FOR THE FLIGHT SURGEON

HERE ARE TWO ARTICLES THAT MAY GIVE GUIDANCE IN REFERRING MILITARY PILOTS UNDER YOUR CARE TO OUR PROGRAM OF RECOVERY.

Both articles originally published in Vol 21, No. 2 Summer (July) 2005 issue of
Flightlines, the official publication of the Society of USAF Flight Surgeons, www.sousaffs.org, reprinted with permission.

It seems like we are seeing it happen more and more frequently. The news program showing the pilots being escorted across the parking lot, hiding their faces, as the announcer tells us of yet another alcohol-related airline incident with airline pilots as the culprits. Is this a new trend or just a consequence of heightened awareness on the part of airline security screeners, managers and/or passengers?
Perhaps the question should be, "Why aren't we seeing even more of these kinds of incidents?" After all, there is no reason to believe that airline pilots are any different from the general population in the United States when it comes to the percentage dependent on alcohol, generally stated these days as around 8 to 10% or so. I believe the answer to this question is that pilots these days are well attuned to the extraordinary scrutiny being afforded to them and they subsequently plan their consumption of alcohol to be within the rules set out by the FAA (8 hours prior to duty) and the various airlines themselves (generally 12 hours before duty). However, what about those crewmembers who are unable to effectively control their consumption of alcohol? I'm talking about the true, alcohol-dependent airman--the pilot suffering from the disease of alcoholism.

     The above is part of an article I wrote for the Flight Physician, the publication of the Civil Aviation Medical Association (CAMA) in January of 2004, here reprinted with permission of the editor, Dr. David Bryman, D.O. His periodical is very similar to Flightlines, the publication of the Society of Flight Surgeons that you are reading now.
     Having been asked my input for this issue of your publication, I jumped at the opportunity and want to basically present the same information I have previously done to the civilian Aviation Flight Examiners, knowing full well that we can easily place the military pilot in any kind of situation that the civilian commercial pilot could find himself.
     So having said that, what do you, the USAF or Navy Flight Surgeon, have to be aware of? Depending on the alcohol-abuse education you received in medical school, plus the seminars and follow-on training you may have received about alcoholism in our society, do you have a game plan when you become aware of a military pilot sitting on your examination table who has an enlarged liver, high blood pressure, a suspect blood profile and liver enzymes off the chart?
     I am not here to comment or recommend the specific course of action you would take in this situation. I am just a layperson when it comes to the decisions of doctors. I may be familiar with some of the protocol or procedures the USAF/USN follows to help a pilot who self-discloses or is referred to rehab, but not all of it. I can, however, tell you of an organization that you can refer your pilot to, should he want or need help, officially or unofficially.

     The organization I am referring to is Birds of a Feather International. Birds of a Feather is, basically, a self-help group for pilots and cockpit crewmembers that are active or inactive in the private, commercial or military fields of aviation. Its principles and tenets are based on a well-known organization that had its own start way back in 1935 in Akron, Ohio. Birds was formed in 1975 in response to the need for a meeting place for pilots where the subjects of addiction to alcohol or drugs might be discussed with impunity and anonymity. The cultural bias concerning these subjects has prevented many pilots in the past from seeking advice in this area. Birds of a Feather addresses, in an atmosphere of support, that its members are alcoholic themselves and have a means whereby productive lives in their chosen profession can be maintained.
     Birds of a Feather has no loyalty or official association with any branch of the military, any company, any Employee Assistance program, treatment center, civilian or military medical program, the FAA or even the successful airline HIMS program.
     The fear of loss or limitation to a pilot's career because of this misunderstood disease has been a very real concern to pilots and the understanding of those concerns to be found at Birds is priceless. The setting has contributed to the recovery of pilots, and the spirit of passing this philosophy on to others who might also benefit is the reason for Birds of a Feather.
     There are many "Nests" of Birds of a Feather across the U.S. and in a few European countries. These Nests hold weekly meetings that are attended by any pilot who would like support, whether he has been through rehab or not. In the cases where a major city does not have a regularly scheduled meeting, there are "solo" Birds in those cities who are available to take calls to offer support. A convention is held each year for all the Nests where everyone gets together for fellowship, a business meeting, professional presentations, self-help support group meetings and a banquet. There is every reason to believe that any Air Force or Navy base could also have its own Birds of a Feather meeting. All it takes is a minimum of two pilots who have a serious desire to stop drinking and they are in business. . . the business of helping others who will join.

