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. 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 irreversible medical conditions. 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.
Once you have filed your claim for disability, the SSA must make sure you meet the following basic requirements:
If you do not meet these basic requirements, the SSA will automatically deny your claim.
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 chronic substance abusers will have irreversible medical or mental problems because of the changes that occur throughout the body from prolonged use of narcotics.
Social Security no longer has a disability "listing" for drug addiction. Until 2017, there was a listing for substance addiction disorders that you could meet if you had suffered specific changes in your behavior or physical health due to regular abuse of any prescription or illegal drug that affected your central nervous system. The changes that qualified were brain damage, liver damage, pancreatitis, gastritis, peripheral neuropathy, seizures, anxiety disorder, major clinical depression, or personality disorder.
The listing for substance addiction disorders required that you met the criteria of the listing for the particular condition. As of 2018, there is no longer a listing for addiction, but you can still qualify for disability benefits by meeting the criteria of any of the listings for impairments caused by substance abuse:
For more information on the listings for these individual disorders, visit the above links.
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 determines that your illness would go away if you stopped abusing drugs, the SSA can properly 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 a 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.
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.
If you don’t meet the listing requirements for one of the above disability listings, it's 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 two hours per day). If you suffer from a physical illness, the SSA will assess your physical 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 impairments, 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 condition, the MRFC will reflect this. 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.
At this stage, the SSA will determine whether, given your RFC and/or MRFC, you can still do your old job despite your illness. If not, the SSA will consider your age, education, and past work experience along with the combined effects of your medical condition to decide if there is other work you can do. If the agency finds you can do another job, your claim will be denied. Learn more about how the SSA assesses your physical RFC and your mental RFC.