Severe Mental Illness and Substance Use Disorders Among Former Supplemental Security Income Beneficiaries for Drug Addiction and Alcoholism

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Abstract
Background: Recently enacted federal legislation tar- geted at curbing perceived abuses of cash benefits for former Supplemental Security Income beneficiaries for drug addiction and/or alcoholism (DA&A) may be cre- ating a residual population that is too seriously im- paired to work owing to psychiatric and substance use disorders. Method: Data in this report were derived from 1-year follow-up interviews of 204 randomly selected DA&A beneficiaries in Chicago who were initially interviewed between January 1997 and March 1997, immediately fol- lowing their termination in the Supplemental Security Income DA&A program. Information on subjects' work and benefits status were collected along with DSM-III-R psychiatric and substance use disorder diagnostic infor- mation. Urine specimens were also collected and tested for recent use of marijuana, cocaine, opiates, phencycli- dine, amphetamines, and methadone. Results: Twenty-six percent had a past-year severe men- tal illness while 34% met the DSM-III-R criteria for drug dependence. Illegal drug use was also prevalent with about 50% of the sample testing positive for marijuana, co- caine, or opiates. Compared with those working and earn- ing at least $500 a month, unemployed or underem- ployed subjects who had lost all federal benefits had a much greater likelihood of being dependent on drugs (odds ratio, 5.0; P,.005; 95% confidence interval, 1.6- 15.7) and of having 2 or more comorbid psychiatric dis- orders (odds ratio, 6.9; P,.005; 95% confidence inter- val, 1.9-24.7). Conclusions: Those who have lost DA&A disability benefits and who continue to be unemployed or under- employed have elevated rates of drug dependence and psychiatric comorbidities; consequently, helping these cases make the transition from government assistance to sustained employment is increasingly difficult. Arch Gen Psychiatry. 2000;57:701-707

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