Once you've done it a time or two, setting up the "clone the db"/"erase the db for each test" pattern isn't that much work (plenty of libraries to help too).

And of course once its set up for a project, adding more tests to it is pretty straightforward. It is slower for each test run, but I had hundreds of tests running serially erasing a MySQL DB before each one and it only took a minute or so, which was well within my tolerance.

So overall I'm a fan; I think there's more benefits than drawbacks. Especially if it's SQLite, where setup is even easier.