Disability Benefits and Substance Abuse - dummies

Disability Benefits and Substance Abuse

By Jonathan Peterson

Copyright © 2018 by AARP. All rights reserved.

The Social Security Administration’s (SSA’s) longstanding policy has been not to provide disability benefits for drug addiction and alcoholism (DAA). But if someone is disabled for another reason, and substance abuse isn’t the cause, that person may qualify for benefits even if he or she has drug and/or alcohol problems.

This situation can get confusing, and it’s the source of many disputes. Today’s stricter policy is also a change from an earlier era when the SSA viewed DAA as a disease and individuals could qualify for benefits. The SSA allowed benefits if the DAA met the standard of being so serious that it prevented someone from working for a year or could end in the person’s death.

But in the 1990s, following news reports that thousands of people were using their disability benefits to pay for drugs, Congress stepped in to stop the practice. The SSA identified 209,000 beneficiaries with DAA conditions and gave them the chance to show they qualified for benefits based on unrelated disabling impairments. After all appeals, 123,000 individuals were kicked off the rolls.

Today, if DAA is considered “material” to a disabling condition, the applicant isn’t eligible for benefits. But if someone has a condition that is disabling, independent of any substance abuse, he or she may qualify for benefits. If the person has stopped abusing drugs or alcohol but the disabling condition remains, he or she may qualify because the substance abuse isn’t considered material.

Further, the DAA must be determined through medical evidence of signs, symptoms, and laboratory findings. If someone says he or she has a drug problem, that’s not enough for the claim to be turned down on the basis of DAA.

Deciding when substance abuse is “material” to a disability can lead to Catch-22 disagreements on which problem is causing the other. What if someone has developed cirrhosis of the liver because of years of alcohol abuse? If he has stopped drinking, he may be approved for benefits. But if he’s still drinking and this current behavior is making the problem worse, it’s harder to win approval of the claim.

The issues can be especially difficult if they involve disabling mental problems and substance abuse. In one case, a claimant who was an alcoholic contended that his disabling panic disorder made it impossible for him to hold down a job and that his severe anxiety wasn’t caused by alcoholism. His claim for benefits was turned down three times by an administrative law judge. Finally, he sued the SSA in federal court — and won. The judge ordered the SSA to pay him almost nine years of back benefits.