Welfare Reform and Addiction: A Priori Hypotheses,Post Hoc Explorations,and Assisted Sensemaking in Evaluating the Effects of Terminating Benefits for Chronic Substance Abusers
Restricted accessResearch articleFirst published online December, 2004
Welfare Reform and Addiction: A Priori Hypotheses,Post Hoc Explorations,and Assisted Sensemaking in Evaluating the Effects of Terminating Benefits for Chronic Substance Abusers
The passage of the Contract with America Advancement Act terminated the Social Security Administration’s Disability Insurance and Supplemental Security Income benefits for persons diagnosed with drug or alcohol addiction (also known as DA&A recipients), effective January 1, 1997. From an evaluation standpoint, the law created the opportunity for a “natural” experiment, specifically, an interrupted time series quasi-experiment. Through the availability of person-level data on an entire state population, the present study combines the design tradition of interrupted time series with the analytic tradition of growth curve modeling to create an “enriched” interrupted time series with greater flexibility and explanatory power than the standard design based on aggregate data. Additional techniques from the contemporary evaluation toolkit include: use of propensity scoring for matching and covariance adjustment, multilevel modeling, alternate estimates of the counter-factual, and sensitivity analyses to empirically test the plausibility of validity threats. The study assesses the net impact of the law on labor force participation and criminal behavior among former DA&A recipients in Washington State, using person-level data on employment and arrests from 2 years before implementation to 3 years after. Hypothesis tests showed unambiguously that the law increased employment but did not increase arrests. Post hoc exploratory analyses—framed by Mark et al. [Mark, M. M., Henry, G. T., & Julnes, G. (2000). Evaluation: An integrated framework for understanding, guiding, and improving policies and programs. San Francisco: Jossey Bass] theory of evaluation as assisted sensemaking with particular attention to generative mechanisms and social betterment—suggest a more nuanced interpretation. The combination of a priori and post hoc analyses confirmed that, as a result of the law, there were fewer DA&As on public supports, more DA&As in the workforce, and no evidence of more criminals menacing the public. Analyses also confirmed that a segment of the population, already poor, was made destitute.
Get full access to this article
View all access options for this article.
References
1.
Anderson, T., Goldstein, P., & Schyb, I. (1998). The impact of termination of SSI and SSDI for drug abuse and alcoholism on three types of recipients in Cook County. Annual conference of the Society for the Study of Social Problems, August 1998.
2.
Baumohl, J., Swartz, J. A., & Muck, R. D. (Eds.). (2003). Special issue: The multi-site study of the termination of supplemental security income benefits for drug addicts and alcoholics. Contemporary Drug Problems, 30, 391-424.
3.
Campbell, D., & Stanley, J. (1966). Experimental and quasi-experimental designs for research. Chicago, IL: Rand McNally.
4.
Campbell, K., Baumohl, J., & Hunt, S. R. (2003). The bottom line: Employment and barriers to work among former SSI DA&A beneficiaries. In J. Baumohl, J. A. Swartz, & R. D. Muck (Eds.), Special issue: The multi-site study of the termination of supplemental security income benefits for drug addicts and alcoholics. Contemporary Drug Problems, 30, 195-240.
5.
Campbell, K., Krupski, A., & Scott, R. (1998). The impact of eliminating the SSI drug addition and alcoholism category: Trends in utilization of welfare program, criminality and employment. Paper presented at the American Public Health Association Annual Meeting, November 18, 1998.
6.
Campbell, K., Peterson, P., Krupski, A., Holm, K., Jones, W., Formoso, C., et al. (1996). Final evaluation report for the Washington State SSI Managed Care Project (CSAT Grant #5HS6 T100 833-03). Olympia, WA: Washington State SSI.
7.
Choudhry, G. H., & Helba, C. (2003). Rationale and procedures for weighting the SSI study data. In J. Baumohl, J. A. Swartz, & R. D. Muck (Eds.), Special issue: The multi-site study of the termination of supplemental security income benefits for drug addicts and alcoholics. Contemporary Drug Problems, 30, 137-146.
