Sometimes, potential clients ask how drug and alcohol use impact a disability claim. Whether due to a mental or physical condition, certain claimants turn to drugs and alcohol as a form of self-medication when struggling with the limiting and debilitating symptoms of a disability. Also, certain conditions may arise due to the long-term effects of drug and alcohol use that prohibit one’s ability to perform the material duties of his or her occupation. Physical or mental impairments may then prohibit the performance of the material duties of any occupation to which he or she is reasonably suited.
Drug or Alcohol Use and the Disability Insurance Claim
By way of example, consider prosecution of claims under a disability insurance policy for a client suffering from avascular necrosis. Such a claimant may have been a highly educated individual and a high wage earner. However, stress and anxiety came with the territory. Habitual and heavy alcohol use followed. Due to the claimant’s high earnings, the claimant was able to purchase an insurance policy for disability insurance independently.
This disability insurance policy was not governed by the Employee Retirement Income Security Act (ERISA) and, instead, was governed by the Texas insurance code and Texas state law in the handling of disability insurance claims. This gave the claimant certain causes of action that would otherwise be unavailable under ERISA. Not only could he file suit for wrongful denial of benefits, but he could also sue for violation of the Texas Deceptive Trade Practices Act (DTPA) and pursue damages for intentional or knowing conduct in the context of the disability claim and denial of his disability insurance benefits.
According to the Mayo Clinic, avascular necrosis is a condition that may cause pain and severe discomfort in the lower body; while symptoms may be mild at first, the pain may become severe and affect the groin, thigh, buttocks, and continue even when lying down. Avascular necrosis (also called osteonecrosis) is death of the bone tissue and may affect the hips or knees. What’s more, it may be caused by joint or bone trauma, various diseases, and/or overuse of alcohol. Thus, some people may develop the condition without alcohol use disorder, and others because of it.
This disabling impairment may cause such physical limitation as to give rise to a meritorious disability insurance claim. Likewise, the compounding effects of pain and suffering may further limit the ability to perform not only the duties of the claimant’s own occupation, but also any occupation. Ultimately, the disability insurance company in such a case may recognize the severe limitations arising from this medically determinable condition, even if it was brought on by alcohol use disorder.
Drug or Alcohol Use and the Social Security Disability Claim
Social Security disability claimants struggling with drug and alcohol problems also must understand how Social Security evaluates these claims. Alcohol and/or Drug Use Disorder in and of itself is not considered a disability by Social Security that allows entitlement to either Social Security disability (SSDI) or Supplemental Security Income (SSI) benefits). Social Security has struggled in the past in evaluating the impact of drug and alcohol use on Social Security disability claims. Social Security acknowledged that is still uses the terms “drug addiction” and “alcoholism” though they are outdated. See SSR 13-2p, Titles II and XVI: Evaluating Cases Involving Drug Addiction and Alcoholism (DAA). Social Security follows the definitions of Drug Addiction and Alcoholism used by the American Psychiatric Association with one exception: Social Security does not recognize nicotine use disorder in the same way.
Social Security considers the “key factor” in determining whether drug or alcohol use is a contributing factor to the determination of disability is deciding on whether the claimant would still be found disabled if he stopped using drugs or alcohol.
Social Security Disability: Continuing Disability Reviews
Even after a favorable decision and approval, Social Security may perform a Continuing Disability Review (CDR) to evaluate if the claimant continues to meet the requirements to receive Social Security disability benefits. Social Security will find a clamant has a “DAA Condition” (Drug and Alcohol) when the claimant has a medically determinable substance use disorder that is not “material.” See DI 900070.060 DAA Condition.
Drug and alcohol use is considered material when the claimant would not meet the criteria of Social Security’s definition of disability if drugs and alcohol were not being used. In such a case, the claimant will not be considered disabled. Likewise, drug and alcohol use is considered not material if the claimant would still meet Social Security’s definition of disability even if drug and alcohol use ceased entirely.
Likewise, drug and alcohol use is not considered material where drug or alcohol use caused the disabling impairment, but it is now irreversible or could not improve to the point of non-disability. Examples given by Social Security include peripheral neuropathy, permanent encephalopathy, cirrhosis of the liver, and substance-induced persisting dementia and substance-induced persisting amnestic disorder from long-term alcohol or drug use.
Other Evidence: Opinion Letters, Questionnaires, and Testimony
Motivation and attitude are viewed as important when evaluating the impact of drug and alcohol use on the claimant making a disability claim. The vocational assessment performed at a Social Security disability hearing involves interpretation of the occupational history and the impact of medically determinable limitations on the claimant’s ability to work. As always, the claimant has the burden of proof on the first four steps of the sequential evaluation. The burden only shifts to Social Security once step-five of the sequential evaluation is reached; then, Social Security must put forth evidence of other occupations existing in the national economy that the claimant may perform.
There was a vocational expert I cross examined innumerable times in Social Security disability hearings when I first started practicing in the area of disability law in Houston, Texas. Over the years, this vocational expert would testify regularly that his evaluation of the claimant’s motivation and attitude – as he could see it through the medical records and as he heard it in testimony- impacted his analysis regarding the claimant’s truthfulness and employability. This testimony would come into play during the step-five analysis under the five-step sequential evaluation.
This vocational expert and I became so well-acquainted that we later worked together in prosecuting and defending claims outside of Social Security disability hearings where clients needed the opinion of a qualified vocational expert. As you will see in other blogs we have written, opinion letters from expert witnesses, including vocational experts, can be very useful when making either a disability insurance claim, appealing the denial of disability insurance benefits by a disability insurance company, or appealing a Social Security disability denial.
