Substance Use Disorders

Entitlement Eligibility Guideline (EEG)

Date reviewed: 11 July 2025

Date created: July 2010

ICD-11 codes: 6C40, 6C41, 6C42, 6C43, 6C44, 6C46, 6C50

VAC medical codes:

30390

Alcohol use disorder

30520

Cannabis use disorder

30550

Opioid use disorder

30521

Sedative, hypnotic, or anxiolytic use disorder

29289

Stimulant use disorder

This publication is available upon request in alternate formats.
 Full document – PDF Version

Definition

Substance use disorders is a category of conditions in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition- Text Revision (DSM-5-TR).

Substance use disorders include classes of drugs which produce such an intense activation of the reward system that normal activities may be neglected. These substances activate the reward system and produce feelings of pleasure or euphoria, often referred to as a "high".

For the purposes of this entitlement eligibility guideline (EEG), the following conditions are included:

Note:

  • For Veterans Affairs Canada (VAC) entitlement purposes, other DSM-5-TR categories of substances may be considered based upon individual merits and the medical evidence provided for each case. Consultation with a disability consultant or medical advisor is recommended.
  • Not all substances within a DSM-5-TR category are considered for entitlement by VAC.
  • The substance(s) must be identified in the application for substance use disorder.
  • Each substance is considered on an individual basis in accordance with the criteria for substances considered for entitlement by VAC.
  • The substance(s) accepted by VAC are identified in the entitlement decision as a substance category.
  • The substance category is not all inclusive. The substance(s) included in the entitled substance category are limited to the substance(s) which meet the criteria for entitlement by VAC.

Diagnostic standard

A diagnosis from a qualified medical practitioner (family physician or psychiatrist), nurse practitioner, or a registered/licensed psychologist is required.

The diagnosis is made clinically. Supporting documentation should be as comprehensive as possible.

Clinical features

Substance use disorder is a grouping of cognitive, behavioral, and physiological issues where the individual continues using the substance despite significant consequences.

An important characteristic of substance use disorders is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders. The behavioural effects of these brain changes may be shown in repeated relapses and intense drug craving when the individual is exposed to drug-related stimuli.

Addiction is a chronic, relapsing disease of the brain triggered by repeated exposure to substances in individuals who are vulnerable because of genetics, developmental, or adverse environmental exposures. The brain reward system’s capacity to respond to actions that are not substance use decreases, the sensitivity of the emotional circuits to stress is enhanced, and the capacity to self-regulate is impaired. The result is compulsive substance seeking and usage despite severe harms. There is an inability to control strong urges to use the substance or participate in the addictive behaviour, even when there may be a strong desire to quit.

The changes in the brain responsible for these behaviours can persist for months, or even years, after substance discontinuation. Understanding substance use disorders requires an understanding that addiction is a complex interplay of biological, psychological, and social considerations. None of the considerations for a substance use disorder alone is sufficient for the development of a substance use disorder, as these considerations operate at various levels to contribute to the onset and progression of the condition.

Biological considerations include genetic risks that are shared across substances and serve to increase an individual’s susceptibility to addiction. Certain genetic variations can affect how an individual responds to substances, experiences reward, and pleasure, and processes and metabolizes substances.

Psychological considerations can influence vulnerability to addiction:

  • co-existing mental health conditions can share similar biological pathways
  • stress and coping mechanisms can be impaired and increase the risk of addiction
  • personality traits can attract individuals to pleasurable experiences substances may provide
  • trauma and adverse childhood experiences can increase vulnerability to addiction with substances serving as a way to cope with trauma-related emotional pain.

Social considerations may influence addiction and substance use disorders:

  • peer and social influence can impact an individual’s decision to use substances
  • availability and accessibility of substances can influence patterns of use
  • socioeconomic status (including poverty, lack of access to education and resources, and limited economic opportunities) can contribute to stress and increase the risk of turning to substances as a means of coping
  • cultural and social norms regarding substance use can impact an individual's attitudes and behaviours toward substance use.

A simplified overview of the key components of the pathophysiology of substance use are outlined here:

Brain reward system: The brain’s reward system centers on the release of dopamine, a neurotransmitter playing an important role in pleasure and reinforcement. Substance use can lead to an exaggerated release of dopamine in the brain’s reward pathways associated with feelings of pleasure and reinforcement.

Frontal cortex dysfunction: The prefrontal cortex is an area of the brain responsible for decision making, impulse control, and judgement. It becomes impaired in addiction, leading to further difficulties assessing the long-term consequences of substance use and in exercising self-control.

Hijacking natural rewards and stress regulation: Chronic substance use can hijack the brain’s natural reward system and make the pursuit of substances more compelling than other natural rewards like food, social interactions, and hobbies. The brain’s stress response system becomes altered, making individuals more susceptible to stress and negative emotional states.

