Guide for Aviation Medical Examiners

Substances of Dependence/Abuse (Drugs and Alcohol)

As an Examiner you are required to be aware of the regulations and Agency policy and have a responsibility to inform airmen of the potential adverse effects of medications and to counsel airmen regarding their use. There are numerous conditions that require the chronic use of medications that do not compromise aviation safety and, therefore, are permissible. Airmen who develop short-term, self-limited illnesses are best advised to avoid performing aviation duties while medications are used.

Aeromedical decision-making guidance includes an analysis of the underlying disease or condition and treatment. The underlying disease has an equal and often greater influence upon the determination of aeromedical certification.

General Information for all AMEs


  • This refers ONLY to Pilots who fly for an airline with a HIMS Chairman.
  • Case submissions must be sent electronically to WASHINGTON, DC via Huddle AND have an accompanying HIMS Data Sheet. HIMS DATA SHEET.
  • Paper format submissions will NOT BE ACCEPTED after January 1, 2023.
  • Airline HIMS Chairs will be advised of HIMS AMEs not in compliance at that time.
  • All HIMS AMEs must successfully complete Huddle training to be placed on the FAA HIMS AME List. Send training requests to
  • Send ALL OTHER Drug and Alcohol cases to AMCD at the address indicated on the HIMS-Trained AME Checklist. (No Data Sheet needed.)
  • To Transfer HIMS CASES see HIMS AME Change Request

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.

Drug and/or Alcohol monitoring - Initial Certification

Drug and/or Alcohol monitoring - Recertification

HIMS AMES should use this section once the airman has a valid Special Issuance Authorization for a Drug or Alcohol condition. In response to NTSB Safety Recommendation A-07-43, the FAA has extended follow up for airmen with a diagnosis of substance dependence on a HIMS Step Down Plan. HIMS AMES should use the following guidance in recommending testing frequency and general milestones.

Drug and/or Alcohol monitoring – Step Down Transition

If the pilot is on a Special Issuance for substance dependence, with or without any other condition, in some instances the HIMS AME may have the option to transition the pilot to another Phase. For guidance on applicable Phases and when this is allowed, see the information below:

Monitoring/HIMS Frequently Asked Questions (PDF)

For information on the Industry Drug and Alcohol Testing Program see Aviation Industry Antidrug and Alcohol Misuse Prevention Programs

Last updated: Wednesday, October 25, 2023