Jan 28, 2010

Policy Change On Substance Abuse Coming?

From a Request for Comments to be published in the Federal Register tomorrow:
We are requesting your comments about our operating procedures for determining disability for persons whose drug addiction or alcoholism (DAA) may be a contributing factor material to our determination of disability. ...

To provide guidance on how we interpret the DAA provisions of the Act, we issued instructions to our employees in an Emergency Message on August 30, 1996. ...

We are asking for your comments on the procedures we follow when evaluating DAA. In particular, we would like your opinion about what, if any, changes you think we should make to our instructions. For example, do you have any suggestions about:
  • What evidence we should consider to be medical evidence of DAA?
  • How we should evaluate claims of people who have a combination of DAA and at least one other physical impairment?
  • How we should evaluate the claims of people who have a combination of DAA and at least one other mental impairment?
  • Whether we should include using cigarettes and other tobacco products in our instructions?
  • How long a period of abstinence or nonuse we should consider to determine whether DAA is material to our determination of disability?
  • Whether there is any special guidance we can provide for people with DAA who are homeless?
Social Security's position has been that if it is impossible to separate the effects of DAA from the effects of other psychiatric illness that the combined effect of both may be considered disabling. This situation is frequently present in individuals suffering from bipolar disorder, a psychiatric illness which has a high degree of association with DAA. A change in this policy would be of considerable importance.

Social Security has never previously asserted or even suggested officially that tobacco use could be considered DAA.

The talk of whether a period of abstinence should be required before a person could be found disabled is worrisome. The statute does not forbid disability payments to alcoholics and drug addicts. It merely prohibits consideration of alcoholism and drug addiction in determining disability. A person may have a raging substance abuse disorder but be found disabled due to other health problems. This has always bothered some people. They find drug abuse and alcoholism so loathsome that they believe that no one alcoholics or drug addicts should be on Social Security disability benefits even though the statute says otherwise. One interpretation of this notice is that Social Security has a desire to move towards forbidding benefits to anyone with a substance abuse problem.


Anonymous said...

Well, if Social Security wants to significantly cut down on their benefit payments, blacklisting all cigarette smokers, alcoholics and drug addicts who are otherwise disabled would go a long way towards reducing their liability. I hate to say it, but a very large majority of my clients smoke cigarettes, many are frequent drinkers, and a few are obvious drug addicts. This is worrisome indeed.

Anonymous said...

Next it will be the morbidly obese.

Anonymous said...

If a person is an alcoholic but they've had multiple back surgeries and the latest MRI is bad, the alcohol abuse should never be relevant except in possibly determining whether they can manage funds.

The tougher question is the smoker with COPD. The damage done previously by smoking isn't relevant but additional damage after diagnosis and exacerbation of shortness of breath is much tougher question.

Anonymous said...

its is called self medicating. sometimes that is the only thing you can do. what some people dont realize is that these people cant afford to go to the doctor and use these drugs to deal with or escape the problems they have that makes them disabled. i self med but not with acholol i use vitamins to help me out but still it is a problem. but what we really need to do is make it easier for them to get medical help so they can get off the drugs.

Anonymous said...

I'm sorry but it is easily arguable that all substance abuse is self-medicating. There needs to be a clear rule - any evidence of substance abuse results in a denial or substance abuse does not matter. I am for the former. The current rule is a farce.

Social Worker said...

Speaking from clinical experience...It's hard to find an alcoholic or drug abuser without some degree of mental disorder that meets diagnostic criteria. Many use to such a degree, it's almost impossible to differentiate the mental disorder because people won't stop using long enough to take medication safely and/or benefit from counseling. In some cases, it's easier if there's a history with periods of abstinence. Sometimes, there isn't. Many professionals refuse to treat a subtance abuser for mental health if they are not in substance abuse treatment. But these patients need access to health care. I don't want someone with a pscyhotic disorder drunk and high in my neighborhood. On the other hand, many professionals have overused some diagnoses (especially bipolar disorder) because it is the latest popular diagnosis.. and for convenience of billing insurance companies who limit treatment for substance abuse. Add a mental disorder and the person gets treatment.