SUBSTANCES OF DEPENDENCE/ABUSE

(Updated 09/30/2026)

General Information for All AMEs

For FAA Drug and/or Alcohol Monitoring Program and the HIMS Program—see next page:

FAA Drug and/or Alcohol Monitoring Program and the HIMS Program:

Airmen who have a regulatory diagnosis of alcohol dependence or abuse may require evaluation and monitoring before they can obtain a medical certificate. If an airman requires monitoring they should establish with a HIMS (Human Intervention Motivation Study) trained AME (HIMS AME) to help them work through the FAA process.

o HIMS-Trained AME Checklist Drug and Alcohol Monitoring Recertification o FAA Certification Aid - Drug and Alcohol Monitoring Recertification o

For information on the Industry Drug and Alcohol Testing Program see:

Aviation Industry Antidrug and Alcohol Misuse Prevention Programs

• General Information for ALL AMES
• DUI/DWI/Alcohol or Drug Use/Abuse (Updated 09/27/2017)

Drug and alcohol use, abuse or dependence can be of significant concern to the flying public. Arrest(s), conviction(s) and/or administrative action(s) affecting driving privileges may raise questions about the applicant's fitness for certification and may be cause for disqualification. When an airman checks yes to items 18.n. 18.o., or 18.v., or AME notes Item 47 concerns, additional history should be obtained by the AME regarding these events. The AME should then follow the instructions in the corresponding disposition table(s).

Some of the most common Substances of Dependence/Abuse are listed below. This list is not totally inclusive or comprehensive. No independent interpretation of the FAA's position with respect to a medication included or excluded from the list should be assumed.

Substance or Medication

• I. All Classes: 14 CFR 67.107(a)(b), 67.207(a)(b), and 67.307(a)(b)
• First-Class Airman Medical Certificate: 67.107
• Second-Class Airman Medical Certificate: 67.207
• Third-Class Airman Medical Certificate: 67.307

(ii) "Substance dependence" means a condition in which a person is dependent on a substance, other than tobacco or ordinary xanthine-containing (e.g., caffeine) beverages, as evidenced by- (A) Increased tolerance

(B) Manifestation of withdrawal symptoms;

(C) Impaired control of use; or (D) Continued use despite damage to physical health or impairment of social, personal, or occupational functioning.

(ii) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

II. Exam Techniques

The FAA has concluded that certain conditions are such that their presence or a past history of their presence is sufficient to suggest a significant potential threat to aviation safety. It is, therefore, incumbent upon the AME to be aware of any indications of these conditions currently or in the past, and to deny or defer issuance of the medical certificate to an applicant who has a history of these conditions. An applicant who has a current diagnosis or history of these conditions may request the FAA to grant an Authorization under the special issuance section of part 67 (14 CFR 67.401) and, based upon individual considerations, the FAA may grant such an issuance.

III. Aerospace Medical Disposition

The following items list the most common conditions of aeromedical significance, and course of action that should be taken by the AME as defined by the protocol and disposition in the table. Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed in the table that may result in sudden or subtle incapacitation without consulting the AMCD or the RFS. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate.

DUI/DWI/Alcohol Incidents (18 v.)

All Classes

(Updated 09/30/2026)

CONDITION	EVALUATION DATA	DISPOSITION
A. History of alcoholrelated event(s)Previously reported to FAA and written proof* from the FAA stating that monitoring is not required.*This should be a letter from the FAA to the individual often referred to as an “eligibility letter” or “warning letter”.	The individual should bring their letter(s) from the FAA (for this condition) for the AME to review.The AME should review the letter and obtain any additional history necessary from the individual to verify NO subsequent events have occurred.*Note 1	ISSUEIn Item 60, summarize findings, record the date (mm/yyyy) of the most recent event and confirm no further events or status changes have occurred.If the individual does not provide evidence of FAA clearance for the specific event(s), or if there are changes/new events, see Note 1.
B. Single lifetime event with Blood Alcohol Content (BAC) or Breath Alcohol Content (BRAC) 0.149 or below	The AME must review all required documents listed below, complete, and upload the Alcohol Event Status Report for the AME.Submit the following for FAA review:1. DUI / DWI Personal Statement 2. Arrest report. DUI arrest report (arresting officer’s narrative with field and chemical sobriety testing) 3. BAC/BRAC documentation. Official breath, blood, or urine test results. 4. Court & Probation records. Include pre-trial diversion programs, judgments, warrants, etc. 5. Driving History – Official driving records from every state where they held a driver’s license in the preceding 10 yrs. 6. All prior substance abuse evaluations (SAE) and/or treatment records, include both mandatory or voluntary evaluations or treatment.*Note 2 and 3	ISSUEIf ALL responses are in the left/clear column on the Alcohol Event Status Report, the AME mayISSUE.Summarize this history in Item 60, including date (mm/yyyy) of the offense.Upload ALL required documents with the exam prior to transmission.
	All supporting information must be uploaded with the AME exam for consideration.
C. Single lifetime event with a Breath or Blood Alcohol Content (BrAC/BAC) that is:1. Unknown, or 2. Refused, or 3. 0.15 or higher (>= 0.15)If ANY of the following apply, see Substance Use Disorders (DSM); Substance Abuse or Substance Dependence (DSM or CFR) page:• TWO or more events in a lifetime, or• a history of substance dependence or a substance use disorder, or• any BAC >= 0.20	Submit the following for FAA review:• A completed Alcohol Event Status Report for the AME• All items in Row BAll supporting information must be uploaded with the AME exam for consideration of Medical Certification.*Note 3	DEFERSubmit the information to the FAA for review.

