Will Alcohol or Drug Addiction Affect My Disability Claim?

Alcohol and drug addiction can have long-term impacts on your health and contribute to heart disease, liver failure, nerve damage, personality disorders, and other health problems. When the medical problems caused by the continued use of alcohol and drugs are intertwined with health issues unrelated to substance abuse, it can affect your ability to get disability benefits.

As a result, if you are still drinking or using drugs, your alcohol or drug dependence will affect your application for disability benefits. If the Social Security Administration (SSA) determines that your drinking or drug use is causing your disability or making it worse, your application for disability benefits will be denied.

Although your addiction will play a role in your disability determination, it might not prevent you from getting disability benefits. If the SSA sees your drug or alcohol addiction as unrelated to your disabling medical condition—that is, the SSA believes you would still have the disability if you didn't use drugs or alcohol—you could still get disability benefits.

Here's more on applying for disability when you're addicted to or dependent on drugs or alcohol, including how the SSA evaluates substance abuse and what you need to show to win your claim.

You Can Get Disability Despite Alcohol or Drug Addiction

If you have physical or mental health issues other than alcohol 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 your physical or mental problems in the first place.

For instance, you could be found disabled because you lost your eyesight in a car accident. Or, Social Security could determine you're disabled because of irreversible liver damage caused by chronic alcohol or drug abuse. In either case, Social Security's medical consultant will try to determine if your drinking or drug dependence makes your disability worse.

The First Steps in Your Disability Determination

First, the medical consultant will determine if all of your physical and mental conditions, including your alcohol or drug use, make you disabled. To meet the SSA's definition of disabled, you must be unable to work at some type of job for at least 12 months. If you don't meet that standard, you won't get benefits, regardless of how your alcohol or drug use affects your ability to work.

If the medical consultant decides you're disabled and the SSA has received evidence that you have a "substance use disorder," the medical consultant will start a process to determine if your alcohol or drug use is contributing to your disability (if it is, you won't get benefits). Essentially, the SSA adds another step to its evaluation process called a drug addiction/alcoholism (DAA) determination.

What Prompts a DDA Determination?

If the SSA suspects that you're actively addicted to, or dependent on, alcohol or drugs—either because of something you say, something you write on your application, your medical record, or perhaps a doctor's notation that says something like "suspected of alcohol abuse"—the SSA must first try to determine if you actually have a substance use disorder.

The medical consultant will look for evidence from your doctor(s), psychiatrist(s), or psychologist(s). The medical consultant may talk to your family members. Evidence of time in rehab plus continued drinking or drugging will be considered good indicators of addiction or dependence.

Note that if you've been "self-medicating" with alcohol (or drugs) because of a mental illness and you're still using—even if you don't feel you have an alcohol or drug problem—you'll face an uphill battle getting SSDI or SSI benefits. But, if you've stopped taking drugs or drinking and the SSA believes you're in recovery, you can get disability.

If the medical consultant finds you don't have an addiction or dependence that satisfies the diagnostic requirements for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), you'll be granted disability benefits. If the medical consultant finds you do have a substance use problem, the next step is the DAA determination.

DAA Determination (Evaluation of Addiction's Effect)

The medical consultant who makes your disability determination and decides whether you have a drug or alcohol use disorder also makes your DAA determination. To evaluate whether your alcohol or drug use contributes to your disability, the key question the medical consultant tries to answer is:

"Would you be able to work, or 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 would toss out any limitations that would likely go away if you stopped using drugs or alcohol. That would include conditions like:

• alcoholic hepatitis (liver inflammation)
• hypertension
• kidney problems, and
• depression, anxiety, or paranoia.

Determining Which Other Limitations Are Related to Drugs or Alcohol

It can be difficult for a medical consultant to forecast if other limitations would remain if you stopped drinking or taking drugs.

If you stopped using for a while (say you were in rehab), the SSA could 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, it could help your case.

The SSA might request a medical opinion from the doctor or specialist currently treating your disabling medical condition if:

• you've been drinking or using drugs continuously (without a break)
• you stopped using for a time but don't have any medical records from that time, or
• you don't have records documenting your condition before your addiction began.

If the medical consultant can't determine whether your impairment would go away if you quit drinking or using drugs, you would likely 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 drugs or alcohol for years without a break, the consultant has no way of knowing whether the drug abuse is contributing to your condition.

If your doctor—or a doctor the SSA sends you to for a "consultative examination"—can't be reasonably certain that your limitations would go away if you stopped drinking or taking drugs, you'll probably pass the DAA determination and be able to get disability benefits.

The medical consultant will examine the effect your drinking or drug use has on your remaining limitations. You won't get benefits if the consultant finds that your alcohol or drug addiction is a "material contributing factor to your disability"—that is, if your limitations would stop being disabling (or go away entirely) if you stopped drinking or doing drugs.

Are the Unrelated Limitations Disabling?

If you have any remaining limitations, the medical consultant will then re-evaluate them to see if they're disabling enough on their own to qualify you for disability benefits.

For instance, let's say you're addicted to drugs and have hypertension, seizures, and a herniated disc. If the medical consultant finds that your hypertension and seizures would go away if you stopped taking drugs and your degenerative disc disease alone doesn't meet the requirements for a disability, you won't qualify for disability benefits.

But if the medical consultant finds that your remaining limitations are disabling on their own, your drinking or drug use won't be considered a material contributing factor to your disability, and you can get benefits.

For example, let's say you've had both legs amputated below the knee because of complications from diabetes. Your drinking wouldn't be considered 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‘re 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.

Getting Benefits With Conditions: The Representative Payee

If you pass the DAA determination, you'll be approved for disability benefits, but if you're still using, the SSA can put some conditions on your benefits. If the SSA believes you can't manage your financial affairs responsibly because of your alcohol or drug use, it will require you to use a representative payee. The SSA would then send your disability checks to the representative payee to prevent you from spending the money on alcohol or drugs.

What If You Disagree With the DAA Determination?

A substance use disorder can make getting disability benefits extremely difficult—especially if you're still using drugs or alcohol. But the SSA can't penalize you by denying benefits just because your disabilities were caused by drug or alcohol abuse, even if you're still using.

If you believe you're being unfairly denied benefits because of your addiction, you'll probably benefit from speaking with a lawyer who specializes in disability cases.