Neuroplasticity: Repeated substance use can cause changes in neuroplasticity, the brain’s ability to reorganize its structure and function. These changes can lead to strengthening the pathways associated with substance use and weakening the pathways related to self-control and decision making.

Neurotransmitter change: Chronic substance use can disrupt the balance of neurotransmitters, including dopamine and serotonin, leading to an imbalance that contributes to the dysregulation of mood, motivation, and impulse control.

Substance craving: Environmental cues associated with substance use (such as places, people, and objects, can trigger intense cravings and responses) that activate the brain’s reward system and can lead to relapse, even after periods of abstinence.

Tolerance and withdrawal: Prolonged substance use can lead to tolerance where higher doses are needed to achieve the same effects. When substance use is abruptly stopped, physical and psychological withdrawal symptoms can occur. These symptoms contribute to the cycle of addiction by driving individuals to continue using substances to avoid discomfort.

Individual substance use disorders

Please see the following sections for more details on individual substance use disorders included in this EEG.

Alcohol use disorder (AUD)

In this section

Clinical features of alcohol use disorder

Males have higher rates of drinking and alcohol use disorder (AUD) than females, although this gap is narrowing as females are initiating alcohol use at younger ages. Higher rates of AUD have also been reported among sexual minority Veteran populations, including transgender Veterans, compared to their heterosexual, cisgender peers. Sexual minority encompasses anyone whose sexual orientation differs from heterosexuality. Females who drink heavily tend to develop higher blood alcohol levels per drink, and females who drink heavily may also be more vulnerable than males to some of the physical consequences associated with alcohol (including liver disease).

Criteria set for alcohol use disorder

The alcohol use disorder criteria set is derived from the DSM-5-TR.

This EEG provides the DSM-5-TR diagnostic criteria; however, the International Classification of Diseases, 11th Revision (ICD-11) is also considered an acceptable diagnostic standard.

Criterion A

A problematic pattern of alcohol use leading to pain disorder impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. alcohol is often taken in larger amounts or over a longer period than was intended
  2. there is a persistent desire or unsuccessful efforts to cut down or control alcohol use
  3. a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects
  4. craving, or a strong desire or urge to use alcohol
  5. recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home
  6. continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
  7. important social, occupational, or recreational activities are given up or reduced because of alcohol use
  8. recurrent alcohol use in situations in which it is physically hazardous
  9. alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol
  10. tolerance, as defined by either of the following:
    1. a need for markedly increased amounts of alcohol to achieve intoxication or desired effect
    2. a markedly diminished effect with continued use of the same amount of alcohol
  11. withdrawal, as manifested by either of the following:
    1. the characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal in the DSM-5-TR)
    2. alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Entitlement considerations for alcohol use disorder

Section A: Causes and/or aggravations of alcohol use disorder

Causal or aggravating factors versus predisposing factors

Causal or aggravating factors directly result in the onset or aggravation of the claimed psychiatric condition.

Predisposing factors make an individual more susceptible to developing the claimed condition. These experiences or exposures affect the individual's ability to cope with stress. For example, severe childhood abuse may be a predisposing factor in the onset of a significant psychiatric condition later in life. These factors do not cause a claimed condition. Partial entitlement should not be considered for predisposing factors.

Physical/constitutional symptoms are prevalent in people living with psychiatric diagnoses and are often associated with psychological distress. Physical and mental health symptoms frequently co-occur. Physical symptoms associated with psychiatric conditions are included in entitlement/assessment. However, once a symptom has developed into a separate and distinct diagnosis, the new diagnosis becomes a separate entitlement consideration.

For VAC entitlement purposes, the following factors are accepted to cause or aggravate alcohol use disorder, and may be considered along with the evidence to assist in establishing a relationship to service. The factors have been determined based on a review of up-to-date scientific and medical literature, as well as evidence-based medical best practices. Factors other than those listed may be considered, however consultation with a disability consultant or medical advisor is recommended.

The timelines cited below are for guidance purposes. Each case should be adjudicated on the evidence provided and its own merits

Factors for alcohol use disorder

  1. Having a clinically significant psychiatric condition at the time of clinical onset or aggravation of an AUD. A clinically significant psychiatric condition as defined by the DSM-5-TR is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.

