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How substance addiction is factored into the SSDI disability equation

The Social Security Administration recently clarified its policy on the impact of "drug addiction and alcoholism," or DAA, when the agency analyzes whether an applicant for Social Security Disability Insurance (or Supplemental Security Income) is disabled from working and qualifies for benefits.

In March 2013, the new Social Security Ruling, or SSR, took effect, detailing how SSA decides if DAA is "material" in a disability determination. Basically - and arguably counterintuitively - if DAA is a material part of a claimant's disabling condition, he or she will not be considered disabled under the law and would be ineligible for SSDI.

What is substance addition?

According to Psychology Today, the definition of "addiction" depends on whom you ask and the context. However, it can be said that substance addiction happens when the consumption of alcohol or another drug "becomes compulsive and interferes with ordinary life responsibilities." Psychology Today identifies two main types of addiction:

  • Physical addiction, characterized by biological tolerance to the substance that causes physical symptoms when use is stopped or by significant brain reaction to the substance itself or to "cues associated with the drugs"
  • Psychological addition, the more common type, typified by compulsive alcohol or drug use in response to "stress"

The article concludes that addiction is not connected to "morality or strength of character." Despite this, in almost all situations, the federal government will not provide SSDI to an applicant whose primary disability is substance addiction.

Federal attitude toward substance addiction

SSDI is Social Security's disability insurance program that provides monthly cash benefits to otherwise-qualified workers who have become disabled by physical or mental impairments or combinations of impairments. Everyone knows that substance addiction may prevent a person from being able to hold a job. However, the approach taken by Congress and the SSA toward DAA is that a person whose substance addiction materially contributes to his or her work-preventing disability is not considered disabled under the law for purposes of SSDI benefits.

This was not always the case. Before a 1996 federal law, an SSDI claimant would have been eligible for benefits even if his or her disability was entirely based on alcoholism or drug addiction, so long as the addiction could be supported by objective medical evidence and other eligibility requirements were met. After the new law, recipients whose eligibility had been based entirely or materially on addiction were no longer eligible, unless they could provide reliable medical evidence of other physical or mental impairments or combinations of impairments that met the SSA definition of disability.

According to the SSA, the new standard reduced the numbers of people receiving SSDI drastically and going forward, new applications were denied if DAA contributed materially to the claimant's disability.

The new SSR

The new ruling is long and detailed in its explanation of how the SSA considers substance addiction in the SSDI disability equation. The evaluator must determine and document whether DAA is a materially contributing factor to an applicant's disability and if it is, the application would be denied.

The analysis of DAA materiality can be arduous. For example, a person may have a combination of physical and mental impairments from which the thread of substance addiction must be lifted and considered for its material contribution to the overall disabling condition.

Because of this complexity, anyone with substance addiction who is applying for SSDI should consult with a lawyer experienced in complicated SSDI cases and with a thorough understanding of how the federal law determines disability when addiction is in the picture.