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Commercial Pilot Post-Treatment FAA Designated Medical/Neuropsychological/Psychiatric Evaluations
This reference letter was written by Dr. Robert W. Elliott of the Aerospace Health Institute in 2001 to explain the role and procedures that FAA approved doctors follow in re-certifying pilots for a Special Issuance medical upon a diagnosis of alcoholism.
(Re-printed with permission)
Commercial Pilot Post-Treatment FAA Designated Medical/Neuropsychological/Psychiatric Evaluations
Robert W. Elliott, Ph.D.
Aerospace Health Institute
5777 W. Century Blvd, Suite 1601
Los Angeles, CA 90045
310-545-6400
December 3, 2001
Commercial airline pilots are required, under federal law, to adhere to specified medical standards (Federal Aviation Regulations, Medical Standards and Certification, Part 67, 2001) to qualify for an Airman Medical Certificate. One regulation applies to Mental Standards (Subpart B, 67.107). Under Part 67.107 a commercial pilot must have "No established medical history or clinical diagnosis. . . of substance dependence. . . or substance abuse. . . " to be eligible to hold an Airman Medical Certificate.
After a commercial pilot has been identified as having a substance abuse/dependence problem the pilot is medically grounded under federal regulations and not able to perform the job functions of a commercial pilot. The determination whether the pilot meets criteria for substance abuse or dependency is made by a doctor qualified and knowledgeable in the area of substance abuse/dependency.
To be eligible for re-issuance of an Airman Medical Certificate, the pilot must demonstrate
". . .satisfactory evidence of recovery (DOT, FAA, Specifications for Psychiatric and Psychological Evaluations In Cases Involving Substance Abuse/Dependence, 1997). The clearest evidence of satisfactory recovery is completion of an inpatient treatment program, a comprehensive recovery program, and medical, psychological/neuropsychological and psychiatric fitness.
After the commercial pilot is discharged from an inpatient program the pilot can apply for a Special Issuance of his/her medical certificate (Subpart E, 67.401). Granting of such a waiver will allow the pilot to resume his/her piloting duties. To apply for the Special Issuance the pilot must undergo comprehensive medical, psychiatric and neuropsychological/psychological evaluations. Soon after discharge the pilot is referred to an FAA approved team of "qualified" doctors who conduct the medical, neuropsychological/psychological and psychiatric evaluations required by the FAA. The FAA maintains and distributes to the airlines a list of "qualified" doctors that are eligible to conduct the special issuance evaluations.
The standards and specifications for the psychiatric and psychological evaluations are described in the FAA publication, Specifications for Psychiatric and Psychological Evaluations In Cases Involving Substance Abuse/Dependence (Department of Transportation, Federal Aviation Administration, Revised 6-5-97). All approved doctors are knowledgeable about substance abuse/dependence consequences, treatment options and recovery, are familiar with the applicable federal aviation regulations, and are available to provide training for medical, flight and employee assistance personnel. The Medical Sponsor member of the team must be a physician who is an FAA designated Senior Aviation Medical Examiner (AME). Not only are the qualifications of the doctors specified but the parameters of the evaluations are described in the Specifications document.
The purpose and medical necessity for the psychological evaluation is to determine if there are significant neurological, cognitive, affective and/or psychomotor deficits remaining following the patient's inpatient treatment for alcoholism. The focus of the evaluation is to formulate, from the data compiled, any relevant diagnoses which will be of assistance in the development of a treatment plan. Without such information an individualized treatment plan cannot be developed.
Alcoholism is an incipient disease that has varying degrees of adverse effects upon the nervous system. Research has shown that many factors determine the extent and nature of the residual neurological effects. Alcoholism can lead to temporary or chronic brain damage. An adequate neuropsychological/psychological evaluation can identify the functional consequences and possible damage to the nervous system. In addition, there may be mental and emotional problems that are inextricably related to recovery and the effectiveness of various treatment modalities. A comprehensive neuropsychological/psychological evaluation can systemically investigate such issues and use the data generated to develop an effective treatment and rehabilitation plan.
Research has demonstrated that, for the alcoholic, a period of time is needed following cessation of drinking for the nervous system to recover from significant physiological adverse effects related to alcohol toxicity. Because of the adverse acute effects of alcohol toxicity the evaluation process takes place after discharge from an inpatient treatment program. The resultant fees, for an outpatient versus an inpatient evaluation, are less resulting in lower costs to the insurance company and to the patient. After several weeks of sobriety a better perspective of the patient's recovery and rehabilitation potential becomes apparent.
The patient's neuropsychological evaluation is medically necessary to track the patient's recovery curve and to provide and plan for appropriate treatment.
Rober W. Elliott, Ph.D., ABCN, ABPN
Diplomate in Clinical Neuropsychology
Fellow, National Academy of Neuropsychology
Medical Consultant -
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The following article was written by Dotty W., a retired airline pilot, and was published in the Fall 2002 issue of the newsletter of The International Society of Women Airline Pilots. We reprint it here in its entirety.
