In reality, the SSA can award disability benefits to claimants even if they’re currently struggling with active drug or alcohol abuse, but only if the agency determines that the claimant is disabled despite the drug or alcohol addiction.
Social Security publishes rulings (SSRs) that provide guidance for claims examiners and administrative law judges on how they should decide disability applications. SSR 13-2p is the agency’s ruling on how to evaluate claims with evidence of drug addiction or alcoholism (DAA).
The SSA can deny a disability claim if the agency determines that DAA is "a contributing factor material to the determination of disability." Material means that substance abuse plays such a significant role in your claim that the agency isn’t sure whether you’d be disabled if you stopped using drugs or alcohol.
SSR 13-2p clarifies Social Security’s procedure for deciding when DAA is material. The DAA process consists of a series of six questions.
The SSA will review your medical records for references to the abuse of drugs or alcohol. Red flags include the use of illicit street drugs such as methamphetamine, cocaine, and heroin, but the agency will also be on the lookout for signs of prescription drug abuse, such as getting a refill for opioids (like Vicodin) too quickly.
Social Security isn’t concerned with occasional or responsible use of alcohol or recreational drugs, so having a glass of wine at dinner won’t raise any eyebrows. But if you’re regularly indulging in excessive drinking to the point that your doctor diagnosed you with a substance use disorder, the SSA will likely consider that to be evidence of alcoholism.
Social Security will look at all your physical and mental limitations—including those resulting from DAA—and apply the sequential evaluation process to determine whether your impairments are disabling. If you wouldn’t be found disabled even while using drugs or alcohol, the agency will deny your claim without needing to consider if DAA is material.
The SSA no longer awards disability benefits based solely on substance abuse. (The agency used to approve claims based on addiction, but a 1996 law currently prevents Social Security from awarding benefits that way.) Later, the SSA would sometimes find claimants disabled under the listing of impairments for substance abuse, but the agency stopped that in 2017.
For people dealing with drug and alcohol addiction, no option currently exists for Social Security to award benefits on that basis alone. You’ll have to show that you have another condition that prevents you from working.
If Social Security determines that you do have disabling impairments, the agency’s next step is to determine whether they’re disabling by themselves or if they’re only disabling because of how they interact with your substance abuse.
The issue most frequently comes into play when a claimant is alleging disability due to a mental health condition, because even mild use of drugs and alcohol can exacerbate symptoms of depression and anxiety. In these cases, it’s important to establish a period of abstinence so that the SSA can get a picture of your mental health baseline without the effects of substance abuse.
Many physical conditions persist regardless of whether the claimant is abusing drugs or alcohol. In these cases, Social Security is unlikely to find that DAA is material, even when the physical condition resulted from substance abuse. For example:
The trickiest part of deciding whether DAA is material is determining whether a claimant would be disabled if drugs or alcohol weren’t in the picture. Social Security claims examiners and administrative law judges have to make an educated guess based on the evidence in the medical records.
Claimants who have recently stopped using drugs or alcohol and claimants with mental health issues can get tripped up at this step. For claimants newly clean and sober, Social Security might not yet have enough information about how they’re managing without the use of substances to tell if they could return to work. And because DAA affects work performance in areas like memory, mood, and concentration in much the same way that mental illnesses do, the agency can have a hard time deciding which limitations are a result of the mental condition and which are the result of DAA.
Let's look at an example to understand how the SSA makes a determination about whether substance abuse is material to a disability claim.
It doesn’t matter that Fred’s cirrhosis was likely caused by long-term alcohol abuse. The only relevant question is whether Fred would still be disabled if he quit drinking.
Claims involving DAA are rarely approved at the initial level. Especially when the claim involves both DAA and mental conditions, it can be very difficult for the claims examiner to determine whether the impairment would exist without drug and alcohol addiction. But you can greatly increase your chances of approval by getting your doctors to write a medical source statement in support of your disability claim.