  2. Directly experiencing a traumatic event(s) within the five years before the clinical onset or aggravation of an AUD.

    Traumatic events include, but are not limited to:

    • exposure to military combat
    • threatened or actual physical assault
    • threatened or actual sexual trauma
    • being kidnapped
    • being taken hostage
    • being in a terrorist attack
    • being tortured
    • incarceration as a prisoner of war
    • being in a natural or human-made disaster
    • being in a severe motor vehicle accident
    • killing or injuring a person
    • experiencing a sudden, catastrophic medical incident.
  3. In-person witnessing of a traumatic event(s) as it occurred to another person(s) within the five years before the clinical onset or aggravation of an AUD.

    Witnessed traumatic events include, but are not limited to:

    • threatened or serious injury to another person
    • an unnatural death
    • physical or sexual abuse of another person
    • a medical catastrophe in a close family member or close friend.
  4. Experiencing repeated or extreme exposure to details of a traumatic event(s) before the clinical onset or aggravation of an AUD.

    Exposures include, but are not limited to:

    • viewing and/or collecting human remains
    • viewing and/or participating in the clearance of critically injured casualties
    • repeated exposure to the details of abuse and/or atrocities inflicted on another person(s)
    • dispatch operators exposed to violent or accidental traumatic event(s).

    Note: If the exposure under factor four is to electronic media, television, movies and pictures, the exposure must be work related.

  5. Living or working in a hostile or life-threatening environment for a period of at least four weeks before the clinical onset or aggravation of an AUD.

    Situations or settings which have a pervasive threat to life or body include, but are not limited to:

    • being under threat of artillery, missile, rocket, mine, or bomb attack
    • being under threat of nuclear, biologic or chemical agent attack
    • being involved in combat or going on combat patrols.
  6. Having a serious medical illness or injury which is life-threatening or which results in serious physical or cognitive disability within the five years before the clinical onset or aggravation of an AUD.
  7. Experiencing the death of a close family member or close friend within the five years before the clinical onset or aggravation of an AUD.

    Note: The relationship between individuals in a leadership role and subordinates should be considered akin to close family or friend.

  8. Inability to obtain appropriate clinical management of an AUD.
Section B: Medical conditions which are to be included in entitlement/assessment of alcohol use disorder

Section B provides a list of diagnosed medical conditions/categories which are considered, for VAC purposes, to be included in the entitlement and assessment of AUD.

Note:

  • If a specific condition is listed under a category, only this condition is included in the entitlement and assessment of substance use disorders. Otherwise, all conditions within the category are included in the entitlement and assessment of substance use disorders.
  • Separate entitlement is required for a DSM-5-TR condition not included in this section.
  • Somatic symptom and related disorders, such as functional neurological symptom disorder (conversion disorder), somatic symptom disorder, illness anxiety disorder, and bodily distress disorder (ICD-11 diagnosis) are entitled separately and assessed on individual merits.
Section C: Common medical conditions which may result, in whole are in part, from alcohol use disorder and/or its treatment

Section C is a list of conditions which can be caused or aggravated by AUD and/or its treatment. Conditions listed in Section C are not included in the entitlement and assessment of AUD. A consequential entitlement decision may be considered where the individual merits and the medical evidence of the case support a consequential relationship. Conditions other than those listed in Section C may be considered through consultation with a disability consultant or medical advisor.

Cannabis use disorder

In this section

Criteria for consideration of entitlement for cannabis use disorder

Cannabis use disorder includes problems associated with the use of substances derived from the cannabis plant and chemically similar synthetic compounds.

Cannabis substances considered for entitlement are limited to those available under Canadian law and authorized or prescribed by a qualified health professional for the purposes of treatment of the client’s medical or dental condition.

Clinical features of cannabis use disorder

General cannabis use tends to be higher in males than females. Approximately 10% of regular cannabis users and up to 50% of chronic daily users may have a cannabis use disorder. Females tend to report more severe cannabis withdrawal symptoms than males, especially mood symptoms such as irritability, restlessness, anger, and gastrointestinal symptoms. These withdrawal symptoms may contribute to a faster transition from first cannabis use to cannabis use disorder.

Criteria set for cannabis use disorder

The cannabis use disorder criteria set is derived from the DSM-5-TR.

For VAC purposes, this EEG provides the DSM-5-TR Diagnostic Criteria; however, the International Classification of Diseases, 11th Revision (ICD-11) is also considered an acceptable diagnostic standard.

