Social Security: Major Changes Needed for Disability Benefits for Addicts
(Letter Report, 05/13/94, GAO/HEHS-94-128).

The number of addicts receiving disability benefits has grown
substantially during the last 5 years--from fewer than 100,000 to about
250,000 today. The annual cost of providing benefits to addicts is about
$1.4 billion.  The vast majority of addicts receiving disability
benefits are either not in treatment or their treatment status is
unknown.  About 100,000 addicts have not been assigned a third-party or
representative payee to manage their benefits. Consequently, the Social
Security Administration (SSA) has no guarantee that these persons are
not using their benefit checks to buy drugs or alcohol. Even in cases
when payees have been assigned, their control over benefit payments is
questionable; most of these payees are friends or relatives.  Because
addicts can abuse, threaten, and pressure their payees, GAO believes
that organizations would make better payees for addicts than friends or
relatives.  SSA needs to ensure that all disability benefit recipients
are in treatment and that all addicts have a third-party or
representative payee.  Also, Congress needs to consider expanding the
treatment requirement to all addicts and restructuring the program to
improve the payoff from treatment.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-94-128
     TITLE:  Social Security: Major Changes Needed for Disability 
             Benefits for Addicts
      DATE:  05/13/94
   SUBJECT:  Social security benefits
             Alcohol abuse
             Drug abuse
             Drug treatment
             Alcoholics treatment
             Rehabilitation programs
             Eligibility criteria
             Internal controls
             Disability benefits
             Questionable payments
IDENTIFIER:  Supplemental Security Income Program
             SSI Drug Addiction and Alcoholism Program
             AIDS
             Social Security Disability Insurance Program
             
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Cover
================================================================ COVER


Report to Congressional Requesters

May 1994

SOCIAL SECURITY - MAJOR CHANGES
NEEDED FOR DISABILITY BENEFITS FOR
ADDICTS

GAO/HEHS-94-128

Disability Benefits for Addicts


Abbreviations
=============================================================== ABBREV

  AIDS - acquired immunodeficiency syndrome
  DA&A - drug addiction and alcoholism program
  DDS - disability determination service
  DI - Disability Insurance
  HHS - Department of Health and Human Services
  RMA - referral and monitoring agency
  SAMHSA - Substance Abuse and Mental Health Services Administration
  SSA - Social Security Administration
  SSI - Supplemental Security Income

Letter
=============================================================== LETTER


B-253838

May 13, 1994

The Honorable Andy Jacobs, Jr., Chairman
The Honorable Jim Bunning, Ranking Minority Member
Subcommittee on Social Security
Committee on Ways and Means
House of Representatives

The Honorable Harold Ford, Chairman
The Honorable E.  Rick Santorum, Ranking Minority Member
Subcommittee on Human Resources
Committee on Ways and Means
House of Representatives

Recent media reports as well as February 1994 hearings held by your
committees\1 have raised several issues concerning disability benefit
payments to addicts, including (1) the alarming increase in the
number of addicts receiving benefits, (2) the need for tighter
controls on benefit payments, and (3) the desirability of
restructuring the program to improve the payoff from treatment.  As
you requested, we have assessed the effectiveness of Social Security
Administration (SSA) controls over disability payments made to drug
addicts and alcoholics (addicts). 

Addicts may receive disability payments under SSA's Disability
Insurance (DI) and Supplemental Security Income (SSI) programs.  Both
programs have the same disability criteria.  State agencies called
disability determination services (DDSs) determine whether applicants
meet the criteria. 

You expressed particular interest in payments to certain addicts
under SSI.  By law, these individuals must participate in
treatment--when appropriate treatment is available--for their
addiction and have a representative payee or third party manage their
benefits as a condition of receiving disability benefits.  These
requirements provide the framework for SSA's drug addiction and
alcoholism (DA&A) program.  According to SSA, addicts required to
participate in the program are those who qualify for disability
because of their addiction.  You also sought our recommendations for
improving SSA's controls over payments to addicts in general. 