Alcohol and pilots. Not a pretty picture. And we've gotten a lot of publicity recently around this issue: America West pilots, Atlantic Southeast pilot, Mesa. The old myth of the pilot swaggering out to an airplane after partying just isn't real, but there is a problem. Even now, some hang on to the idea that alcoholism is a social disorder or that it's caused by mental immaturity. While it affects at least 10% of the general population, crossing social, economic and racial lines, people still think that a drinker can just put down the bottle if he/she really wants to. It's not that easy. Alcoholism is a disease. Even the AMA finally came out with that fact way back in 1956. "The alcoholic's enzymes, hormones, genes and brain chemistry work together to create his abnormal and unfortunate reaction to alcohol." (Under the Influence, Dr. James R. Milam and Katherine Ketcham, p. 35).
Back in 1972 a brave pilot in recovery spoke to the ALPA Board of Directors. Up to that time, pilots simply were terminated if they had a problem with alcohol. Some airlines insisted that they absolutely had no alcoholic pilots, and if one perchance were found, he would be fired immediately. This brave soul was speaking about the need to keep pilots' jobs after they were in recovery. In 1974 HIMS (Human Intervention and Motivation Study) was funded by a grant to ALPA from the National Institute of Alcohol Abuse and Alcoholism. HIMS training sessions began in March 1975 and, in the beginning, the target airlines were Continental, Frontier and Braniff. And finally in 1976, with approval of the General Service Board of Alcoholics Anonymous in New York City, a meeting in AA for pilots only was born. They called it Birds of a Feather.
What is this all about and why is it in our ISA publication? Since we're a bunch of female pilots here, I thought you souls would enjoy this part. For a pilot with an airline, the process of returning to the cockpit after being busted for drinking is a long and arduous one. Perhaps you know of a fellow pilot who's gone through this. She may keep this completely to herself; others, however, may feel no need to hide the fact of their recovery. They finally figure it out: everyone else knew they were drinking too much anyway--although while their drinking's going on, they are sure they've been hiding it well enough and that no one knows. Ah, that's the thinking of the true alcoholic. But someone found out and they were intervened, caught, stuffed into a treatment program and eventually popped out again to face the world without alcohol. Some of us walk into a recovery program under our own steam having had enough of the confusion, pain and deception business which goes along with alcoholism. I'm one of those.
It's been fifteen years since I made the phone call to a friend I knew who was in recovery. My final decision to call wasn't really an 'aha' phenomenon; it was the result of an accumulation of the sorrowful and angry looks my kids would give me, the utter demoralization of realizing I had no power over my actions, and the stomach churning fear that my flying was at risk. I'm sharing this for the ISA pilots, women airline pilots. My purpose is twofold: to get in front of the 90% the fact that alcoholism is out there, it is a disease, and perhaps to open your eyes to the thought of helping someone whose drinking you noticed. And then to the 10%--perhaps to put another brick in their wall to eventually stop them from drinking. I felt that way about my process. Each sorrowful look from the kids, each calm word from a concerned friend--these were bricks in my wall which eventually stopped me, causing me to make the call. I have learned a lot, seen a lot of fellow pilots and fellow humans survive major changes in their family structure, have watched them rejoice in their new lives, and yes, suffer from relapses too--all of it. Kind of like living is--only now it's clearer and sharper since alcohol isn't there to blur the edges and soften the hard knocks. You'd be interested to also know that pilots have the best recovery record of any. With this disease under control in my life, I was able to finish my professional flying career, retiring as a B727 Captain and I now fly a Cub and an Aztec with my husband, a retired Delta Captain.
During this journey, I have found a meeting which has helped me immensely and it's called Birds of a Feather. It's the same batch of pilots who found themselves in the forefront those 26 years ago, gathering together for their own benefit and to extend the hand to another stumbling flyer. Up until 1999, Birds of a Feather had been headed up by male pilots. After all, female airline pilots were few and far between during those early days, and, of course, they didn't drink too much alcohol. Ha! We females share the same percentage of alcoholism among ourselves--approximately 10% of us are destined to be alcoholics. That's just the way it is.
In 1999 Birds of a Feather had, as usual, its yearly international conference. This one was held in Colorado Springs. Since BOAF aspires to the same principals as AA, we do not have a president, a tsar or a dictator; we just have a Secretary, know as "The Big Bird" and an Alternate Secretary/Treasurer to take care of the details of the yearly international convention and the other business which presents itself to any organization. At the 1999 gathering they chose me as the first female to serve in the number two spot of Alternate Secretary/Treasurer and in 2001 to take the job of Big Bird. I teased them upon acceptance there in Dallas, where the convention was held that year, saying "Thank you for the trust you have invested in me. And thank you for recognizing, after only a quarter of a century, that there is also a woman in the cockpit."
To say I have been totally supported in this process by the Birds is to put it much too lightly. The pilots in AA work with each other in ways too numerous to count--from providing transport to meetings, to listening to gripes and problems (real and imagined), to rallying behind another pilot who may be having a particularly tough time with his/her company or family or life itself. Good stuff. Having made the decision to take the step into sobriety--and knowing that decisions are the only things over which we have much control in life--we are fortified and championed by our fallow pilots in recovery.
The organization has "moved" this year to assure the continuation of Birds of a Feather. We have applied to get federal registration for the names we use--Birds of a Feather, BOAF International and The Bird Word, our quarterly publication. We're stepping out, putting notices in publications such as ISA News, ALPA Pilot and the like, about the fact that we exist and we can help. Notices were put in publications in years past, and articles were written, so this is not new ground. We're just reiterating the good news: pilots can recover from alcoholism. Pilots can go back to work after a diagnosis of alcoholism. Companies now support the process, the FAA supports it, and ALPA has been a champion of it since the beginning. We are making known our presence in the hopes that even just one soul, thinking she might drink a bit too much, would make the phone call which would set her on the path to recovery.
