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Commercial airline pilots experience stress due to very tight and complicated flight schedules, handling the responsibility associated with a highly booked commercial airliner, and having to constantly deal with safety concerns. Having the perception of continual levels of high stress is often identified as a particularly salient risk factor for the development of numerous physical and mental health services. As a result, commercial airline pilots often need to find ways to address their stress levels. Different individuals may do this in different manners.

Drinking alcohol is a common approach used by many to deal with chronically high stress levels. Alcohol use is viewed by society as acceptable as long as it is not excessive and does not lead to problems with the person’s ability to function within their environment; however, alcohol use by airline pilots is considered to be a very sensitive situation. Airline pilots should not use alcohol when they are on duty, and the use of alcohol should be limited to drinking very small amounts on a few select occasions when they have no professional responsibilities.

How Extensive Is the Problem of Alcohol Abuse in Commercial Pilots?

The tendency of the media to devote attention to events that are actually rare in nature often results in rare events being perceived as more common than they really are. Even though there are no standardized international rules on alcohol consumption and regarding alcohol testing in commercial airline pilots, violations of the standards of the Federal Aviation Association’s guidelines regarding alcohol use in commercial hybrids are quite rare. Violations are heavily publicized in the media, often leading to the misperception that this is a common problem.

The Jet Airliner Crash Data Evaluation Centre (JACDEC) is an independent organization that has become a global source for reporting professional and accurate information regarding aviation safety. According to JACDEC, in a typical year in the United States, there are between 11,000 and 13,000 random alcohol checks for commercial airline pilots. In 2015, only 10 pilots were in violation of the rules regarding alcohol use. Since 1980, the data indicates that of 12,000 incidents, there were only 11 commercial aviation accidents linked to the abuse of alcohol. Thus, while any violation by a commercial airline pilot regarding the use of alcohol while operating a commercial airliner is of concern, the extent of the problem is not as pervasive and overarching as it is often portrayed.

There is no reason to believe that commercial airline pilots are operating jet airliners under the influence of alcohol to the extent that individuals operate automobiles under the influence of alcohol. However, it is important to restate that any violation of alcohol use by a commercial airline pilot is a serious offense and should be dealt with quickly and effectively. Commercial airline pilots who violate the rules and/or who are diagnosed with alcohol use disorders need to be relieved from duty and, if possible, placed in alcohol use disorder treatment programs.

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Specialized Treatment Programs for Commercial Airline Pilots

The Federal Aviation Association (FAA) has a drug and alcohol monitoring program for pilots. Any commercial airline pilot who tests positive for alcohol or who has a diagnosis of an alcohol use disorder is required to be monitored and evaluated through the Human Intervention Motivation Study (HIMS) and received treatment.

HIMS works specifically with commercial airline pilots and professional organizations to identify pilots with substance use disorders, get them into treatment, and return them to work when possible. HIMS works in conjunction with airline companies, commercial airline pilot unions, and the FAA to ensure safety. Programs are customized to fit the specific needs of the case in question. According to its website, the program claims a nearly 90 percent success rate in its efforts.

The steps in the HIMS program include:

  • Substance use disorder assessment: The first step is to assess the pilot for a substance use disorder. Professionals are accredited in the assessment of substance use disorders and have an understanding of the standards associated with the industry. The FAA has far more conservative standards regarding diagnosing substance use disorders than organizations such as the American Psychiatric Association. Assessments are tailored to the situation and geared toward revealing any evidence that the pilot does have a problem with alcohol or drugs. The FAA adopts the approach that it is better to misdiagnose pilots with a substance use disorder, even when they may not fully meet fit the diagnostic criteria for one, to maintain the safety of the industry.
  • Treatment: When the assessment reveals there is a problem, the person is required to enter treatment. Most often, this means an initial four-week (28-day) residential or inpatient treatment program followed by at least several weeks to months of outpatient treatment before reevaluation to determine if the pilot is fit to continue their service.
  • Established company and peer sponsorship: The FAA requires that the pilot obtain a peer sponsor, such as another pilot who may be a union representative, and a sponsor from either the aviation industry or the airline. Sponsorship involves a personal relationship where a sponsor and the pilot meet, determine the progress of the pilot’s overall recovery program, and identify any areas that need to be addressed or improved.
  • Three months of intensive outpatient treatment (IOP): Initial treatment is followed by another three months of IOP (typically a minimum of 10-12 hours per week of outpatient treatment).
  • Intensive involvement in Alcoholics Anonymous (AA): During IOP treatment, the pilot is also required to attend 90 AA meetings in 90 days. Following this intensive involvement, continued AA attendance is required, but may not be required at the same level of intensity.
  • Involvement in regular aftercare treatment: After the above conditions have been met, the pilot is expected to be involved in a long-term aftercare program and to document their involvement.
  • Random screenings: Pilots are subject to regular and random drug and alcohol screenings.
  • An intensive evaluation by approved FAA addiction specialists: When there is a consensus reached by the pilot’s sponsors, treatment providers, and HIMS, the pilot is required to undergo a comprehensive evaluation that includes a psychiatric evaluation, neuropsychological testing, and other assessments to determine if the pilot is ready to return to work. These evaluations are very extensive, and the pilot needs to meet very stringent requirements before being allowed back in the air.

Regarding the decision to return the pilot back to duty, there are several important factors that must be met. First, there should be a consensus by all the parties involved, including the pilot’s sponsors, counselors, other treatment providers, and examiners at the FAA, that the pilot is safe to return to work. This involves an extensive evaluation process that is discerning and detail-oriented. Pilots need to continue to document sobriety even if they meet all of these requirements. In order to be recertified, the pilot must demonstrate:

  • Ongoing treatment participation: The pilot must demonstrate at least weekly participation in AA meetings and at least periodic participation in substance abuse counseling. Monthly participation in counseling sessions is preferred.
  • Continued contact with sponsors: The pilot is expected to engage in at least monthly meetings with peer sponsors, company sponsors, AA sponsors, etc. Sponsors are expected to submit monthly reports.
  • Random drug and alcohol testing: Continued random drug and alcohol screenings are performed and must be passed.
  • Quarterly progress reports: Quarterly progress reports are submitted by treatment providers, sponsors, union coordinators, etc., in addition to any monthly progress reports.
  • Annual follow-up assessments: The pilot is expected to participate in annual physical and mental health assessments. The length of time over which these annual assessments continue is specified in the agreement, but typically, the pilot must demonstrate complete sobriety for a minimum of a two-year period following reinstatement.

The process is rigorous, designed to detect any indication that the pilot is using alcohol or drugs, and also designed to help the pilot recover from their alcohol use disorder. While there is quite a bit of focused treatment to assist the pilot, it should be remembered that the major motivation for the rigorous program is to ensure the safety of the public.

Any indication that the pilot is unsafe to return to work is deemed as sufficient evidence not to allow them back in the air. This places quite a bit of responsibility on treatment providers and the assessment process to be thorough and to detect any indication of relapse, no matter how trivial it seems. Any of the professionals involved in this process who has any doubt about the pilot’s ability to return to work is sufficient evidence for the FAA. The decision to allow the pilot to return to work must be unanimous and without doubt.

The HIMS assessment/treatment program is also customized to fit the special conditions of any specific case and has been extended to include flight attendants and other airline personnel. The program is rigorous, has numerous checks, and is designed to ensure that public safety is its first concern. Pilots are not reinstated unless there is a consensus that they have achieved sobriety, are committed to treatment, and are not at risk for future reoccurrences.