In doing our work, we analyzed SSA's computerized SSI and DI records
and interviewed SSA headquarters and regional officials.  We also
visited drug and alcohol treatment facilities and organizations under
contract with SSA to monitor the treatment of addicts receiving
benefits.  Appendix I includes additional details on our objectives,
scope, and methodology. 


--------------------
\1 Joint hearings were held on February 10, 1994.  GAO testimony was
titled Disability Benefits for Drug Addicts and Alcoholics are Out of
Control (GAO/T-HEHS-94-101). 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :1

The number of addicts receiving disability benefits has grown
substantially in the last 5 years--from fewer than 100,000 to about
250,000 currently.\2 The cost of providing disability benefits to the
current addict population is about $1.4 billion per year. 

The vast majority of addicts receiving disability benefits are either
not in treatment or their treatment status is unknown.  Although the
78,000 addicts in the SSI DA&A program are required to attend
treatment, because of poor monitoring by SSA, only about 1 in 5 are
in treatment.  The remaining addicts are not required to attend
treatment, and SSA does not know their treatment status. 

About 100,000 addicts have not been assigned a third-party or
representative payee to manage their benefits.  Consequently, SSA has
no assurance that these individuals are not using their benefit
checks to buy drugs or alcohol.  But, in many cases when payees have
been assigned, how tightly they control benefit payments is
questionable.  Most of these payees are relatives or friends. 
Because addicts can abuse, threaten, and otherwise pressure their
payees, we believe that organizations would make better payees for
addicts than friends or relatives.  Organizational payees, such as
those under contract with SSA to monitor addicts' treatment, would be
better positioned to provide the tight controls needed over benefit
payments. 

We believe that SSA needs to act to ensure that all DA&A recipients
are in treatment and that all addicts have a third-party or
representative payee.  Also the Congress needs to consider expanding
the treatment requirement to all addicts and restructuring the
program to improve the payoff from treatment. 


--------------------
\2 In commenting on a draft of this report, SSA said that our
estimate "most likely does not reflect the true number" of addicts. 
We agree and, as discussed in this report, believe it is likely
greater than 250,000. 


   BACKGROUND
------------------------------------------------------------ Letter :2

Eligibility for disability benefits involving drug or alcohol
addiction is determined like any other medical disorder.  Benefits
are awarded to those who cannot work and whose physical or mental
impairment is expected to last for at least 12 months or result in
death.  The impairment must be established by medical evidence
consisting of symptoms, signs, and laboratory findings.  Those
awarded benefits are to be periodically reviewed to determine whether
they are still disabled. 

About 250,000 addicts receive disability benefits under the DI and
SSI programs at an annual cost of about $1.4 billion.  More than half
of these addicts qualify for benefits on the basis of medical
problems in addition to their addictions.  For example, an addict may
be eligible for benefits because of acquired immunodeficiency
syndrome (AIDS) or disabling medical problems associated with heart
disease or cancer.  But all these people have addictions severe
enough that the condition is included as a part of their diagnosis. 
Other addicts qualify solely on the basis of addiction, which by
itself can be a disabling medically determinable impairment. 

Under the SSI program, addicts who qualify for benefits on the basis
of their addiction are required by law to get treatment for their
addiction and have a third-party or representative payee manage their
benefits.  These addicts are included in the SSI DA&A program and are
those who would not qualify for disability if their addiction ended. 
The DI program has no similar requirements.\3

The objective of the SSI DA&A program is to rehabilitate addicts to
be productive members of society and remove them from the SSI
disability rolls.  As of December 1993, the program had about 78,000
addicts.\4

The average age of the SSI DA&A recipients is 42, the majority are
male, blacks outnumber whites, and more suffer from alcoholism than
from drug abuse.  Benefit payments to these individuals amount to
about $285 million annually. 

