Characteristics of recipients of Supplemental Security Income (SSI) benefits for drug addicts and alcoholics

Welfare Reform and Housing: Assessing the Impact to Substance Abusers

The addiction disability (Supplemental Security Income and Social Security Disability Income program for drug abuse and alcoholism) was terminated by Congress in December 1996 as part of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). Discussions about welfare reform policies in the latter 20th century have centered on Aid to Families with Dependent Children (AFDC) receipt by the general population. Far less attention has been paid to programs such as the addiction disability that were also affected by the PRWORA. Our purpose is to study the effect of this policy change on the housing status of former addiction disability recipients and to also explore whether and how disruptions in living situations increased risks for drug and alcohol use, criminal participation and victimization. We utilize insights from two major sociological theories of housing or homelessness, i.e., individualistic and structural, to guide our exploration of the policy's impact on housing. A qualitative analysis, featuring in-depth interviews with 101, nonrandomly selected former recipients revealed that disability benefits promoted housing autonomy, successful cohabitation, and overall housing stability. The termination of benefits, at a time of diminishing social services (e.g., cash and housing assistance) and a housing market explosion, increased various types of homelessness for respondents and dependency on family and friends. Such negative living outcomes, in turn, further escalated the risk of drug and alcohol use, criminal participation, and victimization. Individual-level factors also complicated the matter. Implications for research and policy are discussed.

Gender-Specific Barriers to Self-Sufficiency among Former Supplemental Security Income Drug Addiction and Alcoholism Beneficiaries: Implications for Welfare-To-Work Programs and Services

This study examines barriers to economic self-sufficiency among a panel of 219 former Supplemental Security Income (SSI) drug addiction and alcoholism (DA&A) recipients following elimination of DA&A as an eligibility category for SSI disability benefits. Study participants were comprehensively surveyed at six measurement points following the policy change. Generalized estimating equations were used to examine full-sample and gender-specific barriers to economic self-sufficiency. Results indicate that access to transportation, age, and time are the strongest predictors of achieving self-sufficiency for both men and women leaving the welfare system. Gender-specific barriers are also identified. Future research needs to assess the generalizability of these results to other public assistance recipients.

The effects of eliminating supplemental security income drug addiction and alcoholism eligibility on the mental health of low-income substance abusers

On January 1, 1997, as the result of federal legislation, many low-income substance abusers lost income and healthcare benefits provided by the Supplemental Security Income (SSI) program. This study examined the effects of eliminating drug addiction and alcoholism (DAA) as qualifying impairments for SSI benefits on the mental health and mental health treatment utilization of former beneficiaries 3.5 years following the policy change. Study participants in four Northern California counties were categorized into three comparison groups based on their primary income source over the lifetime of the study. Findings indicated that overall the reported mental health status of former SSI DAA beneficiaries improved following the policy change; however, study participants who relied primarily on some other type of public assistance post-termination reported an increase in mental health treatment utilization.

Consequences of eliminating federal disability benefits for substance abusers

Using annual, repeated cross-sections from national household surveys, we estimate how the January 1997 termination of federal disability insurance, Supplemental Security Income (SSI), for those with Drug Addiction and Alcoholism affected labor market outcomes among individuals targeted by the legislation. We also examine whether the policy change affected health insurance, health care utilization, and arrests. We employ propensity-score methods to address differences in observed characteristics between likely substance users and others, and we used a difference-in-difference-in-difference approach to mitigate potential omitted variables bias. In the short-run (1997-1998), declines in SSI receipt accompanied appreciable increases in labor force participation and current employment. There was little measurable effect of the policy change on insurance and utilization, but we have limited power to detect effects on these outcomes. In the later period after the policy change (1999-2002), the rate of SSI receipt rose, and short-run gains in labor market outcomes diminished.

Substance abuse treatment and criminal justice involvement for SSI recipients: results from Washington state

This study examined the association between receiving substance abuse treatment and subsequent criminal justice involvement. The sample consisted of Supplemental Security Income (SSI) recipients in the state of Washington that were determined to be in need of treatment. Fifty-two percent of those clients entered substance abuse treatment during the study period, while 48% did not. Arrests, felony convictions and convictions for less serious crimes were tracked for 8343 adults for one year following the end of an index treatment episode. Results showed that entering treatment was associated with reduced risks for each outcome. In addition, further analyses were conducted just on those entering treatment. Among that subset of the study population, the completion of treatment and having an episode of treatment lasting at least 90 days were both associated with reduced criminal justice risks. These results suggest that efforts to provide substance abuse treatment for SSI recipients have the potential to provide substantial public benefits.

