Drink, Drugs and Disability: An Introduction to the Controversy

This paper reviews the history of the drug addiction and alcoholism (DA&A) program within Supplemental Security Income (SSI) and the controversies that dogged the years before its termination in 1996. The DA&A program began in 1972, and for reasons understood early on, it was susceptible to rapid growth and discrediting scandal. Through the mid-1980s, the program remained very small, mainly because of a conservative judicial climate that limited the ground for claiming substance abuse as a disabling impairment. Once the legal barriers were breached, SSI became an attractive welfare alternative for impoverished substance abusers and for local governments seeking to shift welfare and medical assistance costs to the federal government. By the early 1990s, program growth was extraordinary, and oversight bodies deemed the program out of control. This was compounded by highly publicized misuse of funds by beneficiaries. Seen as an instance of state-induced harm, the program became an early target of the conservative welfare reformers who took control of Congress after the 1994 elections

Now Invited to Testify: Former Beneficiaries Appraise the SSI Drug Addiction and Alcoholism Program

As part of the larger SSI Study, we conducted detailed semistructured interviews with 156 respondents in four sites. They spoke at length about matters of legislative concern during the reform and subsequent abolition of the drug addiction and alcoholism (DA&A) program. Respondents were quite aware of the problems considered by Congress. Some acknowledged using SSI payments to buy alcohol and other drugs, and a few claimed to have squandered large retroactive payments. Most insisted that they spent their checks wisely, however, and discussed how they did so. With a remarkable degree of consensus, respondents favored the DA&A program\u27s paternalistic features of representative payment and mandatory treatment, and while less in agreement about time limits, they approved in theory of benchmarks to measure progress. A substantial majority believed the DA&A program had been an unalloyed good, and only 12 judged it to have been wholly harmful

Now Invited to Testify: Former Beneficiaries Appraise the SSI Drug Addiction and Alcoholism Program

As part of the larger SSI Study, we conducted detailed semistructured interviews with 156 respondents in four sites. They spoke at length about matters of legislative concern during the reform and subsequent abolition of the drug addiction and alcoholism (DA&A) program. Respondents were quite aware of the problems considered by Congress. Some acknowledged using SSI payments to buy alcohol and other drugs, and a few claimed to have squandered large retroactive payments. Most insisted that they spent their checks wisely, however, and discussed how they did so. With a remarkable degree of consensus, respondents favored the DA&A program\u27s paternalistic features of representative payment and mandatory treatment, and while less in agreement about time limits, they approved in theory of benchmarks to measure progress. A substantial majority believed the DA&A program had been an unalloyed good, and only 12 judged it to have been wholly harmful

The Bottom Line: Employment and Barriers to Work among Former SSI DA&A Beneficiaries

The Supplemental Security Income (SSI) program for drug addicts and alcoholists (DA&A beneficiaries) ended in January 1997 without any special effort to create employment for those who lost benefits. Relying on data from a nine-site, two-year panel study of 1,764 former DA&A recipients and detailed semistructured interviews with subsamples in four sites, this paper examines employment outcomes and barriers to employment among 611 respondents who lost SSI and did not replace it with another form of publicly funded income assistance. Despite the tight labor market of the late 1990s, this group was plagued by widespread unemployment and sub-employment. At the two-year follow-up, only 25% earned $500 per month or more, and only 12% typically earned this much throughout the study. Given their age, health problems and limited human capital, it is likely that many former DA&A beneficiaries will remain indigent, returning to the SSI rolls when they requalify upon turning 65

Modeling the initiation of others into injection drug use, using data from 2,500 injectors surveyed in Scotland during 2008-2009

The prevalence of injection drug use has been of especial interest for assessment of the impact of blood-borne viruses. However, the incidence of injection drug use has been underresearched. Our 2-fold aim in this study was to estimate 1) how many other persons, per annum, an injection drug user (IDU) has the equivalent of full responsibility (EFR) for initiating into injection drug use and 2) the consequences for IDUs' replacement rate. EFR initiation rates are strongly associated with incarceration history, so that our analysis of IDUs' replacement rate must incorporate when, in their injecting career, IDUs were first incarcerated. To do so, we have first to estimate piecewise constant incarceration rates in conjunction with EFR initiation rates, which are then combined with rates of cessation from injecting to model IDUs' replacement rate over their injecting career, analogous to the reproduction number of an epidemic model. We apply our approach to Scotland's IDUs, using over 2,500 anonymous injector participants who were interviewed in Scotland's Needle Exchange Surveillance Initiative during 2008-2009. Our approach was made possible by the inclusion of key questions about initiations. Finally, we extend our model to include an immediate quit rate, as a reasoned compensation for higher-than-expected replacement rates, and we estimate how high initiates' quit rate should be for IDUs' replacement rate to be 1

Early development of accelerated graft coronary artery disease: Risk factors and course

