Alcoholism and Drug Addiction Social Security Disability Claims

Welcome to Season 1, Episode 39 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into the complicated topic of "Alcoholism and Drug Addiction Social Security Disability Claims."

Most people think substance abuse and Social Security Disability benefits don’t mix - that a history of addiction means automatic denial. The reality is more nuanced. Substance abuse can affect your claim, but it doesn’t automatically disqualify you. The key is understanding how Social Security evaluates cases, what “materiality” means, and how your medical conditions fit the rules. In this episode of Winning Isn’t Easy, disability law expert Nancy L. Cavey explains how substance abuse influences Social Security Disability claims - and what you must prove. She outlines the strict guidelines around addiction, what Social Security looks for in medical records, and why the central question is whether you’d still be disabled if you stopped using drugs or alcohol. Nancy also breaks down confusing scenarios: why addiction alone can’t qualify you, how substance abuse interacts with conditions like liver disease, neuropathy, or mental illness, and how Social Security decides if addiction remains “material” to your disability. You’ll learn which evidence matters most - treatment history, periods of sobriety, documentation of ongoing medical problems, and medical opinions showing your limitations independent of substance use. She clears up misconceptions about addiction-related claims and explains how judges assess your condition, what they expect in your records, and why consistent evidence is essential. By the end, you’ll understand how Social Security views addiction, the hurdles you may face, and the steps you and your attorney can take to show your disability is real and not solely due to substance use. Winning isn’t easy, but with preparation and honest documentation, you can present a strong case.

In this episode, we'll cover the following topics:

One - Why Are Alcoholics or Drug Addicts Getting Paid Social Security Disability Benefits?

Two - What Do You Have to Prove to Get Your Social Security Disability Benefits?

Three - How Does the Social Security Administration Evaluate “Materiality” in Addiction-Related Disability Claims?

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:00]:
 Foreign. Welcome back to Winning Isn't Easy. Social Security Disability Benefits this is the podcast where we break down everything you need to know about navigating the Social Security disability claims process. I'm your host, Nancy Cavey. Before we get started, I've got to give you that blasted legal disclaimer, this podcast is not legal advice. Now, the Florida Bar association says that I have to say this and I've said it, but nothing will ever prevent me from giving you an easy to understand overview of the Social Security disability claims process, the games that are played, and what you need to know to get the disability benefits you deserve. So off we go. Now, in today's episode, we're going to tackle a difficult subject, drug addiction and alcoholism and how that can impact your Social Security disability claim.
 
 Nancy Cavey [00:01:04]:
 It's no secret that substance abuse can destroy someone's health, career and family life. But when it comes to a Social Security disability claim, I'm going to tell you that the rules are very strict and many people don't understand where that line is is drawn in the sand. Can you get benefits if your only issue is addiction? What if your addiction has led to other serious medical conditions like liver disease, neuropathy or mental illness? And how does the Social Security Administration decide whether your addiction is still material to your disability? Now, these are the kinds of questions I hear all the time, both from people who are struggling with recovery and from families who are worried about their future. The truth is that the Social Security Administration isn't just looking at your past. It asks whether you're still disabled if you stopped using drugs or alcohol today. And that's what makes these cases so complicated. We're going to walk through the actual law that talks about addiction and disability benefits, the extra proof that you need to submit to succeed with your claim and how Social Security decides when whether your condition would remain disabling even if you were sober. I'm also going to try to clear up some big misconceptions so you know exactly what is expected if substance abuse is part of your case.
 
 Nancy Cavey [00:02:24]:
 So the goal here is that you'll understand how Social Security Administration views addiction related disability claims, the hurdles that you face, and the steps that you can take to present your case in the strongest light possible. Got it. Let's get started. So what am I going to talk about today? Number one, why are alcoholics or drug addicts getting paid Social Security disability benefits? That's a question I hear all the time. Two, what do you have to prove to get your Social Security disability benefits for alcoholism or drug abuse? And three how does the Social Security Administration evaluate materiality in an addiction related disability claim? Let's take a break for a moment before we get started on this difficult topic.
 
