Social Security Disability Insurance (SSDI) provides monthly benefits to individuals who cannot work due to a severe medical condition. Many applicants worry that a history of substance abuse will automatically disqualify them from receiving benefits. The reality is more nuanced. While the Social Security Administration (SSA) takes substance abuse seriously, it does not automatically deny claims based on drug or alcohol use alone.
The SSA recognizes that individuals with substance abuse histories may also have legitimate, independent disabilities. The key question SSA asks is whether your disabling condition would exist even if you stopped using drugs or alcohol. This distinction forms the foundation of how substance abuse affects SSDI eligibility in New York and across the country.
The “Materiality” Test: How SSA Evaluates Your Claim
To understand how this test works, it helps to look at the key term SSA focuses on when reviewing claims involving substance use.
What Does “Material Contributing Factor” Mean?
The SSA uses a specific legal standard called the “materiality test” to evaluate substance abuse in disability claims. Under 20 CFR 404.1535 and 416.935, SSA must determine whether your drug addiction or alcoholism is a “material contributing factor” to your disability determination.
A material contributing factor means your substance abuse substantially contributes to your disabling condition. SSA evaluates this by asking: Would you still be disabled if you stopped using drugs or alcohol? If the answer is yes, then your substance abuse is not a material factor, and it should not prevent you from receiving SSDI benefits.
How SSA Evaluates Substance Use in Disability Claims
SSA uses a six-step evaluation process under SSR 13-2p to determine whether substance use is “material” to your disability — in other words, whether you would still be disabled if you stopped using.
To make this easier to understand, here is a six-step practical guide that shows how you can prepare stronger evidence for your claim:
Step 1: Confirm Your Medical Diagnosis and Substance Use History
Make sure your medical records clearly show any diagnosed substance use disorder and your treatment or history with drugs or alcohol. SSA relies heavily on medical documentation.
Step 2: Identify All Medical Conditions That Could Cause Disability
List and document all physical and mental impairments, not just those related to substance use. This might include traumatic injuries, spinal disorders, or major joint dysfunction. These conditions should be supported by medical records, specialist evaluations, and test results.
Step 3: Gather Evidence Showing the Severity of Your Medical Conditions
Collect medical records that show how your conditions limit your daily functioning and ability to work. Include lab results, imaging, treatment notes, and doctor observations.
Step 4: Show How Your Disability Would Still Exist Without Substance Use
This is key. SSA will look at whether your medical condition would remain disabling if you stopped using drugs or alcohol. Evidence showing symptoms, limitations, or diagnoses that persist during periods of sobriety is especially helpful.
Step 5: Document Any Treatment and Recovery Efforts
Show that you have taken steps such as counseling, rehab, medication-assisted treatment, or support programs. Periods of abstinence and your functioning during those times can strongly support your claim.
Step 6: Organize Your Records for a Clear Disability Argument
Make sure your evidence tells a consistent story: you have a medically documented condition, it severely limits your ability to work, and it would continue to do so even without substance use.
Note: Work history requirements (generally at least five of the past ten years of work and Social Security tax contributions for adults age 31 and older) are separate SSDI eligibility criteria evaluated outside the DAA materiality framework.
When Substance Abuse Can Lead to Claim Denial
Substance abuse can result in SSDI claim denial in specific circumstances. Understanding these scenarios helps you recognize potential challenges and address them proactively.
Can I Still Get SSDI If I Have a History of Drug or Alcohol Use?
Yes, you can receive SSDI with a substance abuse history. However, your claim faces denial if SSA determines that your substance abuse is a material contributing factor to your disability. This occurs when:
- Your disabling condition is directly caused by substance abuse
- Your condition would improve significantly or resolve if you stopped using drugs or alcohol
- Medical evidence shows your symptoms are primarily substance-related rather than from an independent medical condition
For example, if your only disabling condition is cirrhosis caused by chronic alcohol use, SSA may deny your claim if the condition would be expected to improve to a non-disabling level with abstinence, because the condition would be considered directly attributable to substance abuse. However, if you have cirrhosis and also have hepatitis C (an independent condition), SSA must evaluate whether hepatitis C alone would be disabling.
Conditions that face heightened scrutiny under the materiality test when substance abuse appears to be the primary cause include:
- Liver disease solely from alcohol consumption
- Lung damage solely from drug inhalation
- Cognitive impairment solely from substance use
However, applicants can still receive approval for these conditions if they demonstrate through medical evidence that the condition would remain disabling despite abstinence.
