How Drug or Alcohol Abuse Will Affect a Mental Disability Claim

How Addiction Affects a Disability Claim

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:

• medical impairments or limitations that aren't caused by or made worse by drug or alcohol use, and
• medical limitations caused by drugs or alcohol that cannot be reversed by stopping use.

How Drug and Alcohol Use Is Assessed in Mental Claims

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:

• It is clear from the treating psychiatrist's records and opinion that the disability applicant has the ability to refrain from such behavior, and
• Significant improvement in the applicant's condition would almost certainly occur if the inappropriate use of medications stopped.

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:

• a mental consultative examination with a doctor paid by Social Security, or
• the applicant's treating psychiatrist's records.

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.