Are drug addiction and alcoholism disabilities?

  1. I've noticed more and more patients who have ended up on government disability payments. I know it because they tell me during casual conversation in the course of my caring for them.

    Often they are active drug addicts or ETOH abusers/addicts. I know this because as their nurse I review their H&P during the course of a day of caring for them as patients. I also have access to their drug and ETOH screens on their lab profiles.

    Is active alcoholism or drug addiction now considered official disabilities under SSI? Also, does SSI make people accountable with random drug or alcohol testing?

    Usually these patients are males, often in their 40s or 50s, although I recently cared for a man who was in his 30s. He had used heroin and cocaine immediately prior to his admission for a revision of a blown knee. He told me that he received disability.

    If a person receives disability for, say, a mental health problem, shouldn't they be drug tested? And, how do they afford heroin, meth, booze, if they are on such a meager income? Shouldn't Uncle Sam make these folks more accountable?
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  3. by   GilaRRT
    Interesting question. I have had to think about what constitutes a disability. I recently had an injury that could have been career ending, or may still, who knows. However, I continue to work, but have to seriously consider my role as as an RN.

    While I do not use medications other than Ibuprofen for pain, and addiction is not the issue. The definition of disability is a curious question worth a good argumen..err...debate.
  4. by   NRSKarenRN
    americans with disabilities act:

    ada questions and answers. a 31-page booklet giving an overview of the ada's requirements for ensuring equal opportunity for persons with disabilities in employment, state and local government services, public accommodations, commercial facilities, and transportation, and requiring the establishment of tdd/telephone relay services.

    q. what practices and activities are covered by the employment nondiscrimination requirements?

    a. the ada prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. it applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment-related activities.


    q. who is protected from employment discrimination?

    a. employment discrimination is prohibited against "qualified individuals with disabilities." this includes applicants for employment and employees. an individual is considered to have a "disability" if s/he has a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment, or is regarded as having such an impairment. persons discriminated against because they have a known association or relationship with an individual with a disability also are protected.

    the first part of the definition makes clear that the ada applies to persons who have impairments and that these must substantially limit major life activities such as seeing, hearing, speaking, walking, breathing, performing manual tasks, learning, caring for oneself, and working. an individual with epilepsy, paralysis, hiv infection, aids, a substantial hearing or visual impairment, mental retardation, or a specific learning disability is covered, but an individual with a minor, nonchronic condition of short duration, such as a sprain, broken limb, or the flu, generally would not be covered.

    the second part of the definition protecting individuals with a record of a disability would cover, for example, a person who has recovered from cancer or mental illness.

    the third part of the definition protects individuals who are regarded as having a substantially limiting impairment, even though they may not have such an impairment. for example, this provision would protect a qualified individual with a severe facial disfigurement from being denied employment because an employer feared the "negative reactions" of customers or co-workers.


    q. who is a "qualified individual with a disability?"

    a. a qualified individual with a disability is a person who meets legitimate skill, experience, education, or other requirements of an employment position that s/he holds or seeks, and who can perform the oeessential functions of the position with or without reasonable accommodation. requiring the ability to perform "essential" functions assures that an individual with a disability will not be considered unqualified simply because of inability to perform marginal or incidental job functions. if the individual is qualified to perform essential job functions except for limitations caused by a disability, the employer must consider whether the individual could perform these functions with a reasonable accommodation. if a written job description has been prepared in advance of advertising or interviewing applicants for a job, this will be considered as evidence, although not conclusive evidence, of the essential functions of the job.

    social security: [color=#2200cc]ssr 82-60


    policy statement: the definition of disability is the same under title ii and title xvi. also, the principles underlying the adjudication of disability claims from drug addicts or alcoholics are the same as those underlying the adjudication of claims from other any individual. any determination that an individual meets the definition of disability must be based on sufficiently detailed medical evidence describing the severity of the impairment and, when appropriate, on other information such as the individual's vocational history. the medical evidence must describe an impairment which results from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. furthermore, the impairment must be established by medical evidence consisting of symptoms, signs, and pertinent clinical and laboratory findings, not only by the individual's allegations or statement of symptoms. finally, impairments must be of sufficient severity to meet or equal a listed impairment in appendix 1 of subpart p of regulations no. 4 (incorporated by reference fir title xvi in section 416.925) or, considering appropriate vocational factors, to prevent the individual from performing past relevant work or any other work.

    drug addicts or alcoholics cannot be considered "disabled" on the basis of that diagnosis alone; on the other hand, a diagnosis of drug addiction or alcoholism should not have an effect on a disability evaluation that is adverse to the applicant. drug addicts and alcoholics are subject to all the ills that may affect any other applicant. drug addiction and alcoholism are diagnostic terms; they do not denote impairment value or severity. it is necessary to evaluate the severity of the impairment which may be associated with, manifested by, result from, or coexist with these diagnoses.