Social Security values the opinions of doctors and mental health providers who you’ve seen regularly, so having a statement from your treating doctor saying that you have an ongoing disabling condition that would exist without DAA can be very helpful to win your case. If you think your doctor would write a supporting statement, try to get the opinion in writing as early as possible.
In practice, claimants with a history of drug or alcohol abuse face an uphill battle. Examiners and judges are mindful of damaging stereotypes about the disability program and can be reluctant to feed into them. Consider hiring an experienced disability attorney to help you with your claim. As long as you are upfront with your legal representative and with the SSA, you can show Social Security that your struggle with DAA doesn’t mean that you’re not disabled.
Updated October 28, 2022
]]>The Social Security Administration (SSA) considers you disabled if you have a "medically determinable" severe impairment that prevents you from working full-time for at least one year. Prior to 1997, that included applicants who were unable to work solely on the basis of drug addiction, alcoholism, or both.
Following the passage of the Contract with America Advancement Act of 1996 (H.R. 3136), however, the SSA is no longer allowed to award disability benefits based only on addiction or alcoholism, or any type of substance use disorder. (So alcoholics and drug addicts can't get disability without another severe physical or mental condition.)
Instead, the agency looks to see if you have any other physical or mental conditions that keep you from working and then determines whether your substance abuse is “material” to your disability. Drug or alcohol abuse (DAA) is material to your disability when your underlying medical condition would get better or go away entirely if you stopped using drugs or alcohol.
If Social Security finds that DAA is material to your condition, your claim will be denied. But it’s important to know that “materiality” doesn’t mean that the agency can deny a claim for disability solely because the applicant is an alcoholic or has a drug addiction. Even intentional misuse of illicit substances doesn’t automatically disqualify you from receiving benefits. However, you must show that you’d be unable to work even if you were clean and sober.
Before considering whether DAA is material to your disability claim, Social Security must see evidence that you’re using drugs or alcohol in a dysfunctional way. Generally, this means that a doctor has diagnosed you with substance abuse disorder, but a claims examiner might find evidence elsewhere in the medical records (such as clinic notes or hospital intake forms).
Not every instance (or instances) of alcohol or drug use are addictive—the SSA isn’t concerned if you have a glass of wine with dinner. But if your substance abuse disorder is damaging your body or causing disruptions in your work, family life, or social activities, it’s likely that Social Security will need to evaluate whether DAA is material in your case.
Materiality evaluations are technically a six-step process, but can be boiled down to two fundamental questions about the nature of your addiction or alcoholism.
Applicants are often surprised to learn that you can get disability for a medical condition that’s caused by substance abuse, as long as the limitations from the condition persist even when abstaining from drugs or alcohol—in other words, the effects aren’t “reversible.”
For example, say you have greatly reduced liver function from advanced cirrhosis despite years of sobriety. Social Security may find that the liver damage is permanent and can’t be repaired. Therefore, your history of alcoholism wouldn’t be material in determining disability. On the other hand, if your doctor tells you that your liver enzyme and protein levels would return to normal if you stopped drinking, the agency is very likely to conclude that DAA is material to your claim.
DAA is considered material when it makes the difference between finding you disabled or not disabled. So even if your medical condition would improve with abstinence or sobriety—but not so much that you’d be able to work—the SSA won’t deny you benefits based on substance abuse.
Returning to the cirrhosis example above, if your liver enzymes improved slightly but remained abnormal after you stopped drinking—resulting in excessive fatigue that made even sit-down jobs too difficult—Social Security would likely find that DAA isn’t material in your case, since you wouldn’t be able to work full-time regardless of sobriety.
Showing that disabling symptoms aren’t affected by substance abuse is easier for some conditions than others. For example, if severe degenerative disc disease reduces your range of motion to the point that you can’t lift anything heavier than five pounds, the agency will probably conclude that your limitations would be the same whether or not DAA was involved.
