After more than a decade of failing to stop gross abuses in an aid program for disabled drug addicts and alcoholics, the Social Security Administration is preparing to spend nearly $300 million on a crackdown ordered by Congress that will force thousands of chronic substance abusers off the rolls.
That's the estimated cost of enforcing a new law that aims to cut off payments to all addicts after three years -- a move triggered by reports from investigators that Social Security has failed to keep recipients from spending the money on drugs and alcohol.
In some cases, addicts have used their monthly checks to drink and drug themselves to death at taxpayers' expense, investigators found.
Critics have called the program "revenue-sharing for addicts" and "death on the installment plan." But addiction counselors say the drastic response by Congress will rob thousands of sick individuals of their only income and that it amounts to punishing the needy for Social Security's failure to run the program properly.
They say that the cutoff may cause a crisis in large cities such as Baltimore, where addicts will face long waiting lists for the publicly funded drug treatment programs that they would need to get themselves clean before they lose their monthly aid checks.
Meanwhile, Social Security officials said last week that they still do not know how many of the agency's 9 million physically and mentally disabled check recipients are addicts and alcoholics. Figuring that out, notifying addicts of the cutoff, and defending against legal challenges is likely to cost taxpayers $285 million over the next five years.
That much money would buy a year of intensive residential care for 15,000 of the hard-core addicts currently on the rolls, treatment experts say.
"It's an insane misapplication of public funds that can only make the situation worse," said Jack Gustafson, who represents state rehabilitation directors in Washington. "It's almost beyond dispute at this point that treatment is far less expensive than incarceration or welfare programs -- which is exactly where these people are going to wind up if the best we can do is shove them back out onto the street in 36 months."
Sen. William S. Cohen, the Maine Republican who is considered a prime mover behind the legislation, has called the current program "revenue-sharing for addicts." But he said Friday that he, too, is troubled by the final version of the cutoff he helped initiate.
Attached to a larger bill that will make Social Security an agency independent of the Health and Human Services Department, the measure would drop some addicts even if they can't find rehabilitation. The bill is expected to win final congressional approval this week.
"We can't have taxpayers' dollars going directly into the arms and stomachs of addicts," Mr. Cohen said Friday. "But it's also not fair to tell people you have 36 months to find treatment where treatment isn't available."
The current aid program cost taxpayers about $1.4 billion last year and provided monthly checks to as many as 250,000 addicts and alcoholics nationwide, congressional investigators estimate. The recipients, many of whom are unable to work solely because of their addictions, are supposed to spend the money on food, shelter and clothing.
Further, a third of them are supposed to be in mandatory rehabilitation as a condition of receiving $446 in monthly checks. But Social Security officials admitted at hearings earlier this year that they have failed to keep tabs on the vast majority of addicts to make sure they are in treatment.
Translation: Of the nearly 80,000 addicts supposed to be in treatment, the agency knew of fewer than 8,000 who actually were.
At the same time, tens of thousands of new recipients are entering the disability program every year, many as a direct result of outreach campaigns by Social Security and state welfare agencies.
100,000 on waiting lists
As the rolls have grown, treatment slots have dwindled in many )) cities. There are at least 100,000 addicts and alcoholics on waiting lists, according to federal, state and private estimates -- and there may be as many as 3.2 million who need help.
In Baltimore, a study by the non-profit Abell Foundation last year found that there were 62,000 addicts and alcoholics in the city in need of treatment, and that Baltimore's rate of heroin-related emergency room admissions was among the highest in the nation. The study also found that eight of every 10 inmates in the city jail were drug users.
Yet there were only 5,500 publicly financed, out-patient treatment slots available in the city. There were no in-patient slots for hard-core addicts, and the jail had almost no treatment programs for inmates.
Gwendolyn King, who served three years as Social Security commissioner in the Bush administration, said such wide gaps between treatment supply and demand further argue against the cutoff.