SSA arranges for representative payees to manage the benefits of SSI
recipients put into the DA&A program.  SSA also is responsible for
treatment referral and monitoring.  In some states--18 by the end of
1993--SSA sends the case to a referral and monitoring agency or RMA. 
RMAs are state government or private organizations that arrange
treatment for DA&A recipients, monitor treatment participation, and
report to SSA on treatment status, including noncompliance. 

The types of treatment for SSI DA&A recipients can range from
intensive inpatient care to outpatient care in informal support group
settings.  Data are not available on the types of treatment provided
specifically for SSI DA&A recipients.  In general, however, the vast
majority of treatment for addiction in this country is provided on an
outpatient or ambulatory basis, rather than through an inpatient or
residential program. 

Exactly who pays for what types of treatment for SSI DA&A recipients
is not known.  SSA is not permitted to pay for treatment nor can the
addict be required to pay for it.  Some services are covered by state
Medicaid programs, but states vary greatly in the type, amount,
duration, and scope of services provided.  How much money state
Medicaid programs spend on treatment is generally not known because
states do not keep specific records on payments made on behalf of
addicts or other subpopulations.  In general, most treatment for
addiction in this country is paid for by funds from federal block
grants and state and local governments. 


--------------------
\3 Under the DI program, DI beneficiaries are not required to attend
treatment.  However, when claimants have been determined to be
incapable of managing benefits or legally incompetent, SSA assigns
representative payees for them. 

\4 The analyses in this report are based on the SSI DA&A caseload of
69,419 at the end of August 1993. 


   SUBSTANTIAL GROWTH IN PROGRAM
   ROLLS
------------------------------------------------------------ Letter :3

The number of addicts receiving SSI and DI disability benefits has
increased significantly in recent years, totaling over 250,000 people
today.  See appendix II for information on the number of addicts
receiving benefits in the 50 states and the District of Columbia. 

Five years ago, fewer than 100,000 addicts were on the rolls.  The
DA&A population has also grown substantially.  From December 1989
through August 1993, the number increased from about 17,000 to about
70,000--more than a fourfold increase in the 4-year period.  The
annual growth in allowances with addiction diagnoses and DA&A cases
is illustrated in figure 1. 

   Figure 1:  Disability Claims
   Allowed Annually With an
   Addiction Diagnosis Compared
   With Increases in DA&A Cases
   (1989-93)

   (See figure in printed
   edition.)

Note:  Number of claims allowed with addiction diagnoses is not
available for 1993. 

Many possible explanations exist for these increases, including
increased SSI outreach and cutbacks in state general assistance
programs that have resulted in more SSI applications.  However, the
extent to which these and other factors contribute to the increase is
not known. 

While the number of individuals with addiction diagnoses has
increased significantly in recent years, the number of such
individuals receiving benefits remains relatively small in comparison
with all individuals receiving disability benefits.  People diagnosed
with addiction account for about 4.8 percent of the adult SSI
population while DA&A recipients represent about 2.6 percent. 
Similarly, DI beneficiaries who are diagnosed with addiction
represent about 2.8 percent of the adult DI population. 


   THE TREATMENT STATUS OF THE
   VAST MAJORITY OF ADDICTS IS
   UNKNOWN
------------------------------------------------------------ Letter :4

Except for some of the addicts in the DA&A program, SSA does not know
whether the vast majority of addicts are in treatment.  About
two-thirds of SSA's addict population is not required to attend
treatment as a condition for receiving benefits.  With respect to
addicts in the DA&A program for whom treatment is a requirement,
relatively few are in treatment. 

SSA has poorly monitored compliance with the treatment requirement
for addicts in the DA&A program.  While SSA can monitor treatment
status through its computerized records and through RMA reporting,
both methods are deficient.  According to SSA records, only about 9
percent of the DA&A recipients are in treatment.  The remainder are
not in treatment (7 percent) or their treatment status is unknown (84
percent).  This same situation was reported by the Department of
Health and Human Services' (HHS) Inspector General in a 1991 report. 

