Will Alcoholism or Drug Addiction Affect My Disability Benefits Claim?

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Alcoholism and drug addiction can have a long-term impact on your health and can contribute to heart disease, liver failure, nerve damage, and personality disorders, among other health problems. Problems caused by continued use of alcohol and drugs are often intertwined with problems that exist independently of substance abuse. As a result, if you are still drinking or using drugs, your alcoholism or drug addiction will affect your application for disability benefits with the Social Security Administration (SSA). If your drinking or drug use is seen to cause, or worsen, your medical condition, you won’t be granted disability benefits. However, if your alcoholism or drug addiction is seen as irrelevant to your disabling medical condition, you could be granted disability benefits. 

Getting Disability Benefits Despite Alcoholism or Drug Addiction

If you have physical or mental problems other than your alcoholism or drug addiction that are disabling, and the problems would clearly exist even if you stopped drinking or using drugs, you should qualify for disability benefits. This is true whether or not your drinking or drug use caused the physical or mental problems in the first place. For instance, you can be found disabled because of irreversible liver damage caused by chronic alcoholism or drug abuse – of for something else altogether – such as the loss of an eye in a car accident.

They key in either case is that your drinking or drug dependence can’t exacerbate the problem. In SSA terms, the medical consultant assigned to you by the SSA will determine whether your drinking or drug use is a “contributing factor material to the determination of disability.”

First, the medical consultant will first determine if all of your physical and mental conditions, including your addiction, render you disabled.

If the medical consultant finds you are not disabled according to the SSA’s definition – that is, you are not unable to work at some type of job for at least 12 months– you won’t get benefits, regardless of how your alcoholism drug addiction affects your ability to work.

If the medical consultant decides you are disabled, and the SSA has received evidence that you are addicted to alcohol or drugs, the medical consultant will then start a process to decide if your alcohol or drug dependence is contributing to your disability (if it is, you won’t get benefits). Essentially, the SSA adds an additional step to its sequential evaluation process to determine this, called a drug addiction/alcoholism (DAA) determination.

Evidence of Alcoholism or Drug Addiction

If the SSA receives notice that you are actively addicted to alcohol or drugs – either through something you say, something you write on your application, your medical record, or perhaps a doctor’s notation that says “suspected of alcohol abuse” – the medical consultant will first decide whether you have a true addiction by looking at evidence from a doctor, psychiatrist, or psychologist and perhaps by talking to family members. Evidence of time in rehab, plus continued drinking or drugging, is also a good indicator of addiction. If you have been “self-medicating” with alcohol because of a mental illness but don’t feel you have an alcohol addiction, you’ll have an uphill battle getting benefits.

If the medical consultant decides you do not have an addiction that satisfies the diagnostic requirements for alcoholism or addiction in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), you will be granted disability benefits. If the medical consultant finds you do have a real addiction, the next step is the DAA determination.

Note that if you have stopped taking drugs or drinking and the SSA believes that you are in recovery, you can be granted disability benefits.

DAA Determination (Evaluation of Addiction’s Effect)

The medical consultant who makes your disability determination and decides whether you have a drug addiction also makes your DAA determination. To evaluate whether your alcoholism or drug addiction contributes to your disability, the key question the medical consultant tries to answer is: “Would you be able to work (that is, would you still have disabling impairments) if you stopped drinking or using drugs?”

Which Limitations Are Related to Continued Drinking or Drug Use

To answer this question, the medical consultant will try to figure out which of your disabling physical and mental limitations would still exist if you stopped using drugs or alcohol. The consultant will toss out any limitations he or she has reason to believe would go away if you stop using drugs or alcohol, such as alcoholic hepatitis (liver inflammation), hypertension, kidney problems, depression, anxiety, or paranoia. If you have any remaining limitations, the medical consultant will then re-evaluate the limitations to see if they are sufficiently disabling on their own to qualify for disability benefits.

Determining Which Limitations Are Related to Drugs or Alcohol

It can be difficult for a medical consultant to forecast which limitations would remain if you stopped drinking or taking drugs. If you stopped using for a period of time (say you were in rehab), the SSA would request your medical records from that time to see if your limitations disappeared during this period. Or, if you have any medical records showing the pre-existence of your impairments before your drug or alcohol abuse began, this would be helpful for your case.

If you haven’t stopped drinking or doing drugs for a period of time (or have no records from during your hiatus), or you have no records documenting your condition before your addiction, the SSA may request a medical opinion from your treating doctor or a specialist. If the medical consultant can’t determine whether your impairment would go away if you quit drinking or using drugs, it’s likely that you would qualify for benefits. For example, if you have a severe anxiety disorder and agoraphobia that prevents you from leaving the house, and you’ve been using for years without a break, the consultant has no way of knowing whether the drug abuse is contributing to this condition. Unless your treating doctor – or a doctor the SSA send you to for a consultative examination – is reasonably certain that your limitations would go away if you stopped taking drugs, the consultant may have to pass you on the DAA determination and grant you disability benefits.

Are the Unrelated Limitations Disabling?

If the consultant finds that your remaining limitations would not be disabling if you stopped drinking or doing drugs (or if you have no limitations that would remain if you quit taking drugs), the consultant will find that your alcoholism or drug addiction is a material contributing factor to your disability and you would be denied benefits. For instance, if the medical consultant finds that your hypertension and seizures would go away if you stopped taking drugs, and that your degenerative disc disease problem does not meet the requirements for a disability alone, you would be denied benefits.

But if the medical consultant finds that your remaining limitations are disabling independently of your drinking or drug use, the consultant will find that your addiction is not a material contributing factor to your disability and you will be granted benefits. For example, if you have had both legs amputated below the knee because of complications from diabetes, your drinking is not a contributing factor to your amputation disability (even though it may have contributed to your diabetes). Or, suppose you have an eye condition resulting from a brain injury, and the eye condition makes it nearly impossible for you to sustain gainful employment.   If you are also an alcoholic, but your doctor says that your eye condition is in no way caused or worsened by your drinking, you should pass the DAA determination. 

Use of a Representative Payee

If you are approved for disability benefits and the SSA believes you can't manage your financial affairs responsibly because of your alcohol and/or drug use, it will require you to use a representative payee, who will receive your Social Security checks and prevent you from spending the money on alcohol or drugs. For more information, see our article on representative payees.

by: , J.D.

This article is provided for informational purposes only. If you need legal advice or representation,
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