WELFARE CHECKS SPIKE DRUG SALES, DEATHS, STUDY HINTS

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.