Although about 85 percent of the DA&A population (60,000) is in those
states with RMAs, as mentioned earlier, SSA had established RMAs in
only 18 states through 1993.  For those states without RMAs, SSA
regional offices were to assume responsibility for treatment
monitoring.  According to SSA, however, no evidence exists that the
regions monitored treatment. 

Of the addicts living in states with RMAs, however, RMAs report that
only half of them (30,000) are being monitored, and only half of
these (about 15,000) are in treatment.  Data are not available to
explain why the treatment status of the remaining 30,000 DA&A
recipients in the RMA states is not being monitored.  Two possible
reasons are that (1) SSA lacks the necessary funding for the RMAs to
monitor all DA&A recipients and (2) appropriate treatment may not be
available.\5


--------------------
\5 Where appropriate treatment is not available, RMAs do not actively
monitor these cases.  In fiscal year 1993, the 18 RMAs reported about
400 cases where treatment was not available. 


   ADEQUATE MONITORING BY RMAS IS
   NEEDED IN ALL STATES
------------------------------------------------------------ Letter :5

The absence of RMA monitoring in most states may have contributed to
the underreporting of addiction diagnoses and DA&A recipients.  Also,
inadequate monitoring may have contributed to the relatively poor
outcomes under the DA&A program.  SSA is taking steps to correct
these shortcomings. 

Underreporting of addiction diagnoses and DA&A recipients in the
states without RMAs may occur because SSA and the state DDSs
apparently have given a low priority to identifying these cases. 
California, for example, has an RMA and had about 26,000 DA&A
recipients, while populous states without RMAs, such as Texas and
Florida, had only 365 and 543 DA&A recipients, respectively.  Only 38
DA&A recipients were reported for the District of Columbia, which has
no RMA. 

In the states with RMA monitoring, little evidence exists of positive
outcomes.  For example, during 1993, the RMAs reported that, on
average, only 75 addicts successfully completed treatment each month. 
During this same period, the rolls of the DA&A program were
increasing by about 2,000 addicts a month. 

Moreover, the successes reported by the RMAs are not necessarily
examples of rehabilitation and removal from the SSI rolls.  Rather,
they reflect completion of a specific treatment plan.  SSA does not
know how many addicts in the SSI DA&A program have been removed from
the disability rolls due to rehabilitation.  Also, the SSI DA&A
program refers few addicts for vocational rehabilitation. 

SSA is establishing RMA monitoring in all 50 states and the District
of Columbia.  We believe this move, while belated, is nonetheless a
good one.  An SSA study showed that--in comparison with a control
group that did not receive RMA monitoring--the RMAs accomplished
their basic mission of keeping addicts in treatment.  However, as
evidenced by the inadequate monitoring in RMAs, simply establishing
RMAs does not necessarily guarantee that all addicts will be
monitored, much less get treatment. 

SSA, in conjunction with the Substance Abuse and Mental Health
Services Administration (SAMHSA), has initiated two demonstration
projects in the states of Washington and Michigan to improve the DA&A
program.  Both projects are attempting to enhance case management and
to develop improved referral and monitoring procedures that could be
applied in other states. 


   EFFECTIVENESS OF THE CURRENT
   REPRESENTATIVE PAYEE
   REQUIREMENT IS QUESTIONABLE
------------------------------------------------------------ Letter :6

While virtually all addicts in the DA&A program have representative
payees, many other addicts do not have payees.  We estimate, for
example, that about 100,000 of the 250,000 addicts receiving SSI and
DI disability benefits do not have payees. 

Finding qualified payees for addicts has been a long-standing problem
for SSA.  Payees are generally unpaid volunteers.\6 These
circumstances, coupled with the potential for incurring abuse or
threats from addicts, make finding representative payees difficult
for SSA.  When addicts have payees, the vast majority of them are
relatives or friends. 

Studies in general have shown that, in those cases in which payees
are present, how tightly they control benefit payments is
questionable.  In the absence of tight controls, addicts are free to
purchase drugs and alcohol to maintain their addictions.  This
situation leaves the government open to charges of "enabling" because
the benefit payments give addicts the means to support their
addictions. 

