One of the most common psychological problems amongst aircrew is substance misuse, most often it concerns alcohol and or prolonged use of medical drugs without consulting an Aero Medical Examiner.

It is important to identify substance misuse in an early stage before dependency will lead to loss of control, compulsive use and continued use despite adverse consequences on health, social relationships and/or profession. The impact on the medical license of flight crew and cabin crew can be extensive. European legislation mandates to withdraw a pilot and cabin crew medical license in case of substance misuse or abuse, with or without dependency. A fit assessment may be considered again after a documented period of treatment and evaluation. Depending on individual cases this will require in-patient of out-patient treatment of some weeks and inclusion into a support program.