Disability Claims Based, in Part, on Substance Abuse

The finer points of how the SSA decides if drug or alcohol use is a contributing factor to your disability.

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It is widely believed that having a substance abuse problem makes it impossible to receive SSD benefits. That is simply not true.

Since 1996, the Social Security Act has stated that an individual may not be found eligible for SSD or SSI benefits if drug and/or alcohol addiction or abuse (DAA) is a "material factor" causing the disability. What this means, in everyday words, is that benefits will not be paid to a claimant whose disability is mainly caused by DAA, if the person is still using drugs or alcohol. However, if the claimant has a disabling medical condition in addition to an alcohol addiction, benefits can sometimes still be awarded even if the person is still drinking or drugging. A simple example of this is that a blind person is still eligible for benefits even if they have have a drug addiction, because their vision deficit prevents them from working, regardless of whether they are doing drugs.

The Rules on Drug or Alcohol Abuse

First, having a history of drug and/or alcohol abuse does not prevent a client from receiving benefits. If, for instance, a claimant has irreversible liver damage caused by alcoholism, but no longer drinks, the ongoing effects of the liver condition will be considered as part of their disability.

Second, if the disability applicant is still drinking or using drugs, the Social Security Administration will do a DAA determination -- that is, the agency will evaluate whether the drug or alcohol abuse is causing or adding to the applicant's other mental or physical problems.

Third, it is understood that recovery from drug and/or alcohol addiction is a long process and that relapses can, and many times do, occur. The fact that a claimant relapsed does not doom their case. Since, as explained above, the analysis is whether their non-DAA conditions are disabling regardless of the effects of DAA, in a case involving relapses, there will undoubtedly be evidence of how the client was functioning during periods of sobriety; in fact, Social Security policy states that periods of 30 days of sobriety are sufficient in most cases to evaluate the impact of DAA on other medical or mental conditions. And, to state the obvious, the adjudicators and Judges at Social Security are people too—when it is clear that the client is working at overcoming their addiction(s) it is easier to give him or her the benefit of the doubt.

How Other Impairments Impact the Claim

Of course it can be much more complicated than that, especially when the other impairment(s) is a mental health impairment. This is true because of the fact that drug or alcohol addiction (DAA) exacerbates many mental impairments, and because of the inherent "chicken or egg" question involved (for example, is the claimant depressed because he drinks, or vice versa?). These borderlines can be challenging but successful cases if they are handled correctly.

Cases of Continuous Use without Treatment

The real "problem case" lies in continuous, current use or drugs or alcohol and no treatment. Even here, however, if there are periods of sobriety of 30 days or more, and there is documentation that the client's other severe medical or mental health symptoms continue to disable him or her during these periods despite refraining from drugs and alcohol, it is possible to make an argument for disability.

Treatment Is Key

The bottom line is that, from the standpoint of being successful in a Social Security disability case where DAA is involved, there just isn't any better "strategy" than for the disability applicant to be in a regular treatment plan. The message of accountability is not only the best plan for a claimant's life, it's the best plan for their case. Compliance with treatment is an issue in all disability claims, but judges are generally more sensitive on this issue in cases involving DAA. Perfection is not the standard; it has been our experience that when the client has been making honest efforts to seek help, and to help themselves, that it is usually possible to be successful in their disability claim, despite DAA.

Fore more information, see all of our articles on how drug and alcohol use affect Social Security disability.

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