I feel honored and privileged to have been given the opportunity to tell you a little about Birds of a Feather International.. There is more information available to you, much more than could be written in this article. I would like to refer you to our website www.boaf.org where you can find references, information and a complete history of BOAF to include how it impacted the beginnings of the airline HIMS program for returning rehabilitated airline pilots back to the cockpit. The site has information about Nests in cities worldwide, phone numbers of trusted individuals to contact who will always maintain strict anonymity with the person calling, plus information on how to subscribe to The Bird Word, our quarterly newsletter with articles, letters and information for the pilot interested in turning his life around from this debilitating disease.
My mission on writing this article would be complete if each Flight Surgeon reading this would at least place the website and the Bird Word address in a location in his office where he could refer a military patient to them. (Note: Click on this link to a separate page which you may print out for placing in your office in an appropriate location or to hand out). If just one military pilot would access the site, call for help or subscribe to The Bird Word, then I believe my time spent writing this for you and the time you have spent reading it will have been worthwhile. Perhaps it may keep another pilot from the pain of seeing himself on CNN dodging the media because he had an alcohol related incident while on duty and then having to suffer the unfortunate circumstances that occur afterwards.

The author is a former USAF pilot and is now a Captain for a major U.S. airline where he is involved with substance abuse recovery programs for pilots. He works closely with union committees and airline management and is familiar with FAA procedures for returning pilots to the cockpit upon successful rehabilitation from substance abuse. He has been associated with Birds of a Feather since 1990 and is a past Secretary of that organization.

A Highly Effective Model to Restore Pilots to Flight Status Following Clinical Addiction Diagnosis

An interview with Mr. Dave Fredrickson, American Airlines Chief Aerospace Operations (SGOP)

American Airlines HIMS/EAP program is the recognized benchmark for the successful restoration of aviators to active flight status following a clinical addiction diagnosis within the commercial aviation community. The pilots at American Airlines are represented by the Allied Pilots Association and the individual responsible for the HIMS/EAP Aeromedical oversight of their 13,500 + pilots is David Fredrickson. Dave is a pilot with American as well as a pilot in the USAFR and brings with him 23 years of experience in the field of addiction recovery. Flightlines recently caught up with Dave on his way to the USAF ADAPT conference in St. Louis and used this opportunity to discuss the American Airlines HIMS/EAP model.

FLIGHTLINES:
What does HIMS/EAP stand for?
Dave:
HIMS stands for Human Intervention Motivation Study. Back in the 1970's when a clinical diagnosis of addiction was permanently grounding to an aviator, it was virtually impossible to get direct funding to study the feasibility of rehabilitating pilots. Therefore, an alliance between the National Institute for Alcohol Abuse and Alcoholism (NIAAA) and the Air Line Pilots Association was formed to test a program for dealing with alcoholism among the airline pilot population. The name HIMS comes from that Congressional grant to NIAAA. Since the 1970's HIMS alcohol study the majority of companies have expanded their employee programs under the heading of Employee Assistance Programs (EAP) to deal with a wide range of maladies, not just alcoholism.

FLIGHTLINES:
So, what is HIMS?
Dave:
HIMS is an industry-wide substance abuse program, specific to airline pilots, that coordinates the identification, treatment, intensive follow-on care, monitoring and return to the cockpit of addicted aviators. HIMS is a cooperative effort between the FAA, airline companies and their pilot unions to work together to restore the pilot's health while preserving his/her career and the tremendous investment the pilot represents.

