Disability payments, drug use and representative payees: an analysis of the relationships

Aims  This study attempted to determine: if US federal cash disability payments increase the use of cocaine or opiates among those requalifying for supplemental security income (SSI) disability benefits compared with those who lost benefits; if drug use peaks at the beginning of the month after the receipt of the disability cash disbursement; and if money management by representative payees of requalifying SSI recipients suppresses drug use. Design  A multi‐site, prospective, 2 year longitudinal design was used with follow‐up interviews conducted every 6 months. Urine samples were collected at the final three follow‐up interviews. Setting  Data were collected in Chicago, IL, Los Angeles, CA, and Seattle, WA, USA. Participants  This study used a randomly selected sample of 740 former recipients of SSI who had received disability benefits for drug addiction and alcoholism (DA&A) in 1996, were between the ages of 21 and 59 years, had not received concurrent social security disability insurance and provided testable urine samples and complete self‐report data for at least one follow‐up interview. Measurements  Independent variables included demographics, SSI status at follow‐up, representative payee status, drug treatment participation and income. Time of drug testing was operationalized as the first 10 days of the month versus the last 20–21 days based on when the urine sample was collected. The dependent variables were cocaine and opiate use, determined by urinalysis results. Findings  Participants were 28% more likely to test positive for cocaine use in the first 10 days of the month than later in the month. This effect was general across all subjects and was not restricted to those receiving SSI benefits. No such effect was found for opiate use. Receiving SSI benefits did not increase cocaine or opiate use generally, nor did having a representative payee suppress use. Conclusions  The findings do not support the contentions that federal cash benefits appreciably increase drug use or that representative payees discourage use, at least when use is defined dichotomously. The ‘check effect’ for cocaine use appears to be general and not confined to those receiving federal cash benefits. The lack of a ‘check effect’ for opiate use is probably the result of the difference between a relatively steady state of opiate use associated with addiction and a binge pattern of cocaine use triggered by suddenly flush resources.