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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 personís disability.

The key decision for the SSA is whether the claimantís 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 personís 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 personís disability claim. 

The SSA will then look at any other limitations that are unrelated to the alcohol tainted claim to see if the personís remaining limitations are sufficient to award disability insurance benefits. If the SSA decides that the personís 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 personís 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 personís 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

 

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