FLIGHTLINES:
Why does HIMS work?
Dave:
Well, in a word. . . cooperation. Everyone involved in the HIMS/EAP process recognizes that it's in everyone's best interest to spend the time and effort to help the affected pilot. The pilot is a huge resource and totally recoverable with the right treatment. The FAA realizes a benefit by ensuring chemically free pilots. The companies benefit by saving a huge investment and a valuable resource. The employee preserves his career and family while regaining his health. Hence, everybody wins.

FLIGHTLINES:
     So how did American get their HIMS program started?
Dave:
     Well, we first had to change the "culture of termination" as the fix for an addicted employee. We had to educate our leaders about addiction and get away from the stereotypes associated with alcohol/drug addiction. A major component of American's program now is an acceptance of the problem--everyone understands that we are dealing with an addiction and that addiction is a treatable disease:
     1. It's a chronic, permanent condition that is prone to relapse.
     2. It's primary and exists independently from any other underlying malady.
     3. It's progressive and always gets worse if left unchecked.
     4. It's contagious in that it produces dysfunctional coping behavior in others.
     5. Its primary symptom is denial. This makes the disease insidious because the
           individual has the perception that there is nothing wrong and, therefore, nothing
           to fix.
     6. It's completely treatable if the correct treatments are administered.

FLIGHTLINES:
Assume we have an addicted pilot, where do you begin?
Dave:
First, we have to start with identification. How do we know we have a pilot in trouble? Since pilots are such great "compartmentalizers" work is often the last place for the effects of addiction to show up. This can make it very tough to find the pilot in trouble. At American because we have an open system and don't terminate, we get a tremendous amount of communication from fellow workers. If they know they can help without risking someone's job they offer up invaluable data toward identifying afflicted pilots. We use supervisor reports, peer reports, increased sick leave usage, and incident reports to identify a potential problem. Second, once we have enough data to suspect there is a problem we have a meeting with the pilot to discuss options.

FLIGHTLINES:
What are your options?
Dave:
It depends of the situation. If this is a first time event, a case of poor judgment with alcohol involved, we will recommend they seek help through counseling to address the underlying cause of the behavior. If it is more severe we might suggest going to Alcoholics Anonymous (AA) and Birds of a Feather (BOAF). When we offer this option we make it clear that this is their "one-time good deal" to find help. We let them know that if they aren't successful in AA we will be entering them into HIMS. If they have had previous alcohol related events in the past (even if it was a DWI 20 years ago) the only option we offer is HIMS. Also, if the FAA is aware of previous incidents, they can revoke the pilot's medical and mandate HIMS.

FLIGHTLINES:
What happens in HIMS?
Dave:
Well, by regulation we start out with 28 day rehabilitation. After rehab we use the aftercare report as a blueprint for the individual's recovery. It will require aftercare meetings, group counseling and maybe intensive outpatient therapy. We also encourage intensive use of AA, we recommend 90 meetings in 90 days, getting a sponsor and active work on the 12 steps. As a minimum we like to have the pilot up to Step 9 before they return to the cockpit and the stresses of flying again. We also help the pilot contact Birds of a Feather and then we have the monthly monitor meetings.

FLIGHTLINES:
What is Birds of a Feather?
Dave:
It's really pilots helping pilots. Because of the immediate loss of your medical with a diagnosis of addiction there is a need for a specialized support group which is Birds of a Feather. BOAF is a sub-group within Alcoholics Anonymous and it's a group made up solely of recovering pilots. There is no substitute for helping a pilot in trouble than a pilot who has already been down the path. And most recovered pilots will tell you "Birds" is the cornerstone of their recovery.

FLIGHTLINES:
What are the "monthly monitoring meetings" you mentioned?
Dave:
Monitoring is where we get together all the pilots in HIMS and meet to check up on their progress. Also at the meeting could be the Chief Pilot or his designee, the flight doctor, the EAP and a peer like myself. During the monitor meeting the pilots get to share about their recovery, their counseling, their aftercare, their home lives etc. After the monitor meeting we write up a joint report for each pilot as part of their FAA required re-certification paperwork.

