SSDI/SSI Disability Benefits For Drug And Alcohol Addiction

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

January 24, 2019

Currently, drug or alcohol addiction alone is not enough to warrant disability benefits. Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) disability benefits are not available to those that have a disabling condition that stems from addiction if the condition is considered to be reversible. Despite these stumbling blocks, it is not impossible for you to obtain disability.

General Eligibility Requirements

The SSA has basic requirements for adults over 18 to quality. They state that a person must “have a medically determinable physical or mental impairment.” They list the following conditions as requirements of eligibility if it:

• results in the inability to do any substantial gainful activity; and
• can be expected to result in death; or
• has lasted or can be expected to last for a continuous period of not less than 12 months.

If they deem that you fulfill these and your illness falls within the guidelines for conditions stated in the SSA’s Listing of Impairments, then you may qualify for benefits.

How Does A Drug Or Alcohol Addiction Affect The Eligibility Process?

When the Social Security Administration is considering your case, they will try to determine what effect drug addiction or alcohol use (called DAA by the Social Security) has on your current state. This is called a drug and alcohol abuse (DAA) evaluation.

This determines if the substance abuse is a contributing factor. In other words, does the drug use cause the condition or does the condition exist separately of the addiction? For someone that has a disabling condition the claim will only be successful if it is determined that the continued use of the substance does not contribute to the state of disability. In this case, drug use is an immaterial factor.

It is only when the addiction causes irreversible medical conditions that the government will allow a person these benefits. Inversely, if the addiction is causing the state of disability and it is deemed that the condition may be reversible if use ceases, then the administration will not approve the condition.

In addition to the vast benefits for your health you should cease using to increase your chances of obtaining benefits. By doing so you gain the chance to exhibit that your condition continues to exist outside of the scope of your substance abuse.

This will make it easier for them to determine that your disability is independent of any substance abuse. Additionally, entering into a treatment program to aid in the cessation of the substance may be helpful in helping you achieve this goal.

Disabilities Caused By Substance Abuse That Qualify

Prolonged exposure to drugs or alcohol carries great risk of irreversible damage. The SSA does acknowledge Substance Addiction Disorders under its Disability Evaluation, section 12.09. If you can prove, beyond a reasonable doubt, that you suffer from an irreversible impaired physical or mental state that is derived from the impact of the drug or alcohol on your central nervous system, you can qualify for benefits.

In order to do so, you must meet the listing criteria for the specific illness in order to prove this. The conditions that can be considered are:

• Anxiety
• Depression
• Peripheral neuropathies
• Personality disorders
• Seizures
• Organic mental disorders
• Liver Damage
• Gastritis
• Pancreatitis

It is important that you can illustrate the exact nature of your condition and disability and provide clear examples and evidence of how the circumstance stands separate from any drug or alcohol use.

The Importance Of Medical Documentation

For these reasons it is very important to work closely with a physician so you can provide accurate and in-depth documentation of the entire state of your health. The greater familiarity that a doctor has with your case and current state of medical conditions, the better.

It is important that leading up to and through the application process you seek the regular medical care and treatment that is necessary to treat the scope your condition, ensuring that proper documentation is present. Prepare thorough documentation of the dates, location, and specifics of any appointments, treatments, and hospitalizations that are pertinent to your impairment. Listing specific physicians, prescriptions, or any tests and their results can also be important.

Take care to examine your medical records especially any notes the physician or care provider included. Sometimes these may contain notations that may either aid or harm your case. It always is better to be aware and prepared.

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 (DDS).

How Does My Current Substance Abuse Affect My Benefits?

It is strongly recommended that as soon as you consider applying for benefits you cease using drugs or alcohol. If you continue to struggle with an ongoing substance abuse problem and the SSA suspects this, it is likely that they will only issue your benefits to a representational payee. In some instances, they may also require that you enter a treatment program.

A representational payee is someone—it could be a friend, family member, or member of a qualified organization—that is responsible for overseeing your benefit checks and financial spending so you do not spend the money on drugs or alcohol.

What If I Don’t Meet Any Of The Listing Requirements?

If you’ve progressed through the application process, and you’ve found you don’t meet the listing requirements for the SSA’s List of Impairments, you may still have a chance to gain disability benefits if you posses a certain amount of functional limitations. In fact, a large amount of people that obtain benefits, secure them via this approach.

The SSA utilizes two things to gauge this: a RFC and MRFC evaluation which are conducted by a medical consultant for the Disability Determination Services (DDS), which is a state agency that works for the SSA.

An RFC evaluation assesses your residual functional capacity through various methods and determines how your body is physically able to exert itself and what circumstances limit your ability to perform your job. The RFC will also contain any non-exertional restrictions which may include tasks pertaining to your fine and gross motor skills.

The MRFC evaluation gauges your ability to engage in situations utilizing mental and social functioning skills including your social, mental, and cognitive abilities. This is broken down into four areas: understanding and memory; adaptation; social interactions; and sustained concentration and persistence.

Then, they will determine your limitation based on these areas, and use that to determine what work you are able to do. The addiction should also be listed in a properly prepared MRFC.

After review of your RFC, if the SSA determines that you are unable to fulfill the responsibilities of gainful employment, they will issue you a medical-vocational allowance. This will allow you to claim benefits via another venue besides a disability listing.

In order to obtain a medical-vocational allowance, they take into account your age, education, and skills, comparing them to the prior jobs you’ve had within the past 15 years. If you don’t fulfill the requirements of their vocational rules you may receive the allowance.

Not only do they consider your past employment, but they will also consider if there are any unskilled jobs that you are capable of doing. If they find another job they believe you are capable of engaging in, you will be denied.

In both instances, they will take into account your age, medical records, and any recommendations from your doctor. It is very beneficial if you have your personal physician fill out the documentation as a supplement and comparison to the DDS findings.

Get The Help You Deserve

Don’t let drugs or alcohol stop you from receiving the benefits and care you need. If you have any other questions about this process or need professional help to contend with a substance abuse problem, please contact our highly trained staff at RehabCenter.net to request more resources.