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A Guide to Disability and Substance Abuse

Until relatively recently, many people – including medical professionals – often viewed those suffering from addiction as lazy or lacking in self-control. But that stigma is changing. Today, addiction is viewed by many, including the American Medical Association and the American Society of Addiction Medicine, as a disease of the brain, one that requires serious treatment to overcome.

With a more holistic and scientific view of addiction, there has been an increased effort to treat and prevent the addictive behavior rather than punish the person who suffers from it. One particularly common form of addiction involves substance abuse, which often has a relationship with individuals who are also disabled. We’ll look deeper into this connection and explain disability within the legal context, as well as explore substance abuse among disabled individuals.

Until relatively recently, many people – including medical professionals – often viewed those suffering from addiction as lazy or lacking in self-control. But that stigma is changing. Today, addiction is viewed by many, including the American Medical Association and the American Society of Addiction Medicine, as a disease of the brain, one that requires serious treatment to overcome.

With a more holistic and scientific view of addiction, there has been an increased effort to treat and prevent the addictive behavior rather than punish the person who suffers from it. One particularly common form of addiction involves substance abuse, which often has a relationship with individuals who are also disabled. We’ll look deeper into this connection and explain disability within the legal context, as well as explore substance abuse among disabled individuals.

Do Physical, Mental, or Behavioral Disabilities Contribute to Substance Abuse?

Do disability and substance abuse really go hand-in-hand? Do physical and psychological disabilities increase a person’s chances of becoming addicted? Let’s explore the answers.

According to the US Census Bureau numbers from 2010, approximately 56.7 million people have a disability and about 23 million people require treatment for substance abuse problems. Unfortunately, there is a significant amount of overlap among the two groups, with an estimated 4.7 million adult individuals experiencing both a disability and a substance abuse problem.

With so many disabled individuals also suffering from addiction, it begs the question whether being disabled creates a higher chance of suffering from an addiction to drugs or alcohol. The answers to this question are unclear. Some studies seem to prove that disabled individuals have higher rates of substance abuse, while other studies show the exact opposite. However, there is clear evidence that many individuals who suffer from substance abuse issues are also mentally or physically disabled.

How Disabilities May Contribute to Addiction Disorders

Even though many medical and addiction professionals do not believe that having a disability will actually increase the chances of an individual acquiring a substance use disorder, there are still many signs or factors that can increase the risk or contribute to the potential problem.

Some of these factors include:

  • Suffering from chronic pain. In a study published in the Journal of Pain, almost 25% of respondents admitted to using alcohol to self-treat their arthritis and oral pain.
  • Unemployment
  • Poverty
  • Easy access to painkillers, especially opiates and opioids
  • Lack of social relationships
  • History of abuse (mental, physical or sexual)
  • Poor education
  • Binge drinking
  • Caregivers who enable the addictive behavior
  • Suffering from severe emotional and/or physical trauma
  • Suffering from mental illness

An examination of these contributing factors reveals a pattern that puts special population groups at higher risk of developing an addiction. Some of these special groups include women, military personnel and teenagers.

Other Groups Vulnerable to Substance Abuse

People with disabilities are only one of many groups that may be more susceptible to drug and alcohol use. The following are among them.

Recognizing the Signs of Addiction

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Many individuals learn to hide their addiction. As a result, close friends and coworkers may have no idea how a person is suffering. However, there are many warning signs that may signal an addiction to drugs or alcohol. Some of these signs include:

  • Difficulty sleeping
  • Slurred speech
  • Trouble walking
  • The smell of drugs or alcohol on the individual
  • Dilated pupils
  • Family history of substance abuse
  • Difficulty keeping appointments or being punctual
  • Drastic changes in mood or behavior without clear justification
  • Nasal or eye irritation
  • Anxiety
  • Surrounded by peers who use drugs and/or alcohol
  • Lack of motivation to do anything constructive, such as work, study or spend time with friends and family
  • Trouble focusing on tasks at hand
  • Poor memory or complete memory blackouts
  • Irritability
  • Depression

When deciding if someone you know shows any of these signs, understand that you need to take a totality of the circumstances approach. This means that if you see one or two of these signs in someone else, that may not mean they are struggling with substance abuse or misuse. But the more of these signs you observe, the greater the chance they have an addiction.

