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    Your AME: A Second Chance for Substance-Addicted Pilots

    Charles Mather 2018 Spring

    Since my last column, I now work for the FAA in the Aerospace Medical Certification Division. I hope to continue sharing insights with you about how to maintain your medical certification and fly safely.

    I imagine you read the title of this article and asked, “What does HIMS stand for?” HIMS stands for Human Intervention Motivation Study. It originated as a collaboration between the FAA, the Air Line Pilots Association, and the major airlines as a program intended to return to the cockpit pilots who have a history of substance-use disorders such as alcohol or drug dependence.

    As you can imagine, the founders of this program thought the public might have a strong reaction to an organization called the Alcoholic Pilot’s Program or similar, so they came up with an acronym that sought to be discreet. However, despite the public’s understandable concerns, HIMS is a highly successful program that allows experienced pilots to return to the cockpit safely after treatment, under close monitoring through their treatment providers, their employers, and the FAA.

    A fundamental tenet of the HIMS program is that alcoholism is a disease. This applies to other substance-use disorders as well. These disorders are chronic, meaning they are lifelong; primary, meaning they exist independent of other medical or psychiatric disorders; and progressive, meaning they generally worsen over time.

    Some people still believe alcoholism and drug abuse represent a character flaw. Modern medical science disagrees with this sentiment, and there is robust evidence that chemical dependency is treatable.
     

    How it Works

    The HIMS program requires a structured treatment program, which involves inpatient or intensive outpatient treatment, followed by continued weekly meetings with a chemical dependency counselor called aftercare. HIMS also requires that pilots participate in a standard self-help recovery program, the most common and well known of which is Alcoholics Anonymous (AA).

    HIMS allows its participants to work with any commonly practiced self-help recovery program (Birds of a Feather is an AA-based program for pilots and cockpit crewmembers), but AA participation is strongly encouraged and preferred. AA provides pilots with fellowship and accountability throughout the recovery process and is believed to be essential to a successful program.

    During and after treatment, pilots complete no-notice drug and/or alcohol testing. Lastly, pilots are required to meet monthly with someone in their management, typically a chief pilot or employee assistance program representative. Many programs also provide pilots with a peer — a fellow pilot who can help guide them through the process.

    There are additional components pilots in HIMS must complete, including a neuropsychological evaluation that involves a battery of testing designed to detect subtle brain dysfunction. Alcohol and drugs often cause damage to the brain, and this testing ensures an adequate amount of time has passed for this damage to resolve.

    Assuming the neuropsychological testing is favorable, the pilot next meets with a HIMS psychiatrist. This psychiatrist is usually addiction-medicine certified and receives specialized training to evaluate pilots. Once this is complete, the pilot will then go for his FAA examination with a HIMS aviation medical examiner (AME). These AMEs, like the psychiatrists, receive specific training to evaluate and monitor pilots in recovery. The HIMS AME compiles the clinical information and submits the packet to the FAA.

    If the FAA feels the pilot is in good recovery, it grants a Special Issuance Authorization for a medical certificate. As part of the Special Issuance, the FAA requires ongoing monitoring that typically includes continued AA meetings, aftercare, monitoring through the pilot’s employer, continued no-notice drug and/or alcohol testing, and yearly visits with a HIMS psychiatrist.
     

    The Results

    This probably sounds like an involved process, and it is. However, the results speak for themselves. Eighty-five percent of pilots in the HIMS program maintain successful long-term recovery; that figure compares to around 20 percent in the general population. 

    Most of the major airlines pay for their pilots’ treatment (yes, you heard that right). If you are thinking this sounds like an expensive investment, a cost-benefit analysis of the program showed a $9 return for every $1 spent on treatment.

    Most importantly, HIMS enhances aviation safety. Estimates are that about 11 percent of the US population will suffer from a substance-use disorder during their lifetime. Pilots are no exception. Intoxication or unsupervised withdrawal from these substances could lead to unsafe operation of an aircraft or an accident.

    In addition, simply replacing an experienced pilot with a less experienced one can also diminish safety. A 2003 study showed pilots with more than 5,000 total hours of flight time were 57 percent less likely to be involved in an accident. The HIMS program not only helps pilots get the treatment they need, it also enhances aviation safety and can provide your helicopter operation a substantial return on investment.

    For more information, visit the HIMS Program website at www.himsprogram.com. Although the major airlines helped design this program, you can set up a HIMS program in a helicopter operation. If you have questions, contact any of the HIMS program committee members listed at the bottom of the program website. You can also find a list of HIMS AMEs online at www.hims​program.com/Content/HIMSAMEs

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