Between Social Welfare and Public Health: Substance Abuse and Co-occurring Disability

Abstract

Through the decades, disability was defined along a number of dimensions. From the purview of labor and law, the US Social Security disability programs introduced in 1945 [I] framed a disabled individual as one unable to fully participate in civic and economic activities, requiring financial assistance from the state. Americans with Disabilily Act of 1990 operates on a sociopolitical model, in which a disabled person is entitled lo reasonable accommodation in order to function in society without discrimination. Both reflect what scholar Brucker deems a "positive" social construction of disability, that of equality and nondiscrimination. Introduction of substance abuse as a disability does not neatly fit into this discourse of charity and integration. Some stales like Louisiana and Michigan have considered and imposed laws to require drug testing for welfare recipients, ban ing those who test positive from food stamps, and other aids. Chicago Housing Authority, for example, has a policy requiring random drug resting of residents without grounds for suspicion. Along the same lines, ADA excludes active users of illicit substances from employment and to give tests for illegal use of drugs, a "punitive" model consistent with the above. The above purviews of medicine and law paint an ambiguous picture of substance abuse that spans a spectrum between irresponsible personal choice and disability. The chapter further elaborates on this biaxial model of substance abuse in the historical context of Social security disability programs and current public health guidelines. (PsycInfo Database Record (c) 2020 APA, all rights reserved)