Notes:

REMINDER: Question 18V specifies a history of any arrest and/or conviction and/or administrative action involving driving while intoxicated, impaired, or under the influence of alcohol or a drug. This includes operation of any motorized vehicle.

Alcohol Event Status Report for the AME (18 v. related detainment or arrest) (Updated 09/30/2026) Name _______________________________________________ Birthdate _______________________________

Applicant ID# _________________________________________ PI# ____________________________________

AME Instructions:

Evaluate: Complete all items based on your in-office evaluation and documentation review.

Sign and Upload Status Report: Sign, date, and upload the page as DA-Alcohol Event Status Report.

Upload Records: Upload ALL supporting documentation reviewed to complete this checklist.

AME ATTESTATION: I have received and reviewed the following documentation for each event NOT previously cleared by the FAA in formal correspondence. If all documents are not uploaded, the AME must defer.

………………………………………………………………………………………….……….

……………………………………………………………………...…………………

AME REVIEW: List DATE(s) of any arrest, conviction or administrative action here: ____________________________________

behaviors?........................................................................................................................................

Any unknown BAC or unable to obtain records ……………………………………………….…

Did the individual ever REFUSE TO TEST.............................................................................

ANY BAC in the records of 0.15 g/dL or HIGHER ……………………………………………….

List the highest BAC found on report(s) here: ________________

(Do not include court-ordered education programs.) ..................................................................

AME Signature Date of evaluation

Alcohol Event Status Report for the AME (18 v. related detainment or arrest)

(Updated 09/30/2026) AME Instructions: If ALL items fall into the left/clear column, the AME may issue with notes in Block 60 but must upload all documents to the FAA.

If ANY SINGLE item falls into the right/shaded column, the AME MUST DEFER. The AME report should note what aspect caused the deferral and explain in Item 60.

If ANY of the required records are not available to the AME (confirmed in writing by the arresting agency and/or jurisdiction) but the AME has no concerns, contact AMCD Drug & Alcohol Physician or defer.

Remind the airman to report any new event to Security.

DUI / DWI PERSONAL STATEMENT

(Updated 09/30/2026) Name: _____________________________________ DOB: ________________ PI#: ____________ Instructions: Mark all applicable answers, type your statement, sign the document, and bring it to your AME appointment for uploading into your FAA file.

[ ] None. Date of use/last drink (or start of abstinence): ___________ [ ] Yes. Frequency: ___________ | Specific amount per episode: _______________________ 3. Consequences. Prior Offenses & Negative Consequences from alcohol or substance use: Have you had any other drug/alcohol incidents/offenses (MIP, consumption, drug possession charges) or related medical, injuries, nondriving legal issues, or personal issues? [ ] No [ ] Yes (List dates and details):

___________________________________________________________________________________________ a. Have you had ANY other misdemeanors, felonies, or citations where drugs or alcohol were involved, even if they were later reduced to a lower sentence. No [ ] Yes [ ] b. Have you had ANY medical consequences associated with alcohol or substance use, e.g., pancreatitis? [ ] No [ ] Yes (explain) ______________________________________________________________ 4. Treatment & Recovery History. Have you ever in your life attended a drug or alcohol treatment program? [ ] No (go to 5.) [ ] Yes (If yes, complete below) a. Dates: Substance(s): [ ] Alcohol [ ] Drugs ____________________ b. Type: [ ] Residential [ ] Intensive Outpatient [ ] Outpatient [ ] DUI Education [ ] Other c. Currently in a recovery program? [ ] No [ ] Yes (If yes, select all that apply) [ ] AA [ ] BOAF [ ] Celebrate Recovery [ ] SMART Recovery [ ] Narcotics Anonymous [ ] Other _______________ 5. Description: Describe in your own words the circumstances leading up to your arrest(s). Include any other comments for FAA review. (Response must be typed.)

