The misuse of social security disability income on drug and alcohol abuse.
Although the establishment of SSI, along with Medicaid and certain other forms of aid, has made it possible for most of the mentally ill to live in community settings and overall has improved the quality of life; research has documented a high rate of co-occurring substance abuse disorders among SSI beneficiaries with mental health disorders. Studies have shown that up to 80% of individuals disabled by mental illness also had a substance abuse disorder. (3) During 2004, an estimated 192,690 patients in drug-related ED visits were diagnosed with co-occurring substance use and mental disorders. This accounted for nearly 10% of all drug-related ED visits. (4) Substance abusers with psychiatric disabilities had treatment costs that were almost 60% higher than costs for nonsubstance abusers. (5)
As LSUHSC-S is a public hospital, a third of our patient population receives disability; patients who presented with psychiatric emergencies during a 30 day time span were questioned as to whether they received Social Security disability income and whether they used illicit substances. Approximately one third of the patient population sampled received SSI (32.4%); approximately half (51.3%) of these patients abuse drugs, with 68.4% admitting that they spend the money they receive from SSI on drugs. According to our data, up to $11,115 of social security income was spent on drugs or alcohol in only one month. This extrapolates to $133,380 a year, just in our patients alone. Most disabled patients receive the full benefit amount of $585.00 a month. It was not possible to determine how much of the patient's disability income was spent on drugs and alcohol. Many of the patients evaluated rely on family for food and housing, thus their disability income becomes their spending money. Of those evaluated, 31.6% who abused substances and received SSI denied spending this money on substances, stating that they borrowed the money or borrowed the drugs. Even if true, it is taking away from the purpose of SSI, which is designed to meet basic needs for food, clothing, and shelter, since abusing drugs will hinder fulfilling those needs and unquestionably exceeding those needs.
Although our figures are limited to our region, if the trend of 50% substance abuse holds or even a portion thereof for the 6,987,845 recipients of SSI, potentially millions of tax dollars are being wasted on illicit drugs or alcohol. Legally, we are prohibited from reporting the spending of SSI money on substances without the patient's consent, as this violates the patient's right to privacy. This legal conundrum not only prevents us from reporting the misuse of Federal disability income, it interferes with the quality of patient care, since patients continue to receive money with which to abuse drugs. While it is possible to have a responsible family member receive the check so the money can be spent on activities of daily living as intended, this is not feasible in most situations.
As taxpayers, we are subsidizing substance abuse; as physicians; we are impairing our management of mental illness; and as a society, we are allowing Federal Tax dollars to be wasted, when there is already a deficit of funds for care of the mentally ill. We feel that comorbid substance abuse and mental illness is a significant public health concern; we suggest revising current law to allow physicians to report the misuse of SSI money on substances of abuse.
Manish Saran, MD
James Patterson, MD
Louisiana State University Health
1. SSI Recipients by State and County, 2004. Available at: http://www.ssa.gov/. Accessed December 5, 2006.
2. SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003. Available at: http://www.oas.samhsa.gov/. Accessed December 5, 2006.
3. Drake RE, Bartells SJ, Teague GB, et al. Treatment of substance abuse in severely mentally ill patients. J Nerv Ment Dis 1993;181:606-611.
4. SAMHSA, Office of Applied Studies, Drug Abuse Warning Network, 2004. Available at: http://www.oas.samhsa.gov/. Accessed December 5, 2006.
5. Regier DA, Farmer ME, Rae DS, et al. Co-morbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study. JAMA 1990;264:2511-2518.Case Report
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|Publication:||Southern Medical Journal|
|Date:||Feb 1, 2007|
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