We have a website (www.boaf.org) which gives the history in more detail than I have. We have links to other help sites. And we always have our hands out to help in any way for the pilot who needs help. Anonymity is strictly preserved, no question about that. Thanks for the opportunity to write this.
Dotty W.
Birds of a Feather -
![HELP FOR THE PILOT WITH SUBSTANCE ABUSE A primer for the Flight Surgeon]()
HELP FOR THE PILOT WITH SUBSTANCE ABUSE A primer for the Flight Surgeon 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 a retired Captain for a major U.S. airline where he was involved with substance abuse recovery programs for pilots. He worked 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. -
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A Primer on Blood Alcohol Content
A Primer on Blood Alcohol Content
By Donald Hudson, M.D., M.P.H., ALPA Aeromedical Advisor
In 2002, several high-profile incidents involved pilots and alcohol use. In the aftermath of the intense negative publicity and subsequent public outcry, the FAA has tightened its enforcement penalties for pilots who test above the violation level of .04 blood alcohol content. In almost every case, the pilots involved seriously underestimated the time required to metabolize alcohol consumed before flight duty.
Surprisingly, many professional pilots seem not to be aware of the .04 percent testing limit. However, even though this is the threshold for FAA violation action, understanding that responsible professional pilots should have no detectable alcohol in their bodies before starting flight duties is very important. For the average pilot coming on duty from home or a layover situation, this means, first of all, that one must strictly observe both company policies and FAA regulations with regard to time of alcohol consumption and starting flight duties.
Also, while you may have heard the phrase “alcohol is alcohol,” you should keep in mind some general parameters. A “standard drink” is defined as 1.5 ounces of distilled liquor (80 proof, or 40 percent alcohol by volume), 5 ounces of wine (generally 12-15 percent alcohol), or 12 ounces of beer (6 percent alcohol for most domestic brands). Consequently, each “standard drink” contains approximately 0.6 fluid ounces of pure alcohol. Alcohol is metabolized and eliminated at an average rate of about 0.3 fluid ounces per hour, so about 2 hours is needed to metabolize one “standard drink” and get blood alcohol levels down to zero.
For the “average” 160-pound person, consuming the “standard drink” will result in a peak blood alcohol concentration in the .03-.04 range in approximately 1 hour.
Obviously variables, such as rate of ingestion, body weight, presence of food in the stomach-even gender (on average, women metabolize alcohol a bit slower than men)-can affect this calculation but clearly caution is warranted in this area.
Knowing the regulations and the basic physiology is important for every pilot (and also a good thing to keep in mind regarding driving as well).
If you have any doubt concerning your fitness to fly after consuming alcohol, do not report for duty.
In most of the incidents in 2002, persons who weren’t crew members alerted authorities to a potentially unsafe operation. If you suspect a fellow crew member who has shown up for duty might be impaired, do not jeopardize the safety of flight by trying to proceed with the flight and “cover” for him or her. Take the person aside and try to convince him or her to withdraw from duty, to call in sick if necessary. Under no circumstance try to operate the flight with a crew member you believe to be impaired or under the influence of alcohol or an illegal substance. Your airman certificate is also at risk if it can be demonstrated that you knowingly allowed a person under the influence of alcohol or drugs to act as-or attempt to act as-a crew member.
This is an issue on which it is essential for pilots to look out for each other-ALPA has a well-developed peer intervention and treatment program (known as HIMS) for helping individuals who might have the disease we know as alcohol dependence. Under the HIMS program, pilots with this condition can be successfully treated and returned to the cockpit. If you suspect this might be the case with yourself or a fellow pilot, please contact your MEC HIMS representative or the ALPA Aeromedical Office in Denver for guidance. -
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A FLIGHT ATTENDANT'S STORY
A FLIGHT ATTENDANT'S STORY
"Anybody know a guy named Bill W.?"
Grace was a flight attendant and had been suspended from her job with a major airline due to her untreated alcoholism. She had been stealing the little miniature liquor bottles and drinking in airport bars in uniform. Her employer, realizing she needed help, sent her to treatment.
After the eight week program, it was suggested to her it might be a good idea to solidify her foundation in recovery before returning to work as she would be working in a high-risk environment (service alcohol, being out of town alone, etc.). Grace did, however, return to work shortly after completing outpatient treatment, One day while she was departing from a plane at the end of a long day a major craving for alcohol overpowered her. There she was, in the Los Angeles International Airport pulling her roller-bag behind her when this massive craving to drink came over her. She tried to just "think though it" or "just forget about it", but it was way too powerful. It was so powerful, in fact, that she had resigned to herself that she would just go drink. Grace thought, Oh, the heck with it, I'll get another job; or maybe no one will find out anyway. But deep down inside Grace did not want to drink. She truly had wanted to stay sober, but she was in trouble.
On her way to the bar in the airport, Grace had a moment of sanity. She stopped, picked up the airport paging phone and said, "Will you please page Friends of Bill W.," she paused, quickly looking around for an empty gate, "to come to Gate 12?"