Signature: ___________________________________________ Date: _________________

DRUG USE - PAST OR PRESENT

All Classes

(Updated 09/30/2026)

CONDITION	EVALUATION DATA	DISPOSITION
A. Any lifetime history of drug use, drug-related event(s), or drug dependence (illicit or prescription).Previously reported to FAA and written proof* from the FAA stating that monitoring is not required.*This should be a letter from the FAA to the individual often referred to as an “eligibility letter” or “warning letter”.	The individual should bring their letter(s) from the FAA (for this condition) for the AME to review.The AME should review the letter(s) and obtain any additional history necessary to verify no subsequent use or events have occurred.*Note 1	ISSUEAnnotate Block 60 with the date (mm/yyyy) of the most recent event and if there have been no further events or changes in condition.If there are changes, consult with AMCD/RFS or defer
B. History of drug use (including cannabinoids), drug-related event(s), or drug dependence (illicit or prescription) during the airman’s lifetime:- NOT previously reported to the FAA and not cleared for regular medical certification.NOTE: Must include use of marijuana and/or psilocybin/mushrooms for both medical and recreational use.	Submit the following for FAA review:1. Drug Use Personal Statement (see template).2. Driving History – Official driving records from every state where they held a driver’s license in the preceding 10 yrs.3. Police, Court & Probation records. Include pre-trial diversion programs, judgments, warrants, etc. (if applicable)4. All prior substance abuse evaluations (SAE) and/or treatment records, include both mandatory or voluntary evaluations or treatment. (if applicable)5. Copies of previous positive drug testing (if applicable)*Note 2	DEFERSubmit the information to the FAA for review.

Notes:

DRUG USE PERSONAL STATEMENT

(Updated 09/30/2026) Name: _____________________________________ DOB: ________________ PI#: ____________ Instructions: Mark all applicable answers, type your statement, sign the document, and bring it to your AME appointment to upload into your FAA file.

[ ] No [ ] Yes (If yes, complete below)

[ ] BOAF [ ] Celebrate Recovery [ ] SMART Recovery [ ] Narcotics Anonymous [ ] Other ______ Signature: ___________________________________________ Date: _________________

Substance Use Disorders (DSM);Substance Abuse or Substance Dependence (DSM or CFR)

(e.g. Positive DOT or FAA alcohol or drug test; Failed alcohol or drug test; yes to 18n or 18o; or medical complications associated with drug/alcohol)

All Classes

(Updated 09/30/2026)

CONDITION	EVALUATION DATA	DISPOSITION
A. Prior FAA CFR Determination of Substance Abuse or Dependence (previously on Special Issuance or Special Consideration)• CFR Substance Abuse: Has written documentation* from the FAA stating that current and ongoing monitoring is NOT required,• CFR Substance Dependence: Has written documentation* from the FAA stating that current and ongoing monitoring is NOT required AND the letter includes a warning for permanent abstinenceANDNo evidence or concern of a relapse or new substancerelated incident.*Official FAA letter to the individual often referred to as an “Eligibility Letter” or “Warning Letter”.	The AME should:Review any letter(s) from the FAA (for this condition) verifying ongoing monitoring is no longer required.Obtain any additional history necessary to verify no subsequent substance-related events have occurred.If required to remain abstinent, the AME, based on their clinical assessment, should note in Item 60 if they are adhering to this requirement*Note 1	ISSUEIn Item 60, summarize findings, record the date (mm/yyyy) of the most recent event and confirm no further events or status changes have occurred.If the individual does not provide evidence of FAA clearance for the specific event(s), or if there are changes/new events see Note 1.If there are any changes or new events, go to row B.
B. Regulatory FactorsB1 - Previously warned by the FAA for substance abuse or	Submit the following for FAA review:	DEFERSubmit the information to the FAA for review.
dependence, with a NEW substance-related event and/or violation of permanent abstinence warningORB2 - NEW affirmative answer to any of the following on the 8500-8:• 18N: Failed a drug test ever (including a positive DOT/FAA test or refusal)• 18n or 18o: Alcohol/Substance dependence• 18n or 18o: Alcohol/Substance abuseORB3 - Two or more alcohol/substance-related events in the individual’s lifetime	7. DUI / DWI PERSONAL STATEMENT or Drug Use Personal Statement (as applicable) 8. A completed Alcohol Event Status Report for the AME (if applicable) 9. DOT test results (if applicable)10. All supporting information used to complete the aboveAdditional information may be required after review of this documentation
C. Clinical Factors**:C1 – Medical records indicate:• Alcohol/Substance dependence• Alcohol/Substance abuse• Alcohol/Substance Use DisorderORC2 - Medical consequences of alcohol/substance use, including (but not limited to):• Delirium tremens (DTs)• Withdrawal seizures• Alcoholic cirrhosis• Esophageal varices• Recurrent pancreatitis (not associated with gallstones)	Submit the following for FAA review:For a diagnosis of substance use disorder/abuse/dependence, submit all diagnostic and treatment recordsFor diagnoses of medical conditions related to alcohol/substance use, ALSO SUBMIT the required items from those sections (e.g. cirrhosis, esophageal varices, TBI).	DEFERSubmit the information to the FAA for review.
• Mallory-Weiss tears• Alcohol/substance related injuries or trauma

