Drug or alcohol misuse or dependence: assessing fitness to drive
Source: gov.uk (2025-11-07)

Advice for medical professionals to follow when assessing drivers with drug or alcohol misuse or dependence.

Alcohol use disorders

DVLA have 2 standards for alcohol use disorders. These standards are for:
- persistent alcohol misuse and alcohol dependence without any high-risk features
- alcohol dependence with one or more high-risk features
The high-risk features are either or both:
- alcohol withdrawal seizures (not alcohol associated seizures)
- medication assisted alcohol withdrawal needed or required
The presence of one or more high-risk features is used to identify individuals with a physiological dependence on alcohol who are at an increased risk of relapse into dependant drinking.

Guidance on diagnosis of alcohol use disorders can be found in the Internal Classification of Diseases (11th revision) produced by the World Health Organisation, relevant codes 6C40.2 and 6C40.1, or the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) for alcohol use disorder, relevant code FS10.20.

For both Group 1 (car or motorcycle) and Group 2 (lorry or bus):
- licensing may require satisfactory medical reports from a doctor
- DVLA may need to arrange independent medical examination and blood tests
Persistent alcohol misuse

Definition of controlled drinking

Controlled drinking means drinking at a level and in a manner which their clinician confirms acceptably controls their alcohol use disorder and their alcohol use is unlikely to impact on personal, social, and work responsibilities.

Alcohol dependence

Guide to definition of dependence

Alcohol-related disorders

Alcohol-related seizure

The relevant standards for any associated alcohol dependence should be applied.

Seizures associated with alcohol use may be considered provoked in terms of licensing (for details see neurological disorders (https://www.gov.uk/guidance/neurological-disorders-assessing-fitness-to-drive) and Appendix B (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-b-epilepsy-and-seizure-rules-and-further-guidance)).

Drug misuse or dependence

The relevant classification codes for drug misuse or dependence are World Health Organization F11 to F19 inclusive (ICD-10).

The below requirements apply to cases of single-substance misuse or dependence, whereas multiple problems – including with alcohol misuse or dependence – are not compatible with fitness to drive and licensing consideration, in both groups of drivers.

Note on methadone/buprenorphine treatment programmes

Group 1

Applicants or drivers complying fully with a methadone or buprenorphine maintenance programme may be licensed subject to favourable assessment and normally annual medical review. There should be no evidence of continuing use of other substances including non-prescribed cannabis.

Application may be considered when all of the following conditions can be met:

stable on the programme for a minimum of 1 year

the treatment programme is for management of opiate dependence and managed according to the guidance detailed in the publication ‘Drug misuse and dependence. UK guidelines on clinical management’ (known as the ‘Orange Book’)

oral or sublingual treatment only (not parenteral) but subcutaneous long-acting buprenorphine or naltrexone implants may be considered

there has been compliance with the programme (adherence to prescription and appointments, and toxicology testing with sustained stability)

no non-prescribed psychoactive drug use during the programme or extra use of prescribed drugs such as methadone, buprenorphine, benzodiazepines

there should be no other disqualifying conditions (as specified in the other sections of this guidance (https://www.gov.uk/government/publications/assessing-fitness-to-drive-a-guide-for-medical-professionals))

Group 2 and C1/D1

Applicants or drivers complying fully with a methadone or buprenorphine maintenance programme may be considered for an annual medical review licence, once a minimum 3-year period of stability on the maintenance programme has been established.

Application may be considered when all of the following conditions can be met:

stable on the programme for a minimum of 3 years

the treatment programme is for management of opiate dependence and managed according to the guidance detailed in the publication ‘Drug misuse and dependence. UK guidelines on clinical management’ (known as the ‘Orange Book’)

oral or sublingual treatment only (not parenteral) but subcutaneous long-acting buprenorphine or naltrexone implants may be considered

there has been compliance with the programme (adherence to prescription and appointments, and toxicology testing with sustained stability)

no non-prescribed psychoactive drug use during the programme or extra use of prescribed drugs such as methadone, buprenorphine, benzodiazepines

there should be no other disqualifying conditions (as specified in the other sections of this guidance (https://www.gov.uk/government/publications/assessing-fitness-to-drive-a-guide-for-medical-professionals))

Seizure associated with drug use

Seizures associated with drug use may be considered provoked in terms of licensing (for details see neurological disorders (https://www.gov.uk/guidance/neurological-disorders-assessing-fitness-to-drive) and Appendix B (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-b-epilepsy-and-seizure-rules-and-further-guidance)).

In addition, the relevant standards for any associated drug misuse or dependence should be applied.

Relicensed drivers with former drug misuse or dependence should be advised as part of their aftercare that recurrence would mean they must stop driving and must notify DVLA.

High-risk offenders

The definition ‘high-risk offender’ applies to drivers convicted of the following:
- 87.5 mcg per 100 ml of breath
- 200.0 mg per 100 ml of blood
- 267.5 mg per 100 ml of urine
- two disqualifications within the space of 10 years for drinking-driving or being in charge of a vehicle while under the influence of alcohol
- one disqualification for refusing or failing to supply a specimen for alcohol analysis
- one disqualification for refusing to give permission for a laboratory test of a specimen of blood for alcohol analysis
Defined in terms of the alcohol-related driving convictions above, the courts notify DVLA of drivers convicted of an offence.

An independent medical examination will be arranged when an application for licence reinstatement is received by DVLA. The assessment may include:
- questionnaire
- serum CDT assay
- any further testing indicated
Should the above assessment be successful, and the application accepted, either a licence will be issued or medical enquiries will be undertaken. Medical enquiries take place when there is a known or suspected relevant medical condition.