
The Federal Aviation Regulations (FARs), specifically Part 67, outline the medical standards for airmen holding FAA medical certificates and highlight the conditions that may disqualify airmen from holding such a certificate. Under Title 14 Code of Federal Regulations (CFR) § 67.107, 207, and 307, which outline the mental standards for certification, “substance dependence” and “substance abuse” are specifically disqualifying conditions.
These conditions are not the same as clinical diagnoses. In fact, the regulatory definitions of substance dependence and abuse differ drastically from the clinical definitions of alcohol or substance use disorders. Unfortunately, the FAA has failed to substantively update these mental health regulations for decades to keep up with the more rapidly evolving clinical world. Accordingly, pilots and air traffic controllers (ATCs) should understand the unique and archaic regulatory landscape of alcohol and substance use that governs the issuance of FAA medical certificates.
Substance Dependence and Abuse
Substance Dependence
Substance dependence is defined by the Federal Aviation Regulations (FARs) as “a condition in which a person is dependent on a substance other than tobacco or ordinary xanthine containing (e.g., caffeine) beverages.” To be “diagnosed” with regulatory substance dependence, an airman only needs to meet ONE of four broad factors. Those factors are: (1) increased tolerance, (2) manifestation of withdrawal symptoms, (3) impaired control of use, and (4) continued use despite damage to physical health or impairment of social, personal, or occupational functioning.
The most black-and-white of the four substance abuse factors in practice, and, frankly, the only factor that has been outlined in any detail beyond the regulatory language by the FAA, is “increased tolerance.” The FAA generally considers an airman’s blood alcohol content (BAC) at the time of an “alcohol event” to determine whether they have an increased tolerance to alcohol. Most often, an alcohol event involves an arrest under suspicion of driving under the influence (DUI) or driving while intoxicated (DWI) but is not necessarily limited to DUI/DWI arrests. An airman with a BAC equal to or greater than 0.15% who shows “minimal behavioral evidence of intoxication” is considered to have increased tolerance. An airman with a BAC equal to or greater than 0.20% who is “conscious and responsive” is also considered to have increased tolerance.
Finally, the FAA considers substance dependence a lifelong condition. So, if an airman is found to meet any of the four factors at any time in their life, they will not be able to escape the substance dependence label. That is not to say the airman is entirely disqualified from holding an FAA medical certificate for the rest of their life. Airmen with a history of substance dependence may hold an FAA medical certificate if they can show “established clinical evidence, satisfactory to the Federal Air Surgeon, of recovery, including sustained total abstinence from the substance(s) for not less than the preceding 2 years.”
Significantly, airmen may be granted an Authorization for Special Issuance (SI) of a medical certificate at the discretion of the Federal Air Surgeon. Generally, for airmen with a history of substance dependence, special issuance requires compliance with the Human Intervention Motivational Study (HIMS) Program. The HIMS Program typically begins with an addiction evaluation, followed by residential treatment, continued abstinence testing, intensive outpatient or individual treatment, engagement in a peer support group (AA, SMART Recovery, Birds of a Feather), HIMS neuropsychological and psychiatric evaluation, HIMS AME examination and report, then lengthy review by the FAA. After all that is completed properly, the airman may be granted an SI, which will require monitoring terms such as continued aftercare, peer support group attendance, and abstinence monitoring in order to maintain the SI.
Substance Abuse
Substance abuse is defined in three different ways by the FAA and an airman can be denied medical certification if they meet any of the following criteria:
- Use of a substance in a situation in which that use was physically hazardous, if there has been at any other time an instance of the use of a substance also in a situation in which that use was physically hazardous;
- A verified positive drug test result, an alcohol test result of 0.04 or greater alcohol concentration, or a refusal to submit to a drug or alcohol test required by the U.S. Department of Transportation or an agency of the U.S. Department of Transportation; or
- Misuse of a substance that the Federal Air Surgeon, based on case history and appropriate, qualified medical judgment relating to the substance involved, finds—
- Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
- 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.
Considering most readers are not attorneys and may not appreciate the legalese of that regulation, it is worth restating those definitions:
- Use of a substance in a situation where that use was physically hazardous (read: while driving or operating machinery);
- A positive DOT drug or alcohol test; or
- “Misuse” that the Federal Air Surgeon thinks would prevent the airman from safely performing flight duties.
Unlike substance dependence, substance abuse is not considered a lifelong condition. The regulation clearly states that substance abuse is only disqualifying if it occurred in the two years preceding the application for airman medical certification.
Similarly to substance dependence, the Federal Air Surgeon may grant an SI to airmen with a history of substance abuse, even if the substance abuse occurred within two years of application. The requirements to obtain an SI with a history of substance abuse are much less rigid and often are limited to simple abstinence monitoring for an extended period of time.
Be Proactive
If you are applying for a medical certificate or reporting an alcohol event to the FAA under 14 CFR § 61.15, it is crucial that you address any potential concerns regarding your history of substance use up front. You have one shot to get that report right. Once an airman is found to meet the criteria for substance abuse or dependence, that bell cannot be unrung, except in extremely rare circumstances. An aviation attorney may be able to help you present your case in the best possible light and ensure you do not face expensive and overly burdensome monitoring terms unless it is appropriate under the circumstances.