August 26, 1999
Study links sobriety to money management among mentally ill patients
More freedom to manage their money independently can be an incentive for mentally ill substance abusers to abstain from drugs and alcohol, according to new research at Harborview Medical Center.
The study, funded by the National Institute of Drug Abuse, tracked 47 patients at the Harborview Recovery and Rehabilitation Program (HAARP) who receive Social Security benefits for severe mental illness and who also have drug and alcohol problems.
Out of a typical $500 per month total benefit, about $300 in rent was paid, and the remaining $200 was split differently among two groups. The control group received cash payments throughout the month with no strings attached, while the experimental group received their allotments based on behavior. Those in the second group who continued to use substances received small daily amounts of cash or food vouchers to deter them from spending large sums on drugs. After six months, the experimental group was found to have about 30 percent more weeks “clean.”
“The program is aimed at preventing patients from spending money on drugs or in an impulsive manner, and at creating incentives and benefits to stay clean and sober,” says Dr. Richard Ries, director of outpatient psychiatry and of the Chemical Dependency Program at Harborview, and University of Washington associate professor of psychiatry.
When it started in 1992, HAARP was one of a handful of large-scale programs to seamlessly integrate treatment for severe drug and alcohol addiction and persistent mental illness. “Historically the two disorders were under separate administrative and treatment systems, and patients would fall between the cracks, with drastic consequences,” says Ries.
The program, now with 330 patients, has served as a model for similar mental- health programs in the US and Canada. It provides “one-stop shopping” by treating patients for mental health and taking care of their housing, banking and even nutritional needs, if needed.
Problems are minimized by regulating housing for certain patients. Housing coordinators arrange leases with apartment managers, who are receptive because they can fill their units with tenants whose rent is guaranteed, says Ries. If behavioral problems occur, case managers are called to handle them. Later this year, a 15-unit apartment complex in West Seattle will open for those receiving long-term outpatient care from Harborview Mental Health Services and who are on federal assistance. Harborview staff will visit daily to assist with medications and counseling.
HAARP also provides vocational development for those in later phases of treatment to prevent them from turning to drugs or alcohol out of boredom. Many patients help recycle some 20 tons of paper at Harborview each month. Others are placed in community jobs that are monitored by Harborview case workers. However, one of the main obstacles to paid employment for those who are well enough to work is the potential loss of health-care benefits. “Hopefully, Congress will soon pass a law that will continue these benefits for those with disabilities who make the effort to work,” says Ries.
“Our biggest challenge is to help people who have been out of work for some 20 years, or who have never worked, to do something productive,” he adds. “Many patients remain fearful or unmotivated. Better medications and our integrated treatment models are helping, but we have a long way to go.”
