Disability Benefits For Substance Abuse

It is not always easy to qualify for government disability payments in the United States.

Given the penchant for fraud and abuse of the system, Social Security Administration (SSA) officials are much more likely to deny a person’s initial disability application than to approve it. Those tenacious enough to keep trying, however, often achieve a positive outcome.

Disability benefits for substance abuse are permissible, along with Medicare and Medicaid access, but can be difficult to set up.

Qualifying for disability payments

In order to qualify for Social Security disability assistance, a person needs to prove three things — that they do not make more than the income limit (about $1,000 per month), that their disability will last longer than a year, and that their disability “severely” impacts their job performance. Once they’ve established these basic elements, SSA must then agree that their particular physical or mental condition is one that qualifies for disability payments under the current law. If it does, the person wins. The monthly amount awarded to any individual will vary based on past tax contributions for Social Security Disability (SSD) or need for Supplemental Security Income (SSI).

If asked to draft a list of the type of people who normally receive disability payments, we would likely include people with bad backs, mobility issues, hearing or vision problems and those who are mentally or physically underdeveloped. Although we may also include some people with significant mental illnesses, like schizophrenia, one wouldn’t be so quick to include people with moderate depression or even borderline personality disorder. While these illnesses can obviously be debilitating is certain cases, the severity varies widely among patients. We’d also probably avoid including alcoholics or drug addicts on the list, especially if we consider that these conditions are treatable (at least in the short-term).

You might be surprised to learn that substance abuse can, in fact, lead to a disability finding serious enough to warrant monthly payments from the U.S. government. That is not to say, however, that the interplay between substance abuse and disability is clear cut. It’s not. While the more enlightened of us have come to consider addiction as an “illness,” rather than a moral failing, simply being a drug addict or alcoholic does not, in and of itself, mean you are disabled. Not being allowed to work because you are actively under the influence of intoxicating substances won’t cut it either. That will just get you fired for cause and make you ineligible for unemployment benefits. But if your past or present substance abuse has caused a permanent and irreversible physical or mental defect, you may very well have a valid claim.

The reason for this is simple. When deciding whether a permanent physical or mental disability is serious enough to qualify for benefits, the Social Security Administration is not permitted to pass judgment on how the condition came to pass. Unlike the folks at the unemployment office, who can decide what level of culpability you had in getting yourself fired, the people who decide disability payments are not a moral authority. For example, if you become paralyzed because you crashed your car while drunk, your case would be decided exactly the same as it would if a spinal tumor caused your condition instead.

Substance addiction and disability payments

Pursuant to Section 12.09 of the Social Security Administration’s list of qualifying disabilities, Substance Addiction Disorders are defined as behavioral or physical changes associated with the regular use of substances that affect a person’s central nervous system (CNS). These types of issues include organic mental disorders, depressive syndrome, anxiety disorders, personality disorders, peripheral neuropathies, liver damage, gastritis, pancreatitis and seizures.

Since many substance abusers eventually suffer some form of permanent damage as a result of their behavior, the pool of potential “substance abuse disability” claimants is quite large and will only increase if the level of abuse continues to rise. What’s more, the SSA cannot refuse to pay benefits to someone simply because they are still actively abusing drugs or alcohol as long as the qualifying condition will remain, whether the person is sober or not.

Adjudicators use the drug and alcohol addiction evaluation (DAA) to determine the permanency of the disability. Unfortunately, it can be almost impossible for some applicants to show that certain mental issues, including depression and anxiety, that arose from past substance abuse would not improve if the abuse were to cease.  Further, active abusers will not be given direct access to their disability payment. Instead, a 3rd party “representative payee” will take charge of the funds in the hope that the money will not be used to further the person’s habit.

Eligibility for Medicare and Medicaid?

Patients who have suffered a permanent disability as a result of drug or alcohol use should be encouraged to evaluate whether they might qualify for disability benefits under the SSA. This is especially true if they are uninsurable under current state medical insurance plans as an SSA disability award can qualify certain applicants for Medicare or Medicaid, in addition to the cash payments. If one is approved for needs-based SSI disability, they will be automatically eligible for Medicaid. If one is approved for work-based Social Security Disability, they may be eligible for Medicare after two years. In either case, this could mean life-saving medical treatment for certain applicants.

Note: Eligibility requirements for government-backed disability programs should not be confused with eligibility requirements for disability policies offered through employers or on the private insurance market. Eligibility requirements for private policies can be vastly more restrictive than what the US government considers to be a covered disability.

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