SSA’s policy on how it evaluates drug and alcohol addiction is stated in Social Security Ruling (SSR) 13-2p. In short, SSR 13-2p provides that, if drug or alcohol addiction (“DDA”) is “material” to the determination of disability, then the claimant must be found disabled.
SSR 13-2p states how materiality is determined. First, SSA determines whether the claimant has DAA in the first place. A claimant has DAA only if he or she has a medically determinable “substance use disorder” as that term is defined in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. In general, the DSM defines “substance use disorders” as maladaptive patterns of substance use that lead to clinically significant impairment or distress. This can include the maladaptive use of alcohol, illegal drugs, prescription medications, and toxic substances such as inhalants. DAA does not include disorders such as fetal alcohol syndrome, fetal cocaine exposure, or use of prescription medications when taken as prescribed, including methadone, Suboxone and narcotic pain medications. A claimant’s occasional maladaptive use of alcohol or illegal drugs does not qualify as a medically determinable substance use disorder. Incidentally, although DSM includes a category for nicotine-related disorders, including nicotine dependence, SSA will not make a determination regarding materiality based on these disorders. If claimant does not have DAA, then no materiality determination is necessary. If the claimant does have DAA, the inquiry will proceed to the next step.
Second, SSA determines if the claimant is disabled considering all of his or her impairments, including DAA. If the claimant is not disabled considering all of his or her impairments, including DAA, then the case is denied without the need for a materiality determination. If the claimant is disabled when considering all of his or her impairments, including DAA, then SSA will go on to the next step.
Third, SSA determines if DAA is the only impairment. If it is the only impairment, then DAA is deemed “material” and the case is denied. If it is not the only impairment, the inquiry will proceed to the next step.
Fourth, SSA determines if the other impairment(s) are disabling by themselves, i.e., without the DAA. If they are not disabling by themselves, then DAA is deemed “material” and the claim is denied. If they are disabling by themselves, the inquiry will proceed to the next step.
Fifth, SSA determines whether the DAA causes or affects the claimant’s medically determinable impairments. If they don’t, DAA is deemed “not material” and the claimant prevails. If they do, but the other impairments are irreversible or could not improve to the point of nondisability, DAA is deemed “not material” and the claimant prevails. However, if they do, and DAA could be material, the inquiry proceeds to the sixth and last step.
Sixth, SSA determines if the other impairments improved to the point of nondisability in the absence of DAA. If the answer to this question is “yes,” then DAA is deemed “material” and the case is denied. If the answer is “no,“ then DAA is deemed “not material” and claimant prevails.