Little data exist on how well representative payees control benefit
payments for addicts.  However, anecdotal data, including previous
testimony before the Social Security and Human Resources
Subcommittees, suggest that the representative payee requirement is
not working well.  A previous SSA study of the addict population
found payee controls to be lax in many cases, particularly when
addicts' friends were the payees. 

This study also showed that organizational payees such as RMAs and
treatment facilities tended to provide the most control.  We believe
that organizational payees would be better positioned to implement
the stringent controls needed over benefit payments to addicts.  The
reason for this is that organizations can more effectively deal with
situations in which addicts are abusive or threatening. 

We believe SSA should use organizations as representative payees to
the maximum extent possible.  One way to expand the use of
organizations is to use RMAs to provide payee services.  Making RMAs
the payees would consolidate case management functions, including
treatment monitoring and money management. 

As with addicts in the DA&A program, we also believe the
representative payee requirement should be applied to all SSI and DI
addicts.  The nature of such beneficiaries' medical problems suggests
that SSA should require representative payees for all addicts
receiving benefits.  This is not the case now.  In fact, no
regulatory or programmatic requirement exists for addicts not in the
DA&A program to have representative payees.  The public must have
confidence that these benefit payments are being used for the basic
program purposes of food, clothing, and shelter. 


--------------------
\6 SSA is currently carrying out a demonstration program in which
qualified organizations can be paid up to $25 per month for acting as
a representative payee.  The beneficiary pays the fee. 


   REEXAMINATION OF THE DA&A
   PROGRAM NEEDED
------------------------------------------------------------ Letter :7

The DA&A program has not changed since the SSI program began more
than 20 years ago.  While the fundamental structure of the program is
sound--that is, requiring addicts to have a representative payee and
attend treatment--a rethinking of the program is long overdue. 

First of all, benefit payments to addicts should be examined in a
broader context.  The DA&A program as currently structured applies
only to about one-third of the addicts currently receiving DI and SSI
disability benefits.  As noted earlier, we believe that all addicts
should be required to have representative payees.  We also believe
that the Congress should consider expanding the DA&A treatment
requirement to all addicts who receive DI and SSI disability
benefits. 

Several other reform proposals were disclosed in a February 10, 1994,
joint hearing before the Subcommittees on Social Security and Human
Resources, Committee on Ways and Means.  These proposals include the
following: 

  requiring addicts to complete 3 months of treatment before they are
     eligible to receive benefits;

  providing addicts vouchers instead of cash for buying essentials
     such as food, clothing, and shelter; and,

  establishing a "bridge" for addicts who are "cured" of their
     addiction, possibly a continuation of benefits in decreasing
     amounts. 


   CONCLUSIONS
------------------------------------------------------------ Letter :8

SSA payments to addicts are out of control.  The number of addicts is
increasing at an alarming rate for reasons that are not well
understood.  The requirements for treatment are not being complied
with or properly monitored.  And there is little assurance that
benefit payments are being used for the basic necessities rather than
for the purchase of drugs and alcohol.  SSA needs to take immediate
action to deal with these problems, and the Congress needs to tighten
controls for both the SSI and DI programs as they relate to drug
addicts and alcoholics. 

In the short term, SSA needs to place RMAs in all states and
strengthen RMA monitoring to assure that all DA&A recipients in pay
status are accounted for and monitored as required.  Also, SSA needs
to expand and strengthen representative payee monitoring. 

It is clear that more effective treatment referral and monitoring
must occur with the current DA&A population.  SSA needs to work
closely with the RMAs and SAMHSA to better identify the treatment
needs of these addicts and to see that they receive appropriate
services. 

Over the longer term, the Congress needs to consider expanding the
treatment requirement of the DA&A program to include all addicts
receiving DI and SSI disability benefits.  Also, the Congress should
rethink the program design to improve the payoff from treating
addicts. 