Criterion A

A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring in a 12-month period:

  1. cannabis is often taken in larger amounts or over a longer period than was intended
  2. there is a persistent desire or unsuccessful efforts to cut down or control cannabis use
  3. a great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects
  4. craving, or a strong desire or urge to use cannabis
  5. recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home
  6. continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis
  7. important social, occupational, or recreational activities are given up or reduced because of cannabis use
  8. recurrent cannabis use in situations in which it is physically hazardous
  9. cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis
  10. tolerance, as defined by either of the following:
    1. a need for markedly increased amounts of cannabis to achieve intoxication or desired effect
    2. markedly diminished effect with continued use of the same amount of cannabis
  11. withdrawal, as manifested by either of the following:
    1. the characteristic withdrawal syndrome for cannabis (refer to Criteria A and B of the criteria set for cannabis withdrawal in the DSM-5-TR)
    2. cannabis (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Entitlement considerations for cannabis use disorder

Section A: Causes and/or aggravation of cannabis use disorder

Causal or aggravating factors versus predisposing factors

Causal or aggravating factors directly result in the onset or aggravation of the claimed psychiatric condition.

Predisposing factors make an individual more susceptible to developing the claimed condition. They are experiences or exposures which affect the individual's ability to cope with stress. For example, severe childhood abuse may be a predisposing factor in the onset of a significant psychiatric condition later in life. These factors do not cause a claimed condition. Partial entitlement should not be considered for predisposing factors.

Physical/constitutional symptoms are prevalent in people living with psychiatric diagnoses and are often associated with psychological distress. Physical and mental health symptoms frequently co-occur. Physical symptoms associated with psychiatric conditions are included in entitlement/assessment. However, once a symptom has developed into a separate and distinct diagnosis, the new diagnosis becomes a separate entitlement consideration.

For VAC entitlement purposes, the following factors are accepted to cause or aggravate cannabis use disorder, and may be considered along with the evidence to assist in establishing a relationship to service. The factors have been determined based on a review of up-to-date scientific and medical literature, as well as evidence-based medical best practices. Factors other than those listed may be considered, however consultation with a disability consultant or medical advisor is recommended.

The timelines cited below are for guidance purposes. Each case should be adjudicated on the evidence provided and its own merits.  

Factors for cannabis use disorder

  1. Having a clinically significant psychiatric condition at the time of clinical onset or aggravation of a cannabis use disorder. A clinically significant psychiatric condition as defined by the DSM-5-TR is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion, regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
  2. Directly experiencing a traumatic event(s) within the five years before the clinical onset or aggravation of a cannabis use disorder.

    Traumatic events include, but are not limited to:
    • exposure to military combat
    • threatened or actual physical assault
    • threatened or actual sexual trauma
    • being kidnapped
    • being taken hostage
    • being in a terrorist attack
    • being tortured
    • incarceration as a prisoner of war
    • being in a natural or human-made disaster
    • being in a severe motor vehicle accident
    • killing or injuring a person
    • experiencing a sudden, catastrophic medical incident.
  3. In-person witnessing of a traumatic event(s) as it occurred to another person(s) within the five years before the clinical onset or aggravation of a cannabis use disorder.

    Witnessed traumatic events include, but are not limited to:

    • threatened or serious injury to another person
    • an unnatural death
    • physical or sexual abuse of another person
    • a medical catastrophe in a close family member or close friend.
  4. Experiencing repeated or extreme exposure to details of a traumatic event(s) before the clinical onset or aggravation of a cannabis use disorder.

    Exposures include, but are not limited to:

    • viewing and/or collecting human remains
    • viewing and/or participating in the clearance of critically injured casualties
    • repeated exposure to the details of abuse and/or atrocities inflicted on another person(s)
    • dispatch operators exposed to violent or accidental traumatic event(s).

    Note: If the exposure under factor four is to electronic media, television, movies and pictures, the exposure must be work related.

  1. Living or working in a hostile or life-threatening environment for a period of at least four weeks before the clinical onset or aggravation of a cannabis use disorder.

    Situations or settings which have a threat to life or body include, but are not limited to:

    • being under threat of artillery, missile, rocket, mine, or bomb attack
    • being under threat of nuclear, biologic, or chemical agent attack
    • being involved in combat or going on combat patrols.
  2. Having a medical, surgical or psychiatric condition for which a course of cannabis was authorized or prescribed within the 12 months before the clinical onset or aggravation of a cannabis use disorder.
  3. Having a serious medical illness or injury which is life-threatening or which results in serious physical or cognitive disability within the five years before the clinical onset or aggravation of a cannabis use disorder.
  4. Experiencing the death of a close family member or close friend within the five years before the clinical onset or aggravation of a cannabis use disorder.

    Note: The relationship between individuals in a leadership role and subordinates should be considered akin to close family or friend.

  5. Inability to obtain appropriate clinical management of a cannabis use disorder.
Section B: Medical conditions which are to be included in entitlement/assessment of cannabis use disorder

Section B provides a list of diagnosed medical conditions/categories which are considered, for VAC purposes, to be included in the entitlement and assessment of a cannabis use disorder.