8.
Cohen, W. S. (1994). Tax dollars aiding and abetting addiction: Social Security Disability and SSI cash benefits to drug addicts and alcoholics. Investigative Staff Report of the Minority Staff of the Senate Special Committee on Aging.
9.
Congressional Budget Office [of the United States]. (1995). Estimate of HR4, The Family Self-Sufficiency Act of 1995. Washington, DC: Congressional Budget Office.
10.
Curran, D. J., & Renzetti, C. M. (1994). Theories of crime. Needham Heights, MA: Allyn & Bacon.
11.
Department of Health and Human Services, Office of the Inspector General. (1994a). Requirements for drug addicts and alcoholics on SSI (OEI-02-94-00110).
12.
Department of Health and Human Services, Office of the Inspector General. (1994b). SSI payments to drug addicts and alcoholics: Continued dependence (OEI-09-94-007).
13.
Gallagher, J., Uccello, C. E., Pierce, A. B., & Reidy, E. B. (1999). State General Assistance Programs 1998. Washington, DC: The Urban Institute.
14.
Goldstein, H. (1995). Multilevel statistical models. New York: Edward Arnold, London Halsted Press.
15.
Gresenz, C. R., Watkins, K., & Podus, D. (1998). Supplementary Security Income (SSI), Disability Insurance (DI), and substance abusers. Community Mental Health Journal, 34, 337-350.
16.
Hunt, S., & Baumohl, J. (2003). Drink, drugs and disability: an introduction to the controversy. Contemporary Drug Problems, 30(1-2), 9-76.
17.
Kral, A. H., Lorvick, J., & Bluthenthal, R. N. (1997). Impact of withdrawal of SSI disability benefits for injection drug users in San Francisco Bay Area. In Proceedings of eighth international conference on the reduction of drug related harm.
18.
Mark, M. M., Henry, G. T., & Julnes, G. (2000). Evaluation: An integrated framework for understanding, guiding, and improving policies and programs. San Francisco: Jossey Bass.
19.
Mashaw, J. P., & Reno, V. P. (1996). Disability policy panel report: Balancing security and opportunity: The challenge of disability income policy. Washington, DC: National Academy of Social Insurance.
20.
Moffit, R. (1992). Incentive effects of the U.S. welfare system: A review. Journal of Economic Literature, 30(March), 1-61.
21.
Morgan, C., & Cox, G. B. (1998). Individuals who received social security disability insurance or supplemental security income on the basis of drug addiction and alcoholism and some effects of disallowing those benefits. Seattle, WA: University of Washington.
22.
Morrell, C. H., Pearson, J. D., Carter, H. B., & Brant, L. J. (1995). Estimating unknown transition times using a piecewise nonlinear mixed-effects model in men with prostate cancer. Journal of the American Statistical Association, 90, 45-53.
23.
Naumova, E. N., Must, A., & Laird, N. M. (2001). Tutorial in biostatistics: Evaluating the impact of ‘critical periods’ in longitudinal studies of growth using piecewise mixed effects models. International Journal of Epidemiology, 30, 1332-1341.
24.
Noble, C. (1997). Welfare as we knew it: A political history of the American welfare state. New York: Oxford University Press.
25.
Norris, J., Scott, R., Speiglman, R., & Green, R. (2003). Homelessness, hunger and material hardship among those who lost SSI. In J. Baumohl, J. A. Swartz, & R. D. Muck (Eds.), Special issue: The multi-site study of the termination of supplemental security income benefits for drug addicts and alcoholics. Contemporary Drug Problems, 30, 241-274.
26.
Orwin, R. G., Schucker, R. E., & Stokes, R. C. (1984). Evaluating the life cycle of a product warning: Saccharin and diet soft drink sales. Evaluation Review, 8, 801-822.
27.
Orwin, R. G. (in review). Lighting a candle versus cursing the darkness: The use of counterfactual projections to interpret and present findings from complex longitudinal evaluations.
