Alcoholism, Substance Abuse and
Disability Benefits
By: Pitt
Dickey - Attorney
Preface: Since Social
Security Disability is directed under Federal law, the information
in this column will apply anywhere in the United States.
However each Office of Hearings and Appeals and District Office
have their own ways of doing things as does the various Federal
District and Circuit Courts. I have kept this column
primarily dealing the the mechanics of how the Social Security
District Offices and Office of Hearings and Appeals evaluates
disability claims.
- Pitt Dickey
This column will examine the
impact of alcoholism and substance abuse on eligibility for Social
Security Disability benefits. It is not uncommon for someone in
chronic pain to attempt to self medicate with illegal or
prescription drugs.
In years past, a person could be
eligible for Disability Insurance Benefits as a result of
alcoholism and substance abuse. Congress changed the law several
years ago to reverse its position on substance abuse so that now
substance abuse and alcoholism is a major obstacle to receiving
disability benefits.
The Social Security
Administration will evaluate the claimant based on his physical or
mental health related claim before reviewing the impact of the
substance abuse or alcoholism on the person.
To obtain disability insurance
benefits a person must prove that he has a medical condition that
can be expected to last for at least twelve months or result in
death; that he is not working now; and that his health problem not
only prevents him from doing his past work but that he is also
unable to do any type of work at all that exists in the American
economy.
If a person has a history of
substance abuse, the Social Security Administration will carefully
review that fact to determine if the substance abuse will prevent
the person from receiving Disability Insurance Benefits.
The general rule is that if the
Social Security Administration (SSA) makes a decision that a
person is disabled for benefits purposes and there is also
additional medical evidence that the person has a history of drug
abuse or alcoholism, then the SSA will make a further decision to
decide if the drug abuse or alcoholism contributes to the
person’s disability.
The key decision for the SSA is
whether the claimant’s drug abuse or alcoholism materially
contributes to the disability of the claimant. The issue is
whether the SSA would still award disability insurance benefits if
the person stopped using drugs or alcohol.
The SSA looks at the limitations
imposed by the person’s physical or mental problems and then
decides if any of these limitations would remain if the person
stopped abusing drugs or alcohol. If a limitation would not exist
if the person stopped using alcohol then the SSA will disregard
that limitation in deciding the person’s disability claim.
The SSA will then look at any
other limitations that are unrelated to the alcohol tainted claim
to see if the person’s remaining limitations are sufficient to
award disability insurance benefits. If the SSA decides that the
person’s remaining limitations are not disabling, then it will
decide that the drug or alcohol abuse is a contributing factor to
the determination of disability and will deny the claim.
If the SSA decides that the
person’s remaining limitations after eliminating the drug or
alcohol related limitations still meet the requirements for the
award of disability insurance benefits then it will find the
person is disabled independently of the substance abuse problem
and can award disability benefits.
If the SSA decides that a person
does have a substance abuse problem that contributes to his
disability and the person wishes to pursue his disability claim,
then the SSA will require the person to undergo appropriate
treatment at a facility and to make progress in their treatment
for substance abuse.
The SSA must approve the
treatment facility that treats the claimant. The SSA will not pay
benefits to a claimant who is required to obtain treatment if the
claimant does not comply with the requirements of the treatment
facility. The SSA will also not pay benefits if the person refuses
to undergo treatment after he has been notified that it is
available to him.
The types of treatment that the
SSA considers appropriate are based on the severity of the
substance abuse problem. Appropriate treatment is supposed to be
the least restrictive setting possible consistent with the needs
of the person.
This treatment can range from
outpatient counseling services up to intensive in patient
residential treatment which can include "acute
detoxification, short-term intensive residential treatment, long
term therapeutic residential treatment, and long term recovery
houses."
The treatment must be prescribed
by a State licensed or certified addiction professional based on a
detailed assessment of the person’s substance abuse
problems.
The claimant can be treated with
a variety of options which include medical examination and
management, detoxification, medication management including
substitution therapy such as methadone for heroin addicts,
psychiatric, psychological, vocational or other substance abuse
counseling in a residential or outpatient setting.
The SSA will then review
information from the treating facility to determine if the person
is complying with his treatment plan. The facility will report to
the SSA on the attendance and participation in treatment sessions,
reports of clinical testing such as blood tests for substance
abuse, observational reports from treatment professionals on the
progress of the person in the program, and assessments as to
whether the person is complying with the requirements of the
program.
The SSA will measure the progress
of the person in the treatment facility by such things as
abstinence from drug or alcohol usage; consistent attendance and
participation in treatment sessions; improved social functioning
and levels of gainful activity; and avoidance of criminal
activity.
In summary, if a person would not
be disabled if he stopped using drugs or abusing alcohol then the
SSA will deny disability benefits. It is possible for a person who
has a drug or alcohol abuse problem to obtain disability insurance
benefits if his disability is not related to the substance abuse
problems.
Substance abuse is a very large
red flag for the Social Security Administration in its disability
determination process. Help for substance abuse is available but
it is no longer a basis for disability insurance benefits.
Pitt Dickey has practiced law
in Fayetteville since 1978. He has handled SSA disability claims
for over twenty years. He practices with the firm of Smith,
Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place
and can be reached at 910-485-8020 or at pitt@smithdickey.com
. Or at the firm web site of www.smithdickey.com
.
Copyright © 2002 Pitt Dickey -
Used with permission
