Course Correction

Getting Back in the Air After Substance Abuse and Dependence

By Michael Berry, M.D., Federal Air Surgeon
Source: FAA Safety Briefing, September/October 2017

It’s no secret that substance abuse and dependence is a real problem in the modern world. Like it or not, that also means that substance abuse is a real problem in aviation as we are an integral part of that world. Our post-accident toxicology reports have confirmed this. For obvious reasons, substance use and dependence don’t mix with flying. That’s why both are considered disqualifying. But while use of a substance can be temporary and does not preclude a return to flight provided the proper wait times are heeded, substance abuse and dependence is another story. How do you deal with a chronic relapsing disease like substance dependence?

A New Path

Until 1974, there were no options available to a pilot with a diagnosis of substance dependence other than to stop flying forever. That’s when Air Line Pilots Association (ALPA), in cooperation with the FAA and funded by the National Institute for Alcohol Abuse and Alcoholism (NIAAA) implemented a study, the Human Intervention Motivation Study (HIMS). In the years before this, ALPA and the FAA were looking for a way to get pilots in recovery back into the cockpit without compromising safety. This was around the time the medical community and we in the medical certification business were beginning to approach substance dependence as what it is, a chronic disease. Our goal was to treat the disease, not punish the airman.

With this shift in thinking, we started to look at what kind of program we might need to treat this disease in a way that would allow the FAA to authorize a special issuance medical certificate to those pilots who were in satisfactory recovery, and allow them to fly again. The HIMS program not only did that, but also became the gold standard for such programs worldwide. In the private sector, a treatment program would be considered good if it achieved a success rate of 25-30 percent. The HIMS success rate is 85 percent. I’m quite familiar with this program as I was a HIMS Aviation Medical Examiner (AME) for 25 years before I joined the FAA. Having seen what HIMS has accomplished on both an individual pilot as well as an industry level, has made me quite proud of the program.

What is HIMS?

HIMS was originally designed for airline pilots, but is now available to be used by pilots with all classes of medical certificates. In fact, over the last 10 years the number of third-class medical certificates issued under the HIMS process has accounted for almost a third of the total airmen in the program. The goal of HIMS is to get airmen treated and into recovery, and then allow them to rejoin the aviation world under supervision.

HIMS is a multi-step process that is designed to be tailored to each individual, but there are a few milestones. First, the pilot must attend either a residential or acceptable intensive outpatient treatment center. Next, in consultation with a HIMS AME, the pilot must be active in a group aftercare program to continue recovery after initial treatment. The FAA also expects pilots to engage with a peer pilot, usually one that’s in recovery as well, and in other support programs, like Alcoholics Anonymous, to help reinforce the structured aftercare. The goal of this phase is to establish a supportive network between aftercare, peer support, and the HIMS AME. The FAA also requires monitoring via random alcohol and drug testing, which can occur daily in some cases.

The HIMS AME helps design a recovery program that best fits the pilot’s individual needs. When reviewing cases as a HIMS AME, I always looked for an “aha!” moment in the records from the pilot’s initial treatment. This evidence of acceptance of the disease is critical to the success of long-term recovery.

So what happens if a pilot relapses? Like any chronic disease, the first step is to treat the underlying cause of the disease. The HIMS AME will consider the circumstances and make changes to the HIMS program to address the relapse. While repeated relapses may require a more stringent program, there is no maximum limit to the number of relapses allowed.

Here’s the bottom line: If an airman is willing to do the work to get better, we’re willing to help. HIMS may not be the easiest program to return to flying, but it is one of the most effective when it comes to substance abuse and dependence.