Can My Use of Drugs or Alcohol Affect My Disability Claim?

Use of drugs and alcohol can affect your disability claim if it is a medically determinable impairment (MDI) that meets certain drug addiction and alcohol (DAA) criteria. By law, a person cannot be approved for Social Security disability benefits if DAA exists and is material.

First of all, Social Security must decide whether drug and alcohol use is DAA. To be DAA, the drug and/or alcohol use be an MDI of substance use disorder that rises to the level of maladaptive use as defined in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association.  One exception is nicotine use disorder is not DAA under Social Security policy.

Another very important criterion is whether DAA is material. Even if the individual’s drug addiction and/or alcoholism is DAA, a person can still win their claim for Social Security disability if DAA is not material.  If DAA is material, however, then a person would not qualify for disability benefits.

Social Security DAA policy is set out in Social Security ruling, SSR 13-2p Evaluating Cases Involving Drug Addiction and Alcoholism (DAA).

Is All Drug and/or Alcohol Use DAA?

Not all drug and alcohol use meet the criteria for DAA.  The important factor in deciding whether drug and/or alcohol use is DAA is whether an individual has a pattern of using drugs and/or alcohol in a dysfunctional way that causes disruption of work, family relationships, social activities, or results in physical damage to the individual.  Since addiction to, or use of, prescription medications taken as prescribed does not involve maladaptive substance use, this is not DAA.

Evidence of occasional or binge use of drugs or alcohol or a history of drug or alcohol use does not establish that the individual as an MDI of substance use disorder. Additional examples of evidence that, by itself, does not establish DAA are:

  • Self-reported drug or alcohol use.
  • Arrest for “driving under the influence” or “public intoxication”.
  • Third-party report of an individual’s drug and alcohol use.

How Does Social Security Determine Whether DAA is Material?

Once Social Security has evaluated a person’s impairments including DAA and found that the person’s condition is disabling, Social Security then conducts a second evaluation to determine whether DAA is material to disability. During the second evaluation, Social Security reviews the evidence again to determine whether the person would continue to be disabled if he or she stopped using drugs or alcohol.

Essentially, material means DAA substance use is contributing to, or worsening a person’s medical impairment(s).  DAA is not material to the determination that the claimant is under a disability if the person would still meet the definition of disability if he or she were not using drugs or alcohol. 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 limitation caused by the substance abuse is irrelevant. Irreversible damage from alcohol or drug use, for example, is not material.  If DAA is not material, the claimant is disabled.  If DAA is material, there is evidence that the person’s impairment(s) can improve absent drugs and/or alcohol and the person is denied disability benefits.

When a person has a physical impairment(s), Social Security considers medical opinions from treating or non-treating sources about whether the physical impairment(s) would likely improve absent DAA.  For example, if a person who has drug addiction and a medically determinable physical impairment, such as a seizure disorder, Social Security will rely on medical opinions about whether the seizure disorder would medically improve if the person stopped using drugs.  If improvement is likely, then DAA is material and the disability claim would be denied.  However, if improvement is not likely, the case would be allowed.

Unlike cases involving physical impairment(s), Social Security cannot rely exclusively on medical expertise and the nature of a claimant’s mental disorder.  To support a finding that DAA is material, Social Security must have evidence in the record that establishes that a person with a co-occurring mental disorder(s) would not be disabled in the absence of DAA.  If the record is fully developed and there is no evidence that the person’s co-occurring mental disorder(s) would improve to the point of non-disability in the absence of DAA, then DAA is not material and Social Security would allow the disability claim.

For these reasons it is very important to have well documented medical records of medical impairment(s), both physical and mental.

What Must the Social Security Disability Decision Contain in a Claim Involving DAA?

When the issue is whether DAA is material, a Social Security adjudicator must make the following findings:

  • The person hasDAA;
  • The person’s impairment(s) are disabling considering all of his or her impairments, including DAA.
  • The person would still be disabled in the absence of DAA, or a finding that the person would not be disabled in the absence of DAA.

A Social Security adjudicator must provide sufficient information and document their reasons in the disability decision.

Contact a Disability Lawyer for Help

If you have a disability case that involves drug addiction and/or alcoholism, find a disability lawyer that is experienced to help you address these complicated issues. When a disability lawyer at Cardea Disability, LLC represents you, we show our commitment by providing you with information, guidance, and support at every step. We know what it takes to win your disability case. For a free consultation, contact a disability lawyer at Cardea Disability, LLC at 334-440-6261 and visit our website at https://cardeadisabilityllc.com.