 Speaker B [00:03:09]:
 Are you considering filing for Social Security disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security disability benefits, which will cover everything you need to know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:03:45]:
 Welcome back to Winning Isn't Easy. Why are alcoholics or drug addicts getting paid Social Security disability benefits? Well, I tell you what, I hear that question all the time and the answer is they aren't. If an alcoholic or drug addict's only disabling condition is the addiction itself, the Social Security law makes it very clear that they are not going to be paying Social Security disability benefits. It doesn't matter how severe debilitating the addiction may be. The law says that addiction alone does not qualify someone for benefits. This rule exists for a simple reason. Social Security wants to ensure that disability benefits are provided only to individuals who have a permanent or long term impairment and that would remain disabling regardless of lifestyle choices. However, if you have a disabling condition that's associated with or caused by addiction, you may still be eligible for Social Security disability benefits.
 
 Nancy Cavey [00:04:42]:
 So let's say you contracted hepatitis from using dirty needles, but you're now clean and you're sober. Congratulations. In that case, you might qualify for Social Security benefits because of the long term effects of hepatitis, which remain a disabling condition even in the absence of the ongoing drug use. Similarly, conditions such as cirrhosis of the liver, pancreatitis, cardiomyopathy, neuropathy, certain types of brain damage may continue to interfere with your ability to work even after you stop drinking or using drugs. On the other hand, if you are still actively using or abusing substances, your claim is going to be denied even if you have another serious medical condition. So let's say you are someone who has hepatitis and you continue to abuse drugs. Social Security is most likely going to deny this because they see the ongoing addiction as material to the disability. In short, your medical condition has to stand on its own as disabling separate from the substance abuse for benefits to be awarded now.
 
 Nancy Cavey [00:05:50]:
 Additionally, every applicant, regardless of whether they have a drug or alcohol issue, has to establish they meet the five Step Sequential Evaluation test to determine their entitlement to benefits. So this test applies equally to individuals who have histories of drug addiction or alcoholism. And even if you get over the materiality issue. You still have to meet that five step sequential evaluation. Medical documentation consistent with sobriety and strong legal guidance can be crucial to in getting your Social Security disability benefits if you have a history, a past history of substance abuse. So let's take a break because we're going to come back and we're going to address what you have to prove to get your Social Security disability benefits. Got it. Let's take a break.
 
 Nancy Cavey [00:06:50]:
 Welcome back to Winning isn't Easy. What do you have to prove to get your Social Security disability benefits? So let's talk first about the five step sequential evaluation test. You have to establish that you've been out of work for at least a year or have a medical condition that would be expected to keep you out of work for a year. Number two, your condition has to be severe enough to significantly limit your ability to perform basic work activities. Number three, your condition meets or equals one of the Social Security's listed medical impairments, which potentially, in the case of addiction issues, can be things like having a problem with hepatitis, having a liver issue, cirrhosis. It could be that you have avascular necrosis because of alcohol abuse and you have a, have undergone a total hip replacement. So what we're looking at here is what is the underlying medical condition caused by or contributed to, or maybe even independent of the past abuse issues. Now at step four, you have to establish that you can't go back to the lightest and simplest job you performed in the five years before your claim was decided and where most of these cases are decided.
 
 Nancy Cavey [00:08:07]:
 Step five, that you can't perform other work in the mythical, hypothetical, not real world, national economy in view of your age, education, skills and your limitations. Remember, for individuals who have a history of addiction, there are additional hurdles. So once you're establishing the five step sequential evaluation is met, you have to demonstrate sobriety and in my view, based on my experience, active participation in aftercare or support programs. Judges are looking for that. But ultimately the question is going to be, is your current disability caused solely by your substance abuse or is it caused by these other medically documented conditions? Like I said, liver failure, neuropathies, heart disease, avascular necrosis. Those are the kinds of things that Social Security is going to be looking at. And they're going to look closely at your medical records and treatment notes to verify that ongoing sobriety and, and whether that disabling condition would continue to exist if you stayed sober. Now, let me give you an example.
 
