The withdrawal of SSI payments from individuals whose eligibility for benefits is related to drug or alcohol dependence is currently an issue of great concern. Supplemental Security Income (SSI) is a federal income support program for the aged, blind, and disabled. Effective January 1, 1997 under the "Senior Citizen Freedom to Work Act,"1 SSI benefit payments were to cease for individuals whose drug or alcohol addiction is considered "to be a contributing factor material to the ... determination that the individual is disabled." William Thomas (R-Bakersfield), co-author of the bill, cited concern that SSI funds were being spent on drugs as the major impetus for the legislation.2

The number of SSI beneficiaries classified as drug addicts and/or alcoholics ("DA&A") increased from 16,100 in 1989 to 130,924 in 1995.3 The number of beneficiaries who have DA&A as a partial reason for their eligibility has also grown, from 5,210 to 61,569. Thus, over 190,000 people will potentially suffer from these cuts.

When the policy change was announced in mid-1996, the Urban Health Study (UHS) began to examine what these cuts in SSI might mean for injection drug users (IDUs). UHS conducts data collection and HIV-antibody testing and counseling with street-recruited IDUs in six San Francisco Bay Area communities. We present here the results from our pilot study exploring the potential impact of SSI cuts, conducted before benefits were withdrawn. We are currently conducting a second study designed to measure the effects of the cuts as they happen. Those results are not yet available.

We examined 1995 data from six Bay Area communities (n=1,224). Thirty-eight percent (466) of study participants were SSI recipients. This includes people eligible for any reason, not just drug or alcohol addiction. SSI recipients differed significantly from non-recipients in a number of demographic and social characteristics, some of which are listed in Table 1, below.

Table 1. SSI Recipients v. Non-Recipients in the San Francisco Bay Area, 1995 (n=1,224) Variable SSI (n=466) n (%) Non-SSI (n=758) n (%) Bivariate p value African-American 314 (67) 450 (59) 0.001 Considers self homeless 73 (16) 244 (32) 0.001 # weeks living on street during past year mean (s.d.) 3.0 (9.8) 7.1 (15.5) 0.001 Received income from illegal sources 85 (18) 291 (39) 0.00001 Jailed during past year 163 ( 5) 333 (44) 0.002 Currently in drug treatment 144 (31) 81 (11) 0.00001 # injections during past 30 days mean (s.d.) 53.9 (53.0) 70.9 (60.3) 0.001 # times shared syringes in past 30 days mean (s.d.) 2.9 (11.9) 4.9 (16.8) 0.013

As Table 1 shows, SSI recipients were less likely to be homeless, less likely to report receiving income from illegal sources, and more likely to be in drug treatment.

In June 1996, UHS conducted a separate pilot study to determine what percentage of SSI recipients receive benefits specifically for reasons related to drug or alcohol dependence. This pilot study was conducted in a single community with 202 participants. Thirty-eight recipients (18%) reported receiving SSI benefits specifically for drug or alcohol addiction. Respondents were sometimes unclear as to how their eligibility for SSI benefits had been determined. Therefore, the percentage of IDUs affected by the DA&A policy change may actually be higher than 18 percent.

These preliminary data suggest that IDUs who received SSI benefits were more stably housed, less reliant on illegal income, used drugs less frequently, and shared needles less often than IDUs without SSI benefits. In other words, it appears that SSI benefits contribute to general life stability and a reduction in drug-related harm. This finding is consistent with many other studies that have shown that drug users who receive income supports and/or subsidized drug treatment are less likely to be homeless, engage in illegal activities, or use drugs.4 Conversely, penalizing drug users by withholding benefits may in fact increase the severity of the social ills of homelessness, incarceration, illegal activity, and unsafe drug use.

The authors are researchers with the Urban Health Study of the University of California-San Francisco.

1. Public Law No. 104-121, enacted March 29, 1996.
2. M. Garcia, "Cold Turkey: New Law Axes Disability Benefits for Alcoholics, Addicts; Advocates Fear Homeless Upsurge," SF Weekly, July 14, 1996.
3. S. Barber, Supplemental Security Income Recipients for Whom the Alcoholism and Drug Addiction Provisions Apply (DA&A Recipients), December 1995. Washington DC: Office of Program Benefits Policy, Social Security Administration (1996).
4. National Opinion Research Center, University of Chicago and Research Triangle Institute, National Treatment Improvement Evaluation Study. Prepared for SAMHSA/Center for Substance Abuse Treatment (1996); R.H. Needle and A.R. Mills, Drug Procurement Practices of the Out-of-Treatment Chronic Drug Abuser. Rockville, MD: National Institute on Drug Abuse, NIH Publication No. 94-3820 (1994); S.B. Sells, R. Demaree, and C. Hornick, Effectiveness of Drug Abuse Treatment Modalities. Rockville, MD: National Institute on Drug Abuse (1980); and R.L. Hubbard, M.S. Rachal, S.G. Craddock, and B.A. Cavanaugh, "Treatment Outcome Prospective Study (TOPS): Client characteristics before, during and after treatment," in F.M. Tims and J.P. Ludford (eds.), Drug Abuse Treatment Evaluation Strategies, Process, and Prospects. Rockville, MD: National Institute on Drug Abuse, Research Monograph No. 42 (1984).