A disability applicant recently asked "Why did Social Security deny me for using drugs/alcohol – I have relatives who got disability benefits for drug addiction/alcoholism." This question shows a misunderstanding of Social Security's stance on drug addiction and alcoholism on two counts.
First, in 1996, the Social Security Act was amended to eliminate eligibility for disability benefits based on drug addiction and/or alcoholism. Prior to that date, individuals could get SSI or SSDI disability benefits if their alcoholism or drug addiction was so severe that it prevented them from working.
The way the law works today is that a person cannot receive disability benefits if drug addiction or alcoholism (what Social Security calls "DAA") is a "material factor" in their disability. In plain language, that means someone can be found disabled only if an applicant has medical conditions that aren't caused by or made worse by drug use (or has damage caused by substance abuse that would not be reversed if the applicant quit using), and these medical conditions are severe enough to meet Social Security requirements for medical severity. What this doesn't mean is that Social Security can deny a disability applicant benefits just because they intentionally abuse or are addicted to drugs or alcohol.
The medical-legal concepts involving drug and alcohol use are easily misunderstood, so it's important to grasp them clearly. This most important principle, which applies to all cases, can be reduced to the following statement:
Drug addiction or alcoholism itself can never legally justify the denial of disability benefits. The only question is whether there are reversible effects of the drug or alcohol use that should be eliminated from consideration in deciding whether someone's impairment is severe enough to warrant disability benefits. Irreversible damage from alcohol or drug use always counts toward the severity of an impairment. Put another way, disability can be granted even if an applicant's impairment was solely caused by drug or alcohol use, unless the impairment could be reversed by stopping the drug use. (And even then, Social Security may consider reversible drug- or alcohol-related limitations for some severe mental disabilities.)
In addition, substance abuse that is secondary to an otherwise disabling impairment cannot prevent a successful disability claim. In other words, if an impairment is disabling without considering any limitations caused by drug or alcohol use, then the substance abuse is not "material" to the claim, since the other impairment is already disabling and any reversible limitation caused by the substance abuse is irrelevant. So if the person has a disabling impairment apart from substance abuse, it doesn't matter how much use or abuse there is, what kind, prescribed or illegal, or why there is substance abuse. (Read Nolo's article to find out how Social Security treats prescription drugs differently.)
Before considering whether drug or alcohol use is material to a disability claim, Social Security must have medical evidence that the person has a substance dependency, addiction, "compulsory dependency," abuse or use disorder. For Social Security purposes, these terms all mean the same thing.
The use of alcohol or drugs is not necessarily drug addiction. When Social Security makes a drug addiction or alcohol (DAA) determination, the important factor is whether a person has a pattern of repeatedly using drugs in a dysfunctional way—in other words, whether the drug use is causing a disruption of work, family life, social activities, and/or physical damage. That is a medical judgment that the Social Security Administration (SSA) makes. Depending on the quality of evidence available from an applicant's medical records, Social Security may order an additional mental examination to determine whether there is a drug or alcohol addiction. (Read about who makes the DAA determination and how mental disability claims involving drugs or alcohol are treated.)
The SSA does not have to establish a drug or alcohol addiction by any specific criteria, such as those in the American Psychiatric Association's Diagnostic and Statistical Manual. Whether a person's drug use is "addictive," a free choice, legal, illegal, or involves a prescribed drug, is not relevant to Social Security's determination of whether drug addiction or alcoholism is present.
If Social Security finds that drug addiction or alcoholism exists, the agency then forms an opinion about whether any damage caused by the drug or drug use is reversible and whether the reversible damage would make any difference between an allowance and denial.
For example, any functional limitations imposed by intoxication itself would not be considered, since these symptoms are obviously reversible. Similarly, the reversible components of stimulant drugs, such as increased blood pressure, are not considered limiting in physical impairment claims.
The Social Security medical consultant, administrative law judge, or other adjudicator (see our article on who can make DAA decisions) should understand the nature of the drugs abused when deciding the reversibility of the effects or drugs or alcohol. Even a treating doctor's opinion that a drug's effect is reversible is not acceptable unless it is both true and applicable to a given case.
Drug or alcohol abuse only matters (is "material") if limitations caused by substance abuse are considered reversible (in which case Social Security would ignore them) and if the applicant doesn't have any other limitations that could qualify him or her for disability benefits. In that case, the absence of non-drug-related and non-alcohol-related limitations is the reason for denial, not the substance abuse.
It is important to emphasize that the SSA's analysis of addiction issues is not punitive, so that any Social Security decision that cites substance abuse as the basis for denial would be a misapplication of the Social Security Act as well as Social Security regulations and policies. No one should ever receive a denial notice that says something like, "We reviewed your medical evidence and, because you have a drug or alcohol problem, your claim is denied."
Although SSA may find that substance abuse is "material" in regard to reversible symptoms of abuse, the irreversible effects of alcohol or drug abuse should always be considered legitimate causes of limitations in the disability determination. For example, someone who abuses alcohol may suffer permanent damage in the form of advanced liver cirrhosis or brain atrophy, and the resulting severity should be part of the disability determination. (Conversely, acute alcoholic hepatitis without liver cirrhosis or ascites might be reversible, meaning that Social Security wouldn't consider any symptoms or limitations caused by acute alcoholic hepatitis in deciding whether someone was disabled.)
Drugs are not as likely as alcohol to result in permanent organ damage, but cocaine and amphetamines can cause strokes, cardiac arrhythmias, and heart attacks. And while various opiates have never been thought to cause direct tissue damage, advances in brain imaging show abnormalities associated with chronic use of codeine compounds. Intravenous injection of narcotics and other drugs can result in serious viral and bacterial infections with both reversible and irreversible complications.
Again, Social Security should never hold alcohol, narcotic, or other drug use as a reason to deny benefits to a claimant, regardless of any opinions by treating doctors. If it does, then federal law, SSA regulations, and policies have been misapplied, because they only concern whether drug- and alcohol-related limitations should be considered as contributing to an impairment's severity—there is no negative, punitive aspect to DAA evaluation other than drug effects being disregarded in some cases. Thus it would be an error for a Social Security consulting physician or claims examiner to say that an applicant should be denied automatically, simply because they are also using narcotics.
To ensure this doesn't happen, any reasoning by Social Security regarding applicant's drug use should be clearly articulated in writing within the applicant's file, along with how the drug or alcohol addiction affected the final determination of disability and who made the decisions on whether there was substance abuse, whether the effects of the substance abuse were reversible, and the final DAA determination. (Read our article on who can make drug- and alcohol-related disability decisions to find out more.)