title: The 'check effect' reconsidered.
abstract: OBJECTIVE
  The 'check effect' refers to the use of disability payments to purchase illegal drugs or alcohol. This paper describes subsequent research concerning three interrelated issues: the check effect, whether receipt of disability payments is associated with more overall substance use, and potential policy responses to misuse of disability payments for substances.
  
  
  METHODS
  Review and synthesis of published papers.
  
  
  RESULTS
  Increased substance use at the beginning of the month has been described in a variety of settings. The tendency to purchase substances at the beginning of the month is impacted by household wealth, the tendency to discount future rewards and cyclical economic activity. However, in naturalistic observational cohort studies, beneficiaries who receive disability payments had no greater substance use than those without disability payments. Potential policy responses to mis-spending of disability checks include financial counseling that discourages spending on drugs and the assignment of a representative payee to prevent misuse of benefits for substances. Assignment of a representative payee per se has not been associated with reduced substance use, but payeeship administered by agencies that integrate payee practice into treatment has been.
  
  
  CONCLUSIONS
  Disability payments impact the timing of substance use, but receipt of disability payments is not associated with more overall substance use than unalleviated poverty. Money management-based clinical interventions, which may involve assignment of a representative payee, can minimize the purchase of substances with disability payments.
authors.affiliation: Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT 06516, USA. marc.rosen@yale.edu
authors.forename: Marc I
authors.initials: MI
authors.lastname: Rosen
mesh_terms: D000428:Alcohol Drinking / Q000191:economics / Q000453:epidemiology; D000434:Alcoholic Beverages / Q000191:economics; D019090:Case Management; D017831:Diagnosis, Dual (Psychiatry); D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D013287:Illicit Drugs / Q000191:economics*; D018868:Insurance, Disability / Q000191:economics*; D001523:Mental Disorders / Q000191:economics / Q000523:psychology*; D019727:Proxy; D012943:Social Security / Q000191:economics*; D019966:Substance-Related Disorders / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology
chemical_list: D013287:Illicit Drugs