The Social Security Administration (SSA) can deny disability benefits to applicants ("claimants") who have evidence of ongoing, untreated problems with alcohol or illicit substances. In the past, the agency used to award benefits based on addiction being a severe impairment, but policy changes now prevent the SSA from approving claimants based on substance addiction alone.
Social Security isn't particularly concerned with responsible or occasional use of alcohol or recreational drugs, so having a glass of wine at dinner is unlikely to disqualify you from benefits. But if your medical records contain signs of drug and alcohol abuse (DAA), the agency needs to determine whether the DAA is "material" to a finding of disability.
The SSA can't award a claimant disability benefits if drug and alcohol abuse is found to be material to a disabling impairment. "Material" means that the substance use is a major factor contributing to a claimant's medical condition, such that their health would be significantly improved if they were clean and sober.
To decide whether DAA is material in a disability application, a claims examiner or administrative law judge (ALJ) will review the evidence and ask the following questions:
A "yes" answer to these questions means that Social Security finds that DAA is material to a disability finding, and the claimant won't qualify for benefits. Claimants frequently have multiple medical conditions, and DAA can be material to some and not others.
Determining that the severity of an impairment would improve if DAA weren't in the picture usually involves making an educated guess. For some conditions, it's pretty easy to show that the symptoms aren't related to DAA. For example, if you have a neck injury that makes it difficult for you to lift a gallon of milk, Social Security is unlikely to find that your limitation depends on whether you're using drugs or alcohol.
Other conditions aren't as clear-cut. Many mental disorders have signs and symptoms that can overlap or mimic those of DAA. Additionally, people who struggle with mental health issues can use drugs or alcohol to "self-medicate" in the absence of regular medical treatment. Having a period of sobriety or abstinence is especially important in these claims, to give Social Security an idea of your mental health baseline without interference from drugs or alcohol.
Gavin filed for disability due to bipolar disorder while a frequent user of methamphetamine. Gavin's doctor suggested that he attend inpatient rehabilitation services for addiction counseling, and prescribed Gavin mood stabilizers like Seroquel and risperidone.
Gavin followed his doctor's orders, entering rehab and taking his medication as prescribed. Gavin's symptoms of anxiety were reduced, but his doctor noted that Gavin still exhibited manic behavior and difficulty with concentration. Even if Gavin relapses, Social Security will likely find that DAA isn't material to his disability because he still had mental health symptoms during a period of abstinence.
If you're applying for benefits based on a mental health disorder such as depression or anxiety and you have a history of substance abuse, you might have a harder time showing that DAA is not material to a finding of disability. Most doctors believe that even moderate drug or alcohol use contributes to depression.
You can help shore up your medical records by getting a medical source statement from a psychologist, psychiatrist, therapist, or counselor who you regularly see for treatment. Social Security values opinions from doctors and providers who've seen you over time and who can help shed light on how to distinguish the signs of your mental impairment from those of DAA. (For more information, see our article on admitting alcohol or drug use.)
You can still qualify for disability for an impairment that was caused by DAA, as long as the substance abuse happened in the past and isn't currently making the condition worse.
A common example involves claims for disability due to hepatitis, a liver disorder sometimes caused by alcohol abuse. Liver function is usually—but not always—restored with abstinence, but disabling symptoms of hepatitis can persist even after a long period of sobriety.
Yvonne was recently diagnosed with alcoholic hepatitis. Her doctor told her to stop drinking immediately and prescribed naltrexone, a medication that helps prevent relapses for alcohol abuse. With this help, Yvonne was able to maintain sobriety, but when she went for blood tests a year later her doctor said that her liver damage couldn't be reversed. Social Security will likely find that Yvonne's past alcohol dependence is irrelevant to her current liver functioning.
Disability claims examiners and ALJs will make a judgment call based on the nature of the condition and the evidence in the record. At the initial application level, a claims examiner will ask a medical consultant to provide an opinion on whether DAA is material. The examiner will likely reach out to the claimant's regular doctors and ask their opinion about what would happen if the claimant stopped drinking or using drugs.
At the hearing level, the ALJ doesn't have to agree with the decision of the claims examiners. Some ALJs might request an opinion from a medical expert who reviews the record and determines whether the condition would improve without DAA.
Representative payees can be required when claimants are awarded benefits, but the SSA is concerned that they won't handle the money properly (like spending it to further an addiction).
A representative payee can be a friend, family member, or organization that specializes in managing money for others. Instead of receiving your disability check directly, the SSA will send it to your representative payee, who is in charge of giving you money and paying your bills. Learn more about representative payees.
Many veterans struggle with drug and alcohol abuse, frequently as a response to chronic pain or PTSD resulting from their time on duty. Like the SSA, the Department of Veterans Affairs (VA) doesn't award disability benefits for substance abuse disorders alone. To get disability compensation, you'll have to show the VA that your substance abuse is related to another condition stemming from your service.
For more information on receiving benefits for substance abuse disorders, see our articles on getting disability for alcoholism or SSDI and SSI benefits for drug addiction.