OP-ED: COUNSEL'S CORNER

The Connection Between Psychiatric Disorders, Drug/Alcohol Use, and Access to Social Security Disability Benefits

By Zoya Yarnykh, Staff Attorney and Steven Bruce, Legal Director

In the Social Security disability process (this includes SSI disability), there is a concept known as DA&A materiality. The DA&A part stands for drug and alcohol addiction. Social Security takes this into consideration in the following manner: If a claimant has a physical impairment or mental condition for which s/he is filing and it can be shown that, minus the effects of that person’s drug or alcohol use, the condition(s) would not be disabling, the claimant would be denied benefits. The burden to prove materiality in some states (CA, AZ, NV & HI), is on the claimant who must prove that a disabling condition would exist in the absence of drug and/or alcohol use.

In nearly all cases involving DA&A materiality, a conclusory statement that substance abuse is not material to a disability will not suffice, especially when the impairment claimed is of a psychiatric nature, such as depression, anxiety, or a form of psychosis. The statement has to be supported with evidence from an acceptable medical source, preferably a treating psychiatrist, who has seen this person clean and sober and can state that even at those times, the claimant’s functioning was extremely impaired. Other similar evidence includes institutional remission when the claimant has been incarcerated for a long enough time to not have access to chemicals or in a program where the chart demonstrates “clean and sober.”

Sometimes it is useful to cite published studies showing a high incidence of dual diagnoses – situations when the risk of substance abuse as a means to self-medicate is especially high, such as with individuals suffering from PTSD, bipolar disorder, etc. While high incidence of comorbidity does not directly affect materiality determination, it can guide the decision-maker in the determination of materiality analysis. For example, once an appropriate diagnosis is made and treatment becomes available and effective, it would obviate the need to self-medicate. There are also gender- and ethnicity-based studies that, for example, show in women, depression usually precedes substance abuse, whereas in men, depression is often after a diagnosis of substance dependence or abuse. Such additional factors can lead the decision-maker to a different conclusion by realizing DA&A is not a simple equation.

Finally, credibility of the claimant is extremely important in all Social Security disability determinations. Full disclosure by a claimant or the representative of the existing or past substance abuse issues can often be in claimant’s favor. For example, excessive long-term use (10+ years) of methamphetamines and/or alcohol can cause meth- or alcohol-induced psychosis or organicity (permanent brain damage), which could result in benefits eligibility because causation is irrelevant in Social Security disability decisions.

PWDF Profile

Who We Are

People With Disabilities Foundation is an operating 501(c)(3) nonprofit organization based in San Francisco, California, which focuses on the rights of the mentally and developmentally disabled.

Services

Advocacy: PWDF advocates for Social Security claimant's disability benefits in eight Bay Area counties. We also provide services in disability rights, on issues regarding returning to work, and in ADA consultations, including areas of employment, health care, and education, among others. There is representation before all levels of federal court and Administrative Law Judges. No one is declined due to their inability to pay, and we offer a sliding scale for attorney's fees.

Education/Public Awareness: To help eliminate the stigma against people with mental disabilities in society, PWDF's educational program organizes workshops and public seminars, provides guest speakers with backgrounds in mental health, and produces educational materials such as videos.

Continuing Education Provider: State Bar of California MCLE, California Board of Behavioral Sciences Continuing Education, and Commission of Rehabilitation Counselor Certification.