"Until we get to the point in this whole process where we're ensuring that people who need treatment can get treatment, an arbitrary limit of time is not going to take us anywhere except into a backward situation, really," Ms. King said in a recent interview.
"A more reasoned approach," she said, "would tie the loss of benefits to the willful refusal to accept treatment" once treatment is made available.
Ironically, advocates say, the bill to cut off aid comes just as pilot projects launched by Social Security in four states are showing success in treating the chronically addicted and getting them back to work.
Addiction as an incentive
But critics of the current system say it offers no incentive to get treatment because addicts know that successful rehabilitation means the end of monthly checks. In short, addiction has become its own reward.
Supporters of the cutoff say it will remove that incentive by ending payments altogether after three years.
Bob Cote is a Denver addiction counselor whose outraged accounts of skid row addicts drinking and drugging themselves to death on government checks helped galvanize support for congressional action. He sees the current program as inherently unworkable.
"The Social Security Administration is the largest single supplier of drugs and alcohol in this town," he says. "They have proudly pointed to their outreach programs to help people get into the program. But they've totally ignored their responsibility to monitor those people and cut them off if they're not in rehab.
"I'm down here trying to get these guys cleaned up and off the street; then check day rolls around and they disappear from the program. The next time I see them, they're strung out and sick, or dead.
"I call it death on the installment plan."
Mr. Cote, himself a former addict, supports cutting off all checks immediately until the agency has the monitoring and treatment facilities in place to control how addicts spend the federal money.
"Instead, Social Security is giving them the checks and worrying about the rest later," he says. "They have the cart so far out in front of the horse that they can't even see it."
As evidence, Mr. Cote points to the agency's own admissions that it isn't even sure how many addicts and alcoholics are on its disability rolls.
One reason for that is because the agency handles two funds that make payments to disabled addicts -- and Congress has required Social Security to keep track of addicts in only one of them.
The first program is for people who have worked and paid payroll taxes into the Social Security trust fund for their retirement. If they become injured or mentally disabled -- including addicted to drugs or alcohol -- they are entitled to draw from the trust's "Disability Insurance" plan.
The second program is a welfare plan for those who haven't contributed to the trust fund. This separate pot of money, known as "Supplemental Security Income," was originally intended to aid the blind, disabled and elderly who could not work. Over time, it grew as courts and Congress expanded eligibility rules.
Two programs
For 20 years, addicts and alcoholics in the two programs have been treated differently.
Congress has required Social Security to steer addicts in the welfare program into treatment and to monitor their progress as a condition of giving them aid checks -- tasks it has failed to perform. But the agency has at least kept track of their numbers: There are about 80,000 of them.
But Congress placed no such conditions on addicts who paid into the retirement fund because their aid checks have traditionally been viewed as "earned benefits." So Social Security never kept a full count of how many addicts were drawing from the fund.
The new law changes that.
Congress will now require addicts on both programs to be in treatment and imposes the three-year cut off on them all. It will also require the agency to have "representative payees" to receive each recipient's check and ensure that they are not spent on drugs and alcohol -- again a requirement not previously placed on the "earned" program.
To carry out these orders now, Social Security would have to spend $75 million to $200 million sifting through the rolls of all its physically and mentally disabled recipients to identify the addicts, said Phil Gambino, the agency's spokesman.
Rather than conduct a search of each paper file, Social Security will do a less accurate and less expensive computer search at its Woodlawn headquarters outside Baltimore that will identify the vast majority of them.
Congress has also opted to continue treating addicts in the two programs differently in one key respect.
For the welfare program, the 36-month cutoff clock starts with the first check. For those on the "earned" benefits plan, the clock starts only when -- and if -- treatment becomes available for them.
Rep. Andrew Jacobs Jr., the Indiana Democrat who heads the Ways and Means' Social Security subcommittee, said the distinction was inserted at the insistence of legislators who felt recipients with "earned" benefits should not lose them before they get into treatment.
"That sounds like a loophole big enough to drive an airplane full of cocaine through," he said.