Although drug addiction often substantially impairs a person’s ability to work, an applicant will not be approved for disability on the basis of the drug addiction alone. Even though the effects of substance abuse may prevent an individual from maintaining regular employment, Social Security does not consider substance abuse to be disabling until it causes other irreversible medical conditions. However, this does not mean that you cannot win approval for a physical or mental condition that was caused by a drug addiction. The Social Security Administration (SSA) begins all reviews of claims for disability in the same manner, regardless of the alleged impairment or its cause.
Basic Eligibility for Disability Benefits
Once you have filed your claim for disability, the SSA must make sure you meet the following basic requirements:
- You may not earn $1,070 or more a month from working.
- Your condition must be expected to last at least 12 months, and
- Your condition must have a severe impact on your ability to work
If you do not meet these basic requirements, the SSA will automatically deny your claim. However, if you do meet these basic requirements, the SSA will then determine whether your illness meets one of the qualifying conditions in the SSA’s Listing of Impairments. If your illness meets all the criteria of one of the conditions in these disability listings, your claim for disability will be automatically approved.
Drug Addiction Disability Listing
Social Security acknowledges that the use of substances can cause medical and mental conditions that cannot be reversed simply by abstaining from the substances. At some point, most substance abusers have irreversible medical or mental problems because of the changes that occur throughout the body from prolonged use of alcohol or narcotics.
Social Security discusses drug addiction in its disability listing called Substance Addiction Disorders. To meet the requirements of this listing (12.09), you must have suffered changes in your behavior or physical health due to your regular abuse of a drug. The drug can be any prescription or illegal drug that affected your central nervous system. You must also have a physical or mental impairment that was caused by the drug abuse, which you must prove by meeting the listing criteria for one of the following conditions:
- Organic mental disorders
- Liver damage
- Peripheral neuropathies, or
- Personality disorders.
For more information on these individual disorders, see our article on disability benefits for chronic alcoholism, which is also evaluated under the listing for Substance Addiction Disorders.
Ongoing Drug Use
If you have been medically diagnosed with drug addiction, the SSA cannot generally hold this against you when determining whether you are eligible for disability because of a physical or mental condition other than drug abuse. However, if the SSA determined that your illness would go away if you stopped abusing drugs, the SSA will deny your claim. For instance, if you have drug-induced hepatitis, the SSA would likely find that it would go away if you quit using drugs.
However, if the SSA finds that your quitting drugs would not improve your disabling condition, you could be granted disability benefits. This could be true if your drug addiction caused the condition, such as advanced, irreversible liver failure, or if your drug addiction is unrelated to the condition, such as thyroid cancer that predated your prescription drug abuse, as long as stopping the drug use would be irrelevant to your disabling condition.
To determine whether your drug use is material or immaterial to your disability, the SSA will perform a drug/alcohol addiction (DAA) evaluation.
If you win your claim for disability but the SSA believes you are still using drugs, the SSA may require that you attend treatment for your drug addiction and that you have a representative payee. A representative payee will receive your Social Security check and manage your payments on your behalf. The representative payee can be a person that you trust such as a parent or it can be a qualified organization. The representative payee is expected to prevent you from spending the money on drugs. Learn more about representative payees.
What Medical Evidence Do I Need?
The medical evidence needed to win your claim will depend on what condition you suffer from as a result of your drug addiction. If you have been diagnosed with a mental illness, you must provide psychiatric reports, names and addresses of your treating physicians (this includes social workers and physician’s assistants), a detailed history of all hospitalizations, mental health status reports, a list of prescribed medications and their side effects, and any other information that supports your claim.
If you suffer from a physical impairment, you must provide the SSA with the names of your treating physicians, reports from any diagnostic tests, a complete list of medications and their side effects, and information about any hospitalizations.
What If I Don’t Meet The Listing Requirements?
If you don’t meet the listing requirements for one of the above disability listings, it is still possible to win your claim for disability if you have significant functional limitations (for example, your doctor says you can walk or stand only 2 hours per day). If you suffer from a physical illness, the SSA will assess your residual functional capacity (RFC) to find out all of the work-related limitations that result from your impairments. The RFC should describe how much you can lift or carry, how far you can walk, how long you are able to sit and stand, and whether there are limits in your ability to reach, bend, or stoop.
If you suffer from mental illness, the SSA will assess your mental RFC (MRFC), which discusses your work-related limitations. For example, if you have difficulty focusing, following directions, being reliable, getting along with others, or relating to authority because of your mental illness, the MRFC should reflect this. An MRFC should also state whether you are currently suffering from your addiction.
At this stage, the SSA will determine whether, given your RFC, you can still do your old job despite your illness. If your only impairment is your drug addiction, the SSA will find that you can perform your old job and your claim will be denied. However, if you have multiple conditions that keep you from working, the SSA will consider your age, education, and past work experience with the combined effects of your illness to decide if there is other work you can do. If it finds you can do another job, your claim will be denied.
The more limitations you can prove, the more likely the SSA is to approve your claim, so provide the SSA with as much medical evidence as possible to support your RFCs. Learn more about how the SSA assess your physical RFC and your mental RFC.