28.
Osgood, D. W., & Smith, G. (1995). Applying hierarchical linear modeling to extended longitudinal evaluations: The Boys Town follow-up study. Evaluation Review, 19, 3-38.
29.
Podus, D., Barron, N., Chang, E., Watkins, K., Guydish, J., & Anglin, M. D. (2003). Medical and mental health services utilization among re-qualified and former Drug Addiction and Alcoholism recipients of SSI. In J. Baumohl, J. A. Swartz, & R. D. Muck (Eds.), Special issue: The multi-site study of the termination of supplemental security income benefits for drug addicts and alcoholics. Contemporary Drug Problems, 30, 365-390.
30.
Raudenbush, S., Bryk, A., Cheong, Y., & Congdon, R. (2000). HLM 5: Hierarchical linear and nonlinear modeling. Lincolnwood, IL: Scientific Software International.
31.
Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models (2nd ed.). Thousand Oaks, CA: Sage Publications.
32.
Reichardt, C. S., & Golub, H. F. (1987). Taking uncertainty into account when estimating effects. In M. M. Mark & R. L. Shotland (Eds.), Multiple methods in program evaluation. New directions for program evaluation: No. 35. San Francisco: Jossey-Bass.
33.
Rosenbaum, P. R., & Rubin, D. B. (1984). Reducing bias in observational studies using subclassification on the propensity score. Journal of the American Statistical Association, 79, 516-524.
34.
Rosenheck, R. (1997). Disability payments and chemical dependence: Conflicting values and uncertain effects. Psychiatric Services, 48, 789-791.
35.
Rosenheck, R., Frisman, L., & Sindelar, J. (1995). Disability compensation and work among veterans with psychiatric and nonpsychiatric impairments. Psychiatric Services, 46, 359-365.
36.
Social Security Administration. (1982). Titles II and XVI: Evaluation of drug addiction and alcoholism (SSR-82-60, pp. 348-351).
37.
Swartz, J. A., Lurigio, A. J., & Goldstein, P. (2000). Severe mental illness and substance use disorders among former Supplemental Security Income beneficiaries for drug addiction and alcoholism. Archives of General Psychiatry, 57, 701-707.
38.
Swartz, J. A., Martinovich, Z., & Goldstein, P. (2003a). An analysis of the criminogenic effects of terminating the Supplemental Security Income impairment category for drug addiction and alcoholism. In J. Baumohl, J. A. Swartz, & R. D. Muck (Eds.), Special issue: The multi-site study of the termination of supplemental security income benefits for drug addicts and alcoholics. Contemporary Drug Problems, 30, 391-424.
39.
Swartz, J. A., Tonkin, P., & Baumohl, J. (2003b). The methodology of CSAT’s study of the termination of Supplemental Security Income benefits for drug addicts and alcoholics. In J. Baumohl, J. A. Swartz, & R. D. Muck (Eds.), Special issue: The multi-site study of the termination of supplemental security income benefits for drug addicts and alcoholics. Contemporary Drug Problems, 30, 77-122.
40.
The Lewin Group, Inc., & Westat. (1998). Policy evaluation of the effect of legislation prohibiting the payment of disability benefits to individuals whose disability is based on drug addiction or alcoholism: Interim report submitted to the Social Security Administration. Fairfax, VA: The Lewin Group, Inc.
41.
U.S. General Accounting Office. (1994). Social security: Major changes needed for disability benefits for addicts (GAO/HEHS-94-128). Washington, DC: GAO.
42.
Warner, R., & Polak, P. (1995). The economic advancement of the mentally ill in the community: Economic choices and disincentives. Community Mental Health Journal, 31, 477-493.
43.
Wish, E. D., Hoffman, J. A., & Nemes, S. (1997). The validity of self-reported drug use: Improving the accuracy of survey estimates. In L. Harrison & A. Hughes (Eds.), NIDA research monograph: Vol. 167. Rockville, MD: National Institute of Drug Abuse.
