Drug Addiction and Alcoholism
Drug Addiction Alcoholism
2010-04-02 2010-04-05 2010-03-17 2010-03-18 2010-03-22 2010-03-18 2010-03-22 2010-02-17 2010-04-02 2010-03-26
SSA-2009-0081-0063 SSA-2009-0081-0079 SSA-2009-0081-0024 SSA-2009-0081-0033 SSA-2009-0081-0040 SSA-2009-0081-0034 SSA-2009-0081-0038 SSA-2009-0081-0007 SSA-2009-0081-0066 SSA-2009-0081-0046
04:00:00 04:00:00 04:00:00 04:00:00 04:00:00 04:00:00 04:00:00 05:00:00 04:00:00 04:00:00
https://api.regulations.gov/v4/comments/SSA-2009-0081-0063 https://api.regulations.gov/v4/comments/SSA-2009-0081-0079 https://api.regulations.gov/v4/comments/SSA-2009-0081-0024 https://api.regulations.gov/v4/comments/SSA-2009-0081-0033 https://api.regulations.gov/v4/comments/SSA-2009-0081-0040 https://api.regulations.gov/v4/comments/SSA-2009-0081-0034 https://api.regulations.gov/v4/comments/SSA-2009-0081-0038 https://api.regulations.gov/v4/comments/SSA-2009-0081-0007 https://api.regulations.gov/v4/comments/SSA-2009-0081-0066 https://api.regulations.gov/v4/comments/SSA-2009-0081-0046
Randall John Kris Candace Deb Jim Shell Doug Svetlana Jim
Simmon Ratcliff Prohl Lauber Chandler Matthews Bowne Morrisson Uimenkova Grennan
Honorable Ladies and Gentlemen:As an attorney regularly representing claimants in disability cases, it is my opinion that the laws and regulations as written are not being followed by a significant number of administrative law judges.  There appear to be a large percentage of ALJs and doctors who testify at hearings who will , because of mere references in the record to past D  A usage, either find that D  A is a material contributing factor or will be biased against the claimant in finding them capable of SGA.   This is decided without evidence that the D  A materially causes their current condition.These decision makers seem to be timid to find that someone with drug usage  in his or her record is disabled, almost regardless of what the diagnosis would be with abstension.  Sadly, persons with schizophrenia, bipolar disorder, and other mental conditions frequently have a history of D  A when trying to self-medicate.  Sometimes the doctors at the hearings will testify that a schizophrenics disability did not start until the date he proves he stopped using.  Obviously, if he or she is disabled now that he stopped using, he or she would have been disabled had he never used D  A.The bottom line is that there is an extreme bias against persons with D  A in their records.  The regulation should state that there should be no bias against the cliamant soley because of D  A in the record.  RECOMMENDATION:  A CLARIFICATION OF THE LAW SHOULD BE GIVEN IN WRITING BOTH TO THE DECISION MAKERS AND ALSO TO MEDICAL DOCTORS AIDING IN THE DECISION PROCESS. THIS HAD TO BE RESUBMITTED: As an attorney who represents disability claimants before the SSA, I would like to endorse the comments already made by NOSSCR in its submission to you on March 24, 2010. In addition I recommend that any comprehnsive policy adopted by the SSA, including any new regulations, include the insights reflected in the answers to questions 27 and 29 in the emergency teletype dated August 30, 1996, EM-96200. Wherever the burdens of proof or coming forward with the evidence are placed, there should be proof in the record that drug addiction or alcoholism is a contributing factor material to the finding of disabiliity. And the proof should be clear and convincing, rather than a mere preponderance (a standard which permits calls which are closer than the evidence can bear and which are often questionable, but protected from correction on appeal as substantial). An increased standard of proof in this particular will reflect the inherent difficulty projecting or reliably predicting (1) what limitations would remain if the claimant stopped using drugs or alcohol or (2) how severe the remaining limitations would be. As the answer to question 29 notes, the answer is not automatic even when there is an actual period of abstinence. Questions of length, recency, and measurement remain. And the proof of the counterfactual (if the claimant were to stop, then . . .) is virtually impossible without research data upon which a prediction can be reliably placed. Most important, however, the requirement of clear and convincing evidence will protect the unrepresented claimant who is mentally impaired and unable to stop (and very great difficulty stopping or inability to stop is of course a characteristic of persons who are addicted and alcoholic). Most of those claimants will find the required proof to be beyond understanding, let alone a proof within the claimants ability. There is a broad range of people with abuse problems from the casual user through the person who is surviving after rehab to the person who is addicted and actively abusing either alcohol or drugs.  You cant start denying benefits without undertaking a massive evaluation component that is beyond government ability.  Substance use is part of society and Substance abuse is quite simply a disease and should not make a person eligible for benefits. I am opposed to drug and alcohol abusers being eligible for Social Security benefits. They make their choice to abuse drugs and alcohol whereas people with actual disabilities have no choice. If the choice were to have a disability or not, a person with a disability would chose not to however, in the case of a bonafide disability, there is no choice. I am a recovering addict who has a bipolar disorder and is currently working as a Peer Support Specialist through Community Mental Health.  