Establishing Eligibility for SSI for Chronically Homeless People. 2.3. Substance Use and "Material Contribution"


Disabling conditions wholly or partly attributable to drug addiction and alcoholism (DA&A, in SSA terminology) have been controversial since Congress established the SSI program in 1972. Over the more than two decades--from program inception to the end of benefits on January 1, 1997 for people whose substance use was “material” to their disability--the role of substance use in determining eligibility for SSI has been a complicating factor in disability decisions.

Philosophical issues were matters of regular discussion, including whether recipients of SSI could work if they would only stop their substance use and, therefore, were therefore not disabled; why the government should be “enabling” people’s addictions by giving them a monthly check; and the continuing absence of good linkages to treatment. The final straw was extraordinary growth in DA&A beneficiaries (and therefore costs) in the 1990s: from under 20,000 when the decade began, to almost 170,000 in 1996. Hunt and Baumohl (2003) discuss several factors that probably contributed to this phenomenal enrollment growth, one of which was an SSI Outreach Project mounted by SSA that was explicitly designedto let people with mental illnesses and substance use disorders know that they were eligible and help them qualify.6 It was quite successful (Livermore, Stapleton, and Zueschner, 1998). In 1996 Congress directed SSA to end SSI/SSDI eligibility in cases where DA&A was material to the person’s disability (Public Law 104-121, Section 105).

Drug addiction and alcoholism can have devastating effects on people’s health, contributing to the development of chronic conditions where there were none before. These effects include permanent damage to many bodily systems and may also entail impaired cognitive and mental functioning. The 1996 statutory change that terminated SSI/SSDI eligibility for people whose drug addiction or alcoholism is material to their disability was not intended to disqualify people who have disabling co-occurring impairments. People with substance use disorders who present sufficient medical evidence of impairment that meets SSA disability criteria are entitled to SSI/SSDI regardless of current alcohol or drug use (Post et al., 2007). Denials of eligibility have nevertheless been widely reported to occur at the initial stage of disability determination, and fewer than half of these denials are reversed on appeal. A National Health Care for the Homeless Council guide offers the best coverage of issues related to DA&A, along with many useful approaches to overcoming the barriers to establishing eligibility (Post et al., 2007).


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