Conversely, irreversible conditions that would remain disabling despite abstinence typically support approval, even with a substance abuse history. These include:
- Permanent neurological damage from stroke or injury
- Severe arthritis or joint deterioration
- Chronic pain conditions with documented structural damage
- Mental health conditions like schizophrenia or bipolar disorder
The burden of proof rests on you as the applicant. In New York (Second Circuit), the claimant must also show that substance abuse is not a material contributing factor to their disability. You must demonstrate through medical evidence that your underlying condition is independent from and more severe than your substance abuse.
Medical Evidence and Documentation You’ll Need
To build a strong disability case, you’ll need medical documentation that clearly shows the severity of your condition, how it affects your ability to work, and its expected duration.
What Medical Records Should I Provide to Support My Claim?
Strong medical documentation is essential when substance abuse appears in your claim history. SSA requires specific types of evidence to evaluate your case fairly.
Gather medical records that document:
- Diagnosis and treatment history – Records from physicians, specialists, and mental health providers showing your medical conditions and their progression
- Objective test results – Lab work, imaging studies, and diagnostic tests that confirm your conditions
- Treatment participation – Documentation of rehabilitation programs, counseling, medication management, and any periods of abstinence
- Functional limitations – Medical provider statements describing how your conditions limit your ability to work
- Substance abuse timeline – Clear documentation of when substance abuse began and its relationship to your medical conditions
Expert medical opinions carry significant weight in DAA cases. If your treating physician can provide a statement explaining that your disabling condition exists independently from substance abuse, this strengthens your claim considerably. Medical providers can also document periods of abstinence and your response to treatment.
Timing matters in substance abuse cases. SSA looks more favorably on claims when applicants have demonstrated sustained abstinence or active treatment participation. Even if you currently struggle with substance use, evidence of treatment engagement and periods of sobriety demonstrates your commitment to recovery and strengthens your credibility.
SSDI vs. SSI: How Substance Abuse Rules Differ
Both SSDI and Supplemental Security Income (SSI) programs apply the same materiality standard when evaluating substance abuse. However, important differences exist between these programs that affect New York applicants.
SSDI is based on your work history and Social Security tax contributions. SSI is a needs-based program for individuals with limited income and resources. Both programs prohibit substance abuse as a standalone qualifying condition since Public Law 104-121 (enacted March 1996).
The materiality evaluation process is identical in both programs. SSA asks the same question: Would you be disabled without substance abuse? However, SSI applicants face additional scrutiny regarding resource limits and income thresholds. If you receive SSI and your substance abuse affects your ability to manage finances, SSA may require a representative payee to manage your benefits.
Protecting Your Benefits: What Happens After Approval
Will SSA Monitor My Substance Use After I’m Approved?
If SSA approves your SSDI claim despite a substance abuse history, your benefits are not automatically secure. SSA conducts periodic reviews to ensure you continue meeting disability criteria.
During continuing disability reviews, SSA may request updated medical evidence and may consider your substance use status only if it affects your medical condition, your ability to manage benefits, or your continued eligibility. If SSA suspects ongoing substance abuse that materially affects your disability status, the agency may:
- Require a representative payee to manage your benefits
- Conduct more frequent reviews of your case
- Consider your treatment history and substance use when reviewing your continued eligibility
- Terminate benefits if evidence shows your condition has improved
Representative payee requirements apply when SSA believes you cannot manage benefits responsibly due to substance abuse or mental health conditions. A representative payee, typically a family member, social worker, or organization, receives and manages your benefits on your behalf.
New York applicants should understand that benefit continuation depends on maintaining their disability status. If you achieve sustained recovery and your medical condition improves, SSA may determine you no longer qualify for benefits. Conversely, if you engage in treatment and demonstrate commitment to recovery, this can support continued benefit approval.
Get Help With Your SSDI Claim Today
An SSDI claim with a substance abuse history presents unique challenges. However, this does not mean you cannot receive the benefits you deserve. The materiality test provides a pathway to approval when your underlying condition is independent from and more severe than your substance abuse. Understanding how SSA evaluates your case—and preparing strong medical evidence—significantly improves your chances of success.
At Fusco, Brandenstein & Rada, P.C., we help individuals throughout New York pursue SSDI benefits despite substance abuse concerns. Our team understands the details of DAA evaluations and knows how to present your case effectively to SSA. We work with you to gather the medical evidence you need, explain the materiality standard, and advocate for your rights throughout the claims process. You can see why many clients trust our firm by reading our client reviews.
If you have questions about how substance abuse might affect your SSDI claim, or if you need representation during your application or appeal, do not hesitate to contact Fusco, Brandenstein & Rada, P.C. today. We offer consultations to discuss your situation and explain how we can help you pursue the disability benefits you need to support yourself and your family. Call 516-496-0400 to get started.