I need to be very blatant about who I am and where Ive come from.  Im not ashamed anymore.  Ive been clean almost a decade.  I used marajuana constantly for about 15 years (only marajuana and yes, I was addicted).  Before I became addicted, I had 3 psych hospitalizations.  I never received an accurate diagnosis or treatment.  Marajuana worked for many years but I was isolated and alone and very depressed.  When I stopped using (I found my own bottom) I became manic and my life spiraled out of control.  I finally was diagnosed and entered into treatment for this bipolar disorder that still very much affects my life.  So I do feel uniquely qualified to speak to these issues.  I have been a sponsor to many and Ive been to alot of funerals.  I firmly believe that until an addict hits that place in his/her life (we call it the bottom) where the pain of addiction is bigger than the fear of stepping off into the unknown, everyone that tries to cushion the blow or give support is just extending the pain.  I dont think that anyone who is actively using should be on SSD.  Id go one further and say I dont think that anyone who is using should be receiving DHS money (but thats a whole other issue).  Theres no way to get an accurate psych diagnosis when drugs and alcohol are on board.  So what would be done about the doctors who so freely are handing out the opiates and benzos?  Now Im really asking for eutopia.I am now a Peer Support Specialist.  I believe its the best thing thats ever happened to mental health.  Flexible hours and the ability to take time off as needed.  To be able to look in someone eyes and say with confidence, Ive been there and there really is hope!  AMAZING! I have worked with people with severe mental illness and various addictions for over 20 years. There is no question that addictions, like severe mental illness, is a brain-based set of disorders. Addictions is not chosen. It has the characteristic of many other disorders of being experienced as chronic, remitting and relapsing. As with many with severe mental illness, requiring a person to have a representative payee (person or agency that handles the Social Security benefits), may be in the best interests of the affected person. In both categories of disorders, the person may have considerable difficutly managing their financial affairs. For too many years, addictions have been regarded in society as a moral failure. It is, in fact, a disorder of the brain that affects many in our society. It is time Social Security recognizes that fact in determining eligibility for disability payments. In my experience, many individuals take illegal drugs in order to self medicate,to feel normal if you will. When diagnosed and on appropriate prescription medications, they no longer need illegal drugs. In additon, many have no health insurance to address thier mental helath needs and turn to illegal means to obtain relief fro the symptoms of their disease. So, the answer is not an easy one. A policy that restricts all drug users from benefits will capture this group who is underserved,  in so many ways, and deny them critical benefits that may save their lives. In our state, the route to SSA benefits is so cumbersome and lenghty that many poor individuals resort to drugs to deal with the daily frustrations of their economic reality. They cannot work, due to disabilities, but may have to wait many years for benefits. Dr. Gitlows comment raises the important point of evidence.  I suggest that one source of important evidence that can help separate out the effects of substance abuse would be the claimants limitations during times of Uninterrupted abstinence [capitalization for emphasis].  This analysis, in turn, raises two other points:(1) Has Uninterrupted abstinence been established?  Again, the burden should be on the claimant to establish Uninterrupted abstinence.(2) How long has the Uninterrupted abstinence been?  Medical experts suggest there must be a minimum time before the effects of the substance abuse can clear the claimants system.  (I have heard doctors give time frames from six months to a year.)Once it has been established that the claimant has been abstinent long enough to reveal the substrate of underlying limitations, it would probably be fairly easy to determine materiality.I believe adjudicators would appreciate some form of guidance on these matters. Comments from the Disability Law Center and the Greater Boston Legal Services, Boston, MA I have represented clients seeking Social Security disability benefits for 38 years.  I find that many clients with mental impairments are A and/or D users because they are seeking comfort for the mental impairments.  Many are so mentally impaired that they qualify for benefits in spite of the A and/or D use.I feel that any regulation regarding A  D should express the requirement that claims of these mental A and/or D claimants should be specifically  evaluated regarding the severity of the mental impairment prior to any denial upon reconsideration to see if disability benefits can be awarded in spite of A and/or D.