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Article Excerpt
Despite differing legal interpretations and changes in how eligibility requirements applied in practice (see Hunt and Baumohl, this issue), all individuals formerly receiving Supplemental Security Income (SSI) for drug addiction and/or alcoholism (DA&As) were determined by the Social Security Administration (SSA) to have abused alcohol or other drugs at some time in their lives up to and including the time of application for DA&A benefits. (1) Indeed, it was largely a concern over the potential misuse of cash benefits by DA&As to purchase alcohol and other drugs that led to significant revisions in (PL 103-296) and ultimately the rescission of (PL 104-121) this impairment category by the United States Congress.
The legislative discontinuation of SSI/SSDI DA&A benefits meant the possible loss of a relatively significant amount of monitored income for DA&As who were not able to requalify under another impairment category or to replace their lost cash benefits (approximately $500 per month) through employment or another government benefit program such as Temporary Assistance for Needy Families (TANF). Additionally, because of the way eligibility for Medicaid benefits is determined in many states, many DA&As who lost disability benefits also lost Medicaid coverage and, consequently, ready access to medical care, including drug treatment. The concurrence of a sudden loss in income along with decreased access to drug treatment services for a population disproportionately composed of drug abusers meant that an unintended but potentially significant social consequence of this policy change was an increase in drug-motivated crime. Numerous studies have shown that drug treatment is effective in reducing subsequent criminality of crime-prone addicts (e.g., Hiller, Knight, Devereaux & Hathcoat, 1996). The sudden loss of access to drug treatment or an incentive to participate in it may have led some DA&As to either return to crime to support their addictions or to continue their criminality without interruption.
The multifaceted relationship between drug use, particularly the use of illegal drugs such as heroin and cocaine, and criminal behavior has been well documented (Anglin & Speckart, 1988; Lurigio & Swartz, 1999). One aspect of this relationship, the propensity of some addicts to commit robbery or property crimes such as burglary and theft in order to obtain money for the immediate purchase of drugs, has received significant emphasis and support in the research literature (Chaiken & Chaiken, 1990; Inciardi, 1981; Johnson, Anderson & Wish, 1988). If in fact some or most of the federal cash benefits received by DA&As was being used to purchase drugs as some politicians contended (e.g., Cohen, 1994) and some research suggested (Phillips, Christenfeld & Ryan, 1999; Shaner, Eckman, Roberts et al., 1995; but see also Frisman & Rosenheck, 1997, and Rosenheck & Frisman, 1996, for findings and opinions contradicting these studies), the loss of DA&A benefits may have prompted some individuals, those who were still using drugs, to begin committing crimes or to intensify their criminal activity to support their illegal drug use.
To date there has been little research on the relationship between the loss of federal cash benefits and crime among DA&As or among other populations similarly affected by federal welfare reform legislation (e.g., TANF recipients). Recent studies of these populations, especially of those on TANF, have focused on the degree to which individuals have been able to replace their lost benefits through employment and the social and psychological impediments that have prevented them from doing so (e.g., Danziger, Corcoran, Danziger et al., 1999). These studies have found that many former welfare recipients have great difficulty attaining and sustaining employment because of drug abuse and/or mental illness (e.g., Jayakody, Danziger & Pollack, 2000). Thus they provide support for the contention that many of these individuals cannot generate much income legally and yet continue to actively use drugs. These studies, however, have not examined the related issue of whether the continued drug use of their subjects was supported by criminal activities.
Preliminary analyses of data collected from the multisite study on which this paper is based suggest this may be the case. In the two years following termination of the SSI DA&A category, only a relatively small percentage (12%) of DA&As interviewed for the multisite study were able to sustain employment at a level sufficient to compensate for the loss of cash benefits, and only 38% had requalified for disability benefits under a different impairment category (see Campbell et al., this issue). Thus about half of the subjects had not been able to replace their lost SSI income through employment or requalification for disability benefits.