    it must be recognized also that the issue of whether the individual has lost the ability to control the use of drugs or alcohol affects the matter of diagnosis. the loss of ability to control these substances identifies the individual as a drug addict or alcoholic diagnostically, but does not provide a conclusive basis for evaluating the severity of the impairment.

    confinement in an institution or other facility, whether for treatment or otherwise, may occur for reasons other than the severity of the impairment. although the circumstances concerning the confinement must be determined and considered, confinement alone does not establish that the impairment is severe. also, confinement which is the treatment prescribed by an appropriate treating source does not establish the presence or severity of an impairment. the presence of an impairment and its severity is established on the basis of the symptoms, signs, and pertinent clinical and laboratory findings appropriate to that impairment. similarly, release from an institution or any other facility does not establish that an impairment has improved, or that an impairment is not severe.
    ultimately, the decision will depend upon the severity of the impairment, as properly documented by the required medical findings, and, for appropriate cases, the limitation of function imposed on the applicant by the impairment in conjunction with applicable vocational factors. an individual may be a drug addict or an alcoholic and not be disabled if the evidence fails to show inability to engage in substantial gainful activity.
    Last edit by NRSKarenRN on Jun 9, '09
  5. by   FireStarterRN
    Thanks Karen. That is a very interesting quote from the Social Security Dept. I was wondering how these people were able to get on SSI, I thought it was quite difficult to get approved. It sounds as if it is very subjective, from case to case.
  6. by   Cherybaby
    I have severe bipolar disorder and epilepsy that has stopped me from working on many occasions (I remove myself from my employment, it is not mandated by my facility). I have been told many times that I am eligible for disability. My take on the matter is a resounding "No". That money is there for people who cannot work due to injury as far as I am concerned. I don't consider my BPD or epilepsy an injury. Hell, I even declined getting a handicapped parking sticker although I am entitled to one. I think a lot of people take advantage of the system and no one holds them accountable.

    I know that the problems I have cause me not to be able to work from time to time...but I am still an able bodied human being who wants to work. I don't want to lay on my backside and collect SSI even though I know I am entitled to it. I have paid into the system my whole life and it should be available when I need it.

    But, as long as I have a breath in my body and an able and willing back/knees...I will continue to work until I can't do it anymore.

    I think offering SSI to someone who is drug addicted is just enabling them. That take may be a bit harsh...but it's how I feel. *shrugs*
  7. by   NRSKarenRN
    SSI is HARD to get,... takes 2 years from ONSET of disability if it occurs over the age of 21. Disability must affect persons life for OVER A YEAR to be considered permanent + affecting one or more functional areas.

    Most cases initially denied and takes 2-3 appeals --- Visit our disability forum to review nurses stories.
  8. by   sissiesmama
    Quote from FireStarterRN
    Thanks Karen. That is a very interesting quote from the Social Security Dept. I was wondering how these people were able to get on SSI, I thought it was quite difficult to get approved. It sounds as if it is very subjective, from case to case.

    Hery - I'm glad you posted this question. This is a subject that is close to us at this time in our household. For the last 2 years, I have been unable to work as a nurse due to the congenital heart defect that my cardiologist just found on an EP study in the cath lab. I do already have damage to my lungs and renals from the underlying disease that was finally found. My PCP and card. both agree that it would be a miracle that after I have my defect surgically repaired on June 30th, that I will regain enough normalty to go back to work in nursing. Even just the walking for just a few minutes at a time causes me such dyspnea and CP on exertion that I can't even walk to our mailbox to check the mail at home.

    I initially applied for disability and quickly get a rejection letter in the mail. We asked around and basically were told that almost everyone gets the first rejection - that it's kind of like they want to see how serious you are when filing, they want to see who just says "forget it", thinking it's not worth the hassle.

    We did our appeal and then were contacted for an interview with one of their judges for a "face to face." We did that on April 13th, and have not gotten a response as of yet. Dh and I were just talking about that last night, it didn't take the system long AT ALL to send us the first rejection, so we're hoping the "no news is good news" applies here.

    But, you hear about so many people app. and get it for dx that don't seem to appect them the way this has affected us. I did wonder about the substance abuse dx, I wasn't sure if this would even help. Someone else hadd told me that they applied and used the CD dx and got it pretty fast - but I thought I had been told that CD can be used, but you have to be active in your disease process. I have 10 years clean and sober, and they said that it wouldn't help me because I went to rehab and have been clean since then.

    Kind of confusing, to me, at least - so I guess we just get to sir and wait and hope for the best. I would never want to go back to my old ways for ANY amount of money, it just really seems to suck (excuse my language) that just because I am in recovery that we have to just wait and hope for the best.

