Drug addiction or alcoholism can lead to debilitating conditions such as lung problems, depression, chronic pulmonary conditions, and insomnia that can severely impact an individual’s ability to work. Thus, people struggling with drug addiction may look into obtaining benefits through the Social Security Administration (SSA).
People applying for SSDI based on drug and alcohol abuse may not be eligible, as the SSA does not consider it to be a disability. However, they might qualify for SSDI benefits provided they have a concurrent disabling condition unrelated to drug addiction or alcoholism.
This article discusses the impact of drug or alcohol use on Social Security Disability Insurance (SSDI) benefits.
What is Drug Addiction?
There are varying definitions of drug addiction used for different purposes. But generally, professionals agree an individual is addicted to a drug when using that drug “becomes compulsive and interferes with ordinary life responsibilities.” The two main types of addiction are:
Physical Addiction
This occurs when your body develops a tolerance to a drug, and when you stop using it, your physical condition deteriorates. It can happen because your brain only reacts strongly to the drug or signals associated with the drug.
Psychological Addiction
This is characterized by the use of drugs as a coping mechanism for emotional or mental “stress.” It is particularly common among people who have high-stress jobs where they need to remain focused for the majority of their work days.
It is important to note that drug addiction has nothing to do with an individual’s moral character. However, it may nonetheless become challenging to receive assistance when an individual has a drug addiction.
How the SSA Sees Drug Addiction
Social Security Disability Insurance is a program that helps workers who are disabled due to a physical or mental illness or a combination of illnesses.
It provides workers with monthly cash benefits that help them stay afloat. People struggling with drug addiction may find themselves developing functional limitations that may cause them to lose their jobs.
Nevertheless, the stance adopted by Congress and the SSA regarding drug addiction is that an individual’s substance addiction does not constitute a disability for SSDI benefits, even if it significantly worsens their ability to work.
This was not always the case. In fact, a federal statute passed in 1996 changed these rules for SSDI. Previously, if an individual’s disability were solely caused by drug use, they would still get benefits as long as there was objective medical proof of their addiction and how it impacts their functioning.
People who used to qualify for benefits because of their addiction are no longer eligible under the new law unless they can show medical proof of other mental or physical disabilities or combinations of disabilities that meet the SSA’s definition of disability.
The SSA claims that the new standard significantly decreases the number of people getting SSDI and that, from now on, new applications would be turned down if the substance abuse contributed significantly to the claimant’s disability.
SSA’s New Ruling on Drug Addiction
The latest ruling includes a lengthy and comprehensive description of how the SSA takes drug addiction into account when calculating SSDI disability. The person evaluating the applicant must take into account evidence that proves drug abuse is a significant cause contributing to their disability. If it is, then the application will be denied.
Analyzing the materiality of drug addiction might be a challenging task. For example, it’s important to separate a person’s substance addiction from any other mental disabilities they may have in order to assess the full extent of their impairment. However, the symptoms of drug addiction greatly overlap with those that are typical of some mental disabilities.
In such a case, anyone who is addicted to drugs and wants to apply for SSDI should talk to a lawyer who has experience in disability law and is well-informed about how the federal government decides if someone is disabled when addiction is involved.
Eligibility Criteria for SSDI with Drug Addiction
First, we’ll go over the general eligibility conditions that all disability applicants must meet (with very few exceptions, such as severe terminal disease). Then, we’ll examine the specific medical requirements related to drug usage.
The general eligibility requirements of SSDI state that the individual must be unable to engage in Substantial Gainful Activity (SGA) due to the functional limitations caused by their disability. In 2023, the maximum monthly income that a beneficiary can earn while receiving their benefits is $1,470. The 2024 SGA amount is $2,590 for blind people and $1,550 for all others who qualify for disability benefits.
Your disability must also have lasted or be expected to last for a minimum of 12 months or result in death.
Additionally, you must have accumulated a sufficient number of work credits. These are earned by working a specific amount of time in jobs that pay social security taxes. The exact amount of work credits required will depend on your age and disability onset.
How the SSA Assesses Drug and Alcohol Use
Social Security must have medical proof that the applicant struggles with substance dependency, addiction, “compulsory dependency,” or substance abuse before they can decide if drug or alcohol use is relevant to a disability claim.
The mere use of drugs or alcohol does not constitute an addiction. In order for Social Security to determine whether an applicant is addicted to drugs or alcohol, they must evaluate how often they use drugs and if their drug use is hurting them physically or causing problems at work.
This is a medical determination made by the SSA. If Social Security finds insufficient proof of a substance abuse problem in an applicant’s medical records, they may request a mental assessment.
Furthermore, when determining eligibility for benefits, Social Security does not take into account whether the drug usage is voluntary, legal, illegal, or involves a prescribed drug.