At the same time, a high proportion of these same subjects continued to use illegal drugs. Urinalysis results based on samples collected in Los Angeles, Seattle and Chicago reveal that 38% of the subjects tested positive for cocaine or opiate use at their two-year follow-up interviews (see also Podus et al., this issue). Moreover, official arrest histories collected on subjects at these same three sites found that over 50% had at least one prior arrest, with many subjects having multiple prior arrests. That many former DA&As have a criminal history along with evidence of continued use of illegal drugs at relatively high rates post-termination of the DA&A impairment category suggests that these same individuals might have returned to or increased their criminal activities after their benefits were terminated. For DA&As lacking either the capacity or the wherewithal to replace their lost income through legal means such as employment, other government programs, or money from family and friends, crime could have been the most expedient means by which at least some of them supported their continued drug use.
The main purpose of this study was to directly explore the potential associations among drug use, criminal behavior, and the loss of SSI benefits among DA&As. Specifically, we wanted to determine if DA&As who were unable to replace their lost cash benefits through legal means, especially those who reported relatively heavy use of illegal drugs such as heroin and cocaine at baseline, increased their level of criminal activities. In our analyses, we thought it would be important to draw further analytic distinctions among subjects who lost DA&A cash benefits and were unable to replace them, those who lost benefits but essentially replaced them through employment, and those who lost DA&A benefits but replaced them through other government assistance programs, including requalification for SSI disability benefits under another impairment category. We expected that those who replaced lost DA&A benefits through employment would be the best off financially (and otherwise) and the least likely to commit crimes (controlling for their initial levels of illegal drug use). Conversely, we also expected that DA&As who did not replace their lost cash benefits through employment or another government assistance program and who reported relatively heavy drug use at baseline would have the highest subsequent rates of criminality. For those in our sample who moved back and forth between replacing and losing benefits intermittently (the group we labeled "PART" in our analyses), we expected an intermediate outcome. Finally, in line with past research on the types of crimes that drug users are most likely to commit, we expected that if the discontinuation of DA&A benefits had a criminogenic effect, it would be most pronounced for income-generating crimes such as burglary, robbery, or drug sales as opposed to non-income-generating crimes like assault and battery.
Method
Data were collected as part of a federally funded multisite two-year prospective study to examine the social, medical, legal, and psychological consequences of terminating DA&A benefits. The study was conducted in nine sites: Los Angeles, San Francisco, Portland, Seattle, Detroit, Chicago, and San Joaquin, Alameda, and Santa Clara counties in northern California. Subject selection, recruitment, sample characteristics, the survey instrument, the collection protocol, and sample weighting have all been described in more detail elsewhere (see Swartz, Tonkin & Baumohl, this issue).
Subjects
The full sample consisted of 1,764 DA&As, interviewed at baseline between December 1996 and April 1997. Subjects were eligible for the study if they received SSI DA&A benefits in 1996, were between 21 and 59 years of age, and were not receiving Supplemental Security Disability Insurance (SSDI) benefits concurrently with their SSI benefits (see Hunt & Baumohl, this issue; Swartz et al., this issue). Subjects were reinterviewed every six months over two years for a total of up to five assessments. The aggregate 24-month follow-up rate was 82%, with 1,444 of the 1,764 subjects interviewed at baseline completing all five interviews. Because of missing data on essential covariates at baseline (i.e., drug use, self-reported criminal activity, and/or baseline government assistance status), we excluded 32 subjects from the analyses. Additionally, because our statistical model required that subjects complete at least three of the five assessments, we excluded an additional 92 subjects, leaving a full analytic sample of 1,640 subjects. Of these, 1,425 were assessed at all five waves, 158 were assessed at four waves, and 57 were assessed at three waves.
Most of the sites, except mainly Los Angeles, excluded subjects from the analyses if they were incarcerated at the time of the interview. Still, it is possible that subjects who were available for interview had been incarcerated for some or all of the follow-up period, meaning they would have had less of an opportunity to commit crimes and hence would have had better outcomes. To rule out this possibility, we examined the proportion of the sample who reported being in a controlled environment (e.g., prison, jail or hospital) for part or all of the follow-up period. The analysis showed that the proportion in a controlled environment was 4.8% at baseline and steadily increased to 10.4% by the time of the two-year follow-up interview. Moreover, other analyses showed that those reporting being in a controlled environment were significantly more likely, not less likely, to report committing a crime, indicating that the more crime-prone portion of our sample had an increased likelihood of spending time in jail or prison. However, because we could not say with any precision how much time a person spent in a controlled environment at each...
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