AbstractObjectives. This study assessed the time of first appearance of angiographic graft coronary artery disease in relation to clinical and laboratory variables and clinical events in heart transplant recipients.Background. Graft coronary artery disease is the main factor limiting long-term survival after heart transplantation, and it is important to understand its natural history.Methods. One hundred thirty-nine consecutive patients who developed angiographic coronary artery disease after heart transplantation were classified according to early (≤2 years) versus late (>2 years) posttransplantation initial detection of coronary artery disease. These subgroups were analyzed for differences in clinical and laboratory demographics, incidence of progression to ischemic events and incidence of antecedent cytomegalovirus infection.Results. The early-onset group (64 patients) had more rapid progression to ischemic events than the late-onset group (75 patients), with 59% of the late group and only 35% of the early group free from ischemic events by 5 years after initial detection (p = 0.02), but there were no significantly correlated clinical or laboratory predictors of ischemic events. The early group had a significantly higher incidence of antecedent cytomegalovirus infection.Conclusions. We conclude that 1) accelerated graft coronary artery disease develops at variable times after heart transplantation; 2) the early appearance of graft coronary artery disease may be a marker of intrinsically more aggressive disease; 3) cytomegalovirus infection is associated with earlier onset of graft coronary artery disease. Patients with early development of graft coronary artery disease should potentially be given priority for interventional strategies as they are developed

Atomic Oxygen Textured Polymers

Atomic oxygen can be used to microscopically alter the surface morphology of polymeric materials in space or in ground laboratory facilities. For polymeric materials whose sole oxidation products are volatile species, directed atomic oxygen reactions produce surfaces of microscopic cones. However, isotropic atomic oxygen exposure results in polymer surfaces covered with lower aspect ratio sharp-edged craters. Isotropic atomic oxygen plasma exposure of polymers typically causes a significant decrease in water contact angle as well as altered coefficient of static friction. Such surface alterations may be of benefit for industrial and biomedical applications. The results of atomic oxygen plasma exposure of thirty-three (33) different polymers are presented, including typical morphology changes, effects on water contact angle, and coefficient of static friction

A genome-wide study of blood pressure in African Americans accounting for gene-smoking interaction

Cigarette smoking has been shown to be a health hazard. In addition to being considered a negative lifestyle behavior, studies have shown that cigarette smoking has been linked to genetic underpinnings of hypertension. Because African Americans have the highest incidence and prevalence of hypertension, we examined the joint effect of genetics and cigarette smoking on health among this understudied population. The sample included African Americans from the genome wide association studies of HyperGEN (N = 1083, discovery sample) and GENOA (N = 1427, replication sample), both part of the FBPP. Results suggested that 2 SNPs located on chromosomes 14 (NEDD8; rs11158609; raw p = 9.80 × 10(−9), genomic control-adjusted p = 2.09 × 10(−7)) and 17 (TTYH2; rs8078051; raw p = 6.28 × 10(−8), genomic control-adjusted p = 9.65 × 10(−7)) were associated with SBP including the genetic interaction with cigarette smoking. These two SNPs were not associated with SBP in a main genetic effect only model. This study advances knowledge in the area of main and joint effects of genetics and cigarette smoking on hypertension among African Americans and offers a model to the reader for assessing these risks. More research is required to determine how these genes play a role in expression of hypertension

The Effect of Cone Opsin Mutations on Retinal Structure and the Integrity of the Photoreceptor Mosaic

Purpose. To evaluate retinal structure and photoreceptor mosaic integrity in subjects with OPN1LW and OPN1MW mutations. Methods. Eleven subjects were recruited, eight of whom have been previously described. Cone and rod density was measured using images of the photoreceptor mosaic obtained from an adaptive optics scanning light ophthalmoscope (AOSLO). Total retinal thickness, inner retinal thickness, and outer nuclear layer plus Henle fiber layer (ONL+HFL) thickness were measured using cross-sectional spectral-domain optical coherence tomography (SD-OCT) images. Molecular genetic analyses were performed to characterize the OPN1LW/OPN1MW gene array. Results. While disruptions in retinal lamination and cone mosaic structure were observed in all subjects, genotype-specific differences were also observed. For example, subjects with “L/M interchange” mutations resulting from intermixing of ancestral OPN1LW and OPN1MW genes had significant residual cone structure in the parafovea (∼25% of normal), despite widespread retinal disruption that included a large foveal lesion and thinning of the parafoveal inner retina. These subjects also reported a later-onset, progressive loss of visual function. In contrast, subjects with the C203R missense mutation presented with congenital blue cone monochromacy, with retinal lamination defects being restricted to the ONL+HFL and the degree of residual cone structure (8% of normal) being consistent with that expected for the S-cone submosaic. Conclusions. The photoreceptor phenotype associated with OPN1LW and OPN1MW mutations is highly variable. These findings have implications for the potential restoration of visual function in subjects with opsin mutations. Our study highlights the importance of high-resolution phenotyping to characterize cellular structure in inherited retinal disease; such information will be critical for selecting patients most likely to respond to therapeutic intervention and for establishing a baseline for evaluating treatment efficacy