There are two common misconceptions about how drug and alcohol abuse can affect a Social Security disability case. The first is that a person with a history of substance abuse or ongoing drug abuse can never be approved for disability benefits. On the opposite end of the spectrum, some people mistakenly believe that disability benefits can be awarded solely on the basis of a diagnosis of alcoholism or drug addiction. While this was in fact the case until the mid-1990s, this policy is no longer in effect.
Somewhere between these misconceptions lies the truth. An individual who was or is addicted to drugs or alcohol may be approved for disability benefits, but only if Social Security determines that the person would still be disabled if he or she wasn't still using drugs or alcohol.
How Social Security Decides Cases Involving Drug and Alcohol Abuse
Social Security can deny a disability claim if the agency determines that drug addiction or alcoholism (DAA) is "a contributing factor material to the determination of disability." DAA is not "material" to the disability determination when an individual would still meet SSA's definition of disability even if he or she were not using drugs or alcohol. The way in which Social Security makes the materiality determination has, over the years, been a source of confusion for disability claimants, disability attorneys, Social Security employees, and even judges. In 2013, the Social Security Administration issued SSR 13-2p, a rule clarifying how cases involving drug addiction and alcoholism (DAA) are decided.
The DAA process consists of a series of six questions:
- Is DAA involved in the case? If there is any evidence in the record of past or current substance abuse, the case will proceed to step two. Which substances are considered "drugs" that could trigger a DAA determination? Street drugs such as cocaine and heroin certainly qualify, but so do prescription drugs like opioids, depressants, and stimulants (unless they are taken as prescribed). Note that while caffeine and nicotine are technically "drugs," use or abuse of these substances does not give rise to a DAA determination by Social Security.
- Do the claimant's impairments, including DAA, qualify him as "disabled"? If the claimant does not meet Social Security's definition of disability, even including the claimant's drug or alcohol abuse, the claimant's case will be denied. If the claimant is found to be disabled, the case proceeds to the next step.
- Is DAA the only impairment? If so, benefits will be denied. Alcoholism and drug addiction cannot form the sole basis for a successful disability claim.
- Are the claimant's non-DAA impairments (whether physical or mental) disabling by themselves, or are they disabling because of the DAA? If your impairments leave you unable to work only because you're using drugs or alcohol, DAA will be found "material" and your case will be denied.
- Does DAA affect or cause the applicant's medical impairments? If the answer is "no," DAA is not material.
- Would the impairments leave the claimant "not disabled" in the absence of DAA? This question is really the crux of the issue, and in practice it is the most difficult to determine.
Example of a DAA Determination
Let's look at an example to understand how SSA makes this determination.
Fred has been an alcoholic for many years and continues to drink even though he was diagnosed six months ago with a severe case of cirrhosis of the liver. He files for disability benefits on the basis of "cirrhosis and alcoholism." How would his case proceed? First, because alcoholism (or drug addiction) can no longer form the sole basis for a successful disability claim, the disability claims examiner would certainly not find him disabled due to alcoholism. But the claims examiner would evaluate whether the claimant's cirrhosis and DAA cause him to meet SSA's definition of "disability." If so, the examiner would ask whether the claimant would continue to be disabled if he stopped drinking entirely. The claimant's case would be approved if the claims examiner finds that Fred would be disabled even in the absence of alcohol.
The DAA determination can go either way in the case of liver damage, depending on whether the cirrhosis is so advanced that quitting drinking wouldn't reverse the impairment.
In practice, claims involving DAA are rarely approved at the initial level. Instead, claims examiners will usually deny benefits at the initial application stage, and administrative law judges must perform the same DAA determination on appeal.
In the above example, notice that it does not matter that the claimant's cirrhosis was likely caused by his lifetime of drinking. The only relevant question is whether the claimant would be still be disabled in the absence of DAA.
Mental Impairments and DAA
In cases involving DAA and mental impairments such as depression and anxiety, it can be nearly impossible to determine whether these impairments would still exist, and to what extent, in the absence of drug and alcohol use. It is a good idea for the claimant to ask his psychiatrist or psychologist to address this question in writing as early as possible. Judges and claims examiners should rely on opinions from the mental health provider who regularly treats the claimant, or at least a consulting doctor in making this determination. If a consulting or treating mental health professional is unwilling or unable to offer an opinion as to how a person might behave in the absence of DAA, Social Security has repeatedly held that DAA should be found "not material."
In practice, individuals who are abusing drugs or alcohol while applying for disability benefits face an uphill battle, though a successful claim is certainly possible, especially for those who are represented by a disability lawyer. The best and most obvious advice for such a person is to stop using drugs and alcohol. Claims examiners and judges are much more likely to approve the case of a person who has recently stopped using drugs or alcohol than one who continues to do so.
Finally, remember that those who are tempted to deceive Social Security about their ongoing drug or alcohol use often create more problems than they solve. Claimants who are caught lying to Social Security lose all credibility and are rarely approved.