Treatment for Individuals with Disabilities

The treatment of addiction or a substance use disorder first requires the individual to admit he or she has a problem. Then there’s the challenge of persuading the person to get help. Once someone finally agrees to seek treatment, there can be additional challenges if they have a disability. There are several factors at play that stack the odds against the person seeking treatment.

FIRST

First, facility that doesn’t have special accommodations for disabled individuals will have trouble convincing the person to seek treatment there. For example, a disabled person may not feel welcome at a treatment center that doesn’t make it clear that it treats patients with disabilities. It’s hard enough to convince someone with an addiction to obtain help, so it’s important not to give them the impression that the treatment facility will not be able to assist them.

SECOND

Second, the treatment facility will need to have special accommodations in place to properly communicate with the disabled patient as well as provide effective treatment. If a patient is blind, they will need written materials provided in braille or audible accommodations. A deaf individual will need a sign language interpreter (or someone who is fluent in sign language) to speak with about treatment options. In a study conducted by the American Association on health and Disability, approximately half of treatment providers turned away prospective patients who had spinal cord or traumatic brain injuries because the facility was unable to properly accommodate and treat them.

THIRD

Third, the treatment facility must be properly equipped to accommodate individuals with certain physical issues. For instance, wheelchair ramps, elevators and signs in braille are vitally important for individuals with physical impairments. These are usually required by law, but not every facility will be in full compliance with every disability law at all times.

FOURTH

Fourth, the treatment of disabled individuals will usually require special training for the doctors, nurses, and other caregivers. This is especially true when treating patients who have learning or cognitive disabilities. Many facilities have trouble merely meeting the needs to non-disabled patients, so it can be an especially notable challenge to adjust a treatment plan for a disabled individual.

FIFTH

Fifth, some treatment providers have prejudices against disabled individuals who seek treatment of substance abuse. Some providers incorrectly believe that addicts who are disabled are “not worthy” of treatment or can’t be helped, so there’s no use in trying and wasting valuable and scarce treatment resources on patients who are disabled. This is certainly not a fair approach to take, but it happens all too often to those who reach out for help.

When choosing a treatment program or facility, prospective patients need to ask if the facility can meet their particular needs. For example, if the individual is in a wheelchair, they need to confirm the facility has wheelchair access to every pertinent part of the building. If a person can’t drive themselves to the facility, they’ll need to make special arrangements to get to their treatments or appointments. And if the individual has a cognitive deficit of some sort, they need to ask if the treatment facility will be able to treat them effectively.

Is Addiction Considered a Disability?

Is addiction a disease, disability, or both? The answer to that question depends on the context. Within the medical and health insurance context, the distinction between the two isn’t usually important, although addiction is generally accepted as a treatable disease or disorder.

In the criminal law context, addiction is not treated as a disease or disability, since crimes that may have been committed on the basis of the defendant’s addiction or substance use disorder are punished through means that rarely include treatment or rehabilitation assistance.

Within the government benefits or civil law context, the primary issue is whether addiction is considered a “disability” under applicable federal laws. If it is, it can provide certain rights and benefits for the individual. Two such benefits and rights stem from the Americans with Disabilities Act and Social Security Disability Insurance.

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Addiction and the Americans with Disabilities Act (ADA)

The Americans with Disabilities Act of 1990 (ADA) is a federal law that prohibits employers from discriminating against qualified individuals within the employment context. The ADA defines a qualified individual as someone who, with or without reasonable accommodations, can perform the major job functions of her or her position

The ADA recognizes someone with a disability if they have a physical or mental impairment that substantially limits one or more major life activities. The ADA disability discrimination protections apply even if the individual is only thought to have a disability or they suffer discrimination because they are associated with or have a relationship to another person with an ADA recognized disability. Lastly, the ADA’s requirements only apply to employers with 15 or more employees

Does the ADA address substance abuse?

According to the Equal Employment Opportunity Commission (EEOC), which enforces the ADA, an individual who casually uses drugs and/or alcohol is not considered disabled under the ADA. However, if their substance use disorder rises to the level of an addiction, they can be considered disabled under the ADA since the addiction substantially limits a major life activity.

