title: Severe mental illness and substance use disorders among former Supplemental Security Income beneficiaries for drug addiction and alcoholism.
abstract: BACKGROUND
  Recently enacted federal legislation targeted at curbing perceived abuses of cash benefits for former Supplemental Security Income beneficiaries for drug addiction and/or alcoholism (DA&A) may be creating a residual population that is too seriously impaired to work owing to psychiatric and substance use disorders.
  
  
  METHODS
  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 following 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 information. Urine specimens were also collected and tested for recent use of marijuana, cocaine, opiates, 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, cocaine, or opiates. Compared with those working and earning at least $500 a month, 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 comorbid psychiatric disorders (odds ratio, 6.9; P<.005; 95% confidence interval, 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 and psychiatric comorbidities; consequently, helping these cases make the transition from government assistance to sustained employment is increasingly difficult.
authors.affiliation: Illinois Treatment Alternatives for Safe Communities Inc., Chicago 60622, USA. jswartz@interaccess.com
authors.forename: J A
authors.initials: JA
authors.lastname: Swartz
authors.forename: A J
authors.initials: AJ
authors.lastname: Lurigio
authors.forename: P
authors.initials: P
authors.lastname: Goldstein
mesh_terms: D000437:Alcoholism / Q000191:economics / Q000523:psychology / Q000534:rehabilitation*; D002641:Chicago; D015897:Comorbidity; D016001:Confidence Intervals; D017831:Diagnosis, Dual (Psychiatry); D004185:Disability Evaluation; D005500:Follow-Up Studies; D006801:Humans; D018868:Insurance, Disability / Q000191:economics / Q000331:legislation & jurisprudence; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D012494:Sampling Studies; D012720:Severity of Illness Index; D012943:Social Security / Q000191:economics* / Q000331:legislation & jurisprudence; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D014478:Unemployment / Q000706:statistics & numerical data; D014481:United States