Within minutes, over the paging system in the LA International Airport came, "Will friends of Bill W. please come to Gate 12. Will friends of Bill W. please come to Gate 12". Most people in recovery know that asking if you are a friend of Bill W. is an anonymous way to identify yourself as a member of AA.
In less than five minutes there were about fifteen people at that gate from all over the world. That brought tears of amazement, relief and joy to Grace. They had a little meeting there at that empty gate, total strangers prior to that moment. Grace discovered that two of those people had gotten out of their boarding lines and missed their flights to answer that call for help. They had remembered what they had seen on so many walls of meeting rooms: "When anyone, anywhere reaches out their hand for help, I want the hand of AA to always be there and for that I am responsible"
Grace did not drink that day. I would venture to guess that none of the people who came to Gate 12 drank that day either. Instead Grace had a moment of clarity, realized she could not do it on her own, took the action of asking for help and received it immediately. This help is available to all of us if we want it and sincerely ask for it. It never fails. -
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A letter to my Colorado friend in recovery
Recently your life has experienced some turmoil. You dropped out of Captain upgrade training due to illness and perhaps other pressures. You made some errors in judgment regarding attendance at some of the training sessions. The company leaned on you to postpone your bid. I certainly wish you no ill will. I do, however, wish you serenity and calmness one day at a time in this program of Alcoholics Anonymous. Let me tell you why:
When the time came for me to take that all important step and commit to the training and scrutiny of upgrading to the left seat at my airline, I was also in turmoil in my life. I had recently been hired by my airline after experiencing the bankruptcy at my previous one. I had small children and a wife depending on me for their livelihood. I had to sell my home in one state and move to another state to rent. My life was in a state of shock but worst of all; I had been relapsing in my program and had started to drink again, after a long period of sobriety.
When the opportunity came for me to upgrade, my ego bid for it immediately. Fast growth back in the late 80’s resulted in many pilots moving rapidly from the right to the left seat and I didn’t want to be left behind. Unfortunately for me, I should have paused, reflected on my current situation, and slowed down a bit. You see, I had a chip on my shoulder, instead of a chip in my pocket. I was angry, upset and fretful of my situation, still reeling from the bankruptcy, blaming the industry and anything else I could think about except accepting what life had given me. . . an opportunity to slow down and reassess. Instead, I jumped into training with both feet on fire.
I went to class. I immediately questioned the training program. “Why do they do it this way! Don’t they know this is wrong, why don’t they ask me the right way to do things?” I entered the simulator thinking I was too smart for this. Just let me fly the thing around a bit and give me my type rating. Why are we wasting all this time? I obviously know what I’m doing. I’ve been a First Officer for nine years; I can be a Captain, no problem.
Well, guess what. I was wrong about everything. My arrogant ego got me in trouble from the very beginning. I thought I could do no wrong. Until I was given remedial training time and again, then my judgment was questioned during the flying phase and finally the final blow came the day in the Chief Pilot’s office when I was told that I will have to go back to the line as a First Officer and take some time to cool off.
Well, that did it. How dare they tell me I can’t make Captain. My distrust, anger and frustration accelerated. I wasn’t going to meetings, had no sponsor, and had no way to express my emotions in a healthy manner. Soon after, I went on a bender during an overnight, waking up in the morning in the hotel the way I always had: a hangover, tired, upset and alone.
Time to shorten up my story. My wife and others recognized my problem. Hell, even my five year old daughter knew something was wrong. She came up to me one night at
home, put her arms around me and said, “Daddy, I’m sorry you didn’t make Captain”. That did it. As I burst in tears I knew something was wrong. A little five year old could see it, I couldn’t.
My entry to rehab was a gift that I opened the very first day I got there. I soaked it up, let it happen, found what I needed. Toward the end of my aftercare more than one year later I once again accepted the bid for Captain upgrade. I entered training with an attitude of gratitude. I was unhurried….and unafraid. I experienced true acceptance for the first time. The result was a successful journey with a new type rating in my pocket and an extra stripe for my uniform sleeve.
My calmness, serenity and acceptance saw me through. The results were a natural extension. I told my higher power that nothing would happen to me that the two of us couldn’t handle together. And I am writing this now to show you that it will work out for you too. You will get the chance again. And when YOU have that new type rating and extra stripe, then you will know.
See you on the line,
Scott H. -
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Alcohol and Substance Abuse - Hope for the Corporate Pilot by Dr. Donald Hudson
by Dr. Donald Hudson
Alcohol and other chemical dependencies are now recognized as part of a disease process that is far beyond the control of the afflicted individual. This disease affects commercial pilots at no less a rate than the general population - somewhere from 5% to 8% depending on the research cited. The cost of misuse of alcohol alone in the United States has been estimated to exceed $150 billion in 1995.
For professional pilots, the diagnosis of alcoholism poses a career threatening risk that, left untreated, can lead to termination of employment, progressive debilitation and premature death. In addition, under the current FAR's, a pilot diagnosed with alcohol or substance abuse must demonstrate successful treatment and 2 years of abstinence before he/she may return to the cockpit. However, there is a program that allows a commercial pilot to come back to work much sooner with careful monitoring.
In the early 1970s, the HIMS program (Human Intervention Motivation Study) grew out of a grant that created an alliance between the National Institute for Alcohol Abuse and Alcoholism (NIAAA), a federal agency, and the Air Line Pilots Association (ALPA) a labor union, to test a program for dealing with alcoholism among the airline pilot population.
