Study Links Welfare Paydays to Rise in Drug Deaths

In the drug culture, “mother’s day” takes place early each month. It is the day when welfare checks arrive--a day when drug dealers know the extra money means more drug sales, so they stock well for the occasion.

This trend--so named because such checks have historically gone to “welfare mothers”--is well known to physicians and social workers who treat low-income substance abusers. The impact of using discretionary funds to purchase alcohol and drugs, however, is poorly documented in the medical literature.

Now, a study released today in the New England Journal of Medicine shows that across the U.S., there are more than 4,000 additional deaths during the first week of any month when compared with the last week of the preceding month. The increase, which was tightly linked to substance abuse, may be a sobering consequence of more drug and alcohol purchases as federal checks come in, the study suggests.

“This study shows that just as there are social changes at the beginning of the month, like evictions from rental property, there are also behavioral changes, like an increase in drug and alcohol use,” said sociologist David Phillips of UC San Diego, principal author of the study.

Previous research revealed fluctuations in certain forms of death during the year, like an increase in flu deaths in the winter months, or a higher rate of fatal car accidents during long weekends.

But the new analysis represents the first large-scale study to document a rise in mortality rates at the beginning of the month, and also the first one to link the peak in deaths to specific causes, such as substance abuse.

The authors examined more than 31 million death certificates in the United States from 1973 until 1988. The average number of deaths per week was about 38,500, or about 2 million per year.

Over the 16-year span, the number of deaths was unusually low in the week preceding the first of the next month, and then sharply increased during the first week of the month. In an average year, this amounted to 4,320 more deaths during the first week of each month than during the last week of the previous month. The authors named this abrupt shift the “boundary effect.”

When the researchers focused on those deaths related to behavioral factors--specifically substance abuse, homicide, accidents and suicide--the increase was significantly greater.

Since the end of the study period 11 years ago, some cities and states have experimented with staggering the mailings of welfare payments. But most welfare recipients continue to receive their stipends at the beginning of the month, according to federal officials.

Other reported causes of death revealing smaller but significant boundary effects included immune, respiratory and circulatory disorders.

Phillips and his colleagues could not directly assess the role of income on the boundary effect, as income status was not included in the death certificates. The authors decided to use race information as a rough determinant of income, since non-whites in the U.S. are more likely than whites to be poor.

The shift in death rates was greater among non-whites, providing indirect evidence that the boundary effect was related to poverty status.

“Presumably, this means a difference between rich and poor, not between black or white,” Phillips said.

Phillips agrees that although the study strongly established a link between the peak in deaths and substance abuse, researchers can only suggest--not prove--that this is caused by a rise in drug and alcohol purchases with federal income received that week.

But other studies support that assumption.

A 1995 article in the New England Journal of Medicine showed that psychiatric hospitalizations and cocaine use increased at the beginning of every month, as veterans got their disability payments.

Research by Dr. Kenneth Tardiff of the psychiatry department at Cornell University, and his colleagues, reveals a similar trend. Tardiff’s group found an increase in drug overdoses at the beginning of the month, and they believe that the shift is linked to arrival of disability payments.

According to Phillips, the findings suggest that limiting the amount of discretionary income available for drugs and alcohol might help reduce the number of deaths that occur at the beginning of the month.

“If the federal government were to deliver support in the same way that private agencies do [in the form of food, clothing and shelter], there would be less deaths,” he said.