Drug addiction and alcoholism as qualifying impairments for Social Security disability benefits: The history, controversies, and congressional response

For 22 years the Social Security Administration (SSA) recognized drug addiction and alcoholism (DA&A) as potentially disabling impairments. Controversy about the wisdom of paying addicted individuals cash benefits led to mandatory treatment and representative payee provisions. These were not systematically enforced, and in 1994 Congress enacted more stringent legislation which put a three-year limit on the receipt of benefits, established a national system to enforce the treatment mandate, and instituted progressive sanctions for treatment noncompliance. However, even while the 1994 reforms were being implemented, Congress enacted legislation in March 1996 to eliminate substance addictions as qualifying impairments in the SSA's disability programs. This policy affected 250,000 individuals.;The analysis shows that over the history of the DA&A program, Congress failed to appropriate funds for its management, and treatment was largely inadequate or unavailable in some areas. Further, due in part to lack of guidance by Congress, the SSA never clearly defined criteria for membership in the DA&A category. The result was uneven administration of the program, with vastly disparate fractions of the pool of potential beneficiaries enrolled in different states and SSA regions. Several factors contributed to the DA&A program's demise: Rapid growth in the DA&A rolls, and the SSA's inability to manage the program effectively, were magnified by negative news stories about “unworthy addicts” supporting their addictions with taxpayers' dollars. The treatment community was divided on the issue and this undermined any unified lobbying effort to save the DA&A program.;The DA&A story provides a lesson about the far-reaching consequences of original policy design. It seems fair to say that the DA&A program was established on terms unlikely to produce anything but controversy and failure. The thesis should be useful to policymakers contemplating income maintenance policies concerning substance-addicted individuals.;This dissertation explores the politics and policies that impacted the DA&A category. The analysis is supported by historical and legislative documents, 79 face-to-face interviews with individuals directly involved with developing and implementing DA&A legislation, and survey data collected from 111 individuals implementing the treatment mandate. Interviews with former DA&A beneficiaries and a secondary data analysis of administrative data were conducted to provide a fuller understanding of the policies' impact.