Several factors prompted development of a pilot specific model. The commercial aviation environment is not well suited for a traditional on-the-job supervisory program. It was assumed that a pilot's ability to function effectively was best observed by other pilots, not managers. Since 1974, over 3,000 airline pilots have been successfully rehabilitated and returned to their careers.
The FAA recertification process encompasses identification, evaluation, treatment, aftercare and close monitoring. The protocol used to allow pilots to return to work inside the mandated 2 year waiting/sobriety period, along with an appropriate timetable, is summarized below:
Inpatient treatment at an accredited facility (preferably 21-28 days). Group orientated aftercare - this should be an encounter group of recovering persons that is led by a treatment professional and meets a minimum of twice monthly. Independent psychiatric and psychological evaluation - accomplished no sooner than 30 days from the completion of the inpatient experience. Monthly monitoring meeting with both a supervisory manager (preferably a Chief Pilot) and a peer pilot sponsor. Highly recommended but not an FAA requirement - regular Alcoholics Anonymous (AA) meetings. Recommendation for FAA certification from a senior Aviation Medical Examiner, who, in this system functions as an Independent Medical Sponsor, or IMS. An IMS is a senior AME who has attended a HIMS training seminar and is designated by the FAA to "sponsor" a pilot for certification under the provisions of FAR 67.401, Special Issuance.
The process encompasses a tri-parte arrangement that includes active participation from management, the pilot union and the FAA. It is important to note that this arrangement is possible with the participation of only four persons, the pilot in rehabilitation, a management supervisor, a peer pilot monitor and a senior Aviation Medical Examiner (AME). Consequently, adapting this system to the Corporate Aviation working environment has been successful in several cases.
In corporate structures without a functioning medical department or an Aviation Medical Examiner, the FAA has been willing to provide assistance in guiding people unfamiliar with the recertification process in these types of situations. The aerospace medicine physicians of Virtual Flight Surgeons (VFS) (www.aviationmedicine.com) are also available to provide expertise and consultation. These same physicians regularly provide training and consultation for many HIMS participants throughout the aviation industry.
In summary, today there is every reason to be optimistic about a successful return to the cockpit of a pilot treated for alcoholism or substance abuse. The pilot committed to recovery and willing to participate in a structured recovery following the HIMS model will have the opportunity to return to flight duties much earlier than standard FAA medical regulations allow.
What are the miracles?
“That I flew again. That my wife stayed with me. That my kids still love me. That I got sober. That I didn’t die like my parents did.”
Lyle Prouse
Additional Archives
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Alcohol Prohibitions for Pilots and Flight Instructors
Air Line Pilot, April 2003, p. 26
By Suzanne Kalfus, Senior Attorney, ALPA Legal Department
(Reprinted from Air Line Pilot April 2003 with permission. Copyright © April 2003 Air Line Pilot, all rights reserved.)
Airline pilots must know and abide by the current regulations governing alcohol use. As a result of certain high-profile cases, the FAA is now taking emergency revocation action against pilots’ airman certificates when alcohol test results are reported above the legal limits or when pilots are believed to have violated other alcohol prohibitions. Clearly, this is the most serious penalty the FAA can impose and one with grave ramifications for the affected pilot. Revocation of an airman certificate remains a permanent part of the pilot’s FAA file.
A pilot whose airman certificate has been revoked may not reapply for one for a full year. The FAA requires the pilot to re-take and pass all of the tests required for each certificate and rating.
Given the gravity of the sanction a pilot may face if the FAA finds an alcohol (or drug-related) violation, understanding and complying with the applicable regulations is vital.
This is a time when airline pilots, other airline employees, and passengers are under tremendous stress. Try to avoid using alcohol in response to the surrounding anxieties and pressures. Look out for your fellow pilots (especially flightcrew members) and be aware if any of your peers appear to be abusing alcohol. Alcohol problems in airline pilots first appear outside the work place. Remember, you might save someone’s career by getting help for him or her sooner rather than later.
If you see a peer drinking to excess on a layover or elsewhere, consider whether that person might need help. ALPA was one of the founders of the highly successful pilot peer intervention and treatment program-known as HIMS-through which airline pilot volunteers help other pilots get assistance with alcoholism and other forms of substance abuse. Do not hesitate to contact a member of your MEC or LEC HIMS or Aeromedical Committees, either to get more information or to report concerns about a fellow pilot. The Committees’ goal is to help peers get help when needed and preserve the pilots’ careers. And of course, you can always contact the ALPA Aeromedical Office for advice or help (see “A Primer on Blood Alcohol Content,” page 28).
In this highly stressful environment in which airline pilots are working, they are subject to greater scrutiny than ever before. Security screeners, passengers, air marshals, and even air traffic controllers have reported allegations of pilot alcohol use to company officials or law enforcement officers. (See “What to Do If Someone Alleges that You Smell of Alcohol or Have Been Drinking,” opposite.) While many of these charges have been unfounded and the pilots exonerated, some have not been.
Do not report for duty in violation of the regulations or your company’s policy, and do not allow your peers to do so either.
What follows is a summary of the main regulatory, alcohol misuse provisions. We urge you to review them, understand them, and comply with them. Do not risk your career and livelihood by misunderstanding the regulations or by making an error in judgment in following them. Please spread the word to ensure that your fellow pilots are also aware of these obligations.
