Drink, drugs and disability: an introduction to the controversy.(Social Security Administration's drug addiction and alcoholism program)

It is highly unlikely that when Congress passed the SSI program in 1972 ... members realized they would be writing a guaranteed annual income and medical care [program] for addicts.

Rep. Rick Santorum, February 10, 1994

I think probably most of the American people would be outraged to find ... that someone is even receiving disability when they inflict it on themselves.

Rep. E. Clay Shaw, Jr., February 10, 1994 (1)

Since 1950 the federal government of the United States has provided income support to people with work disabilities unrelated to military service. The eligibility of alcoholics and drug addicts for these benefits has always been controversial, but for over 25 years drug addiction and alcoholism were treated as potentially disabling impairments--albeit with official reluctance and confusion. In this paper we examine the history of the drug addiction and alcoholism (DA&A) "program" (2) operated by the Social Security Administration. This began with the authorization of Supplemental Security Income (SSI) in 1972, was extended to Social Security Disability Insurance in 1994, and was eliminated by Congress in March 1996.

In retrospect, it seems fair to say that the DA&A program was established on terms that invited controversy. For technical and fiscal reasons that were well understood early on, the program was extremely difficult to manage, and as a consequence it was susceptible to rapid growth and discrediting scandal. It was thus distinctly unloved by its bureaucratic parent. The Social Security Administration (SSA) largely ignored the program through the 1970s and 1980s and made no official effort to defend it once a newly conservative Congress laid siege in 1994. Still, even had the SSA been inclined to resist the lawmakers, it had little political leverage because the program lacked a unified constituency. Treating addiction as a work disability never sat well with many legislators and some members of the substance abuse treatment community; to use a term that became popular in the 1980s, they believed the program "enabled" addiction.

We consider these issues in due course. However, to properly introduce what is of necessity a complicated story, we first lay some groundwork. Immediately below, we provide a brief summary of the two current Social Security disability programs, followed by a somewhat detailed treatment of the definition of work disability and the process by which it is determined. We then take up definitional aspects of drug addiction and alcoholism as qualifying impairments for disability. At this point, we sketch the DA&A program's implementation from 1974 to the early 1990s. These are rather technical, even laborious sections, but they dissect the serious administrative problems that contributed to the DA&A program's growth, introduce terms that recur throughout this paper and others that follow in this issue, and provide points of reference for these other papers, especially insofar as their findings reflect the influence of administrative processes. (3)