Social Security Policy on Drug Addiction and Alcoholism

Co-Occurring Disorders Conference Sept 19, 2006

Mark Dalton, Belltown Community Services Office AdministratorWashington State DSHS Seattle

Early DA/A History

• Drug Addiction and Alcoholism treated as “potentially disabling” in SSI enabling legislation (1972).

• Controversy from the beginning.• Sen. Harold Hughes, national champion of addiction

treatment and reform, against DA/A allowances.• Confusion over Nature of disability and conditions of

allowance – both within SSA and in the medical community. “Material to disability” concept.

• SSA problems with SSI “welfare program” administration compounded by DA/A requirements.

• Treatment referral requirements largely ignored.

“Benign Neglect”

• 1984 – only 10 states offered treatment referral and monitoring services (RMA)

• RMA services, where available, improved health outcomes, but only 1% went to work

• Few non-compliance sanctions imposed by SSA

• DA/A remained a very small caseload – in 1989, less than 1% of the SSI population

Rapid Escalation in the 90’s

• Continuing regulatory ambiguity

• Court decisions increasingly favored allowances

• State GA cuts and resultant “shifting upwards” to federal SSI program

• Disastrous Reagan disability reviews

• Federally funded SSI outreach – especially to homeless

DA/A Controversy Explodes

• Recipient scandals and media outrage• Continuing ambiguity over “disease

concept” of addiction• Lack of faith in treatment efficacy• Lack of support by professionals

(“enabling” effect of SSI grants)• SSA management seen as ineffective• Funding issues for RMA and treatment

services – lack of access

1994 Congressional Response• RMA services mandated in all 50 states, • Available treatment required for all,• Progress in treatment required to retain

eligibility,• 36 month lifetime DA/A limit, resulting in:• Rapid expansion of RMA services • 42 states managed by Maximus Corp, with

services through sub-contractors in each• Eight states independently contracted

1996 Congressional Response

• Continued political pressure to eliminate DA/A• Poor coordination between RMAs and SSA• Continuing lack of treatment and funding • Lack of effective sanctions, lack of SSA staffing,

changing political winds result in weak commitment to change at all levels

• 1994 reforms effectively DOA• March 1996, Congress eliminated DA/A, no new

approvals, and all current recipients to be term’d 1/1/97, if not eligible on another basis.

Results of DA/A Termination

• Of those who requested review, 49% retained benefits by 12/97 - confirming “tiebreaker” use of DA/A in many cases.

• 35.5% of total DA/A caseload retained benefits during that period (many disappeared, or devolved back onto state programs, at least temporarily)

• People with addiction issues continue to have difficulty getting approved for SSI – even with other well-documented disabling conditions

• Homelessness, addiction and poverty continue to be major national problems, some say a national disgrace.