Monday, April 17, 2006



Bipolar Disorder, Social Security Disability and SSI, and alchol and drugs

After I made my last post (on bipolar disorder) I thought of something that might be worthy of mentioning since I'm sure the vast majority of disability claimants have not heard of the concept.

Imbedded into the social security administration's disability evaluation system is a concept known as DAA materiality, DAA standing for drug and alcohol abuse. What it essentially means is this: if a patient/claimant has a condition (e.g. liver problems, depression, bipolar) and it's clear from a reading of the medical records that the condition, subsequent to the discontinued use of alcohol or drugs, would improve to the extent that the condition would no longer have a disabling effect, then the individual's drug or alcohol abuse would be considered material to the case. Another way of putting it would be: "Hey, you caused your condition and if you stopped using drugs or alcohol, you'd be able to work a job".

Immateriality is, of course, the flip side of the coin. In other words, if a claimant's condition would not improve regardless of whether or not they continued or discontinued their use of substances, the substance use/abuse would be considered "immaterial". Another way of putting it would be: "Your condition exists, it will exist even if you continue to use, and, for all practical purposes, your continued use just doesn't matter, as far as the evaluation of your disability case is concerned".

The issue of materiality versus immateriality is probably a little easier when it comes to evaluating physical allegations, such as liver disease. But apply the concept to mental impairments and things aren't so cut and dry.

Which brings me to Bipolar disorder. In my last post, I voiced my opinion that the social security disability system probably doesn't know it's head from it's @#&bleep*&^ when it comes to rendering disability determinations on the basis of bipolar. However, when the issue of drug and alcohol use or abuse rears its head in a case, it can become even more problematic.

Why is this? Well, as I said before, Disability Determination services examiners aren't exactly well versed in the particulars of bipolar disorder (or any other physical or mental condition, for that matter). What examiners ARE fairly well trained to do is look for kernels of information in a claimant's medical records. And that includes instances of subtance use or abuse.

What happens when a disability examiner finds a mention of usage in a claimant's medical records, such as etoh (alcohol) or cannibis (pot) use/abuse? It sends up a red flag that must be addressed and weighed.

This is fine, of course, because it's completely fair to consider how and to what extent a claimant's condition has been affected by an external substance. The problem with the process here, however, goes back to the fact that disability examiners know little about bipolar disorder. Bipolar individuals who are plagued by thoughts that simply will not stop racing around in their heads may sometimes seek out substances as a means of finding relief and escape.

Fortunately, most disability examiners are familiar with the concept of self-medication. However, will an examiner who is reading an incident (in a claimant's records) of a bipolar episode, with which alcohol use has been associated, be able to discern whether or not the incident was the result of self-medication? Doubtful. Will the DDS psychological consultant who oversees the examiners mental write-ups be able to discern this? Coin toss.

Think about it. Individuals will often be treated by a psychiatrist for years before the psychiatrist GETS the diagnosis right. So, are we supposed to really believe that some DDS psychological consultant---who spends 30 minutes tops glossing over someone's records and an examiner's writeup---can really understand what is happening with a bipolar patient.

Let me say some particularly nasty words about DDS mental consultants. Though many of them are fine and competent individuals, many are also hacks who sought refuge in a state office, rather than devote themselves to the full rigors of practice. I've seen some of them turn down individuals with IQ's in the low fifties. And I've seen many claimants with schizophrenia and bipolar disorder receive E3 durational denials. What's that? This will sound particularly stupid to a long time sufferer of bipolar. It means that the condition is not expected to last at least as long as 12 months (the necessary minimum for social security disability and ssi benefits).

The stupidity of this, of course, is quite amazing. Bipolar is not a durational condition like a broken leg or a sprained wrist. It exacerbates and remisses and tends to slide back and forth on a spectrum between the manic and depressive poles.

So, what's my point in this post? I'm not sure. It would probably be best, certainly, if minor incidents of substance use (e.g. drinking a single can of beer over the weekend) did not receive the attention of social security because this can send up a flag. And considering the shortcomings of the system, you don't want to send up flags. Of course, I am not advocating anything with regard to what information you pass on to your general practitioner, psychologist, or psychiatrist. But just remember: once something makes it into your medical records, it is there to stay.


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5 Comments:

Blogger Bridget Jones said...

I so get that. The term self-medication hasn't been used on me (I have physical limits to drinking and am mentally just turned off of pharmaceutical stuff but can see why others do it) but have heard the term a lot.

Think that gov't folks that claim not to have heard it are just umm trying to find a way to cut gov't costs or is that insurance costs. Glad to have found your blog!!

7:59 PM  
Blogger Disability Blogger said...

Ultimately, I think you are right. Glad to have found your blog, too!

8:50 PM  
Blogger Belinda said...

Yes, one of the hardest things for loved ones of bipolar people to understand and come to grips with is the vicious cycle of self-medication and episodic behavior. Couple that with lack of insight inherent in the disease, and, well...it's a lose/lose, except for the luckiest 20% or so.

I just got through blog-griping about the pharmaceutical racket surrounding atypical antipsychotics. Bleah. It's been that kind of a day.

9:54 PM  
Blogger Disability Blogger said...

Belinda, took a look at your movie list. American Beauty and Das Boot were great ones. Requiem for a dream had to be one of the most depressing ones I've ever seen though.

10:38 AM  
Blogger hereinmyhead said...

I have rapid cycling bipolar disorder, and a current SSDI claim in line for a hearing. I'm always looking for info, & one thing that I resent is this - every single time I try to find information regarding mental illness and any upcoming legislation, proposals, changes in law, etc, it's ALWAYS lumped in with drug & alcohol abuse, seeming to be viewed as "one in the same" by both lawmakers and the government, as if "where there is one, you find the other" in every situation. I am mentally ill, but I have never abused any substance. I resent the implication, but can't seem to avoid it. Love your blog. Loyal reader.

3:46 PM  

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