 Nancy Cavey [00:09:18]:
 If someone has cirrhosis of the liver and the medical notes confirm that they've stopped drinking. Social Security could consider cirrhosis disabling regardless of the past alcohol abuse. But a number of years ago I had a case which we thought was actually a really good case because of the cirrhosis issues. But we get the medical records and lo and behold, there are now multiple emergency room visits because the person started drinking again and they are coming into the ER with blood alcohol limits through the roof. The doctors are saying there's been an aggravation of the cirrhosis because of the drinking and they're not compliant with treatment regimens. They're not going to support groups. Well, you know, when we read that that really great case became an awful case and we had to tell the individual that we couldn't represent them anymore and that they were most likely going to lose. And if they wish, they could find another lawyer to represent them, but that I quite frankly wasn't going to devote my firm's resources or times at that point to helping them get the benefits.
 
 Nancy Cavey [00:10:33]:
 Now that may sound harsh, but the reality is that they would not get the benefits in that situation. And perhaps that was a wake up call for this individual to resume treatment. But you can also understand that this can also impact a person's mental health. Disorders like depression, anxiety, bipolar disorder. It can be worsened by substance abuse. You need to establish that the psychiatric symptoms are going to persist even when clean and sober. That's going to require long term treatment. Reports from psychiatrists, detailed documentation showing that mental illness is not just solely a result of drug or alcohol use.
 
 Nancy Cavey [00:11:14]:
 I understand that it could be a manifestation of, and we need to document that. But again, more often than not, in that situation that tends to be episodic. And by that I mean the person will be sort of functioning, if you will, with their mental illness and then have episodes where they will start using drugs or they will start using alcohol again. And the conditions are exacerbated, the mental illness conditions are exacerbated. And then when they become compliant with their medication or they stop using the other substances, they're still having mental health illness symptoms, but they're clearly disabled at that point as a result of the mental illness symptoms. I mean, there's no straight line in these kinds of cases. And each case obviously is unique. Got it.
 
 Nancy Cavey [00:12:08]:
 Let's take a break.
 
 Speaker B [00:12:12]:
 Struggling with your Social Security disability case. The right attorney can make all the difference. Get our booklet. The key to hiring a great attorney for your Social Security disability case. Discover how to find an experienced attorney who will fight for your rights and navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Nancy Cavey [00:12:51]:
 Foreign welcome back to Winning Isn't Easy how does the Social Security Administration evaluate materiality in addiction related Social Security disability claims? That's a great question, and it's often the key in a Social Security disability claim as to whether or not we'll even take a case and or whether or not we're going to be successful. Social Security regulations specifically prohibit awarding benefits if drug addiction or alcoholism DAAA is considered material to the disability determination. In other words, if you stop using the drugs or alcohol, would that restore your ability to work? If not, then you know the you know the Social Security Administration is going to potentially deny the claim. If stopping the using of the drugs would restore your ability to work, yes, most likely they'll approve. But if it won't, then they won't approve your claim. And again, depends on what's happening in those medical records. It is one of the most important and contested issues. So the key questions are going to be asked is number one, are you still drinking or using drugs? Two, if you're stopped, would your ability to work improve? If the answer is no, then claim is probably going to be denied.
 
 Nancy Cavey [00:14:16]:
 If the answer is yes, then we kind of move on to the question of do you have any medical conditions caused or worsened by the substance abuse? If so, would these conditions still prevent you from working even if you stop drinking or using drugs? And the answer to that is if the conditions would still prevent you from working if you stopped, then the most likely thing is going to be an award of benefits. Then the question always is going to be is your drug addiction or alcoholism material to your inability to work? If it is material, you're going to get denied. If it's not material, you will be approved. So let me give you an example. And again, this is an example from a case of ours many years ago. This client had epilepsy brought on by years of excessive alcohol use and they had seizures. We took the case because they had told us that they weren't using and we believe them. Unfortunately, their medical records showed repeated emergency room visits for seizures while intoxicated.
 