Reversible vs. Irreversible Damage
When Social Security finds out that someone is addicted to drugs or alcohol, the agency determines whether the damage caused by the drug or drug use can be fixed or reversed and if fixed, whether it would impact their eligibility for benefits or not.
For instance, any functional limitations caused by alcoholism would not be taken into account when assessing your eligibility since these effects can be reversed. In the same way, the reversible effects of stimulant drugs, like higher blood pressure, are not seen as limitations in claims involving a physical disability.
When determining whether or not the effects of drugs or alcohol can be reversed, the Social Security medical consultant, administrative law judge, or other adjudicators work together to form a thorough understanding of the nature of the drugs that were abused.
Dependence on drugs or alcohol is only “material” if the conditions caused by the abuse can be fixed (in which case Social Security would not consider them) and the person applying for disability benefits doesn’t have any other conditions that would make them eligible for benefits.
It is not the substance addiction that is the reason for denial in this scenario; rather, it is the absence of limitations that are not tied to alcohol or drugs. Any Social Security decision that uses substance abuse as the reason for denial would be a misapplication of the Social Security Act and Social Security regulations and procedures.
Determination of Materiality
Some applicants with drug abuse problems might wonder who will evaluate their case and determine the significance of their disabilities. The review process can be broken down into many different levels. This means that multiple individuals will review your case.
The following agencies determine whether alcohol or drug use is relevant to your case at each level of review:
The State Agency
A claims worker for the state agency decides if “drug addiction and alcoholism” (DAA) use is important to your claim for benefits at the appeals level of the Social Security review process. This body is in charge of the medical responsibilities of the DAA analysis. For instance, they will determine the limitations that would apply if DAA were not present.
The Hearing Officer
At the lower level of appeal, the hearing officer checks to see if DAA is important to your claim for benefits.
The Hearing Judge
The judge presiding over your Social Security hearing will decide whether your drug use is a substantial factor impacting your eligibility for benefits after looking at all the evidence presented.
The Appeal Council
The Appeals Council reviews the judge’s ruling at the appeal level. Their job is to determine whether the judge followed the DAA guidelines correctly in your case.
There are only two kinds of outcomes at this level: either the appeals council will reject the request for review, essentially upholding the judge’s decision, or they may request the Administrative Law Judge (ALJ) to review the case again.
Documents Needed to Get Disability Benefits With Drug Addiction
In order to receive disability benefits from Social Security, you will need to prove that you are suffering from another mental or physical disability in addition to substance misuse, which means medical evidence is required. Regardless of the circumstances, the SSA will want to verify that you have sought treatment for your addiction.
The SSA doesn’t ask for paperwork from support groups like Narcotics Anonymous, but you should let them know if you’ve been to any official rehab services so they can look at your records (if you give them permission).
Evidence of a Mental Disorder With Drug Addiction
If you have a history of substance abuse and a mental disability, it can be challenging to win disability benefits.
You should tell your doctor everything there is to know about your addiction. The SSA does not have a punitive stance on addiction, so it won’t punish you for relapses as long as you are completely transparent with your healthcare professionals and the agency.
In your medical records, the SSA will be looking for evidence of the following:
- records of any hospitalizations, including admission and discharge paperwork
- mental status exams, which show any changes in your mental state
- progress notes from psychiatrists or psychologists who see you regularly
- information regarding the dosages and side effects of any medications you’ve been prescribed
Ask your doctor, counselor, or therapist who has been seeing you regularly for more than a year and understands your struggles with drug addiction to fill out a medical source statement. Social Security can use your doctor’s note to verify if your impairments are due to substance misuse or another disabling condition.
Evidence of a Physical Disorder With Drug Addiction
Apart from mental health conditions, the SSA will also evaluate your physical health to assess whether there are any conditions that may limit your functioning.
The SSA will evaluate your medical records, including notes from doctors, hospitalization details, and prescriptions, just as they do with mental impairments. They may also be interested in any of the following:
- medical imaging tests, including X-rays, MRIs, or CT scans of the afflicted organs or joints
- physical examinations clarifying any limitations in mobility
- laboratory results, including blood tests and other diagnostics.
Applying for Benefits
If you have a history of substance abuse and are applying for Social Security Disability Insurance benefits, you will follow the same steps as any other applicant; the only difference is that you will need to prove that your drug abuse does not significantly impact your disabilities.
You’ll still have to prove that you’re severely disabled and can’t work for twelve months or more.
You may either qualify through a Blue Book listing or qualify for a medical-vocational allowance. You will also have to provide evidence of other technical requirements, such as work credits, through employment history records.
Conclusion
Substance abuse has a significant impact on whether or not you receive SSDI benefits. And since the Social Security Administration does not consider substance abuse to be a qualifying condition, it can be challenging for individuals to get the benefits they need.
In such cases, it’s important to make sure you highlight any other mental or physical disabilities you may have. You can also increase your chances of approval by providing the SSA with extensive documentation of your condition(s).
