Can Substance Abuse Prevent Me from Obtaining Disability Benefits?

Oftentimes, claimants will wonder can I still receive disability benefits if I have a drug or alcohol addiction. This answer is a resounding – maybe. More specifically, although drug or alcohol addiction may substantially interfere with a Claimant’s ability to perform gainful employment on a regular and sustained basis, the addiction cannot be the basis for the approval.

If you are applying for disability benefits for a drug addiction, contact the Young, Marr, Mallis & Associates today at (215) 515-2954 for a free consultation about your options. Our experienced Pennsylvania disability lawyers can help guide you through the disability application process.

Does Substance Abuse Qualify as a Disability in Pennsylvania?

Since the advent of Public Law 104-121 which was later rescinded by SSR 13-2P, Social Security does not consider a substance abuse to be disabling unless it causes an irreversible medical condition. However, this does not mean that you cannot still be successful with the addiction issue. Under the Social Security Act, you must meet certain, basic requirements to be considered disabled. More specifically, you must have a physical or mental impairment which has lasted or could be expected to last at least 12 months and is so severe that you cannot work either at your usual work or other work based upon your age, education and work experience. While Social Security no longer provides disability benefits for addiction alone, you can still be successful if you have suffered specific changes in your behavior or that have caused major physical and/or mental disabilities such as cognitive impairment or major clinical depression. However, to meet these requirements it must be determined that the abuse is not “material”. 20 CFR 416.0935 addresses how the Administration determines whether the abuse is “contributing factor material to the determination of disability”. If the Administration finds that a Claimant is disabled, they must then determine whether the abuse is “contributing” and a “material” factor to the determination of disability, i.e. whether the condition exists if not for the addiction or abuse issue.

Social Security Disability Process for Drug or Alcohol Addictions

On March 22, 2013, Social Security Administration issued SSR 13-2P, which was an internal promulgation regarding cases involving drug or alcohol addiction disabilities. Prior to that date, the Administration continually struggled with this decision making process. It is important to remember, however, that if the Claimant has a history of abuse but it is not relevant to the period in question, it is not under consideration. Under SSR 13-2P, the Administration has created a six-step evaluation process for disability benefits as follows:

  1. Does the Claimant have a drug or alcohol addiction? If the answer is no, then there can no be materiality and the determination ends at this stage. If the answer is yes, the second question is considered by the adjudication.
  2. Is the Claimant disabled considering all impairment including the drug and alcohol addiction? If the answer is no, there is no drug or alcohol addiction materiality issue that needs to be decided. If yes, the adjudicator proceeds to question 3.
  3. Is the drug or alcohol addiction the only impairment? If the answer is yes, the drug or alcohol is material and the Claimant is not eligible for SSD or SSI. If the answer is no, the adjudicator proceeds to question 4.
  4. Are the other impairments disabling by itself while the Claimant is dependent upon or abusing drugs or alcohol? If the answer is no, drug or alcohol cannot be material. If the answer is yes, the adjudicator proceeds to step 5.
  5. Does the drug or alcohol addiction cause or affect the Claimant’s medically determinable impairment? If the answer is no, then drug or alcohol addiction is not material. If the answer is yes and the other impairment is irreversible and is disabling and cannot improve to the point to non-disability, the adjudicator should not consider the addiction material. If the adjudicator still believes that the drug or alcohol could be material, he or she proceeds to question 6.
  6. Would the other impairment improve to the point of no disability in the absence of the drug or alcohol addiction? If the adjudicator determines the condition would improve then drug or alcohol addiction is material. To the contrary, if the condition would not have improved, then the addiction is not material.

For practical purposes, oftentimes the materiality of drugs or alcohol addiction is an easy determination. For example, it’s clear when a Claimant has a physical impairment such as end-stage liver damage or disabling pancreatitis or HIV, the addiction is no longer relevant. In actuality, the cases that generally present the most troubling fact pattern for both attorneys and adjudicators, are those involving the dual diagnosis of addiction with mental health impairments. As Social Security notes in their promulgation, usually evidence from the period of abstinence, is the best evidence for determining whether the impairment would improve to the point of non-disability. However, even the Administration recognizes that there have been oftentimes Claimants who have been diagnosed with a substance abuse disorder who do not have a period of abstinence. In that instance, it is important that a medical opinion be rendered whether the Claimants’ impairment would be severely limited even if the Claimant stopped abusing drugs or alcohol. Numerous courts have reviewed this issue and are split as to whether the Claimant or the Administration bears the burden of drug or alcohol addiction materiality.

Philadelphia + Bucks County Disability Lawyers Offering Free Consultations

It is suggested that the issue of drug and alcohol addiction and abuse and its materiality on a Claimant’s disability, particularly in cases involving a dual diagnosis with a mental health impairment, will remain a confusing and troubling area and will present significant difficulties. However, coupled with supportive and corroborative treatment providers, it is possible for Claimants to be successful.

Our Chester County disability benefits lawyers have years of experience in representing social security applicants throughout Pennsylvania. Call our Pennsylvania law offices today at (215) 515-2954 for a free consultation about how to best proceed in the disability application process for your drug or alcohol addiction.

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