But many mental disorders can be intertwined with substance use in a way that can make it hard to determine which symptoms, if any, would improve without DAA. For this reason, it’s important for people with a mental disorder to establish some period of sobriety so Social Security can get an idea of your mental health symptoms without interference from drugs or alcohol.
Under Social Security Ruling SSR 13-2p, “Evaluating Cases Involving Drug Addiction and Alcoholism,” if you’re taking your prescription medication as prescribed—even highly addictive medications such as opioids or other narcotics—Social Security doesn’t find that drug use material, or even DAA. In the agency’s eyes, if you’re using your prescribed medication the way your doctor wants you to, you’re not abusing it, so DAA doesn’t come into play. In fact, the SSA takes into consideration any side effects you have from these potent painkillers when deciding whether you could work full-time.
But if you’re taking your medication at a higher dosage or greater frequency than your doctor prescribed, or you’re using prescription drugs meant for somebody else, Social Security can perform a DAA materiality determination and deny your claim if your prescription drug use is material.
Your medication is “taken as prescribed” when you follow the instructions of a licensed medical doctor with whom you have a doctor-patient relationship and who appropriately directs you to take a reasonable amount of medication for legitimate purposes. This means that you can’t ask your cousin the nurse to give you a fentanyl patch for a sprained ankle and expect that Social Security will ignore any DAA issues.
Any medication taken outside the scope of a doctor-patient relationship (or when the doctor-patient relationship has been “broken”) isn’t considered to be prescribed and is a potential contender for a DAA evaluation. Some examples may include:
Keep in mind that the SSA is aware of the addictive properties of these medications, and understands that disability applicants might make an undesirable or ill-advised decision when faced with a lack of availability. But the agency also recognizes the difference between somebody who takes a Vicodin pill from a friend to deal with an unexpected surge of pain and somebody with few doctors’ visits who buys large amounts of morphine off the internet. The former is less likely to need a DAA determination than the latter.
The most difficult, yet effective, method of proving that you’re disabled despite substance addiction or abuse is to establish a period of sobriety. If you have several months where you weren’t drinking or using, but you still experienced physical or mental symptoms from your underlying condition, that’s a strong indicator that DAA isn’t a material issue in your case.
Another persuasive method is to get a doctor’s note from a physician or psychiatrist who’s seen you on a regular basis. Social Security values the opinions of treating doctors, and if your doctor thinks that your drug or alcohol use doesn’t contribute to your medical condition and can provide a written letter to that effect, the agency will likely be persuaded that DAA isn’t material.
Depending on the specifics of your claim, showing that substance abuse doesn’t have an effect on your physical or mental health can be challenging. And even if the SSA doesn’t consider drug or alcohol use material to your case, you still need to prove that your medical condition keeps you from working. Consider contacting an experienced disability attorney to get help with your claim and gather the records needed to show the SSA that you’re disabled.
Updated January 30, 2024
]]>Can disability applicants with mental disorders who abuse medication, drugs, or alcohol still get disability benefits? It depends. Let's look at how Social Security treats applicants with drug or alcohol addictions.
For disability applicants with physical impairments, any limitations caused by substance abuse or addiction (for instance, fatigue, anxiety, depression, or difficulty concentrating) can't form the basis of a disability claim. Specifically, a person can't receive disability benefits if drug addiction or alcoholism (what Social Security calls "DAA") is a "material factor" in their disability. To decide whether drug or alcohol is a material factor, Social Security looks at whether a person's impairments or disabling limitations would be reversed of the applicant stopped using.
For example, if a person abuses alcohol and experiences severe abdominal pain from inflammation of the liver,Social Security won't consider this limitation as potentially disabling -- as long as it goes away when the person stops drinking. Likewise, stimulant drugs like methamphetamines can cause increased blood pressure, but this effect is reversible if the person stops taking methamphetamines, and so is not considered limiting. (However, if a person has a dependency on prescription stimulants, like Adderall, Social Security will consider whether any reversible effects of the drugs are limiting, as long as the medication is taken a prescribed. See Nolo's article on how prescription drugs affect disability for more information.)