Note:

  • If specific conditions are listed for a category, only these conditions are included in the entitlement and assessment of substance use disorders. Otherwise, all conditions within the category are included in the entitlement and assessment of substance use disorders.
  • Separate entitlement is required for a DSM-5-TR condition not included in this section.
  • Somatic symptom and related disorders, such as functional neurological symptom disorder (conversion disorder), somatic symptom disorder, illness anxiety disorder, and bodily distress disorder (ICD-11 diagnosis) are entitled separately and assessed on individual merits.
Section C: Common medical conditions which may result, in whole or in part, from cannabis use disorder and/or its treatment

No consequential medical conditions were identified at the time of the publication of this EEG. If the merits of the case and medical evidence indicate a possible consequential relationship may exist, consult with a disability consultant or medical advisor is recommended.

Opioid use disorder

In this section

Criteria for consideration of entitlement for opioid use disorder

Substances considered for entitlement are limited to medications available under Canadian law for which a Drug Identification Number (DIN) was issued by Health Canada, were legally prescribed under Canadian law, and authorized by a qualified health professional for the purposes of treatment of the client’s medical or dental condition.

Clinical features of opioid use disorder

Opioids include natural opioids (such as morphine and codeine), semisynthetics (such as heroin, oxycodone, hydrocodone, hydromorphone, and oxymorphone), and synthetics with morphine-like action (such as methadone, meperidine, tramadol, fentanyl, and carfentanil).

Opioid use disorder can arise from prescription or illicit opioids. Opioid use disorder consists of compulsive, prolonged self-administration of opioid substances for a purpose other than a legitimate medical one or for use in a “non-medical” manner (for example, exceeding the amount prescribed for a medical condition). An attempt to achieve opioid intoxication may result in fatal or nonfatal opioid overdose. Opioid overdoses can also occur in the absence of intoxication-seeking drug use.

While historically, opioid misuse was more common in males, the gap is narrowing, especially among adolescents, with females initiating misuse at higher rates.  Among people with opioid use disorder, females tend to have more co-morbid psychiatric issues, such as mood and anxiety disorders, while males are more likely to have severe medical conditions. Both genders receive similar treatment, but pathways to opioid use differ; opioid use disorder for females more often starts through medical prescriptions. Opioid use disorder prevalence tends to decline with age, with males having higher rates in young adulthood and females surpassing them in older age. Additionally, LGBTQ+ individuals face heightened risks for substance use disorders due to trauma and isolation, highlighting the need for tailored approaches to treatment.  Military sexual trauma significantly increases the risk of opioid use disorder (OUD) in the veteran population, particularly among males.

Criteria set for opioid use disorder

The opioid use disorder criteria set is derived from the DSM-5-TR.

For VAC purposes, this EEG provides the DSM-5-TR Diagnostic Criteria; however, the International Classification of Diseases 11th Revision (ICD-11) is also considered an acceptable diagnostic standard.

Criterion A

A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. opioids are often taken in larger amounts or over a longer period than was intended
  2. there is a persistent desire or unsuccessful efforts to cut down or control opioid use
  3. a great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects
  4. craving, or a strong desire or urge to use opioids
  5. recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home
  6. continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids
  7. important social, occupational, or recreational activities are given up or reduced because of opioid use
  8. recurrent opioid use in situations in which it is physically hazardous
  9. continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
  10. tolerance, as defined by either of the following:
    1. a need for markedly increased amounts of opioids to achieve intoxication or desired effect
    2. a markedly diminished effect with continued use of the same amount of an opioid

    Note: This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.

  11. withdrawal, as manifested by either of the following:
    1. the characteristic opioid withdrawal syndrome (refer to Criteria A and B of the criteria set for opioid withdrawal in the DSM-5-TR)
    2. opioids (or closely related substance) are taken to relieve or avoid withdrawal symptoms.

    Note: This criterion is not considered to be met for those individuals taking opioids solely under appropriate medical supervision.

Entitlement considerations for opioid use disorder

Section A: Causes and/or aggravation of opioid use disorder

Causal or aggravating factors versus predisposing factors

Causal or aggravating factors directly result in the onset or aggravation of the claimed psychiatric condition.

Predisposing factors make an individual more susceptible to developing the claimed condition. For example, severe childhood abuse may be a predisposing factor in the onset of a significant psychiatric condition later in life. They are experiences or exposures which affect the individual's ability to cope with stress. These factors do not cause a claimed condition. Partial entitlement should not be considered for predisposing factors.

Physical/constitutional symptoms are prevalent in people living with psychiatric diagnoses and are often associated with psychological distress. Physical and mental health symptoms frequently co-occur. Physical symptoms associated with psychiatric conditions are included in entitlement/assessment. However, once a symptom has developed into a separate and distinct diagnosis, the new diagnosis becomes a separate entitlement consideration.