 Nancy Cavey [00:15:28]:
 Well, that wasn't good, was it? The doctor's notes noted that the epilepsy was secondary to alcohol abuse. That's not very good either. Do you think that you would qualify for benefits in that case? The answer is heck no. Now, if the seizures would stop once you quit drinking, the Social Security Administration could conclude that the alcoholism is no longer material and they could pay the claim. On the other hand, if you quit drinking and you still suffer from the seizures, they may find that the epilepsy is disabling on its own right, and therefore not materially related to alcoholism. And again, this applies to drug addiction. If the disabling condition remains even after the sobriety, then benefits are payable. Social Security is going to heavily rely on the medical expert testimony if needed.
 
 Nancy Cavey [00:16:25]:
 They're certainly going to rely on treatment records and, and doctors notes that explicitly limit your condition to the substance abuse are going to harm your case. While documents showing long term severity and continuing symptoms can strengthen it, having consistent medical care, strong physician support and the guidance of an attorney can make all the difference. Now, I have tried a number of these cases, one of which actually did involve epileptic seizures, but the claimant in this case had a brain injury and in this particular case, because of the injury, had problems with impulse control, which led to binge drinking. And the binge drinking was sort of circular. It aggravated the epilepsy. So the question became chicken or egg? And this case was heavily litigated. We lost it. It went up on appeal.
 
 Nancy Cavey [00:17:22]:
 It came back, we had expert testimony about the underlying tbi, the lack of judgment, the impact of the alcohol, and ultimately convinced the judge that those episodes in which they would go out and do binge drinking was not material to the claim in that it was a part of the underlying TBI injury. It was not really a clean alcoholism addiction issue. It was a manifestation of an underlying claim. That was not an easy case. And you can imagine that these cases are not easy. So my general rule and my practice is, look, I will take the case if you are no longer drinking, no longer addicted, you're clean, you're sober, you're in some sort of a, a consistent program. I will take the case if we have a clean, non alcohol related case. Cause for the disability.
 
 Nancy Cavey [00:18:31]:
 So you were in a, you were struck by a motor vehicle and you have a herniated disc. Yes, you may have had alcoholism in the past, you're not drinking, but you, your current injury to your back is not alcohol related. Let's say you have a situation where you are clean and sober, but because of your history of alcoholism, you have avascular necrosis of the hip. And avascular necrosis can be alcohol related and it basically destroys the bony structure of the hip because of the damage done by the alcoholism. But you're clean, you've gotten a total knee. I'm sorry, a total hip replacement. Done. I will probably take that kind of case, but if you're drinking and you have a vascular necrosis and you've had a total hip, I won't take it.
 
 Nancy Cavey [00:19:27]:
 You can see hopefully where we start to parse the analysis of of the Social Security rules and regulations and the kind of fact patterns that we're looking for that we think are winning cases. So every case is unique, but in my view, if you are continuing to use or abuse, I'm sorry, but I won't take the case and most likely Social Security will not award your benefits. Got it. I know this was a tough topic to talk about today, but I thank you for listening to this episode of Winning Isn't Easy tackled one of the toughest areas in Social Security disability law claims involving drug addiction and alcoholism, and we've talked about why addiction alone doesn't qualify for benefits, how medical conditions caused by past use can still be disabling, and what it means when Social Security says that your addiction is material to your inability to work. Clearly, these are difficult and complicated cases, and I hope that you understand that that it takes you being clean and sober to win these kinds of cases, together with strong medical evidence and the right legal strategy. Got it. If you have any questions about your rights to Social Security disability benefits, we hope that these episodes are providing you with guidance. And if you found this episode helpful, please like our page, leave a review, share it with family and friends, and subscribe to this podcast.
 
 Nancy Cavey [00:20:56]:
 Join us next week for another insightful discussion on Winning Isn't Easy. Thanks for listening.