Sally Satel
A Disabling Benefit
Autumn 1995

So far, congressmen debating whether to end federal disability payments for drug addicts and alcoholics have had to rely only on anecdotal evidence that these benefits feed addiction and make other disabilities worse. Now the New England Journal of Medicine brings scientific documentation of this destructive cycle.

UCLA Medical School researchers studied patients in an outpatient treatment program for cocaine abuse and schizophrenia at a Los Angeles veterans' hospital. They found that the amount of cocaine patients use increases dramatically at the beginning of each month, when the patients have money to buy drugs; within days, their psychotic symptoms worsen and they have to enter the hospital. "We concluded that the cycle was driven by the receipt of disability income on the first of the month," says psychiatrist Andrew Shaner, the study's lead author. At first Shaner had trouble explaining another observation: though symptoms peaked after the checks arrived, they began to increase a few days earlier. Reason: local drug' dealers extended credit to 7 the patients at the end of each month, knowing the checks were in the mail. "The certainty of payment makes these patients good credit risks," Shaner says.

The House and Senate have both voted to end payments to patients whose sole "disability" is substance abuse. But all the patients in Shaner's study would be eligible for benefits anyway, since they suffer from schizophrenia too. As congressional conferees hammer out a final welfare-reform bill, they should make sure that the disability program enables—and requires—such patients to get the treatment they need instead of giving them money with no strings attached.

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