O those of the full sample (Supplementary Table 3) (17). Identified participants had an average age of 44.6 years and half were female. Six participants were Caucasian (non-Hispanic), 3 participants were Hispanic (Puerto Rican), and 1 participant was African American (non-Hispanic). Of the 10 cases identified as ambiguous, 5 had order CBIC2 discordant ratings on at least one of the incapability criteria and 7 were identified as difficult to judge. Sources of Ambiguity Distinguishing incapability from the challenges of navigating poverty caused ambiguity–In two people, ambiguities arose because it was unclear whether it was poverty or nonessential spending that had played a greater role in a participant’s failure to meet basic needs. One participant reported spending money on organic food, causing her to run short of money mid-way through the month. She also reported lending money to others despite not always having enough money to meet her own needs. Lack of funds contributed to her occasionally going hungry, as well as missing medical appointments due to an inability to pay for transportation. However the participant’s income was so small that, even if she did not spend any money on non-essential items, she may still have had difficulty meeting her basic needs. A second participant reported spending most of her income on essentials, but would occasionally spend money on things she could not afford (i.e. pets, loaning money to others). She reported difficulty paying bills and meeting basic needs. However, support from family and friends prevented her from losing her housing. In the recent past, she had gone hungry and lost weight after her food stamps were cut off. The amount of nonessential spending that had to occur for a participant to be considered incapable contributed to ambiguity–Ambiguities also arose around the amount of nonessential spending when the beneficiary’s basic needs were being met through the help of outside resources, not SSDI monies provided to the beneficiary for that purpose. One individual reported spending 350 per month on drugs and alcohol, 75 on dining out, and 100 on charitable donations. Most months, however, she was able to meet her basic needs with help from her husband’s income, money from her family, food stamps, and the occasional use of a food bank. Another participant reported spending nearly half of her income on buy Lixisenatide cigarettes and consequently ran low on food at the end of most months, could not replace her worn-out clothes, and only purchased medications that had no co-pays due to lack of funds.Psychiatr Serv. Author manuscript; available in PMC 2016 March 01.Lazar et al.PageNevertheless, her needs were mostly met and she was usually able to get a money order to cover her basic needs. Modest spending on harmful things caused ambiguity–In three beneficiaries, ambiguities were related to judgments about how much spending on harmful things renders someone incapable. In each case, the assessor had difficulty judging the participant’s financial capability because participants were only spending modest amounts, or nothing, on harmful things, but consequences were often quite severe. While substance use alone is not sufficient to find a person financially incapable (20), these beneficiaries’ substance use was associated with risky behaviors, vulnerability to victimization, and intoxication, all of which suggest the beneficiaries are not acting in their own best interest which may impact their ability to manage fun.O those of the full sample (Supplementary Table 3) (17). Identified participants had an average age of 44.6 years and half were female. Six participants were Caucasian (non-Hispanic), 3 participants were Hispanic (Puerto Rican), and 1 participant was African American (non-Hispanic). Of the 10 cases identified as ambiguous, 5 had discordant ratings on at least one of the incapability criteria and 7 were identified as difficult to judge. Sources of Ambiguity Distinguishing incapability from the challenges of navigating poverty caused ambiguity–In two people, ambiguities arose because it was unclear whether it was poverty or nonessential spending that had played a greater role in a participant’s failure to meet basic needs. One participant reported spending money on organic food, causing her to run short of money mid-way through the month. She also reported lending money to others despite not always having enough money to meet her own needs. Lack of funds contributed to her occasionally going hungry, as well as missing medical appointments due to an inability to pay for transportation. However the participant’s income was so small that, even if she did not spend any money on non-essential items, she may still have had difficulty meeting her basic needs. A second participant reported spending most of her income on essentials, but would occasionally spend money on things she could not afford (i.e. pets, loaning money to others). She reported difficulty paying bills and meeting basic needs. However, support from family and friends prevented her from losing her housing. In the recent past, she had gone hungry and lost weight after her food stamps were cut off. The amount of nonessential spending that had to occur for a participant to be considered incapable contributed to ambiguity–Ambiguities also arose around the amount of nonessential spending when the beneficiary’s basic needs were being met through the help of outside resources, not SSDI monies provided to the beneficiary for that purpose. One individual reported spending 350 per month on drugs and alcohol, 75 on dining out, and 100 on charitable donations. Most months, however, she was able to meet her basic needs with help from her husband’s income, money from her family, food stamps, and the occasional use of a food bank. Another participant reported spending nearly half of her income on cigarettes and consequently ran low on food at the end of most months, could not replace her worn-out clothes, and only purchased medications that had no co-pays due to lack of funds.Psychiatr Serv. Author manuscript; available in PMC 2016 March 01.Lazar et al.PageNevertheless, her needs were mostly met and she was usually able to get a money order to cover her basic needs. Modest spending on harmful things caused ambiguity–In three beneficiaries, ambiguities were related to judgments about how much spending on harmful things renders someone incapable. In each case, the assessor had difficulty judging the participant’s financial capability because participants were only spending modest amounts, or nothing, on harmful things, but consequences were often quite severe. While substance use alone is not sufficient to find a person financially incapable (20), these beneficiaries’ substance use was associated with risky behaviors, vulnerability to victimization, and intoxication, all of which suggest the beneficiaries are not acting in their own best interest which may impact their ability to manage fun.