For VAC entitlement purposes, the following factors are accepted to cause or aggravate opioid use disorder, and may be considered along with the evidence to assist in establishing a relationship to service. The factors have been determined based on a review of up-to-date scientific and medical literature, as well as evidence-based medical best practices. Factors other than those listed may be considered, however consultation with a disability consultant or medical advisor is recommended.

The timelines cited below are for guidance purposes. Each case should be adjudicated on the evidence provided and its own merits.

Factors for opioid use disorder

  1. Having a medical or surgical condition for which a course of opioids was prescribed within the 12 months before the clinical onset or aggravation of an opioid use disorder.
  2. Inability to obtain appropriate clinical management of an opioid use disorder.
Section B: Medical conditions which are to be included in entitlement/assessment of opioid use disorder

Section B provides a list of diagnosed medical conditions/categories which are considered, for VAC purposes, to be included in the entitlement and assessment of opioid use disorder.

Note:

  • If specific conditions are listed for a category, only these conditions are included in the entitlement and assessment of substance use disorders. Otherwise, all conditions within the category are included in the entitlement and assessment of substance use disorders.
  • Separate entitlement is required for a DSM-5-TR condition not included in this section.
  • Somatic symptom and related disorders, such as functional neurological symptom disorder (conversion disorder), somatic symptom disorder, illness anxiety disorder, and bodily distress disorder (ICD-11 diagnosis) are entitled separately and assessed on individual merits.
Section C: Common medical conditions which may result, in whole or in part, from opioid use disorder and/or its treatment

No consequential medical conditions were identified at the time of the publication of this EEG. If the merits of the case and medical evidence indicate a possible consequential relationship may exist, consultation with a disability consultant or medical advisor is recommended.

Sedative, hypnotic, or anxiolytic use disorder

In this section

Criteria for consideration of entitlement for sedative, hypnotic, or anxiolytic use disorder

Substances considered for entitlement are limited to medications available under Canadian law for which a DIN was issued by Health Canada, were legally prescribed under Canadian law, and authorized by a qualified health professional for the purposes of treatment of the client’s medical or dental condition.

Clinical features of sedative, hypnotic, or anxiolytic use disorder

Sedative, hypnotic, or anxiolytic substances include benzodiazepines, benzodiazepine-like drugs (such as zopiclone, zolpidem, zaleplon), carbamates, barbiturates, and barbiturate-like hypnotics (such as propofol). This class of substances includes most prescription sleeping and antianxiety medications. These substances are brain depressants and can produce similar substance/medication-induced and substance use disorders.

Sedative, hypnotic, or anxiolytic substances are available by both prescription and illegal methods. Some individuals who get these substances by prescription will develop a sedative, hypnotic, or anxiolytic use disorder; others who misuse these substances or use them for intoxication will not develop a use disorder. Sedative, hypnotic, or anxiolytic use disorders are often associated with other substance use disorders.

Sedatives are often used to ease the unwanted effects of other substances. Tolerance to brainstem depressant effects develops much more slowly. As the individual takes more substance to achieve euphoria or other desired effects, there may be a sudden onset of respiratory depression and hypotension that may result in death. Intense or repeated sedative, hypnotic, or anxiolytic intoxication may be associated with severe depression that although temporary, can increase the risk for suicide attempt or death by suicide.

Sex differences in the prevalence of sedative, hypnotic, or anxiolytic use disorder have not been consistently observed in research.

Criteria set for sedative, hypnotic, or anxiolytic use disorder

The sedative, hypnotic, or anxiolytic use disorder criteria set is derived from the DSM-5-TR.

For VAC purposes, this EEG provides the DSM-5-TR Diagnostic Criteria; however, the International Classification of Diseases 11th Revision (ICD-11) is also considered an acceptable diagnostic standard.

Criterion A

A problematic pattern of sedative, hypnotic, or anxiolytic use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. sedatives, hypnotics, or anxiolytics are often taken in larger amounts or over a longer period than was intended
  2. there is a persistent desire or unsuccessful efforts to cut down or control sedative, hypnotic, or anxiolytic use
  3. a great deal of time is spent in activities necessary to obtain the sedative, hypnotic, or anxiolytic; use the sedative, hypnotic, or anxiolytic; or recover from its effects
  4. craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic
  5. recurrent sedative, hypnotic, or anxiolytic use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to sedative, hypnotic, or anxiolytic use; sedative, hypnotic, or anxiolytic-related absences, suspensions, or expulsions from school; neglect of children or household)
  6. continued sedative, hypnotic, or anxiolytic use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of sedatives, hypnotics, or anxiolytics (e.g., arguments with a spouse about consequences of intoxication; physical fights)
  7. important social, occupational, or recreational activities are given up or reduced because of sedative, hypnotic, or anxiolytic use
  8. recurrent sedative, hypnotic, or anxiolytic use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by sedative, hypnotic, or anxiolytic use)
  9. sedative, hypnotic, or anxiolytic use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the sedative, hypnotic, or anxiolytic
  10. tolerance, as defined by either of the following:
    1. a need for markedly increased amounts of the sedative, hypnotic, or anxiolytic to achieve intoxication or desired effect
    2. a markedly diminished effect with continued use of the same amount of the sedative, hypnotic, or anxiolytic

    Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision.

