DISABILITY INCOME, COCAINE USE, AND REPEATED HOSPITALIZATION AMONG SCHIZOPHRENIC COCAINE ABUSERS - A GOVERNMENT-SPONSORED REVOLVING-DOOR

Background. Many patients with serious mental illness are addicted to drugs and alcohol. This comorbidity creates additional problems for th e patients and for the clinicians, health care systems, and social-ser vice agencies that provide services to this population. One problem is that disability income, which many people with serious mental illness receive to pay for basic needs, may facilitate drug abuse. In this st udy, we assessed the temporal patterns of cocaine use, psychiatric sym ptoms, and psychiatric hospitalization in a sample of schizophrenic pa tients receiving disability income. Methods. We evaluated 105 male pat ients with schizophrenia and cocaine dependence at the time of their a dmission to the hospital. They had severe mental illness and a long-te rm dependence on cocaine, with repeated admissions to psychiatric hosp itals; many were homeless. The severity of psychiatric symptoms and ur inary concentrations of the cocaine metabolite benzoylecgonine were ev aluated weekly for 15 weeks. Results. Cocaine use, psychiatric symptom s, and hospital admissions all peaked during the first week of the mon th, shortly after the arrival of the disability payment, on the first day. The average patient spent nearly half his total income on illegal drugs. Conclusions. Among cocaine-abusing schizophrenic persons, the cyclic pattern of drug use strongly suggests that it is influenced by the monthly receipt of disability payments. The consequences of this c ycle include the depletion of funds needed for housing and food, exace rbation of psychiatric symptoms, more frequent psychiatric hospitaliza tion, and a high rate of homelessness. The troubling irony is that inc ome intended to compensate for the disabling effects of severe mental illness may have the opposite effect.