Now Invited to Testify: Former Beneficiaries Appraise the SSI Drug Addiction and Alcoholism Program

Earlier in this issue we (Hunt and Baumohl) described the drug addiction and alcoholism (DA&A) provisions of the Supplemental Security Income (SSI) program, the controversy leading to their reform in 1994, and the program's elimination in 1996. In February 1994, subcommittees of the House Committee on Ways and Means heard about the DA&A program from 27 witnesses-but none were beneficiaries. In a limited way and long after the fact, we seek to rectify that. In this paper, we are particularly interested in what former DA&A recipients told us about matters of legislative concern.To this end, the paper proceeds as follows. First, we take up briefly how our respondents came to receive SSI benefits as drug addicts or alcoholics. Next, we consider the matter of "dangerous cash," looking at respondents' accounts of their relationships with their representative payees, particularly the rationing of money and its earmarking for specific uses. We consider as well the issue of "back pay," the controversial distribution of retroactive benefits in lump sums, a practice that was discontinued only for DA&A recipients early in 1995. We look next at respondents' views of the requirement that they participate in substance abuse treatment. We then sum up their appraisal of how the DA&A program affected their lives and relay their views about constructive policy. Our concluding discussion revisits issues raised in our earlier paper and foreshadows the policy paper that ends this issue.MethodsAs Swartz, Tonkin, and Baumohl (this issue) describe in more detail, 15-17 months after the end of the DA&A program we conducted semistructured interviews in Portland, San Francisco, Stockton, and Chicago with 156 participants in the larger SSI Study. For this supplemental study we deliberately oversampled people who reported earnings from work at the one-year follow-up of the SSI Study. For the purposes of this paper, it isn't clear what bias this introduced. Except for a few explicit claims of racial bias in the application of the DA&A label, or concerns about the cultural sensitivity of some treatment personnel, we found no systematic differences in respondents' views that we could attribute to demographic characteristics, current employment, or SSI status. On the whole, we were impressed by the substantial agreement among respondents about the strengths and weaknesses of the DA&A program.In terms of demographic characteristics and SSI status, at least, our respondents resemble others in the four site samples from which they were drawn. Overall, 58% were male, almost half (45%) were in their 40s, and roughly a quarter (23%) were 50 or above. Twenty-nine percent were white, 48% black, 15% Hispanic, and a small group (8%) was composed mostly of Asians and American Indians. Some respondents had been on SSI for less than a year when the DA&A program ended (9%) or had received benefits for 10 years or more (5%). Almost two-thirds (64%) had been on SSI for at least one year but less than five, and another 17% had collected benefits for at least five years but less than 10. We interviewed 103 individuals who did not retain SSI after the DA&A program ended (66%) and 53 (34%) who did. At the time we interviewed them, 24% claimed not to be drinking or using, 17% reported drinking or using very little, 28% were moderate users of alcohol and/or other drugs, and 31% were heavy users.2The interviews were organized as short life histories and ranged widely, A few respondents were taciturn, but most were anxious to tell their stories, especially when warmed up, and spoke with striking candor about very private matters. Many reveled in detail and the illustrative anecdote, and it was sometimes difficult for the interviewer to cover every point in the interview guide. Even so, we discussed with most respondents what was good or bad about SSI and what they thought about the representative-payee provision and retroactive payment. …