Can Drug or Alcohol Addiction Affect Your Disability Claim?

Many disability claimants have struggled, or continue to struggle, with drug or alcohol abuse at the time they apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). The causes of addiction are complicated and not always well understood, but it's not uncommon for people with physical or mental health problems to use drugs or alcohol to temporarily relieve their symptoms.

With that in mind, the Social Security Administration has provided some guidance in the form of a specific ruling, SSR 13-2p, that addresses how the agency should decide disability claims involving evidence of drug addiction or alcoholism (DAA). If you have a history or ongoing issues with addiction and you're applying for disability benefits, it's important to know how Social Security will evaluate your substance abuse within the context of your claim as a whole.

How Social Security Decides Cases Involving Drug Addiction and Alcoholism

There are two main misconceptions about how the Social Security Administration (SSA) looks at drug and alcohol abuse—that you can get disability based only on a diagnosis of drug or alcohol addiction, or that you can never get disability if you have a history of substance abuse or alcoholism. 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 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.

Does Your Record Show Evidence of Drug Addiction or Alcoholism?

Social Security 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 agency will likely consider that to be evidence of alcoholism.

Are Your Other Medical Impairments Disabling?

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.

Is Drug and Alcohol Addiction the Only Impairment?

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 impairment that prevents you from working.

Are Your Impairments Disabling on Their Own, or Are They the Result of Drug or Alcohol Abuse?

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.

Does Substance Abuse Cause the Impairments or Make Them Worse?

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:

• conditions that exist separately from substance abuse, such as a degenerative neurological disease (like Parkinson's), a hereditary kidney disease requiring chronic dialysis, or a developmental disability from birth
• conditions that were acquired while using drugs or alcohol, such as an amputation resulting from driving under the influence or HIV/AIDS from sharing needles, and
• conditions that were caused by long-term drug abuse but are irreversible, such as certain types of liver cirrhosis.

Would Your Conditions Improve Enough for You to Work If You Stopped Drinking or Using Drugs?

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 people who are 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 substance abuse 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 drug or alcohol abuse.

Example of a Drug and Alcohol Abuse Determination

Let's look at an example to understand how the SSA makes a determination about whether substance abuse is material to a disability claim.

In the above example, 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.

Does Social Security Drug Test Disability Claimants?

No, the SSA doesn't conduct drug testing. But the agency does review your medical records, which might contain the results of blood or urine tests (including kidney and liver function tests) that can reveal substance use. However, SSR 13-2p says that a single test result showing drug or alcohol use isn't enough for the SSA to decide whether drug or alcohol use is material.

Using Periods of Sobriety from Drugs or Alcohol in Mental Disability Claims

Addiction issues can play an especially significant role in disability claims based on mental health impairments. Many people with mental health disorders have dealt with drug or alcohol abuse, especially before they've received a formal diagnosis or during times when they don't have health insurance and haven't seen a doctor for treatment.

Separating the effects of drug addiction from those of mental health impairments can be challenging. People with bipolar disorder can experience periods of mania and hyperactivity that often mimic symptoms of methamphetamine use. Stimulants like cocaine can increase feelings of anxiety and panic, while depressants such as alcohol and opiates can amplify mood disorders. While the agency doesn't look too fondly on periods of "self-medication," the SSA understands that the relationship between substance abuse and mental health can be complex.

In these cases, it's critical to establish a period of abstinence so that Social Security can get a picture of your mental health baseline without the effects of substance abuse. For example, if you were a regular user of meth before you were diagnosed with schizophrenia and got clean after receiving treatment—but still experience episodes where you're unable to think linearly and finish tasks—the SSA will likely find that meth use isn't material to a disability finding, since the symptoms of the disorder continued after the substance use stopped.

The strongest argument against drugs or alcohol being material to your claim is having a period of sobriety where your mental health symptoms didn't improve or go away entirely. But this doesn't mean that you have to be completely abstinent for the period at issue—the SSA is aware that relapses occur, and won't penalize you for making honest attempts at sobriety. Furthermore, even if you don't have an extended period of abstinence, the agency shouldn't automatically find that drug abuse is material to your claim.