   RECOMMENDATIONS TO THE
   SECRETARY OF HHS
------------------------------------------------------------ Letter :9

The Secretary should direct the Commissioner of SSA to strengthen
controls over disability benefits paid to addicts in the following
ways: 

  establish RMAs in all states,

  take appropriate measures to ensure that all DA&A recipients are in
     treatment and accounted for and monitored as required,

  require all addicts receiving SSI and DI benefits to have
     representative payees, and

  use organizational payees for addicts to the maximum extent
     possible and consider making the RMAs representative payees. 


   MATTERS FOR CONSIDERATION BY
   THE CONGRESS
----------------------------------------------------------- Letter :10

The Congress should consider expanding the treatment requirement to
all addicts and restructuring the program to improve the payoff from
treatment. 


   AGENCY COMMENTS
----------------------------------------------------------- Letter :11

By letter dated April 15, 1994, SSA agreed that it had not done well
in administering the SSI DA&A program but stated that it is
initiating changes to meet this responsibility. 

Concerning our recommendations to improve monitoring, SSA stated that
all states and the District of Columbia would have RMAs by the end of
this year.  With respect to our recommendation that all DA&A
recipients be in treatment, accounted for, and monitored, SSA said
that monitoring does not guarantee that all individuals will get
treatment because appropriate treatment--free to the recipient--must
also be available.  We continue to believe that the status of all
DA&A recipients should be monitored and that this is fundamental to
ensuring that these individuals attend treatment.  Further, while SSA
has no data on the status of the 30,000 individuals not being
monitored in RMA states, lack of appropriate treatment is not likely
a major reason for this.  In fiscal year 1993, for example, the RMAs
reported that appropriate treatment could not be found for only 400
DA&A recipients. 

SSA also said that the report implies that it has a greater role than
ensuring that the SSI DA&A recipients are in treatment and is failing
in this duty.  We disagree.  The report clearly states that currently
SSA is only required to assure that DA&As are in treatment and asks
the Congress to consider extending the treatment requirement to all
addicts on the DI and SSI rolls. 

With respect to our recommendations to strengthen and expand the
representative payee program for addicts, SSA said that immediately
expanding the SSI DA&A criteria to DI beneficiaries would be costly
and it is difficult to find payees.  We know that these changes
cannot be made overnight and will take time to fully implement.  But
we believe that this further supports that SSA act now to develop a
plan to ensure that these addicts are eventually assigned payees. 
Concerning our recommendation requiring payees for all other addicts
receiving DI and SSI benefits, SSA indicated that it did not want to
require that all addicts have payees and that these decisions should
be decided on a case-by-case basis.  We disagree.  Because an
individual is an addict seems to us sufficient justification to
warrant assigning a representative payee.  Further, this is the same
basic rationale for the legislative requirement for assigning payees
under the SSI DA&A program.  SSA agreed that organizational payees
are generally preferable for DA&A recipients.  Moreover, it agreed
with our recommendation that RMAs be considered as organizational
payees. 

SSA also made a number of technical comments, which we incorporated
as appropriate.  SSA's comments in their entirety appear in appendix
III. 


--------------------------------------------------------- Letter :11.1

We are providing copies of this report to the Director of the Office
of Management and Budget; the Secretary, HHS; the SSA Commissioner;
and to other congressional committees with an interest in this
matter.  We will also make copies available to others upon request. 

Please contact me on (202) 512-7215 if you have any questions about
this report.  Other major contributors to this report are listed in
appendix IV. 

Jane L.  Ross
Associate Director
Income Security Issues


OBJECTIVES, SCOPE, AND METHODOLOGY
=========================================================== Appendix I

Our primary objectives were to assess the (1) effectiveness of
eligibility restrictions that the Social Security Act places on drug
addicts and alcoholics who receive disability benefits under the SSI
DA&A program and (2) adequacy of controls over payments to addicts in
general. 

In conjunction with our primary objectives, we were asked to provide
information on addicts in both the SSI and DI programs, including,
but not limited to their numbers and medical diagnoses, the presence
and types of representative payees, and their treatment status.  In
addition, we were asked to answer several questions on the types and
financing of treatment provided to addicts in the SSI DA&A program. 