What protections are available?

Per the EEOC’s Technical Assistance Manual: Title I of the ADA, an employer may make employment decisions on the basis of an employee’s drug or alcohol use if the alcohol or drug use will adversely affect job performance. But if the alcohol or drug use rises to the level of an addiction, the ADA will view a drug or alcohol addiction as a disability. An employer cannot discriminate against an employee purely on the basis of their addiction.

With respect to alcoholism, an employer may not discriminate against the employee who suffers from an alcohol addiction and must make reasonable accommodations for that employee. As for drug use, the ADA protections only apply if the individual is no longer using illicit drugs and has or is currently receiving treatment.

What are the limitations of ADA protections?

If an employee can’t do his or her job because they’re under the influence of drugs or alcohol or suffering from withdrawal symptoms, an employer most likely can fire the employee for being unable to work effectively. But the extent of the protections differs slightly based on whether the addiction is based in alcohol or drugs.

If the individual is currently using illicit drugs, there are no ADA protections. But if the individual is currently consuming alcohol, they enjoy ADA protections and that fact cannot be used against them by the employer. Basically, employees with an alcohol addiction will generally have greater ADA protections than employees with a drug addiction.

  • Eligibility Requirements
  • How is Eligibility Determined?
  • What are the Conditions of Continued Coverage?
  • For an individual to qualify for SSDI benefits, they must meet the following general requirements:

    • Their income must be below a certain level. As of 2017, it is $1,170 per month.
    • The disability preventing the individual from working must be severe. This usually means the disability will prevent the person from working for at least one year or cause death.
    • The individual must suffer from a condition that the Social Security Administration recognizes as a disability. Whether the addiction qualifies as a disability is the key issue in determining an individual’s SSDI eligibility.
  • An addiction based on substance abuse will not be considered a disability until it causes permanent damage to the individual. If the addiction prevents a person from working, but the effects of the addiction can be reversed if the individual stops using drugs or alcohol, that person will likely be ineligible to receive SSDI.

    If an individual suffers from a disability unrelated to the addiction, the addiction cannot be held against the person with respect to determining their SSDI eligibility. As long as the addiction isn’t causing the disability, or making the disability worse, the individual will usually be eligible for SSDI benefits because the addiction is not a “material factor” in his or her disability.

  • If a person is deemed eligible to receive SSDI payments, the individual will usually be required to obtain treatment for the addiction and appoint a legal representative to receive SSDI payments on their behalf. The purpose of having this representative is to make it harder for the recipient to spend SSDI payments on illicit drugs or alcohol.

    Every once in awhile, the Social Security Administration will review the case and make sure the applicant is still disabled and not capable for returning to work. If the person is no longer deemed to be disabled, the SSDI payments will stop. Another way payments will cease is if the recipient has returned to work and the amount of work they prove capable of doing is “substantial.”

Q&A with Attorney Joanna Green Brown

About Joanna Green Brown

Joanna Green Brown is an attorney admitted to the practice of law by the State Bar of Texas. She is fully authorized to practice before the Social Security Administration anywhere in the United States. She has represented clients in Texas, Oklahoma, Alabama, and California. Joanna’s practice, located outside of Dallas, Texas, focuses exclusively on advocating for the disabled.

  • Q. Please provide some insight into how substance abuse addiction might be classified as a disability under the ADA. What challenges would someone face in meeting the standards?

    A. If a person is actively using, there aren’t protections specific to addiction – drug use typically violates a company policy, and may violate state or federal law. If a person felt that they were discriminated against based on past drug use, they would want to discuss the issue with an employment attorney. The definition of ‘disabled’ differs for each program or federal protection

  • Q. Someone suffering from a disability might be eligible for SSI OR SSDI. Does addiction cause a problem when it comes to qualifications, and if so, how?

    A. Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) have the same test for disabled status (they have different asset tests and insurability definitions).

    Every claimant who suffers from addiction will have complex hurdles to face if they are to be approved for Social Security benefits. That is based, in part, on the standard for evaluating drug or alcohol dependence as it relates to a person’s disabled status (as defined by the Social Security Administration). Addiction complicates the disability application process profoundly and it is generally in a person’s best interest to discuss those issues with their attorney before beginning an application.