Reporting for duty within 8 hours after consuming alcohol
Airline pilots are generally well aware that they are subject to the FAA’s longstanding 8-hour prohibition against pre-duty alcohol consumption. Of course, airline pilots must comply with their employer’s policies, which may impose longer prohibitions against pre-duty alcohol use. However, ceasing alcohol consumption in accordance with the pre-duty use prohibitions can be insufficient to comply with other regulations.
A pilot may stop drinking 8 hours before report time and still not be legal to fly 8 hours later. This is because the acceptable alcohol concentration threshold for pilots is extremely low. Do not forget that the rules prohibit pilots from performing safety-sensitive duties with a breath alcohol concentration as low as .02. This is the lowest breath alcohol concentration reading considered to be an accurate indication of the consumption of alcohol. A reported alcohol concentration between .02 and .039, while not a rule violation in and of itself, does preclude the pilot from flying until either 8 hours have passed, or the pilot is retested and reports a reading below .02.
Reporting for duty or remaining on duty while having a blood alcohol concentration
of .04 or greater
Reporting for duty or remaining on duty while having a blood alcohol concentration of .04 is a violation of the rules and, if shown, will likely lead to emergency revocation of one’s airman, medical, and any other FAA-issued certificates (such as a mechanic certificate). Under the FAA regulations, airline pilots are subject to random, reasonable-suspicion, post-accident, return-to-duty, and follow-up alcohol testing. Testing above .04 on a random, reasonable-suspicion, post-accident, or follow-up test is a rule violation subject to FAA sanction.
Be aware that a violation of the .04 blood alcohol concentration prohibition can be shown by means other than a Department of Transportation test. For example, if a pilot reports for duty and is subsequently tested for alcohol at the direction of a law enforcement officer and the results exceed a blood alcohol concentration of .04, that result can demonstrate a rule violation and be the basis of FAA enforcement action.
Using alcohol while on duty or while on call for duty
Flightcrew member duties
A pilot who reports for flightcrew member duties is absolutely prohibited from consuming alcohol from any source (including food and medicines) after reporting. Uncertainties in this area have occurred when a pilot is in an “on call for flight duty” status and not aware of it. If you consumed alcohol while believing you were off the schedule, and are then contacted to report as a reserve pilot, do not report for duty under any circumstances if you are not medically fit-including not being free of alcohol within the meaning of the rules.
You must also be clear about whether your airline policy considers you to be “on call” in any other situations. At some airlines, under certain circumstances, deadheading pilots are considered to be on call for flight duty. Clarity about your obligations, including when you are subject to alcohol prohibitions and when you may be subject to testing, is essential.
Flight instructors
The FAA recently uncovered a little-known and little-disseminated policy “clarification” stating that simulator instructors are considered to be performing “flight instruction” duties for purposes of the alcohol testing regulations. This means that instructors whose duties may involve only training and checking in a simulator and in a classroom are, nonetheless, subject to the alcohol rules, including the testing provisions. This interpretation is not contained in the regulations, was not published in the federal register, is not accessible on the FAA website, was not distributed to certificated airmen, and is absent from many airlines’ alcohol policies.
Nevertheless, the FAA relied upon it in a recent case, revoking a simulator instructor’s certificates, an action that has been upheld by an Administrative Law Judge and the NTSB.
Accordingly, getting the word out about this FAA interpretation of its regulations is very important. Be sure that the pilots you know who perform simulator instruction functions are aware that they are subject to alcohol testing even when on full-time assignment at a training facility.
Reporting for duty under the influence of alcohol
The prohibition against acting-or attempting to act-as a crew member while under the influence of alcohol has been in effect for many years. This obligation predates the FAA’s mandatory alcohol testing scheme. The ban is contained in Federal Aviation Regulations Part 91.17, while the alcohol testing provisions are in Appendix J to Part 121. The requirement to not act (or attempt to act) as a crew member under the influence of alcohol is independent of the prohibition against having a blood alcohol concentration of .04.
Thus, while an alcohol test can demonstrate that one is under the influence, it is not the only means to do so. Do not assume that, because you have not been tested, you could not be charged with being under the influence of alcohol. Evidence of prior alcohol consumption, or other evidence of impairment, can be used.
Do not risk your career by reporting for duty with any measurable amount of alcohol in your body or while suffering any of the effects of alcohol.
Refusing to submit to an employer-requested alcohol
test required under the FAA testing regulations
The DOT/FAA-mandated testing program obligates each air carrier to subject its flightcrew members and flight instructors to various types of alcohol testing. Categories of tests include random, post-accident, reasonable-suspicion, return-to-duty, and follow-up testing. Refusal to submit to a required random, post-accident, reasonable-suspicion, or follow-up alcohol test is grounds for FAA certificate action and may well lead to certificate revocation.
Refusing a request to test directed by a law enforcement officer
Officers enforcing flying-while-intoxicated laws
If asked to submit to an alcohol test by a law enforcement officer, your obligations are as follows:
• First, if the officer is acting under local, state, or federal authority, refusing to submit to a lawful request may have consequences under the applicable criminal law.