We analyzed selected data from SSA's computerized master files for
SSI recipients and DI beneficiaries who were addicts in current
payment status.  We also extracted data from SSA's computerized 831
files, which provide data on claims on a calendar-year basis. 

Data on SSI addicts were extracted from the computer records on
August 2, 1993, and data on the DI addicts were extracted on
September 9, 1993.  The 831 files were analyzed for the years 1988
through 1992.  Calendar year 1993 data were not available at the time
of our review.  Because the master computer files show only primary
medical diagnoses, we used the 831 data primarily to estimate the
number of addicts with substance abuse as a secondary medical
diagnosis. 

We interviewed disability program officials at SSA Headquarters and
in SSA's Chicago, Dallas, San Francisco, and Seattle regional
offices.  We visited treatment centers in Oakland, California, and in
the Seattle, Washington, area.  We also visited referral and
monitoring agencies in California, Washington, Pennsylvania, and
Maryland.  In addition, we obtained data from the RMA in Chicago,
Illinois, and various SSA field offices in the Chicago, San
Francisco, and Seattle regions. 

Our work was performed between July 1993 and February 1994 in
accordance with generally accepted government auditing standards. 


NUMBER OF ADDICTS BY STATE
========================================================== Appendix II



St
at        Grand
e        Totals  SSI DA&As\a    Primary\b  Secondary\c    Primary\b  Secondary\c
--  ===========  -----------  -----------  -----------  -----------  -----------
Al        3,953          397          284        1,847          344        1,081
 a
 b
 a
 m
 a
Al          345          134           26           85           40           60
 a
 s
 k
 a
Ar        2,593          672          207          455          429          830
 i
 z
 o
 n
 a
 \
 d
Ar        2,074          154           97        1,027          168          628
 k
 a
 n
 s
 a
 s
Ca       34,935       23,561        3,564          211        3,613        3,986
 l
 i
 f
 o
 r
 n
 i
 a
 \
 d
Co        3,306          291          206        1,250          226        1,333
 l
 o
 r
 a
 d
 o
Co        3,715          190          193          918          283        2,131
 n
 n
 e
 c
 t
 i
 c
 u
 t
De          517           26           16          109           26          340
 l
 a
 w
 a
 r
 e
Di          920           37           50          583           17          233
 s
 t
 r
 i
 c
 t
 o
 f
 C
 o
 l
 u
 m
 b
 i
 a
Fl       13,728          465          430        7,088          544        5,201
 o
 r
 i
 d
 a
Ge        8,332          484          480        3,387          463        3,518
 o
 r
 g
 i
 a
Ha          957          209           30          158           95          465
 w
 a
 i
 i
 \
 d
Id          536           98           47          195           54          142
 a
 h
 o
Il       27,723       11,643        3,302        2,102        3,705        6,972
 l
 i
 n
 o
 i
 s
 \
 d
In        5,130          957          666          845          901        1,761
 d
 i
 a
 n
 a
Io        1,539          195           54          411          118          761
 wa
Ka        1,721          100           84          628          188          721
 n
 s
 a
 s
Ke        6,374          912          601        3,029          481        1,351
 n
 t
 u
 c
 k
 y
Lo        2,259          189          264        1,228          199          379
 u
 i
 s
 i
 a
 n
 a
Ma        1,615          284          125          225          235          746
 i
 n
 e
Ma        2,472          604          225          408          300          935
 r
 y
 l
 a
 n
 d
 \
 d
Ma        9,287        1,679        1,270        2,066        1,124        3,148
 s
 s
 a
 c
 h
 u
 s
 e
 t
 t
 s
Mi       14,524        6,315          662        2,018        1,853        3,676
 c
 h
 i
 g
 a
 n
 \
 d
Mi        5,171        1,992          308          552          761        1,558
 n
 n
 e
 s
 o
 t
 a
 \
 d