  11. withdrawal, as manifested by either of the following:
    1. the characteristic withdrawal syndrome for sedatives, hypnotics, or anxiolytics (refer to Criteria A and B of the criteria set for sedative, hypnotic, or anxiolytic withdrawal in the DSM-5-TR).
    2. sedatives, hypnotics, or anxiolytics (or a closely related substance, such as alcohol) are taken to relieve or avoid withdrawal symptoms.

    Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision.

Entitlement considerations for sedative, hypnotic, or anxiolytic use disorder

Section A: Causes and/or aggravation of sedative, hypnotic, or anxiolytic use disorder

Causal or aggravating factors versus predisposing factors

Causal or aggravating factors directly result in the onset or aggravation of the claimed psychiatric condition.

Predisposing factors make an individual more susceptible to developing the claimed condition. They are experiences or exposures which affect the individual's ability to cope with stress. For example, severe childhood abuse may be a predisposing factor in the onset of a significant psychiatric condition later in life. These factors do not cause a claimed condition. Partial entitlement should not be considered for predisposing factors.

Physical/constitutional symptoms are prevalent in people living with psychiatric diagnoses and are often associated with psychological distress. Physical and mental health symptoms frequently co-occur. Physical symptoms associated with psychiatric conditions are included in entitlement/assessment. However, once a symptom has developed into a separate and distinct diagnosis, the new diagnosis becomes a separate entitlement consideration.

For VAC entitlement purposes, the following factors are accepted to cause or aggravate sedative, hypnotic and anxiolytic use disorder, and may be considered along with the evidence to assist in establishing a relationship to service. The factors have been determined based on a review of up-to-date scientific and medical literature, as well as evidence-based medical best practices. Factors other than those listed may be considered, however consultation with a disability consultant or medical advisor is recommended.

The timelines cited below are for guidance purposes. Each case should be adjudicated on the evidence provided and its own merits.

Factors for sedative, hypnotic, or anxiolytic use disorder

  1. Having a medical or surgical condition for which a course of sedative, hypnotic, or anxiolytic medication was prescribed within the 12 months before clinical onset or aggravation of a sedative, hypnotic, or anxiolytic use disorder.
  2. Inability to obtain appropriate clinical management of a sedative, hypnotic, or anxiolytic use disorder.
Section B: Medical conditions which are to be included in entitlement/assessment of sedative, hypnotic, or anxiolytic use disorder

Section B provides a list of diagnosed medical conditions/categories which are considered, for VAC purposes, to be included in the entitlement and assessment of a sedative, hypnotic, or anxiolytic use disorder.

Note:

  • If a specific condition are listed for a category, only these conditions are included in the entitlement and assessment of substance use disorders. Otherwise, all conditions within the category are included in the entitlement and assessment of substance use disorders.
  • Separate entitlement is required for a DSM-5-TR condition not included in this section.
  • Somatic symptom and related disorders, such as functional neurological symptom disorder (conversion disorder), somatic symptom disorder, illness anxiety disorder, and bodily distress disorder (ICD-11 diagnosis) are entitled separately and assessed on individual merits.
Section C: Common medical conditions which may result, in whole or in part, from sedative, hypnotic, or anxiolytic use disorder and/or its treatment

No consequential medical conditions were identified at the time of the publication of this EEG. If the merits of the case and medical evidence indicate a possible consequential relationship may exist, consultation with a disability consultant or medical advisor is recommended.

Stimulant use disorder

In this section

Criteria for consideration of entitlement for stimulant use disorder

Substances considered for entitlement are limited to medications available under Canadian law for which a DIN was issued by Health Canada, were legally prescribed under Canadian law, and authorized by a qualified health professional for the purposes of treatment of the client’s medical or dental condition.

Clinical features of stimulant use disorder

Stimulants are a type of psychoactive substance that increase brain activity and can temporarily elevate alertness, mood, and awareness. Stimulants include, but are not limited to, amphetamine and prescription stimulants with similar effects.

