January 23, 1995|By Jim Haner and John B. O'Donnell | Jim Haner and John B. O'Donnell,Sun Staff Writers
"They'll test positive for heroin and we'll flunk them out of the program," Mr. Brown says. "Then they'll sign back up on the waiting list and the whole thing starts all over again. I can honestly say that in my 21 years in this business, I have never had a disability recipient successfully complete the program."
When Congress first decided to let addicts like Ernie Hernandez get aid for merely being addicted, it ordered Social Security to herd them into treatment as a condition of their getting checks.
Any addict who refused was to be cut off -- except for DI addicts, because Congress deemed that they had "earned" their benefits when they were working and should be free to spend them as they saw fit.
The treatment rule was supposed to keep poor addicts on SSI from simply using the money to feed their habits. But former agency officials and legislative aides say they warned Congress as early as 1969 that there were nowhere near enough in-patient treatment slots for them. And no one expected out-patient treatment to work.
But the nation's lawmakers were less interested in accountability for addicts, the aides say, than they were in insulating themselves against outraged taxpayers should the program go wrong. Then-Sen. Russell Long, the legendary Louisiana Democrat, was the prime mover.
"He told us there was no way in hell he would support giving checks to dope addicts without at least making it look like we were getting tough with them at the same time," says Tom Joe, a Washington social policy analyst who helped write the disability rules. "Every-body knew that they probably wouldn't be able to actually find treatment."
Then, or now.
Today, a minimum of 3.2 million addicts and alcoholics need help, ac-cording to federal, state and private estimates. But there are slots available for less than half. And at least 100,000 people are on waiting lists for those slots at any time. For others, there are no lists.
Consider North Carolina, a state with 6,200 addicts on the federal disability rolls and few publicly funded in-patient
treatment slots.
In Asheville, a small town in the pine-blanketed foothills of the Great Smoky Mountains, a downtown Social Security office draws scores of disabled people from the surrounding countryside. Many are illiterate, hobbled by years of hard labor in mines and lumber mills, and suffering from addictions to rot gut wine and moonshine.
"We're basically telling them to get treatment when there isn't a treatment facility within 200 miles of here," says Sharon DeLong of the American Federation of Government Employees, who represents local caseworkers.
"We try to push them into Alcoholics Anonymous or something like that. But how long can they last when all they're getting is a couple hours of group therapy before they head back out to sleep in the woods with a dozen other alcoholics? It's utterly demoralizing."
Her frustration is echoed by caseworkers and drug counselors from Baltimore to Seattle who say Congress and the Social Security Administration have never been serious about rehabilitating addicts -- or in understanding how treatment works.
Counselors surveyed by The Sun say programs like the San Joaquin methadone clinic and Alcoholics Anonymous that bring addicts in off the street for a few weeks of detoxification or a few hours of group counseling every day are the least likely to succeed with hard-core substance abusers.
"It amounts to drive-by therapy," says Dr. Satel, a professor of psychiatry at Yale and the University of Pennsylvania who has worked with addicts for seven years. "It may work fine for the early stage addict who still has a home, a family and a job. But that's not who you see on disability.
"These people are seriously debilitated drug abusers, and they need months of heavy-duty residential care that cuts them off from their addict friends and their old hang-outs, and teaches them a new way of life."
And it is precisely this kind of treatment that Congress has refused for 20 years to provide to the destitute substance abusers on federal disability. Today, there are only 68,000 federally funded in-treatment slots in the entire country.
"It's one of the terrible ironies of the disability program," says Dr. Satel. "Congress tells addicts, 'You have to be in treatment, but we're not going to give it to you -- and you can't use your check to buy it on your own.'"
Under the rules set up by Congress, Social Security is required to stop checks to addicts who are caught spending them in a residential program.
Adding insult to injury, counselors say, Congress ordered Social Security last summer to carry out a plan to cut off addicts' checks after three years. The agency says the move will trigger ** $275 million in notification, processing and legal costs -- enough to buy residential treatment for 35,000 addicts.
