Termination of social security benefits among Los Angeles recipients disabled by substance abuse

Objectives: Although a 1996 federal la vs terminated Social Security disabi lity benefits to individuals disabled primarily by drug addiction and alcoh olism, many were expected to successfully appeal for recertification based on mental illness. This study examined appeal and recertification in Los An geles County. Methods: Data for 2,001 persons receiving Social Security dis ability benefits in 1996 because of substance abuse disability were obtaine d from the referral and monitoring agency, where each person had completed the Addiction Severity Index (ASI) during an initial visit in the past two years. Administrative data were obtained from the Social Security Administr ation. Severity of psychiatric symptoms-low, medium, or high-was based on t he composite score on the ASI psychiatric subscale. Logistic regression ana lyses examined the relationship between severity and appeal and recertifica tion status. Results: Fifty-one percent of the subjects scored in the mediu m- or high-severity range. Appeals were made by 80 percent of the 506 recip ients with high scores, 72 percent of the 510 recipients with medium scores , and 74 percent of the 985 recipients with low scores. Recertification rat es were 60 percent, 45 percent, and 47 percent, respectively. Compared with recipients who had low scores, those with high scores were more likely to appeal and to be recertified. However, benefits were terminated for 51 perc ent of recipients with high scores, including all those who did not appeal. Conclusions: Many recipients of Social Security disability benefits with c omorbid psychiatric problems lost benefits either because they did not appe al or because their appeal was denied.