The Legal Standard: Current Disorder, Not Past Use

Under INA § 212(a)(1)(A)(iv), an applicant is inadmissible if they are determined to be a drug abuser or addict. USCIS interprets this to mean a current substance use disorder as defined by the DSM — not a history of past use that has since resolved.

This is an important distinction. An applicant who experimented with drugs in the past, or who had a substance use disorder years ago that is now in sustained remission, is generally not inadmissible on this ground. The civil surgeon evaluates your current status at the time of the exam.

What the DSM Says About Substance Use Disorders

The DSM defines a substance use disorder as a pattern of use of an intoxicating substance leading to clinically significant impairment or distress. The diagnosis is based on 11 criteria covering areas such as loss of control over use, continued use despite negative consequences, tolerance, and withdrawal.

The severity of a substance use disorder is classified as mild (2–3 criteria), moderate (4–5 criteria), or severe (6 or more criteria). The civil surgeon applies these criteria when evaluating an applicant's substance use history.

Which Substances Are Covered

The immigration medical exam screens for substance use disorders involving any controlled substance, including: alcohol, cannabis (marijuana), cocaine, opioids (including prescription opioids misused), methamphetamine, heroin, and other illicit or misused substances.

Alcohol use disorder is evaluated separately from drug use disorders but under the same general framework. The civil surgeon will ask about both alcohol and drug use as part of the substance use screening.

How the Civil Surgeon Makes the Diagnosis

The civil surgeon conducts a structured clinical interview covering your history of substance use. They will ask about the types of substances used, frequency and quantity of use, any negative consequences (legal, occupational, health-related), prior treatment, and current use.

The civil surgeon may also review any available medical records, prior treatment records, or legal records (such as DUI convictions) that are relevant to the substance use history. The diagnosis is based on the totality of the clinical picture — not on any single factor.

Remission and Its Effect on the Diagnosis

The DSM recognizes two remission specifiers: early remission (3–12 months without meeting criteria) and sustained remission (12 months or more without meeting criteria). An applicant in sustained remission from a substance use disorder may not currently meet the diagnostic criteria for the disorder.

However, even if an applicant is in remission, the civil surgeon may still note the history on Form I-693. Whether a past disorder in remission constitutes a current ground of inadmissibility depends on the specific facts and USCIS's evaluation.

What Happens If a Disorder Is Found

If the civil surgeon determines that you currently meet the criteria for a substance use disorder, they will make a Class A inadmissibility finding on Form I-693. A Class A finding means USCIS will not approve your adjustment of status application without a waiver. A waiver under INA § 212(g) may be available depending on your circumstances. See the related articles below for more information on waivers.