Notes:

**Medical diagnoses or physical complications in the applicant's history that may indicate or stem from alcohol/substance abuse, dependence, or misuse.

DRUG AND ALCOHOL EVENT - FAA CERTIFICATION AID - REQUIRED INFORMATION

(Updated 09/30/2026) AMEs should use this tool to help collect information needed for the Alcohol Event Status Report for the AME.

The following information is to assist you and your treating physician/provider who may be unfamiliar with FAA medical certification requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a determination on an airman medical certificate. You should strongly consider taking a copy to each evaluator so they understand what specific information is needed in their report to the FAA. If the corresponding provider does not address each item, there may be a delay until that information is submitted. Additional information, such as clinic notes or explanations, should also be submitted as needed.

Note: if the above evaluation is not adequate, an additional evaluation from a psychiatrist or other provider may be required.

Security Notification/ Reporting Events

(Updated 06/27/2018) Security Notification for a Conviction or Administrative Action Note: Under 14 CFR 61.15, all pilots must send a Notification Letter (MS Word) to FAA's Security and Investigations Division, within 60 calendar days of the effective date of an alcohol and/or drug related conviction or administrative action.

Federal Aviation Administration

Security and Investigations Division AXE-700;

• P.O. Box 25810
• Oklahoma City, OK 73125-0810

For additional information including a copy of the required Notification Letter, see:

Security

Substances of Dependence/Abuse FAQs

(Updated 09/27/2017) 1. Is there a difference in a regulatory requirement vs a clinical diagnosis? Which one must an airman meet?

Yes. Airmen must meet the regulatory requirements of 14 CFR Part 67, which are not the same criteria used for a clinical (DSM) diagnosis.

“Substance dependence” means a condition in which a person is dependent on a substance other than tobacco or ordinary xanthine containing (e.g., caffeine) beverages, as evidence by:

A. Increased tolerance;

B. Manifestation of withdrawal symptoms;

C. Impaired control of use; or

D. Continued use despite damage to physical health or impairment of social, personal, or occupational functioning.

(ii) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

A. Arrests;

B. Convictions; or

C. Administrative actions - such as if the airman attended an educational or rehabilitation program in lieu of conviction or was given a lesser charge after being arrested (ex: an arrest for DUI that was reduced to reckless driving after court proceedings).

Yes. The 8500-8 specifically asks the airman to report if they “ever in their life have been diagnosed with, had, or presently have...”

The AME should inquire about each event, no matter how long ago, and follow the appropriate disposition table instructions.

The AME should obtain additional history and follow the correct disposition table. In some cases, additional information will be required before a medical certificate may be issued.

Yes. If the airman has reported the event to the FAA, they must continue to report it on ALL subsequent 8500-8 applications. This applies even when the FAA has reviewed documentation and sent the airman a letter saying no further monitoring or information is needed for that event.

If the applicant/airman documented the information on previous exams AND there are no new arrest(s), conviction(s), and/or administrative action(s) since the last application, the Applicant may enter PREVIOUSLY REPORTED, NO CHANGE.

The AME should verify there have been no additional drug or alcohol events/offense(s). If none have occurred, that should be noted in Block 60 per the disposition table. If any additional events have occurred, the AME should refer to the instructions on the correct disposition table.

Airmen must report alcohol and drug events under both Part 67 and Part 61.

This requires two separate actions by the airman:

• Federal Aviation Administration
• Security and Investigations Division, AXE-700
• P.O. Box 25810
• Oklahoma City, OK 73125-0810

For additional information see Security.

No. The airman must take a separate action to report a conviction or administrative action to security.