Receipt of Disability Payments by Substance Users: Mental and Physical Health Correlates

Since 1997, substance users have received disability benefits only for impairments apart from their substance use disorders. It is hypothesized that substance users currently receiving disability benefits would be more severely compromised, medically and/or psychiatrically, than those not receiving disability. Enrolling a community sample of 330 heroin and cocaine users between January 2002 and January 2004, it was found that individuals who were not receiving disability payments had similar mental health scores, current depressive symptoms scores, and lifetime rates of major depression compared to those receiving payments, but significantly lower rates of bipolar or psychotic disorders and psychiatric hospitalization (p < .01). Physically disabled persons had lower physical function scores and were more likely to be HIV-infected or taking medications regularly (p < .001). The authors conclude that schizophrenia, bipolar disorders, and chronic physical illness, but not major depression, are qualifying substance users for disability benefits. Longitudinal studies of disability status and its effects on the lives of substance users are warranted.

Employment outcomes for hard-to-reach persons with chronic and severe substance use disorders receiving assertive community treatment

Many persons with chronic and severe substance use disorders (SUDs) enter and exit public substance dependence treatment systems with limited benefit, but continue overuse of high-cost health and human services. Less than a third holds jobs, earning income below U.S. federal poverty levels. Long-term integrated substance dependency treatment, rehabilitation, and support services will be essential to resolve substance dependence and employment problems. This single-group program evaluation reports adaptation of Assertive Community Treatment (ACT), a multi-component, team-based service model originally designed for persons with severe mental illnesses and multiple disabilities, for effectiveness with persons with severe SUDs. The ACT model delivers an integrated package of treatment, rehabilitation, and support to reduce substance misuse and increase employment. Of the 35 clients admitted 12 months prior to conclusion of this 2-year service demonstration, only one left treatment prematurely. Generally, clients modestly reduced substance misuse and increased employment. However, the evaluation design and small sample limit inferences of causation and generalizability of these promising outcomes. Persuading states to adopt expensive team-based approaches for this population will require firm evidence of favorable cost-benefit ratios.

"Come back when you're dying:" the commodification of AIDS among California's urban poor

As with any other long-term illness, the decline in health that accompanies symptomatic HIV infection often has a profound negative impact on employment and personal finances. However, research to date on the financial consequences of AIDS has focused largely on middle-class working individuals, and cannot account for the experiences of those who are already poor and unemployed at the time of their infection. We conducted in-depth qualitative interviews with 33 Californian heterosexual couples in which one partner was infected with HIV and the other was HIV-negative. Most couples interviewed were low-income, marginally housed, and either former or active substance users. Unlike their middle-class counterparts, it became clear through the course of our study that many participating couples were living in a world in which a positive HIV antibody test or an AIDS diagnosis could result in an improved quality of life by allowing for increased access to Supplemental Security Income, subsidized housing, food and services. This situation is in part a consequence of recent policy decisions related to the "War on Drugs" and welfare reform. These policies have contributed to the creation of an economy of poverty in which the sick, needy, and addicted must compete against each other for scarce resources. Within such an economy, an HIV or AIDS diagnosis may actually operate as a commodity.

The health and mental health of disabled substance abusers

In 1996 Congress terminated Supplemental Security Income (SSI) benefits to individuals disabled by substance abuse. Although most were expected to continue benefits under another disability category, 64% were not reclassified. This article examines data from a longitudinal study of individuals in Los Angeles County affected by the legislation. While poor physical health predicted both continued SSI benefits and receipt of public income assistance, many individuals reporting significant mental and physical health problems were not reclassified and did not receive public income assistance, raising concern for their welfare. Local safety nets may become increasingly important for this population.

Addiction severity index data from general membership and treatment samples of HMO members. One case of norming the ASI

The Addiction Severity Index (ASI) is a widely used interview among substance-dependent populations in treatment. Its value as a treatment planning and evaluation tool has been diminished by the lack of comparative data from nonclinical samples. The present study included four scales from the ASI collected on samples of adult subscribers to a large health maintenance organization (HMO) in northern California, as well as an adult clinical sample from the same geographic region with the same HMO insurance, thereby offering informative contrasts. Interviews (N = 9,398) of non-alcohol-dependent or abuse adults from a random sample of members of a large HMO were analyzed. We collected complete ASI data on the alcohol, drug, medical, and psychiatric composite scales and partial data on the employment scale. A sample of 327 adult members of the same HMO from one of the counties included in the survey, who were admitted to treatment for alcohol and/or drug addiction, was administered the same ASI items at treatment admission. Analyses compare problem severities in the two samples by age and gender. The general membership reported some problems in most of the ASI problem areas, although at levels of severity that were typically far below those seen in the clinical sample. General membership and clinical samples were somewhat similar in medical status and in employment. As expected, alcohol, drug, and psychiatric status were much more severe in the clinical sample. The data from the HMO general membership sample provide one potential comparison group against which to judge the severity of problems presented by drug- and alcohol-dependent patients at treatment admission and at posttreatment follow-up. The authors discuss the implications for treatment planning and the evaluation of treatment outcome.