Welfare Reform and Substance Abuse Treatment Confidentiality:
General Guidance for Reconciling Need to Know and Privacy Technical Assistance Publication (TAP) Series 24
Forward
The need for this guidance emerged from a series of four regional State Team-Building Workshops held on welfare reform and its relationship to substance abuse treatment. These workshops, sponsored by the Center for Substance Abuse Treatment’s (CSAT) Division of State and Community Assistance, were conducted from July through October 1997. They were attended by repre- sentatives of both substance abuse treatment and welfare systems within each participating State. These representatives identified a mutual goal at the workshops: namely, assisting shared clients in overcoming substance abuse issues which create barriers to the clients’ ability to work.
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWA) (Public Law 104-193) has challenged States to help their citi-zens leave welfare and become employed. As a consequence, States are now trying harder than ever to prepare welfare clients to enter and succeed in the workforce. Among the barriers to work identified in research regarding welfare clients are drug and alcohol problems. This Technical Assistance Publication (TAP) provides broad guidance on how two systems—the substance abuse treatment and welfare systems—can share information on their mutual clients.
The goal of this TAP is to assist State alcohol and other drug agencies, substance abuse treatment providers, and welfare officials in addressing confidentiality issues with respect to these shared clients. It familiarizes welfare agency staff with protections about which they may be unaware. It discusses key issues such as how and when disclosure is possible and it provides practical tips to surmount real or perceived obstacles.
Confidentiality laws relating to treatment for substance abuse—defined as abuse of alcohol or other drugs—were originally enacted to encourage substance abusers to seek assistance without fear of public disclosure of their abuse, including disclosure of records of their treatment that could attach for life. Federal regulations that protect the identities of persons in substance abuse treatment have their genesis in two statutes of the early 1970's: first, the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970; and second, the Drug Abuse Prevention, Treatment and Rehabilitation Act of 1972. These two statutes were implemented by regulations issued in 1975 by the U.S. Department of Health, Education, and Welfare (DHEW). Revised in 1987 by DHEW’s successor, the U.S. Department of Health and Human Services, the regulations are set out at title 42, part 2, of the Code of Federal Regulations.
The confidentiality statutes and regulations were later consolidated by Congress within the Public Health Service Act—now title 42, section 290dd-3 of the United States Code (42 U.S.C. §290dd-2). In this TAP, references to the confidentiality law or regulations mean the regulations at title 42, part 2, of the Code of Federal Regulations (42 CFR Part 2). The Federal confidentiality law and regulations are presented as Appendix A.
On behalf of the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration, I hope that this TAP will promote compliance with the Federal confidentiality regulations by both substance abuse treatment and welfare officials, as well as facilitate interactions between the two systems.
H. Westley Clark, M.D., J.D., M.P.H., CAS,
FASAM
Director
Center for Substance Abuse Treatment