Substance Dependence Exam Considerations

Item 47: FAA Policy for Airmen with Mental Health Conditions

Apr 2014

Guidance is compiled and interpreted by professional pilots and physicians at from the 2014 AME Guide page 150, FAA and FDA web data ( &, instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).

FAA Considerations - Aerospace Medical Dispositions
Item 47. Psychiatric Conditions - Substance Dependence

Substance dependence refers to the use of substances of dependence, which include alcohol and other drugs (i.e., PCP, sedatives and hypnotics, anxiolytics, marijuana, cocaine, opioids, amphetamines, hallucinogens, and other psychoactive drugs or chemicals). Substance dependence is defined and specified as a disqualifying medical condition. It is disqualifying unless there is clinical evidence, satisfactory to the Federal Air Surgeon, of recovery, including sustained total abstinence from the substance for not less than the preceding 2 years.

Substance dependence is evidenced by one or more of the following: increased tolerance, manifestation of withdrawal symptoms, impaired control of use, or continued use despite damage to physical health or impairment of social, personal, or occupational functioning. Substance dependence is accompanied by various deleterious effects on physical health as well as personal or social functioning.

There are many other indicators of substance dependence in the history and physical examination. Treatment for substance dependence-related problems, arrests, including charges of driving under the influence of drugs or alcohol, and vocational or marital disruption related to drugs or alcohol consumption are important indicators. Alcohol on the breath at the time of a routine physical examination should arouse a high index of suspicion. Consumption of drugs or alcohol sufficient to cause liver damage is an indication of the presence of alcoholism.

Substance dependence and substance abuse are specified as disqualifying medical conditions.

This page discussed the Substance Dependence portion of the Psychiatric section of the Fight Physical Examination required of pilots.

Reminder: use to familiarize yourself with aviation medical regulations and guidelines, but always discuss your specific situation with one or more AMEs before dedicating resources toward expensive clinical workups. Find an AME now