Alcoholism Or Addiction As A Material Factor
In SSA policy terms, a material factor is a contributing factor material to the determination of the disability. In other words, it is the factor that directly contributes to the condition giving rise to the disability. If this factor is taken away, the disability also likely goes away.
To illustrate this more clearly, consider this example. An alcoholic person routinely consumes heavy amounts of alcohol. This leads to liver problems as well as an inability to earn a meaningful wage. However, if this person stops drinking, the liver problems are non-critical enough to go away. At the same time, the person would be able to get a meaningful wage if he or she stopped drinking. So alcoholism is a material factor in this case.
As per SSA policy since 1996, you cant get disability benefits if alcoholism or drug addiction is a material factor in your case. In simpler words, SSA no longer recognizes alcoholism or drug addiction as a disability in itself. SSA Code of Federal Regulations also lays out how the agency determines whether alcoholism or drug addiction is a material factor.
How Social Security Treats Drugs And Alcohol Past And Present
First, in 1996, the Social Security Act was amended to eliminate eligibility for disability benefits based on drug addiction and/or alcoholism. Prior to that date, individuals could get SSI or SSDI disability benefits if their alcoholism or drug addiction was so severe that it prevented them from working.
The way the law works today is that a person cannot receive disability benefits if drug addiction or alcoholism is a “material factor” in their disability. In plain language, that means someone can be found disabled only if an applicant has medical conditions that aren’t caused by or made worse by drug use , and these medical conditions are severe enough to meet Social Security requirements for medical severity. What this doesn’t mean is that Social Security can deny a disability applicant benefits just because they intentionally abuse or are addicted to drugs or alcohol.
The medical-legal concepts involving drug and alcohol use are easily misunderstood, so it’s important to grasp them clearly. This most important principle, which applies to all cases, can be reduced to the following statement:
Drug Addiction And The Ada
The ADA also addresses drug addiction but treats it differently than alcoholism. For example, the ADA recognizes alcohol addiction as a disability and provides protections, whether the addiction is current or in the past. However, the ADA only offers protections for drug addiction if a person is in recovery and not currently abusing drugs.
This means that an employer cannot fire or refuse to hire someone because they disclose a past addiction. However, a person who is currently abusing drugs like cocaine would not be protected under the ADA.
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Can I Get Disability Benefits For Drug Or Alcohol Addiction
Being that SUDs are considered disabilities under the ADA, you may be entitled to receive behavioral health benefits. However, this applies to situations where an impairment, or disability, persists outside of drug or alcohol use. According to the SSA, this determination involves:9
- Establishing that you have a disability.
- Confirming medical evidence of your drug or alcohol addiction.
- Determining whether your impairment would continue even after stopping the use of drugs or alcohol.
If you are eligible to receive paid benefits, then the SSA requires that you receive treatment services at an approved facility when it is available and that you comply with the terms, conditions, and requirements of the treatment that has been made available to you.10 These services are typically provided at no cost.
Benefits that people get under social security/disability include:11
- Social Security Disability Insurance. Pays benefits if you are insured, which means that you must have worked long enough, and recently enough, in jobs covered by Social Security to qualify for disability benefits.
- Supplemental Security Income. Designed to help persons with disabilities that have little or no income and provides cash to meet basic needs, such as shelter, food, and clothing.
How Would Drug Or Alcohol Addiction Affect Social Security Disability Benefit Requirements
When the SSA considers a case, they will try to determine the level of impact substance use and or addiction has on a persons health and ability to work. They will conduct an evaluation to determine if substance abuse is a contributing factor in a persons impairments and if yes, they will consider whether substance abuse caused the condition, or if the disabling condition exists separately from substance abuse.
The claim for Social Security disability benefits may be successful if a claimant can prove that substance abuse did not contribute to the disabling limitations that they experience. So, in essence, substance abuse has to be determined to be an immaterial factor to the finding of disability.
But what if substance abuse caused irreversible medical problems? In that case, the SSA may grant disability benefits. But if the addiction is causing the persons disability and it can also be reversed by ceasing substance use, then the claim will likely be denied.
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Will The Impairment Improve Without Alcohol Or Drugs
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.
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.
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Social Security Disability: General Requirements
Anyone over the age of 18 can apply for Social Security disability benefits if they have a medically determinable physical or mental impairment that also meets any of the following:
- The condition results in their inability to engage in substantial gainful activity
- The medical condition either has lasted or can be expected to last for at least 12 consecutive months or is considered to be terminal
Are You Living With Substance Abuse And Disability
If you are suffering from a condition caused by past substance use, or are living with a separate condition, we can help you apply for benefits. Our law office provides free case evaluations to all potential clients in order to encourage people to seek the help they need. Contact us today for legal assistance with your Social Security or SSI disability claim.
We expect clients who have a history of substance abuse to be actively participating in treatment for their addiction.
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Qualifying For Ssdi And Substance Abuse Disorders
Here are a few ways you may qualify for Boston SSDI because of a substance abuse disorder.
- Mental Disorder. To receive benefits for a mental disorder, damage must have been caused to your brain by injury or disease. Alcohol abuse can sometimes lead to brain injury. If your mental disorder was caused by alcohol abuse, you may qualify.
- Depression. Substance abuse frequently causes depression. In some cases, depression may limit your ability to work and could qualify you to receive SSDI in Boston.
- Anxiety. Substance abuse can also lead to anxiety. This can make it impossible to work. If you suffer from anxiety, you may qualify to receive benefits.