• Second, if the officer is seeking to enforce a law prohibiting flying while under the influence of alcohol, refusing to submit can also be a violation of the FARs. Part 91.17(c) specifically requires a crew member to submit to such a request. FAR Part 61.16 states that a refusal to do so is grounds for certificate action. In today’s climate, such a refusal may well lead to an FAA revocation action.
The standards and procedures for such testing depend upon the law of the state under which the testing is being directed. The procedures, methodology, and equipment used can vary from state to state, depending upon the standards and requirements of the particular law under which the individual is prosecuted.
While such a test may provide the basis for FAA (and company) action, it can also result in criminal charges and prosecution. Conviction under a state or federal flying-while-impaired law can result in jail time and substantial monetary fines.
A pilot on duty who fears his or her alcohol concentration may exceed the legal limits has no good alternatives if faced with a directive to submit to testing by a law enforcement officer. Do not put yourself in that spot, and do what you can to prevent your crew members from being in that position.
Officers enforcing driving-while-intoxicated laws
Note that FAR Section 91.17(c) addresses officers enforcing flying-while-impaired laws. That is a different provision than the FAR addressing driving a motor vehicle while impaired. Section 61.15 requires pilots who have a “motor vehicle action” to report it to the FAA’s Security Division within 60 days of the date of the action.
A “motor vehicle action” includes a conviction for operating a motor vehicle while intoxicated, impaired, or under the influence of either alcohol or a drug. A “motor vehicle action” also includes an action in which a pilot’s license to operate a motor vehicle is cancelled, suspended, or revoked (or his or her application for such a license is denied) for a cause related to operating the motor vehicle while intoxicated, impaired, or under the influence.
This means that a pilot may have a reportable incident even if never charged or convicted if his or her driver’s license or driving privileges have been adversely affected. In some states, an individual who is asked to submit to alcohol testing but refuses is subject to automatic suspension of driving privileges. The suspension may be contained in the paperwork the person is given. At times, an individual who is stopped in a state other than the one in which his or her driver’s license is issued may not even be aware that the state in which he or she was stopped suspended driving privileges and reported that suspension to the National Drivers’ Registry (NDR).
The FAA monitors pilots’ compliance with their reporting obligations by searching the NDR.
Motor vehicle actions, also, are more broadly defined for purposes of answering the questions on the medical application (Form 8500) and include actions that resulted in a course of counseling or educational program even if no conviction occurred.
The failure to properly report a motor vehicle action, either by not writing to the FAA’s Security Branch or by not answering the applicable question correctly on the medical application, can result in FAA investigation and certificate action. A single motor vehicle action (i.e., a DUI) that is properly reported-without more-is not the basis for certificate action by the FAA. However, two such actions within a 3-year period can result in certificate action.
You should also be aware that a pilot who has a second instance of using alcohol (or any other substance) in a situation in which that use was physically hazardous, such as in connection with a potentially dangerous instrument like a car-no matter how far apart the two incidents were-may no longer be authorized to exercise the privileges of his medical certificate. The FAA has considered DUIs and DWIs to evidence alcohol use in a physically hazardous situation for purposes of the medical standards.
Accordingly, if you get a single DUI or DWI, consider it a warning, and reexamine your drinking habits. Your HIMS and Aeromedical Committee representatives and the ALPA Aeromedical Office doctors are available to help you.
What to Do if Someone Alleges that You Smell Of Alcohol or Have Been Drinking
Airline passengers today are jittery, and security personnel are concerned. In several instances, innocent flightcrew members have heard allegations or off-hand remarks about the “pilots’ drinking.” What should you do when you are free of alcohol but confronted with such allegations while on duty? If the assertion is serious (nonjoking), you should report it to your company and let a company official confirm your fitness for duty before performing any further flying.
In some instances, a company official may make that determination based on a telephone conversation with you and your other crew members. In other cases, a trained company official will want to directly observe you to confirm the absence of any reasonable suspicion of alcohol use.
If your collective bargaining agreement or company policy limits alcohol testing to that required by the FAA testing regulations and states that all such testing shall be in accordance with those procedures, then testing based on “reasonable suspicion” must be based on the direct observation of a trained supervisor-it is not permitted to be based on a third-party report. A finding of reasonable suspicion under the regulations must be “based on specific, contemporaneous, articulable observations concerning the appearance, behavior, speech, or body odors of the employee.” FAR Part 121, Appendix J, Section III.D.1.
In many instances, an airline official will be satisfied that the pilot is not under the influence without the need for any alcohol testing. Many pilots are eager to proceed as quickly as possible. However, some pilots are concerned that with such an allegation having been made, a contemporaneous alcohol test is the only way to fully exonerate themselves and provide a record of rule-compliant behavior. The fear is that, if an irregularity or other problem occurs later in the flight sequence, a question about the pilot’s fitness may resurface. Faced with such allegations, even with company clearance to fly, some pilots insist on being tested for alcohol to provide a record of being “clean.” The request for a test in such circumstances is reasonable and can later serve to protect both the pilot and the airline. In our recent experience, in those situations airlines have been fully responsive to pilots who request alcohol testing in accordance with the FAA testing standards. Absent a directive to submit to such testing by airline management, the pilot should be the one to decide whether to ask for such testing.-SK
A Primer on Blood Alcohol Content
By Donald Hudson, M.D., M.P.H., ALPA Aeromedical Advisor
In 2002, several high-profile incidents involved pilots and alcohol use. In the aftermath of the intense negative publicity and subsequent public outcry, the FAA has tightened its enforcement penalties for pilots who test above the violation level of .04 blood alcohol content. In almost every case, the pilots involved seriously underestimated the time required to metabolize alcohol consumed before flight duty.