FLIGHTLINES:
How long does this process take?
Dave:
Well, it varies. We get most pilots back into the cockpit in 4-6 months. A lot depends on the individual and how well they respond to recovery. If they are "sick and tired of being sick and tired" they make it through pretty quickly. If they are forced into HIMS they tend to take longer. Also, if they are a "relapser" they can take as long as 14-18 months to get past the FAA because we have to be sure they have achieved a stable recovery. Even after they return to flying we continue to monitor the pilots for at least 3 years, sometimes longer.

FLIGHTLINES:
4-6 months seems like a long time, can't you do it quicker than that.
Dave:
We could and some airlines do, the regulations allow for a quicker process but we have found we get a much better product if we go a bit slower. Our goal is 100% recovery with no relapses and by going slower we get significantly higher recovery rates and move closer to out goal.

FLIGHTLINES:
What is your recovery rate?
Dave:
We consistently achieve a 95% recovery rate through 3 years. After 3 years we can petition the FAA to release the pilot from monitoring and most of our pilots do get released by 5 years so it's hard to get statistics beyond monitoring. In all cases, the FAA requires total abstinence from alcohol for life once the pilot has been diagnosed so I'm sure the recovery rates are pretty consistent even after monitoring. I can also tell you this. . . the pilots who fail to get recovery die. Addiction is fatal and this is especially true for pilots. I'm not really sure why, maybe it's something to do with a pilot's persona, but our experience is that the pilots who fail to get recovery almost always limp off and die.

FLIGHTLINES:
     Do you think the Air Force could implement a HIMS type program and achieve recovery
     rates like you have?
Dave:
     With pilots! Absolutely! I'm not sure about how effective you'd be if you try to apply HIMS to all careers but with pilots I'm sure you could achieve what we have. We don't nearly have the resources at American that you have in the USAF and we currently have 100+ pilots in the HIMS pipeline. With ADAPT and the command structure within the Air Force you already have most of what you'd need to start a HIMS type program. The only thing you are missing is monitoring and duplicating that would be a snap. The commanders are the same as the chief pilot, the Flight Surgeon is the same as the AME (Aviation Medical Examiner, the FAA doctor) and ADAPT is the same as the EAP and there are plenty of civilian pilot peers who could assist you until your program got up and running. The hardest part would be to change the Air Force culture. No offense, but the USAF is in the stone ages when it comes to recovery and they are currently destroying some of their most capable individuals because they haven't learned how to rehabilitate them. About 40% of the pilots we get in HIMS were identified with alcohol problems back in the military and unlike the military, instead of getting rid of them, we rehabilitate them and keep them as our best resources.

FLIGHTLINES:
What about the cost?
Dave:
That's the best part . . . We have consistently shown at least a $9 return for every dollar spent on HIMS. Last year at American we saved the company 1.2 million and this year the numbers are even higher. Let's look at how this would apply with the Air Force. What does the Air Force spend to train a Viper driver? Two million, three million? Whatever it costs it's a bunch. What's it worth to keep that kind of investment in the Air Force? Certainly more than just the initial investment in training costs. What a difference it would make if you could keep that resource an extra 10 years because you rehabilitated them. Congress is constantly asking the military to do more with less and here's a perfect chance to keep what we already have. HIMS is not only morally correct, it's good business sense and the HIMS employees become some of our best because they understand that you not only saved their careers, you probably saved their lives and gave them their family back. How do you place a value on that? And remember, since it started, HIMS has returned over 3500 pilots to the cockpit.

FLIGHTLINES:
Well, we're just about out of time, any final thoughts?
Dave:
Yes, just this. As Flight Surgeons you are in tune with treating your patients and I'd encourage you to remember that there are numerous resources on the civilian side like AA and BOAF to help you in that endeavor. It is my hope the the time is finally right for the Air Force to adopt what we've had successfully on the civilian side for 30 years. There are dozens of people just like me who would gladly volunteer their expertise to help get the process going. If I can ever be of help please feel free to contact me a apadave1@aol.com or 214-513-1250. Thank you.