Sometimes the Social Security Administration (SSA) can use the fact that you drink or use drugs as a reason to ignore your disabling symptoms and limitations and deny your claim. In other cases, however, it is possible to get disability benefits even if you drink or use drugs. Whether or not the SSA can deny your claim on the basis of alcohol or drug use depends on the nature of the medical condition for which you're applying.
Whether drug or alcohol use will affect a claimant's eligibility for disability benefits hinges on whether it contributes to the claimant's disabling medical condition. If a claimant's drug or alcohol abuse is deemed a material contributing factor to a medical impairment, that claimant will not win disability benefits based on that impairment. Materiality is determined by asking these questions: Is the medical condition for which the claimant alleges disability exacerbated (made worse)—or even caused—by alcohol or drug use? Would the medical condition improve enough not to be disabling if the claimant stopped using drugs or alcohol? If the answer to these questions is yes, the claimant's drug or alcohol use will be considered material to the alleged impairment, and the claimant may be found ineligible to receive disability benefits.
This evaluation is called a drug and alcohol abuse (DAA) determination. Of course, if the claimant has another medical condition, one that's severely debilitating and completely unrelated to the one caused by or exacerbated by drugs or alcohol, he or she could get disability benefits based on that condition, regardless of drug or alcohol use.
The SSA will ask the question, "If the claimant quits drinking or using drugs, will the claimant's medical condition improve?" To use an example, if a claimant has seizures, and the records indicate substance abuse, a claims examiner or judge (depending on the level the claim is at) will question what role is played by the claimant's use of substances. If the SSA thinks that a claimant's seizure condition would medically improve if the substance use or abuse came to an end, then the substance use or abuse would be labeled as material to the seizure condition. As a result, the claimant could not be awarded benefits on the basis of seizure disorder.
If, however, the conclusion was made that the claimant's frequency of seizures would continue regardless of whether or not the alcohol or drug use was discontinued, such use would be considered immaterial—in other words, irrelevant.
At the initial application level, a medical consultant (a doctor) who works for Disability Determination Services (DDS) will write an opinion giving his or her best guess on whether stopping the use of drugs or alcohol would have a positive effect on the person's medical condition and functional ability. The SSA should also ask the claimant's treating physician whether the claimant has drug addiction or alcoholism and what the expected effect of stopping the use of drugs or alcohol would be on the person's medical condition and functional ability.
On appeal, the judge at the hearing is not required to follow the opinion of a medical professional as to whether an claimant's drug or alcohol use is material; the judge can make a decision based on the regulations regarding DAA.
It doesn't matter whether past alcohol or drug abuse caused the medical condition. Here's another example. A claimant applies for Social Security disability based on liver dysfunction and alcoholic hepatitis. The claimant has a history of alcohol abuse, some of it recent. Will the alcohol abuse harm the claimant's disability case? It depends on whether or not it is currently material or immaterial to his condition. It doesn't matter whether the alcohol abuse caused the liver damage in the first place.
What matters is whether the disabling condition would disappear if the claimant stopped drinking. If the claimant's liver damage is so pronounced that ceasing alcohol use completely would make no difference to the claimant's medical condition, then alcohol abuse would be considered immaterial, or irrelevant, to the case. If, however, ceasing the use of alcohol would result in medical improvement, alcohol abuse would be deemed material to the disability case, and the claim would be denied.
Claimants whose disabling conditions are psychiatric or emotional in nature (for example, depression or anxiety) will have a harder time proving that their alcohol or drug use is not a contributing factor to their mental impairment. Most psychologists and psychiatrists believe that even moderate alcohol use contributes to depression.
Claimants for Social Security disability who have a history of alcohol or drug abuse but who are not currently using substances should carefully review their medical records before they file for disability. Often, medical doctors and mental health professionals will indicate "suspected use" in their treatment notes, and these indications, proven or otherwise, can have a damaging effect on a disability claim. For more information, see our article on admitting alcohol or drug use.
If you win your claim for disability but the SSA believes you are still abusing alcohol or drugs, the SSA will require that you have a representative payee and will refer you to a substance abuse treatment program. The SSA will send your disability check to the representative payee, who is in charge of doling out money to you and paying bills for you, and preventing you from spending money on your addiction. The representative payee can be a friend, family member, a person that you trust, such as a parent, or it can be a qualified organization. Learn more about representative payees.