Addressing a Substantial Problem
by Dr. Leo Hattrup, FAA Medical Officer
Substance use disorders (SUDs) in the United States are a significant problem that can contribute to premature illness and death. SUDs can be devastating to one’s career, family, and others. An astonishing estimate notes that SUDs affect more than 8% of the population over 12 years old. Substances implicated in dependency and abuse include alcohol, prescription drugs such as opioids, stimulants, sedatives, etc., as well as illegal drugs. SUDs also pose a public safety concern due to the increased risk of an accident, including aviation mishaps.
Consequently, substance abuse and dependence are specifically disqualifying conditions for FAA airman medical certification, as listed in Title 14 Code of Federal Regulations (14 CFR) part 67. Even if an individual does not require an FAA airman medical certificate, the provisions of 14 CFR section 61.53 (prohibition on operations during medical deficiency) still apply to all pilots, as do the reporting requirements of 14 CFR section 61.15 (alcohol and drug offenses).
SUDs have affected the aviation community in the same way as the general population. Decades ago, a diagnosis of alcoholism was a career stopper for pilots as there was no pathway back to medical certification. Consequently, many aircrew members were reluctant to report themselves or fellow pilots, despite the safety concerns. Recognizing this problem, industry, unions, and the government (including the FAA) developed the HIMS (Human Intervention Motivation Study) program in the 1970s. HIMS is an aviation safety program that has also preserved the careers of thousands of airline pilots. While the FAA is charged to ensure public safety, a secondary benefit of the HIMS program is that the testing required for evaluation and monitoring frequently improves the airman’s health and care. HIMS also provides support to the airman’s family. As a result of HIMS (and less tolerance by others), pilots affected by a SUD are now encouraged (in some cases strongly encouraged) to come forward, resulting in an improvement in overall flight safety. The airlines have also benefited; they can retain a trained pilot and improve morale with a return of almost $10 for every dollar spent.
Airmen must report any drug or alcohol related motor vehicle convictions within 60 days, but must also report any drug or alcohol events, even if they are not convicted, at the time of their medical application. In some cases where the event was remote and the blood alcohol level was low, the AME (aviation medical examiner) is authorized to issue an FAA airman medical certificate. In cases where a pilot has committed multiple DUIs (driving under the influence) or had higher blood alcohol levels or other indications of a SUD, a more extensive evaluation is necessary.
HIMS targets commercial pilots flying in a very structured environment, so the process is different for general aviation pilots whose flying is much more varied. The FAA tailors the individual’s recovery plan without compromising safety. The first step is to recognize that there is a problem. Ideally, it’s the pilot in the mirror. More often, though, the impetus comes from friends, family, work, or the FAA.
Airmen should use faa.gov/pilots/amelocator to find a HIMS AME who can guide them through the process. Airmen may also need to undergo an evaluation by a HIMS trained psychiatrist and psychologist. Some will also need to enter into a treatment program. Participation in an aftercare program, as well as participation in support groups (e.g., AA (Alcoholics Anonymous) or NA (Narcotics Anonymous)) are usually required.
Some airmen express concern that HIMS appears to be somewhat intimidating, and they wonder if it’s worth their time. The answer is Yes! HIMS has a relapse rate of less than 15-percent, much lower than other SUD treatment programs. According to the Centers for Disease Control, an average of 95,000 deaths occurred from 2011–2015 due to excess alcohol use. In 2018, there were 67,367 deaths from drug overdose, primarily from opioids. Together, SUDs account for 6-percent of all deaths in the United States. These deaths are preventable.
Leo M. Hattrup, M.D., received a bachelor’s degree from Wichita State University, a master’s in public health from Harvard University, and a doctorate from Vanderbilt University. He is retired from the U.S. Air Force in which he spent the majority of his career in aerospace medicine. He is board certified in aerospace and occupational medicine. He is a certificated flight instructor and enjoys flying airplanes, helicopters, and gliders.