Historical Problems

Responding to the needs of individuals with DAA has long challenged policy makers.  Significant historical problems associated with DAA fall into four major categories: funding and cost, ideology, treatment approach, and political will. Each of these four problem areas is discussed below.

In February of 1995, the Center of Addiction and Substance Abuse at Columbia University published a study assessing federal costs associated with the use of tobacco, illegal drugs, and alcohol.  Findings of the study included the following:

•  $77.6 billion of spending on federal entitlement programs in 1995 was due to abuse of illegal drugs, alcohol, or tobacco.  Of this amount, $66.4 billion was spent on health care and disability and $11.2 billion on public assistance for individuals with DAA.
•  The study projected that in 1995 for federal health entitlements alone, substance abuse would cost $60.3 billion (more than 40% of the federal deficit for 1995) or nearly one in every five dollars spent by Medicare, Medicaid, veterans’ health and other federal entitlement programs.

Ideological shifts have significantly influenced legislative initiatives relating to DAA. In the 1960s the American Medical Association identified DAA as a disease and called for measures to appropriately treat individuals with DAA. According to Neighborhood Legal Services (1996), Passage of 104-121 removed "the only source of income available to drug and alcohol abusers who despite the label of "not disabled" are unable to support themselves by work." In this interpretation, PL 104-121 represents a drastic shift from the 1960s call for increased provision of services for individuals with DAA. While the passage of Title I, Section 105 of PL 104-121 was invariably influenced by cost and funding concerns mentioned above, changes in how individuals with DAA were viewed by society and policy makers was a contributing factor as well.

In addition to changes in how DAA is viewed and defined, another historical factor that has influenced legislative initiatives is differences in how best to respond to DAA. For example, in 1972 legislation discussed below, individuals with DAA were identified as appropriate candidates for SSI and SSDI assistance. During the debate of PL 104-121, however, it was the stated belief of congress that providing SSDI and SSI benefits to substance abusers “fails to serve the interests of drug abusers and alcoholics as many use their disability checks to purchase drugs and alcohol” (Mukherjee, 1996).  In place of federal entitlement programs, members of congress encouraged the development of other means to respond to the needs of individuals with DAA. At this time, it is unclear whether the federal approach to DAA was more or less effective than other treatment approaches.

The debate regarding approach extended to include researchers whose work influenced policymakers. In the study earlier discussed by CASA, suggestions were made to policymakers. These include the caution that: “If the Congress and the President are serious about reducing the costs of entitlement programs, they must attend to the prevention and treatment of substance abuse and the protection of children on welfare from parents who abuse them by their own drug and alcohol abuse.  Merely removing individuals who smoke, or abuse alcohol or drugs, from social security disability, veterans disability, and welfare rolls will not lower costs.” CASA president, Joseph A. Califano stresses the importance of providing funding for adequate treatment and calls for two immediate actions:
1) “Cut off welfare payments to drug addicts and alcoholics who refuse to seek treatment and pursue after-care. As employers and health professionals know, addicts need lots of carrots and sticks, including threat of loss of job and income, to get the monkey off their back.”
2) “Put the children of drug- or alcohol-addicted welfare mothers who refuse treatment into foster care or orphanages. Identify those parents who abuse their children through their own drug and alcohol abuse and place those children in decent orphanages and foster care until the parents shape-up.”

The final problem relating to DAA legislation addressed is political will. The desire to effectively respond to DAA requires a consistent and substantial financial commitment. As discussed previously, politicians at the time of PL 104-121’s debate and passage were concerned with reducing costs by 30 percent across the board for all social security related benefits. This action was due to ongoing concern of Social Security system running financial deficits by 2012 and being bankrupted by 2029 (Social Security Reform Center).  Yet at the same time, they wanted to find an effective way to approach DAA.  Confronted by these conflicting concerns of funding and political will to address DAA, DAA policy has fluctuated over the years.
 
 

INTRODUCTION	HISTORICAL PROBLEMS	LEGISLATIVE INITIATIVES	KEY FACTORS
IMPLEMENTATION	CONSEQUENCES	EVALUATION