The ‘check effect’ reconsidered

Abstract

Aims The “check effect” refers to the use of disability payments to purchase illegal drugs or alcohol. This article describes subsequent research concerning three interrelated issues: the check effect, whether receipt of disability payments is associated with more overall substance use, and potential policy responses to misuse of disability payments for substances. Methods Review and synthesis of published articles. Results Increased substance use at the beginning of the month has been described in a variety of settings. The tendency to purchase substances at the beginning of the month is impacted by household wealth, the tendency to discount future rewards, and cyclical economic activity. However, in naturalistic observational cohort studies, beneficiaries who receive disability payments had no greater substance use than those without disability payments. Potential policy responses to misspending of disability checks include financial counseling that discourages spending on drugs, and the assignment of a representative payee to prevent misuse of benefits for substances. Assignment of a representative payee per se has not been associated with reduced substance use but payeeship administered by agencies that integrate payee practice into treatment has been. Conclusion Disability payments impact the timing of substance use, but receipt of disability payments is not associated with more overall substance use than unalleviated poverty. Money management-based clinical interventions, which may involve assignment of a representative payee, can minimize the purchase of substances with disability payments.

Increased drug use and the timing of social assistance receipt among people who use illicit drugs

“…These findings support a growing body of evidence that drug use and drug-related harm increase following SA cheque issue (Rosen, 2011). For example, the results from our study are consistent with prior aggregate-level results compiled from Insite, a supervised injection facility in Vancouver, showing an immediate increase following monthly SA disbursement for both the total number of injections performed and rates of non-fatal overdose (Zlotorzynska et al, 2014).…”

“…A recent review has pointed out that monthly SA disbursement schedule alters the timing of substance use rather than increase the overall level of use over an extended timeframe (Rosen, 2011). Intensified use immediately following SA receipt may be the cause of much of the drug-related harm identified by observational studies to date.…”

Income level and drug related harm among people who use injection drugs in a Canadian setting

“…Conversely, receipt of social assistance has been temporally linked to increases in drug consumption, binge drug use, overdose and violence, with the odds of high intensity drug use being significantly higher in the days following social assistance payments (Dobkin & Puller, 2006; Li et al, 2007; Riddell & Riddell, 2006). However, there is no indication that receipt of social assistance increases overall drug use above unabated poverty (Rosen, 2011). Participation in drug dealing has been associated with elevated risks of overdose and frequent drug use in addition to violence, HIV infection, and incarceration (Curry & Latkin, 2003; Latkin, 2002; Semple et al, 2011; Small et al 2013; Werb et al, 2008).…”

Incomes and Outcomes: Social Security Disability Benefits in First-Episode Psychosis

“…It was unexpected that new SSA beneficiaries showed a tendency toward fewer days of alcohol intoxication after being awarded benefits, since several previous studies have found receipt of a disability benefit check at the beginning of each month to be associated with increased substance use (36,37). While treatment studies have failed to confirm a relationship between public support benefits and substance use (38), none to our knowledge have found a reduction in substance use.…”