But even if some of an applicant's disabling limitations would be reversed if the drug or alcohol use stopped, this doesn't mean the applicant can't get disability benefits. It just means that Social Security will consider only the following to determine if they are severe enough to qualify for disability benefits:
There are a few additional points to consider when the applicant claims a mental limitation or disability on his or her application.
Inability to abstain. Abusing medication is a common problem in clinical medicine. Patients with schizophrenia may, for example, abuse a number of substances in an attempt to control symptoms. These patients, because of their mental disorder, may not be able to abstain from using multiple drugs. For that reason, Social Security should never consider drug use by individuals with medically severe mental disorders like schizophrenia as a material factor unless:
Because of these issues, Social Security should be particularly hesitant to find drug or alcohol use a material factor in psychotic disorders, major depression, autism, bipolar disorder, organic brain disease (that's more than mild), and those with markedly low IQ.
In-person examinations. To make a DAA determination, a medical consultant working for Disability Determination Services will look at medical evidence regarding applicants' inability to sustain from substance abuse and whether their mental limitations would improve without substance abuse.
When information on these questions isn't available from the disability applicant's treating psychiatrist, Social Security will send an applicant to an independent mental consultative examination. Unlike with physical impairments, DDS medical consultants cannot rely on their expertise alone to provide an opinion that a mental disorder will improve with the cessation of drug use – the DDS medical consultant must look at evidence from either:
Further, evidence that a treating psychiatrist has given advice to a patient with schizophrenia or another serious mental disorder that he or she should not abuse legal or illegal drugs and that the advice has been disobeyed is not in itself sufficient for Social Security to consider the drug use a material DAA factor (and to ignore the applicant's mental limitations caused by the drug or alcohol use on account of their being reversible if the applicant stopped the substance abuse.) If there is any question, the benefit of the doubt should go to the applicant. For example, in most cases involving schizophrenia, it is too difficult to make predictions about what the person’s mental condition would be when not taking drugs.
In mental disorders of lesser severity, such as personality disorders, it is much more likely that Social Security will consider the drug use a material DAA issue and that any substance abuse-related mental limitations will be considered reversible if the applicant stopped using drugs or alcohol.
Reversibility of limitations. How does Social Security decide whether an applicant's mental impairments or limitations would still exist if the applicant stopped using drugs or alcohol? As in physical disorders, for those with mental, psychological, or emotional disorders, the informed judgment of a medical doctor (psychiatrist) is needed to evaluate whether drug use is a material factor in mental disability claims. (Read more in our article on who makes DAA determinations.)
Even if the opinion of the applicant's treating doctor is that there will be significant improvement if the applicant stopped using drugs or alcohol, Social Security won't find that DAA is a material factor unless the evidence of record supports that conclusion. Unsupported opinions (guessing or bias) from the applicant's psychiatrist or primary care doctor is no more acceptable from these treating sources than it would be from Social Security consultants or employees.
Also, Social Security should take particular care in accepting opinions from treating psychologists (rather than psychiatrists) that there would or would not be improvement in a mental disorder if the drug or alcohol use stopped. Although such opinions carry some weight, substance abuse issues involve drugs with many possible physical toxicities—including to the brain—of varying reversibility. Denials for drug or alcohol use based on a treating psychologist’s or other non-physician’s opinion would be questionable on the part of Social Security, just as they would be for a Disability Determination Services consulting psychologist or one performing an independent consultative mental status examination.
Periods of abstinence and ability to abstain. If the applicant has abstained from abusing drugs or alcohol for some amount of time, Social Security will look to whether the applicant's mental limitations improved during that time period. But again, even if periods of abstinence show clear and significant sustained mental improvement in the past, that is not a compelling argument that a claimant with drug or alcohol addiction and an additional severe mental disorder, such as a schizophrenia, has the judgment or ability to modify their abusing behavior. This is true even if the applicant's doctor submits an opinion to the contrary.
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