When it comes to drugs and alcohol, no one can deny what the medical record show to be true about their history and struggles (absent errors in the reporting from treating healthcare providers). However, attempts to remain sober and a willingness to engage in the process to overcome drug and alcohol addiction can go a long way when submitting a disability claim. This is true even if drugs and alcohol remain a problem for the claimant in their life experience. Testimony from friends or relatives may also help.
The Supplemental Security Income (SSI) Claimant
We have often seen drugs and alcohol as problematic for the Social Security disability claim where the claimant is making a claim for Supplemental Security Income (SSI). Supplemental security income has the same medical requirements for the claimant to be found disabled by the Social Security administration as Social Security Disability (SSDI). The process is the same to make the claim, request reconsideration if needed, and request a hearing before an administrative law judge, if needed.
However, there is a requirement that the SSI claimant also have little to no household income and resources. For instance, a SSI claimant may have no more than $2,000 in vehicles and money in bank accounts if single or $3,000 in vehicles and money in bank accounts if married. There are exceptions to what is counted; Social Security lists the following as excluded: Supplemental Nutrition Assistance Program (SNAP) benefits, Section 8 housing vouchers, rent rebates, and others.
Supplemental security Income (SSI) is more of a needs-based (i.e. welfare) program for those individuals who have been unable to work during their work lives sufficient to earn quarters of coverage from payment of income taxes and who prove they are suffering from a disability as defined by Social Security. SSI is a federal program funded by U.S. Treasury general funds, and it’s administered by the Social Security Administration. However, SSI is not paid for by Social Security taxes. SSI provides monthly payments to adults aged 65 and older who have limited income and resources, and to other adults, and children, with a disability or blindness who have limited income and resources.
These are some of the most underrepresented and struggling members of our society. Given the nature of the program, these claimants often struggle financially well before making their disability claim with Social Security. Healthcare and insurance are often diminished or nonexistent.
In these cases, it’s not unusual to find claimants self-medicating through the use of drugs or alcohol that they may obtain on their own. Self-medication may be due to the ongoing symptoms they experience with their disability. This is true regardless of whether such claimants are experiencing physical or mental limitations as a result of their disabilities.
A disability lawyer must carefully evaluate the distinction between the disability claimant’s limitations arising from their underlying medically-determinable conditions as opposed to the use of drugs and alcohol. This evaluation may involve the need to consult with a healthcare professional to further explain the issue or obtain an opinion letter or completed questionnaire to understand the disability claimant’s clinical picture and the impact of drug and alcohol use.
On that note, people struggling with finances and substance abuse and/or mental health issues in the North Texas area might consider consulting with the healthcare providers falling under the North Texas Behavioral Authority. The Noth Texas Behavioral Authority oversees state-funded indigent mental health and substance use disorder services for a six-county region that includes Dallas, Ellis, Hunt, Kaufman, Navarro, and Rockwall Counties.
As cited by the authority, a 2018 National Survey on Drug Use and Health found that 20.3 million individuals 12 and older had a substance use disorder. This number is staggering when you think about it. The authority also correctly notes that the term “substance abuse disorder” is the official term for what many consider “addiction.”
Not all people who use substances like drugs and alcohol have a disorder. However, as the authority notes, substance abuse disorder can cause symptoms and problems in behavior, relationships, and emotional responses. “Outreach, screening, assessment, and referral centers (OSAR) may be the first point of contact for people seeking substance use disorder treatment service. Texas residents who are seeking services and information may qualify for services based on need. OSARs are now located at local mental health or behavioral health authorities in all 11 Texas Health and Human Service regions.”
People can search for their local OSAR here:
Taking care of your health should come first, no matter what. As for the disability claim, seeking out and sticking with treatment helps create a record of evidence. As mentioned, medical records and healthcare provider opinions are critical pieces of evidence in supporting disability insurance claims and in making a Social Security disability claim.
Testimony at the Social Security Disability Hearing
At the Social Security disability hearing, and if allowed, it may help to enlist the testimony from a friend or relative about the claimant and her struggles with drugs or alcohol. People often have others around them that observe their daily activities and how their disability impacts their daily lives. As mentioned, a willingness to engage in the process to overcome addictions may assist in obtaining Social Security disability benefits.
Administrative Law Judges are charged with an obligation to follow the law and regulations governing a Social Security disability claim. While this is true, judges are human beings just like the rest of us and part of the disability hearing process is an evaluation of the credibility of the Social Security disability claimant. Medical records provide evidence of limitations and opinions from treating doctors. Previously, Social Security was even to give controlling weight to the opinions of treating doctors. This changed, and now treating doctor opinions are evaluated like those of consulting doctors.
Therefore, testimony from the claimant and a friend or relative may help establish that the claimant truly suffers from a medically determinable condition outside of their drug and alcohol use, that they are attempting to overcome their struggles with drugs and alcohol, and that they’re being honest about these matters. In such cases, the claimant’s attempts to overcome their drug or alcohol disorder should be a credit to them rather than be looked at like an albatross around their neck.
An American and Global Problem
According to the World Health Organization in 2024, 2.6 million deaths occur per year as a result of alcohol consumption. “Stigma, discrimination and misconceptions about the efficacy of treatment contribute to these critical gaps in treatment provision, as well as the continued low prioritization of substance use disorders by health and development agencies.” The American struggle with Fentanyl abuse is well-known. Drug and Alcohol use is a widespread disorder. For some, it is a lifelong struggle.
If you or a loved one are struggling with a disabling condition and with drugs or alcohol, do not give up hope. The key is to put forth evidence that your disabling condition would continue irrespective of the use of drugs and alcohol. Beyond that, seeking help in treating substance abuse disorder should be the focus, first and foremost for the health of the person struggling with the disorder and for the health of those around him.