    The Social Security standard includes analyzing if the use or dependence contributes to the impairment or condition. The analysis includes weighing if mental or physical improvement would improve without alcohol or drug use. In many cases, and very logically, evidence exists to show that a person’s function would improve following cessation of drugs or alcohol.

    It is very difficult for doctors and Judges to distinguish the limitations and symptoms caused by substance abuse and dependence and mental health conditions. Factors like the length of use, the length of sobriety, and the level of function before addiction will be weighed.

    The individual would want to consider entering treatment before the process begins – often, those individuals can return to the workforce after property addressing mental health and pain issues and no longer need disability advocacy. It is important to note that many attorneys now have their client acknowledge that they will not go forward with representation if they have a positive drug test prior to adjudication of disability.

    Stigma is also a large issue. People need to work with their doctors and mental health providers so that their illnesses are treated, symptoms are managed, and the best outcome is achieved. For one person that could mean following the Social Security Disability appeal process (while maintaining sobriety), for another that may mean returning to work following vocational retraining or treatment.

    Individuals who suffer from a broader definition of disability may utilize their state’s vocational rehabilitation programs. These programs can successfully retrain disabled individuals to re-enter the workforce. Some of my clients have been able to re-enter the workforce after being trained in jobs that are less stressful or less physical for them once their disability ends.

    Additionally, if a claimant who suffers from addiction is found to be disabled a Representative Payee may be required. This is when the Social Security Administration appoints an individual to handle the disabled’s SSDI or SSI payment.

Q. Please provide some insight into how substance abuse addiction might be classified as a disability under the ADA. What challenges would someone face in meeting the standards?

A. If a person is actively using, there aren’t protections specific to addiction – drug use typically violates a company policy, and may violate state or federal law. [...]

If a person felt that they were discriminated against based on past drug use, they would want to discuss the issue with an employment attorney. The definition of ‘disabled’ differs for each program or federal protection

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Q. Someone suffering from a disability might be eligible for SSI OR SSDI. Does addiction cause a problem when it comes to qualifications, and if so, how?

A. Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) have the same test for disabled status (they have different asset tests and insurability definitions).[...]

Every claimant who suffers from addiction will have complex hurdles to face if they are to be approved for Social Security benefits. That is based, in part, on the standard for evaluating drug or alcohol dependence as it relates to a person’s disabled status (as defined by the Social Security Administration). Addiction complicates the disability application process profoundly and it is generally in a person’s best interest to discuss those issues with their attorney before beginning an application.

The Social Security standard includes analyzing if the use or dependence contributes to the impairment or condition. The analysis includes weighing if mental or physical improvement would improve without alcohol or drug use. In many cases, and very logically, evidence exists to show that a person’s function would improve following cessation of drugs or alcohol.

It is very difficult for doctors and Judges to distinguish the limitations and symptoms caused by substance abuse and dependence and mental health conditions. Factors like the length of use, the length of sobriety, and the level of function before addiction will be weighed.

The individual would want to consider entering treatment before the process begins – often, those individuals can return to the workforce after property addressing mental health and pain issues and no longer need disability advocacy. It is important to note that many attorneys now have their client acknowledge that they will not go forward with representation if they have a positive drug test prior to adjudication of disability.

Stigma is also a large issue. People need to work with their doctors and mental health providers so that their illnesses are treated, symptoms are managed, and the best outcome is achieved. For one person that could mean following the Social Security Disability appeal process (while maintaining sobriety), for another that may mean returning to work following vocational retraining or treatment.

Individuals who suffer from a broader definition of disability may utilize their state’s vocational rehabilitation programs. These programs can successfully retrain disabled individuals to re-enter the workforce. Some of my clients have been able to re-enter the workforce after being trained in jobs that are less stressful or less physical for them once their disability ends.

Additionally, if a claimant who suffers from addiction is found to be disabled a Representative Payee may be required. This is when the Social Security Administration appoints an individual to handle the disabled’s SSDI or SSI payment.

Find More