    When I say that I wouldn't be able to go back as a nurse, I mean that I can't even walk through the house during the day without having to sit and wait to catch my breath - if I don't, I quickly get diaphoretic and clammy that I feel like I'm going to pass out. In addition to the cardiac disorder, I started having grand mal seizures and have been in the hospital for that. About a month after the last seizure, I did start having syncopal episodes while in the kitchen trying to cook (and believe me, it wasn't some big 7 course gourmet meal. We're talking Hamburger helper, that kind of thing.)

    I've never really been patient, but waiting for this while the bills pile up, really bites.

    Anne
  9. by   FireStarterRN
    That sounds frustrating Anne

    So, you have to be an actively using drug addict to get disability, is that what you're saying.
  10. by   southernbeegirl
    I couldnt tell you the times i've been told by medical professionals that i could go on disability. i am a drug addict/alcoholic (5yrs recovery now tho), i am fat, i have a bad back and 2 yrs ago threw a PE with some scarring that still causes occasional SOB.

    my response? NO! why would i want to do that?????

    disability is for when you cannnot work. not when you are looking for a reason to get out of work and get paid for it! despite all my diagnoses that could qualify me for SSD, i have no problem working 40 hrs a week.

    so i dont understand all these people that get these so called "crazy checks" (thats what they call them around here).

    my first husband was very ill with acute intermittent porphyria. he had no choice but to go on disability. i cant tell you how many times i sat in that SS office looking at these people coming in with "back problems" and the like trying to get SSD. here we were, a young couple with no children, husband in the hospital for 2-3 months at a time and the government was telling me to divorce my husband so he could get more benefits!

    SSD was designed to help people like my husband. unfortuneately now though...people that have learned to "work the system" are milking it dry.
  11. by   UM Review RN
    Let's put it this way:

    If I couldn't work, I'd probably become a drug addict. (Y'all already know I have an addictive personality aeb all the hours I spend here. )

    So your question might be--which came first, the disability or the addiction?
  12. by   FireStarterRN
    SSI doesn't pay very well compared to working, you'd have to be pretty desperate to avoid work to choose that as your source of income.

    When my husband and I had a restaurant we had a dishwasher who was on SSI for legitimate legal blindness. He had a hereditary disorder where he was losing the vision in the center of his eye. I know my husband partially paid him under the table so he could double dip. I think he was allowed to work some minimal hours.
  13. by   FireStarterRN
    Quote from Angie O'Plasty, RN
    Let's put it this way:

    If I couldn't work, I'd probably become a drug addict. (Y'all already know I have an addictive personality aeb all the hours I spend here. )

    So your question might be--which came first, the disability or the addiction?
    I can relate to that comment.
  14. by   c_beshore_rn
    DRUG AND ETOH ABUSE ARE NOT CONSIDERED DISABILITIES ANY LONGER BUT THEIR COOCCURING COUNTERPARTS ARE,ie bipolar disorder, schizophrenia, depression, ptsd, anxiety d/o, etc..... I WORKED FOR A DR OF PSYCH THAT TESTED ALL ADDICTS FOR THESE UNDERLYING MENTAL ILLNESS SO HE COULD GET THEM COMMUNITY SUPPORT AND SSI. THAT MEANS LONGER IN THE SYSTEM, LONGER TIME ON DRUGS N ETOH, AND MORE MONEY IN HIS POCKET.

    I AM A TRUE BELIEVER IN MENTAL ILLNESS- I KNOW IT EXISTS BUT IF PEOPLE ARE ALLOWED 'AN OUT' MOST WILL TAKE IT. IT IS A STRUGGLE TO TRY TO HOLD DOWN A JOB WITH A MENTAL ILLNESS, EVEN A MILD ONE. PEOPLE THAT HAVE GENERATIONAL MENTAL ILLNESS ON THEIR SIDE ARE EVEN MORE AT RISK. IF A CHILD IS RAISED WITH AN ETOH ABUSING MOM WITH A MI (MENTAL ILLNESS) ON SSI AND FOODSTAMPS THEN THAT CHILD GROWS TO NORMALIZE IT, ACCEPT IT AS A WAY OF LIFE, AND RAISE THE NEXT GENERATION ACCORDINGLY.

    IF A CHILD IS RAISED BY A MOM WITH A MENTAL ILLNESS THAT WORKS EVERYDAY, EVEN IF IT IS MOWING LAWNS, NOT USING DRUGS OR ETOH AS A COPING SKILL, AND WORKING ON THEMSELVES FOR THE POSITIVE.....THAT CHILD WILL INTURN, I BELIEVE, GROW UP TO HAVE MORE DIFFICULTY RELYING ON PUBLIC ASSISTANCE AND SUBSTANCES TO COPE. IF YOU WORK PSYCH FOR ANY LENGTH OF TIME YOU WILL SEE THESE FOLKS...OVER AND OVER AND OVER AGAIN. EVENTUALLY YOU WILL SEE THEIR KIDS AND GRANDKIDS TOO

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