Severe mental illness and substance use disorders among former supplemental security income beneficiaries for drug addiction and alcoholism

Background: Recently enacted federal legislation targeted at curbing percei ved abuses of cash benefits for former Supplemental Security Income benefic iaries for drug addiction and/or alcoholism (DA&A) may be creating a residu al population that is too seriously impaired to work owing to psychiatric a nd substance use disorders. Method: Data in this report were derived from 1-year follow-up interviews o f 204 randomly selected DA&A beneficiaries in Chicago who were initially in terviewed between January 1997 and March 1997, immediately following their termination in the Supplemental Security Income DA&A program. Information o n subjects' work and benefits status were collected along with DSM-III-R ps ychiatric and substance use disorder diagnostic information. Urine specimen s were also collected and tested for recent use of marijuana, cocaine, opia tes, phencyclidine, amphetamines, and methadone. Results: Twenty-six percent had a past-year severe mental 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, coca ine, or opiates. Compared with those working and earning at least $500 a mo nth, unemployed or underemployed 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 como rbid psychiatric disorders (odds ratio, 6.9; P < .005; 95%, confidence inte rval, 1.9-24.7). Conclusions: Those who have lost DA&A disability benefits and who continue to be unemployed or underemployed have elevated rates of drug dependence an d psychiatric comorbidities; consequently, helping these cases make the tra nsition from government assistance to sustained employment is increasingly difficult.