Mi        1,547          177          192          363          188          627
 s
 s
 i
 s
 s
 i
 p
 p
 i
 \
 d
Mi        3,586          524          115          927          331        1,689
 s
 s
 o
 u
 r
 i
Mo          985          222           46          389           82          246
 n
 t
 a
 n
 a
 \
 d
Ne        1,091          107           22          379           73          510
 b
 r
 a
 s
 k
 a
 \
 d
Ne        1,174          273           73          137          221          470
 v
 a
 d
 a
 \
 d
Ne          719           26           37          182           64          410
 w
 H
 a
 m
 p
 s
 h
 i
 r
 e
Ne        4,759          366          442        1,770          418        1,763
 w
 J
 e
 r
 s
 e
 y
 \
 d
Ne        1,270          177          121          609          136          227
 w
 M
 e
 x
 i
 c
 o
Ne       15,536        2,887        2,456        5,006        1,668        3,519
 w
 Y
 o
 r
 k
 \
 d
No        6,215          388          275        2,493          413        2,646
 r
 t
 h
 C
 a
 r
 o
 l
 i
 n
 a
No          870           81            9          436           55          289
 r
 t
 h
 D
 a
 k
 o
 t
 a
Oh        9,086         1,91          968        2,749        1,064        2,386
 i
 o
 \
 d
Ok        2,369          167          117        1,372          126          587
 l
 a
 h
 o
 m
 a
Or        2,799          618          159          573          324        1,125
 e
 g
 o
 n
Pe        7,657        1,849          713        2,141          742        2,212
 n
 n
 s
 y
 l
 v
 a
 n
 i
 a
 \
 d
Rh        1,290           96           67          499           83          545
 o
 d
 e
 I
 s
 l
 a
 n
 d
So        2,271          167          137        1,176          201          590
 u
 t
 h
 C
 a
 r
 o
 l
 i
 n
 a
So        1,220          127           24          751           53          265
 u
 t
 h
 D
 a
 k
 o
 t
 a
Te        4,962        1,593          591          816          798        1,164
 n
 n
 e
 s
 s
 e
 e
 \
 d
Te        6,833          319          274        3,425          402        2,413
 x
 a
 s
Ut        1,250           87           74          527           89          473
 ah
Ve          606           90           57          127           74          258
 r
 m
 o
 n
 t
Vi        3,054          516          177          769          382        1,210
 r
 g
 i
 n
 i
 a
Wa        5,003        1,941          312          523          662        1,565
 s
 h
 i
 n
 g
 t
 o
 n
 \
 d
We        2,108          572          218          386          304          628
 st
 V
 i
 r
 g
 i
 n
 i
 a
Wi        6,755        2,524          390        1,137          928        1,776
 s
 c
 o
 n
 s
 i
 n
 \
 d
Wy          458           19           11          252           17          159
 o
 m
 i
 n
 g
================================================================================
To      249,199       69,419       21,268       60,739       26,065       71,708
 t
 a
 l
--------------------------------------------------------------------------------
\a SSI DA&A recipients in current payment status as of August 2,
1993. 

\b Number of addicts in current payment status as of August 2, 1993,
(SSI) and September 23, 1993 (DI). 

\c Estimated number of addicts based on claims allowed during the
years 1989 to 1992 and the relationship between those with primary
diagnoses of substance abuse versus those with secondary diagnoses of
substance abuse. 

\d States (18) with RMAs as of December 31, 1993. 




(See figure in printed edition.)Appendix III
COMMENTS FROM THE SOCIAL SECURITY
ADMINISTRATION
========================================================== Appendix II



(See figure in printed edition.)



(See figure in printed edition.)



(See figure in printed edition.)



(See figure in printed edition.)


MAJOR CONTRIBUTORS TO THIS REPORT
========================================================== Appendix IV

Barry Tice, Assistant Director, (410) 965-8021
Louis G.  Tutt, Evaluator-in-Charge
Luis Escalante, Jr.
Ellen Habenicht
Joanne Newman
Tom Smith
Vanessa Taylor
