Navigating the effects of substance abuse on Social Security

In the United States, more than 8 million people receive disability benefits from Social Security. Some of those people grapple with substance abuse.

Navigating the effects of substance abuse on your benefits eligibility can be confusing and time-consuming. Often, misunderstandings can lead to unjust rejections and uninformed appeals. However, with accurate information and a trusted guide by your side, you can minimize stress and receive the payments you rightfully qualify for.

How does substance abuse affect my Social Security benefits?

Social Security does not consider you to be disabled based on substance abuse alone. Before 1996, it did. But that year, a federal law was passed that removed drug and alcohol addiction as accepted grounds for a benefit claim.

However, that doesn’t mean you are ineligible for Social Security benefits – including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) – if you have a substance abuse disorder. If you have a medical condition that meets the benefit criteria, you are eligible, regardless of whether you live with substance abuse. In other words, your substance abuse is irrelevant to your claim – most of the time.

If the Social Security Administration (SSA) finds that your drug or alcohol abuse contributes to or causes your disability or has rendered you unable to work for over 12 months, you may not be eligible for benefits. In this case, the SSA will consult with disability examiners and medical experts to determine whether you could return to work if you stopped using. If you could, you may not receive SSDI or SSI.

Am I eligible for Social Security benefits?

The rules surrounding benefits eligibility and substance abuse can be challenging to navigate. But, put simply, it comes down to the following two questions:

1. Is my drug or alcohol use causing or worsening my impairment?
2. If I stopped my drug or alcohol use, would my impairment improve enough to allow me to return to work?

If the answer to both of the above questions is yes, the SSA will classify your substance abuse as ‘material.’ That means you would likely not be granted benefits.

If the answer to both of the above questions is no, the SSA will classify your substance abuse as ‘not material’ – your drug or alcohol use is separate from your impairment. That means you would likely be granted benefits.

Critically, the SSA’s analysis of your case and final determination cannot discriminate against you because of your substance abuse or addiction. If the SSA cites your drug or alcohol abuse as the sole basis for your denial, they would be acting illegally.

What about irreversible drug- and alcohol-related impairments?

Let’s say you live with advanced liver disease due to alcohol abuse. If you quit drinking today, your condition might not improve significantly enough to enable you to return to the workplace. In short, the alcohol-related impairment is irreversible.

In this case, the SSA will likely consider you disabled and therefore eligible for benefits, even though your substance abuse played a role in your impairment.

Classifying a condition as reversible or irreversible isn’t always black and white, and a full panel of specialists work together to make a determination. This includes the following:

• A medical consultant or doctor from Disability Determination Services (DDS) – they will assess your condition and the scope of your substance abuse and share their opinion as to whether ceasing use would positively impact your health and capabilities.
• Your current physician – the SSA will consult with your personal doctor or physician to verify your substance abuse and hear their point of view as to whether your impairment is permanent or not.
• Judge – the judge at your hearing is not obliged to agree with the medical professionals. Instead, they determine your eligibility under the law.
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What about prescription drug use?

Prescription drug use is treated a bit differently from alcohol and recreational drug use. You can’t receive disability benefits for a reversible impairment caused by your abuse of prescription drugs like painkillers and other narcotics. But you can receive disability benefits if you take your prescription drugs as instructed by your medical doctor. The material or not material test does not apply.

You may even be able to receive Social Security benefits if you:

• Are prescribed drugs;
• Take the drugs according to your doctor’s orders; and
• Experience drug side-effects (difficulty focusing and fatigue, for example) that prohibit you from working.

My claim was rejected – now what?

If your claim for disability benefits was rejected, and you live with a substance abuse disorder, don’t despair. Many benefits claims are denied upon the first submission – there are several courses of action you can take to have your case reviewed and accepted.

The first step is to read the SSA document explaining why your claim was denied. They will list one or more reasons for the rejection. If you disagree with their findings, you have the right to a reconsideration in which the SSA will review your application from the beginning.

If you decide to file for reconsideration, you must do so within 60 days of receiving your rejection. You should also secure representation – either a disability advocate or specialist attorney – to give you the best possible chance of success.

If your case is rejected again, you can appeal the decision and schedule a hearing with an administrative law judge. At this stage, legal guidance is critical. During the hearing, you will plead your case with a judge and present witnesses and medical experts. The judge will either uphold the SSA’s rejection or overturn it.

Get the professional help you need to move forward

If you believe you are rightfully entitled to Social Security benefits, but the SSA denied your application, please don’t hesitate to contact our friendly team. We are ready to discuss the nuances of your substance abuse disorder and how it affects your impairment.

Give The Law Office Of E.M. Scott a call today and take the first steps toward a bright future.