Many disability applicants ("claimants") have one of two common misconceptions about how the Social Security Administration (SSA) looks at drug and alcohol abuse:
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