Stimulant usage may be chronic or episodic, with binges punctuated by brief non-use periods. Aggressive or violent behaviour is common when high doses are ingested or administered intravenously. High-dosage can induce intense temporary anxiety resembling panic disorder or generalized anxiety disorder, as well as paranoid ideation and psychotic episodes that resemble schizophrenia.

Use of amphetamines and methamphetamines has been increasing. Recent years have seen the prevalence of methamphetamine use disorder more than triple in heterosexual females and more than double in heterosexual males.

Criteria set for stimulant use disorder

The stimulant use disorder criteria set is derived from the DSM-5-TR.

For VAC purposes, this EEG provides the DSM-5-TR Diagnostic Criteria; however, the International Classification of Diseases 11th Revision (ICD-11) is also considered an acceptable diagnostic standard.

Criterion A

A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. the stimulant is often taken in larger amounts or over a longer period than was intended
  2. there is a persistent desire or unsuccessful efforts to cut down or control stimulant use
  3. a great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects
  4. craving, or a strong desire or urge to use the stimulant
  5. recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home
  6. continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant
  7. important social, occupational, or recreational activities are given up or reduced because of stimulant use
  8. recurrent stimulant use in situations in which it is physically hazardous
  9. stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant
  10. tolerance, as defined by either of the following:  
    1. a need for markedly increased amounts of the stimulant to achieve intoxication or desired effect
    2. a markedly diminished effect with continued use of the same amount of the stimulant

    Note: This criterion is not considered to be met for those taking stimulant medications solely under the appropriate medical supervision, such as medications for attention-deficit/hyperactivity disorder or narcolepsy.

  11. withdrawal, as manifested by either of the following:
    1. the characteristic withdrawal syndrome for the stimulant (refer to Criteria A and B of the criteria set for stimulant withdrawal in the DSM-5-TR)
    2. the stimulant (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

    Note: This criterion is not considered to be met for those taking stimulant medications solely under the appropriate medical supervision, such as medications for attention-deficit/hyperactivity disorder or narcolepsy.

Entitlement considerations for stimulant use disorder

Section A: Causes and/or aggravation of stimulant use disorder

Causal or aggravating factors versus predisposing factors

Causal or aggravating factors directly result in the onset or aggravation of the claimed psychiatric condition.

Predisposing factors make an individual more susceptible to developing the claimed condition. They are experiences or exposures which affect the individual's ability to cope with stress. For example, severe childhood abuse may be a predisposing factor in the onset of a significant psychiatric condition later in life. These factors do not cause a claimed condition. Partial entitlement should not be considered for predisposing factors.

Physical/constitutional symptoms are prevalent in people living with psychiatric diagnoses and are often associated with psychological distress. Physical and mental health symptoms frequently co-occur. Physical symptoms associated with psychiatric conditions are included in entitlement/assessment. However, once a symptom has developed into a separate and distinct diagnosis, the new diagnosis becomes a separate entitlement consideration.

For VAC entitlement purposes, the following factors are accepted to cause or aggravate stimulant use disorder, and may be considered along with the evidence to assist in establishing a relationship to service. The factors have been determined based on a review of up-to-date scientific and medical literature, as well as evidence-based medical best practices. Factors other than those listed may be considered, however consultation with a disability consultant or medical advisor is recommended.

The timelines cited below are for guidance purposes. Each case should be adjudicated on the evidence provided and its own merits.

Factors for stimulant use disorder

  1. Having a medical, surgical, or psychiatric condition for which a course of stimulant medication was prescribed within the 12 months before clinical onset or aggravation of a stimulant use disorder.
  2. Inability to obtain appropriate clinical management of a stimulant use disorder.
Section B: Medical conditions which are to be included in entitlement/assessment of stimulant use disorder

Section B provides a list of diagnosed medical conditions/categories which are considered, for VAC purposes, to be included in the entitlement and assessment of stimulant use disorder.

Note:

  • If specific conditions are listed for a category, only these conditions are included in the entitlement and assessment of substance use disorders. Otherwise, all conditions within the category are included in the entitlement and assessment of substance use disorders.
  • Separate entitlement is required for a DSM-5-TR condition not included in this section.
  • Somatic symptom and related disorders, such as functional neurological symptom disorder (conversion disorder), somatic symptom disorder, illness anxiety disorder, and bodily distress disorder (ICD-11 diagnosis) are entitled separately and assessed on individual merits.
Section C: Common medical conditions which may result, in whole or in part, from stimulant use disorder and/or its treatment

No consequential medical conditions were identified at the time of the publication of this EEG. If the merits of the case and medical evidence indicate a possible consequential relationship may exist, consultation with a disability consultant or medical advisor is recommended.

Links

Related VAC Guidance and Policy:

References as of 22 January 2025

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