Surprisingly, many professional pilots seem not to be aware of the .04 percent testing limit. However, even though this is the threshold for FAA violation action, understanding that responsible professional pilots should have no detectable alcohol in their bodies before starting flight duties is very important. For the average pilot coming on duty from home or a layover situation, this means, first of all, that one must strictly observe both company policies and FAA regulations with regard to time of alcohol consumption and starting flight duties.
Also, while you may have heard the phrase “alcohol is alcohol,” you should keep in mind some general parameters. A “standard drink” is defined as 1.5 ounces of distilled liquor (80 proof, or 40 percent alcohol by volume), 5 ounces of wine (generally 12-15 percent alcohol), or 12 ounces of beer (6 percent alcohol for most domestic brands). Consequently, each “standard drink” contains approximately 0.6 fluid ounces of pure alcohol. Alcohol is metabolized and eliminated at an average rate of about 0.3 fluid ounces per hour, so about 2 hours is needed to metabolize one “standard drink” and get blood alcohol levels down to zero.
For the “average” 160-pound person, consuming the “standard drink” will result in a peak blood alcohol concentration in the .03-.04 range in approximately 1 hour.
Obviously variables, such as rate of ingestion, body weight, presence of food in the stomach-even gender (on average, women metabolize alcohol a bit slower than men)-can affect this calculation but clearly caution is warranted in this area.
Knowing the regulations and the basic physiology is important for every pilot (and also a good thing to keep in mind regarding driving as well).
If you have any doubt concerning your fitness to fly after consuming alcohol, do not report for duty.
In most of the incidents in 2002, persons who weren’t crew members alerted authorities to a potentially unsafe operation. If you suspect a fellow crew member who has shown up for duty might be impaired, do not jeopardize the safety of flight by trying to proceed with the flight and “cover” for him or her. Take the person aside and try to convince him or her to withdraw from duty, to call in sick if necessary. Under no circumstance try to operate the flight with a crew member you believe to be impaired or under the influence of alcohol or an illegal substance. Your airman certificate is also at risk if it can be demonstrated that you knowingly allowed a person under the influence of alcohol or drugs to act as-or attempt to act as-a crew member.
This is an issue on which it is essential for pilots to look out for each other-ALPA has a well-developed peer intervention and treatment program (known as HIMS) for helping individuals who might have the disease we know as alcohol dependence. Under the HIMS program, pilots with this condition can be successfully treated and returned to the cockpit. If you suspect this might be the case with yourself or a fellow pilot, please contact your MEC HIMS representative or the ALPA Aeromedical Office in Denver for guidance. -
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A Highly Effective Model to Restore Pilots to Flight Status Following Clinical Addiction Diagnosis
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)NEXT ARTICLE BELOW
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. -
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HELP FOR THE PILOT WITH SUBSTANCE ABUSE A primer for the Flight Surgeon
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 a retired Captain for a major U.S. airline where he was involved with substance abuse recovery programs for pilots. He worked 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. -
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Industry News on Drug Testing
Industry News on Drug Testing
On January 1, 2018, the DOT will be implementing a change in their drug testing regulations. They are adding four semi-syntheticopiate medications to the drugs that are tested as part of their random drug testing program. These medications are: hydrocodone, oxycodone, hydromorphone, and oxymorphone. Some common trade names for these medications are: Dilaudid, Lortab, Norco, Oxycontin, Percodan, Percocet and Vicodin.
These changes have been in process for several years. The Department of Health and Human Services (HHS) establishes the guidelines for federal workplace drug testing programs. They published their update on January 23, 2017, with an effective date of October 1, 2017. The DOT finally published their updated regulations on November 13, 2017.
The DOT regulations have a very structured review process for random drug test results. Any tests that are found by the lab to be nonnegative are sent to a Medical Review Officer (MRO) for review. The MRO’s responsibility is to determine if there is a legitimate medical explanation for the result from the lab. In most cases, this means the medication was prescribed by a doctor. Because these new drugs are all prescription medications, the MRO will have to make a judgment call as to whether the medication was taken appropriately.The DOT has provided some guidance to MROs about this determination, but I expect it will be an evolving process over the next few years.
If a medication has been prescribed by a doctor and has been taken appropriately, the MRO should report it as a negative test. However, the MRO also has the option of reporting a possible safety concern to the company regarding the medication, again using theirjudgement regarding the medication and underlying medical condition. Note that this is optional, but not a requirement in all circumstances. This type of report would most likely result in either a meeting with the chief pilot or possibly a fitness for duty evaluation. Therefore, the best approach is to try and avoid this situation in the first place.
The FAA recommends considering both the medication and the underlying medical condition when determining your fitness for duty prior to a flight. They currently recommend a general guideline of waiting at least 5 half-lives after taking a disqualifying medication before returning to flight status. A half-life is basically the amount of time it takes your body to metabolize about half of the medication in your system. Based on this guidance, and with a little extra margin, allow at least 48 hours after taking most of the medications.For oxymorphone, 72 hours recommended. Of course, longer is better if it’s an option. Please call your AME if you want to discuss in more detail.
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