JSIT19-02: Substance Use Disorder Treatment and Completion among Older Populations

Abstract

Twenty million Americans had a substance use disorder (SUD) in 2014. Nearly 8 million had a co-occurring mental health condition (SAMHSA, 2015). SUDs and mental health are often intertwined but the directionality is less clear (Brady et al., 2013). It has been well-established mental health diagnoses and utilization of mental health services are less prevalent among blacks and Hispanics (AHRQ, 2016). Lack of insurance, social stigma, distrust, lack of diversity and cultural incompetence among providers have been widely cited as contributing factors to disparities in mental health care utilization and diagnosis. The goal of this project is to better understand the landscape of the co-occurrence of SUD and mental health conditions among disability recipients who have been admitted to a SUD treatment facility. While simultaneously peeling back the layers and further assessing how policy changes may have had a heterogeneous effect across racial/ethnic lines. The project will commence by taking a retrospective look at the welfare policy changes of the 1990s and what it meant for individuals struggling with addiction and seeking treatment. Over the last several decades, national attitudes on addiction and substance use have ranged from a detrimental choice to a disease of the brain. Changes in public opinion and among the federal government have spurred policy changes. Unfortunately, these changes did not occur in a vacuum and have had undeniable consequences. The 1996 qualification changes to Disability Insurance (DI) and Supplemental Security Income (SSI) beneficiaries whose primary impairment was `drug addiction and/or alcoholism' (DA&A) had a disproportionate effect on black recipients (Waid and Barber, 2001). While previous research has examined this policy change on labor market outcomes, health care utilization and arrests, the literature on SUD treatment is slim and the examination of treatment by race/ethnicity and other demographics is nonexistent (Chatterji and Meara (2010), Hogan et al. (2010)). Using the Treatment Episode Data Set { Admissions (TEDS) from 1992 to present the project will set out by presenting a snapshot of the demographics of SUD treatment admissions of individuals who are not in the labor force due to a disability and admissions who identify disability payments as their primary source of income. Next, I will seek to use the 1996 changes in the DA&A program to draw causal inference on admissions conditioned on race, ethnicity, gender, substance type and insurance type. While it is clear the elimination of the program disproportionately impacted black recipients, it is less clear how this may have affected SUD treatment utilization.