/or beneficiaries with a “reasonable suspicion” be tested. Thirteen states had such programs in operation in 2017. Those states are:

According to the Alabama Department of Human Resources, 19,529 people in that state applied for TANF benefits in 2017, roughly half of whom were applications solely for benefits for children and therefore not subject to screening . These applicants were asked to make a declaration about whether they had any prior drug convictions and whether they had recently used any drugs forbidden by law or used prescription medications “for nonmedical reasons (meaning just because of the feeling or experience it provides).” That year, not a single applicant was asked to take a drug test. Indeed, since the state legislature enacted the 2014 lawmandating drug testing for TANF applicants and recipients with a “reasonable suspicion” of drug misuse, not a single person has tested positive.

Barry Spear, a spokesperson for the department, told ThinkProgress that the law mandating the testing program expired at the end of September 2017, but “the screening and possible testing remains in our policy and will remain in policy for the foreseeable future. The policy helps protect taxpayer dollars and also aids the Department in identifying and assisting those who may have a drug problem.” But while he said the law cost the state no money last year, it also appears to have saved the state nothing.

Arkansas’ testing regime was only slightly more active, but a lot more costly. Some 3,430 of the 19,228 applicants for TANF in 2017 were screened for drug use via a two-question survey. Those who answered that in the previous 30 days they had used any illegal drugs or had lost/been denied a job due to current illegal drug use were required to take a drug test, according to the Arkansas Department of Workforce Services.

Just five were given drug tests and only two of those admittedly recent drug users tested positive. Another eight refused to take the test. Though the testing itself cost just a couple hundred dollars, with staffing costs included the cost was $32,506.65, a spokesperson told ThinkProgress — an effective cost of more than $6,500 per test.

Though the state’s drug testing requirement netted similarly few positive tests in 2016, the legislature made the law permanent in January 2017. At that time, the legislative sponsor called it a success, noting that the roughly $30,000-a-year price tag was much lower than the $1.2 million cost some predicted.

Over 2017, Arizona’s Department of Economic Security made determinations on 81,286 TANF applications. As the state’s drug testing law applies only to adult recipients, rather than all applicants, only the 3,461 adult recipients (monthly average) were required to sign an “Illegal Drug Use Statement,” answering questions about illegal drug use and related employment or problems in the preceding 30 days.

Just two people were given drug tests as a result of that screening process, both of whom tested negative. A third adult recipient “failed to complete the required drug test and was disqualified from the Cash Assistance program,” according to a department spokesperson. “Cash Assistance was authorized at a reduced grant amount for the other eligible members of the household.” He noted that the total cost for the two tests was $45.60.

In 2017, 22,523 Kansans applied for TANF benefits. The Department for Children and Families screened them and their ongoing recipients by a variety of methods including examining employment records, arrest records, a visual examination for signs of drug use or paraphernalia, and a questionnaire, among others, and, in the end, tested 220 for drugs. Only 46 of these tests came back positive — another 50 refused to take the test.

A department spokesperson said the drug testing and lab costs, staff salaries and benefits, and various other operating expenses totaled $43,879.70 for the year — despite that the state was forced to raise taxes to address a massive budget deficit.

Kansas rejected an open records request for for a copy of the questionnaire saying the Substance Abuse Subtle Screening Inventory, which it licenses from the-for profit SASSI Institute, citing copyright law.

Maine has 3,414 TANF applicants in 2017. Using the SASSI-3, another screening instrument from the SASSI Institute, the state’s Department of Health and Human Services drug tested seven recipients and all seven tested positive (another two were rejected for failure to complete the required test).

A department spokesperson said the tests cost $744 and that the screening materials cost $100. This would put the total cost at $844. The state did not provide the SASSI-3 questions.

The most expensive drug testing program was Missouri’s: it cost the state a whopping $336,297 in public funds to test 108 applicants. Just 11 came back positive, and 305 applicants did not show up for a drug test or refused. The state had 32,774 total TANF applicants that year.

The communications director Missouri Department of Social Services noted that applicants can waive the testing requirement if they wish to be referred to a substance abuse treatment program. That spokesperson also asked ThinkProgress to “refrain from publishing the drug screening question verbatim as it may give some participants an unfair advantage in knowing the question prior to the interview.”

But it wasn’t a complicated test. Applicants were given an one-question screening to determine reasonable suspicion: they were asked how many times in the past year they had used illegal drugs or prescription medication for nonmedical reasons.

Mississippi had 11,407 TANF applications in 2017. After being screened via an online version of the Substance Abuse Subtle Screening Inventory, 464 were given drug tests (and another 26 did not complete the required drug testing for various reasons).

Just six positive tests were recorded — and the total cost to the state was $8,493. A spokesperson for the state’s Department of Human Services was not able to provide the SASSI screening questions.

Of the 28,828 applicants for WorkForce, North Carolina’s TANF benefits program in 2017, 258 were given drug tests by the Department of Health and Human Services, after receiving a score of eight or more on weighted 10-question survey about drug use. Of those tested, 31 tested positive; another 20 refused to take the test and 171 did not show up to do so.

A spokesperson told ThinkProgress that the cost for the process was $14,410.