- Gastritis. Gastritis is the inflammation of your stomach lining. This condition is frequently caused by alcohol abuse. If your digestive system has been compromised after extended substance abuse, you may qualify for disability benefits.
- Liver Damage. Alcohol has a direct impact on your liver. If your liver is permanently damaged because of your alcohol abuse, you may qualify for SSDI.
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Substance Addiction Law And Disability Changes
Before 1996, the Social Security Administration would consider substance addiction to be a disability. However, in 1996, Congress modified and passed the Contract with America Advancement ActPublic Law 104-121 which terminated SSI and SSDI benefits awarded to those whose primary impairment was substance addiction.
On the other hand, this legislation is reflective of various provisions.
Currently, Public Law 104-121 continues to allow the following:
… Individuals who are addicted to drugs or alcohol may continue to qualify for benefits based on another disabling condition , heart disease, schizophrenia, and so forth).
In other words, the Social Security Administration will not approve you for disability benefits on the sole basis of you suffering from substance addiction alone since it is not considered a disabling medical condition. In legal terms, if the finding of substance addition is MATERIAL to the finidng of disability, benefits are not awarded.
The Social Security Administration has specific requirements applicants must meet in order to be considered eligible for disability benefits, including:
- Disability expectancy of 12 months
- Your qualified medically disabling condition must severely impact your ability to work
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Va Disability Eligibility And Requirements
A veteran may be considered eligible for drug addiction disability benefits or alcohol disability benefits if they have a condition that affects their mental or physical health. They must also meet both of the following requirements:
- They have served on active duty, active duty for training, or inactive duty training.
- They have been given a disability rating for their service-connected condition.
At least one of the following must also be true:
- They are able to connect their illness or injury to their time serving in the military.
- They had an illness or injury before serving in the military that was made worse due to active duty.
- They have a disability that was found to be related to their time in service but didnt appear until service was ceased.
Qualified dependents of veterans may also be eligible for disability benefits.7
Are you looking for an inpatient or outpatient rehabilitation center that is designed for veterans? Contact American Addiction Centers today at and discover whether your benefits will cover the full or partial extent of addiction treatment.
What If The Medical Condition Was Caused Or Worsened By 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 usuallyâbut not alwaysârestored 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.
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Drug Addiction And Your Ability To Perform Sedentary Work
Most sedentary jobs require sitting for long periods of time, paying attention to detailed work, and dealing with other people. Many of them also require specialized training or education. While one person with a drug addictions ability to do these things will differ considerably from anothers, it wont really matter if the reason you cant perform available sedentary work is determined to be because of your drug addiction. If, at any time, it is found that you could perform available work if it werent for your drug addiction, your Social Security Disability claim will be denied.
People with a drug addiction face a difficult battle when filing a Social Security disability claim, even if your disability is caused by something else. Howeverm, with that said, it is not impossible to have a claim accepted. Often, those who are addicted to drugs have other mental conditions which do qualify them for Social Security Disability benefits, and as long as it cant be proven that your mental conditions will improve if you stop using drugs, you may be approved. In any case, you should consider hiring an experienced Social Security Disability lawyer who is experienced in winning claims despite the issue of drug abuse.
What Does That Mean For My Case
Though addiction can affect the entire body, it is generally treated as a mental illness in disability law. Compared to a physical condition, mental illnesses tend to be more difficult to provide medical evidence for. Any claimant living with a drug or alcohol addiction could be on the hook to prove whether or not their addiction is material to their disability claim. Working with an attorney who understands the relationship between substance abuse and disability can help make the application process easier and more straight-forward.
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Who Normally Receives Disability Coverage
As defined by the Social Security Administration, disability refers to an injury or illness that renders you unable to work as you did before, cannot adjust to other work because of your medical condition, or your disability has lasted or is expected to last for at least one year or will result in death. Disability benefits are granted after the following three specific criteria are met: You may not earn more than $1,070 a month from working, your condition must be expected to last a minimum of 12 months, and your condition must impact your ability to work significantly. Typically, while drug addiction does affect a persons ability to work, benefits are not extended to the drug-addicted person unless these three primary criteria are first met.
What If I Had A Substance Abuse Disorder In The Past
If you are currently sober but have struggled in the past with a substance abuse disorder, it may be wise to seek the assistance of an attorney that specializes in Social Security Disability cases. They will review your medical records and assist you in better preparing your case and application.
Additionally, we suggest that you work closely with medical professionals that are familiar with your circumstances, history, and the nature of the claim. Having a team of professionals may allow you the advocacy and preparation that could make a difference when your claim approaches the Disability Determination Services .
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Assessing Drug Or Alcohol Use
Before considering whether drug or alcohol use is material to a disability claim, Social Security must have medical evidence that the person has a substance dependency, addiction, “compulsory dependency,” abuse or use disorder. For Social Security purposes, these terms all mean the same thing.
The use of alcohol or drugs is not necessarily drug addiction. When Social Security makes a drug addiction or alcohol determination, the important factor is whether a person has a pattern of repeatedly using drugs in a dysfunctional wayin other words, whether the drug use is causing a disruption of work, family life, social activities, and/or physical damage. That is a medical judgment that the Social Security Administration makes. Depending on the quality of evidence available from an applicant’s medical records, Social Security may order an additional mental examination to determine whether there is a drug or alcohol addiction.
The SSA does not have to establish a drug or alcohol addiction by any specific criteria, such as those in the American Psychiatric Association’s Diagnostic and Statistical Manual. Whether a person’s drug use is “addictive,” a free choice, legal, illegal, or involves a prescribed drug, is not relevant to Social Security’s determination of whether drug addiction or alcoholism is present.
