Bipolar and chemical abuse

Recently Social Security gave notice that SSR 13-2p would rescind and replace SSR 82-60. The change deals with how Social Security is to deal with the issue of a claimant with a claim for disability who at the same time has chemical abuse (alcohol and drugs) issues.

The general statement of the law is that a claimant shall not be considered disabled if chemical use (alcohol or drugs) would be a contributing factor material to the Commissioner’s determination that the claimant is disabled. (Sections 223(d)(2)(C) and 1614(a)(3)(J))

If in the proceedings the claimant is found to be disabled, but is also found to have abused drugs or alcohol the forgoing paragraph must be considered, i.e. then there must be a determination as to whether the claimant would continue to be disabled if he or she stopped using. Put another way, would the claimant still be disabled if he stopped using drugs or alcohol?

When chemical use is an issue, the normal five step sequential evaluation has a sixth step added to it. If found disabled after application of the five step evaluation, the hearing must then determine if claimant’s other impairment(s) improve to the point of non-disability in the absence of drug or alcohol use?

In a prior blog, I talked about this issue in more detail. This issue pops up in many many cases because it has raised so many other issues of interpretation,

The one situation that I want to speak to in this blog is the claimant suffering from bipolar disorder and who has substance abuse issues.

Very often in representing a claimant who suffers from bipolar disorder, I see substance abuse in the medical reports. Is the claimant still disabled when consideration is given to the chemical issues?

I believe that even if chemical abuse is an issue, in most cases the decision should be resolved in claimant's favor, given a prior finding of disability.

When bipolar disorder is involved, there must be consideration given to the effects of the impairment on the claimant. Medical research has shown that bipolar disorder causes substance abuse as a means for relieving symptoms, but there is no evidence that the symptoms of bipolar disorder are triggered by drug and/or alcohol . Consider Kangail v. Barnhart, 454 F.3d 627,629 (7^th Cir. 2006):

“(A)though the medical literature, while noting a positive correlation between the two conditions (bipolar disorder and substance abuse) and speculating that alcohol may trigger bipolar symptoms, does not indicate that the disorder itself can be so caused. American Pyschiatric Association, Diagnostic and Statistical Manual of Mental disorders 187,354 (4^th ed. 1994); Frederick K. Goodwin & Kay Redfield Jamison, Manic-Depressive Illness 219-25 (1990); Willem A. Nolen et al. ”Correlates of 1-Year Prospective Outcome in Bipolar Disorder: Results from the Stanley Foundation Bipolar Network,” 161 Am. J. Psychiatry 1452 (2004); Marcia L. Verduin et al., “Health Service Use Among Persons With Conorbid Bipolar and Substance Use Disorders,” 56 Psychiatric Services 475-76 (2005).

What is clear is the reverse-that bipolar disorder can precipitate substance abuse, for example as a means by which the sufferer tries to alleviate her symptoms. Goodwin & Jamison, supra, at 219-25; Li-Tzy Wu et al., “Influence of Comorbid Alcohol and Psychiatric Disorders on Utilization of Mental Health Services in the National Comorbidity Survey,” 156 Am. J. Psychiatry 1235 (1999); Edward J. Khantzian, :the Self-Medication Hypothesis of Addictive Disorders: Focus on Heroin and Cocaine Dependence.” 142 Am. J. Psychiatry 1259, 1263 (1985).

The Eighth Circuit has held that the burden is on the claimant to prove that drug addiction and /or alcoholism is not material to a finding of disability. Brueggemann v. Barnhart, 348 F.3d 689, 693 (8^th cir. 2003). It is also established that when it cannot be determined whether substance use is a material factor the “…tie goes to (the claimant).”

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