Doctors' Medical Opinions About Drug or Alcohol Abuse

Claims involving drug or alcohol use are rarely approved at the initial level. But you can greatly increase your chances 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 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.

For example, many people with disorders such as autism, traumatic brain injury, and markedly impaired intellectual functioning often try multiple substances (both prescribed medications and "street" drugs) in an attempt to control symptoms. Having a psychiatrist's opinion that these conditions wouldn't improve significantly despite abstinence from drugs can be persuasive evidence to the SSA. If you think your doctor would write a supporting statement, try to get the opinion in writing as early as possible.

What Opinions About Addiction or Alcoholism Mean the Most for Social Security?

Psychologists or psychiatrists who treated you consistently (say every few weeks) for long enough to become familiar with your addiction history (say six months, ideally longer) are the best candidates to provide helpful opinions to the SSA. While many people use the terms "psychiatrist" and "psychologist" interchangeably, these are two different professions that specialize in different areas of mental health.

Notably, psychiatrists are medical doctors with training in pharmacology and the authority to prescribe medications. If you have a history of prescription drug abuse, getting a medical source statement from a psychiatrist who is familiar with specific withdrawal symptoms and possible toxicities of the prescribed medications can be very persuasive to the disability examiner reviewing your claim.

Having an opinion from a therapist or licensed mental health counselor can be useful as well—but generally in addition to, rather than as a substitute for, a psychologist or psychiatrist. Keep in mind that general "lifestyle recommendations," such as advice to drink less or avoid illicit substances, aren't sufficient evidence for the SSA to find that drug and alcohol abuse is material to your claim.

Attending a Consultative Examination

If your medical record isn't conclusive as to whether substance addiction is material to a finding of disability, the SSA may ask you to attend a psychological examination to get more information. While the exam is just one data point in a (hopefully) more robust disability application, the examining doctor can review the notes from your treating psychiatrist or psychologist to help form an opinion about whether your mental health would improve with drugs and alcohol out of the picture.

Frequently Asked Questions (FAQs) About DAA and Disability

Below are answers to some frequently asked questions about drug and alcohol abuse in relation to disability benefits.

Can Substance Abuse Impact Your VA Benefits?

Veterans who have a substance use disorder stemming from a service-connected impairment (such as PTSD or MST) may qualify for an increase in their combined VA rating for disability benefits if the substance abuse results in significant social and occupational limitations.

Can Substance Abuse Impact Getting State Benefits?

Some states require drug testing before you can receive Temporary Assistance to Needy Families (TANF) benefits, but the exact requirements and frequency vary greatly by jurisdiction. Likewise, the few states that currently have state short-term disability programs may or may not require drug testing as a condition of receiving benefits.

Does the ADA Require Accommodations for Alcoholism or Drug Addiction?

Under the Americans With Disabilities Act (ADA), your employer may be required to provide you with reasonable accommodations to attend an outpatient rehabilitation program for substance use disorder if you're currently abstaining from drugs or alcohol. Employees who are actively using, however, aren't entitled to these protections.

Getting Disability Benefits If You Have a Substance Abuse Problem

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. The best thing to do for both your disability claim and your own health is to enroll in a substance addiction treatment program, but these can often be prohibitively expensive.

Social Security will be much more sympathetic to your claim if you can show that you at least tried to manage your substance use disorder. While it can be embarrassing to discuss your addictions at a disability hearing with a judge you just met, honesty is the best policy. If you weren't able to afford the treatment you needed, let the judge know. Definitely don't pretend that drugs or alcohol aren't a problem if that's not the case—downplaying your struggles with addiction may be tempting, but it can backfire if the judge starts to disbelieve your testimony.

When you're ready to file for SSDI or SSI benefits, consider hiring an experienced disability attorney to help you with your claim. You're not obligated to have an attorney at any stage, but it's a smart move, especially if you have a complicated history with substance use. Most disability lawyers offer free consultations, so you can get an idea about the strengths and weaknesses of your case. And because disability lawyers work on contingency—meaning they're only paid if they win your case—you're unlikely to have any up-front costs.