Some 13,361 Oklahomans applied for TANF in 2017 and 3,915 of those were subject to the state’s drug screening requirements. After taking a SASSI screening questionnaire, the Oklahoma Department of Human Services sent 1,196 to a second level of screening, a 90-minute-plus meeting with a mental health professional called the “Addiction Severity Index.” Of those, 841 were given a drug test — just 77 of those tested positive.

A spokesperson told ThinkProgress that the state does not track refusals and that the cost for the program was $50,294.48. She also told ThinkProgress that the state is not permitted to reproduce any part of the SASSI, even under the Oklahoma Open Records Act.

In 2017, 13,058 new applicants were received by the Tennessee Department of Human Services for its TANF/Families First program. The adults applying were then required to answer a three-question screener about any use of or problems relating to marijuana, cocaine, methamphetamines/amphetamines, and opiates over the preceding three months.

Of those who were deemed to use “controlled substances,” 164 were given drug tests, 26 tested positive. Another 95 did not complete the required test within the 45-day time limit. The total cost, according to a spokesperson, was $5,279.25.

Utah’s law requires recipients of the Family Employment Program, part of the state’s TANF program, to be screened for drugs. In 2017, this group included 3,068 Utahans.

A spokesperson for the state’s Department of Workforce Services told ThinkProgress that the state uses SASSI to screen those recipients. “We are not authorized to share a hardcopy or electronic version of the tool,” she wrote.

Of the 450 recipients given a drug test, 94 tested positive. Another 94 were rejected for refusal or failure to take the test. The state paid $30,775.50 for this program, plus staffing costs.

West Virginia is the most recent state to enact a drug testing requirement for WV WORKS, its TANF program. Enacted by the state legislature in 2016, implementation of the the pilot testing program began on October 20, 2017. Between that day and the end of the year, 798 were given the state’s 15 question DAST-10 “drug use questionnaire.”

The questionnaire asked about drugs “excluding alcohol and tobacco” used in the past 12 months. But the questions are confusing and imprecise: some questions could receive a positive response even from someone who only used prescription medications as directed, such as “Do you ever feel bad or guilty about your drug use?” and “Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?” Even a single positive response means the state “must drug test” the applicant. Anyone convicted of any “drug-related offense” within the previous three years was also required to take a drug test, regardless of their answers to the other questions.

Somehow, just 83 people were given a test as a result of this screening. Only 4 of those tested positive. Another five did not complete the required drug test. The year cost of implementing the program estimated to be $50,172, a Department of Health & Human Resources spokesperson told ThinkProgress.

Wisconsin’s drug testing program applies only to non-custodial parents, “a very small subset of TANF recipients” in programs administered by the Department of Children and Families,” a spokesperson told ThinkProgress. Just 2,012 applicants were screened in 2017 — via a 10-question screener — and 29 were given drug tests.

The tests netted just three positive results; two more applicants refused to submit a drug test. The cost, the spokesperson estimated, was between $725 and $2,900, primarily due to different testing locations. He noted that the three who failed were referred for treatment, but that there was no cost to the state for that. as it is “the payer of last resort.”

A new rationale for the same bad policy idea

For years, lawmakers who advocated for drug testing have said they don’t want taxpayers funding drug habits. Now, as lawmakers are forced to confront drug addiction due to the opioid epidemic, many say drug testing is a way to enable substance use disorder treatment.

“Those who test positive will have the opportunity to get treatment, regardless of the ability to pay, so they can get healthy,” said Gov. Scott Walker in a statement when he tried to extend drug testing to the state’s FoodShare program.

Testing positive for a drug does not automatically mean a person has a substance use disorder — and to insinuate this is to fundamentally misunderstand addiction.

“We’re in a place now where we are trying to destigmatize substance use disorder, and we are seeing a lot of lawmakers talk about the need to provide treatment and that we cannot arrest our way out of this problem,” said Drug Policy Alliance’s Grant Smith. “But in the same breath, we are seeing some of these same lawmakers insist that we screen for substance use, as if someone who [tests positive] inherently doesn’t deserve benefits.”

For Rep. Gwen Moore (D-WI), who was on cash assistance during college and has since spent her career trying to change the country’s punitive welfare system, this kind of testing is not only harmful, but insulting.

“I would have been offended by the notion that I had to give up my constitutional rights, my presumption of innocence, my privacy… I would have had a fit,” Moore told ThinkProgress. But she said she could also see herself being so desperate for help that she’d take the drug test.

“I would have been one of those people trying to figure out which lawyer would have took my case and I would have been denied benefits — which I probably wouldn’t have been able to afford.”

Experts told ThinkProgress if public officials really wanted to address substance use disorder, they would expand access to health care or take other steps to expand access to treatment. Ten of the 13 states that impose drug testing did not expand Medicaid eligibility under the Affordable Care Act (ACA), even though Medicaid covers a disproportionate share of people with opioid addiction.

Catasys Chief Medical Officer and addiction expert Omar Manejwala recently talked to ThinkProgress and took a dim view of mandatory testing. “The biggest danger from this is it makes you feel like you are doing something, when you are doing nothing.”