This information has been complied as an orientation to the HIMS program. It is written with the pilot in mind, but can be shared with others who are involved in a pilot’s recovery from drugs or alcohol abuse or dependence. What is described here is the “Gold Standard” for airline pilots, but this program can and should be customized to fit a pilot’s specific diagnosis and aviation circumstances. For example, a 28-day inpatient treatment program may not be appropriate, and in some cases the psychiatric or neuropsychological evaluation may not be needed.
HIMS stands for Human Intervention Motivation study, which was conducted in the mid 1970’s to assess the need for a specialized alcohol recovery program for professional pilots. Initially funded by the National Institute for Alcohol Abuse and Alcoholism (NIAAA) in 1974, subsequently grants from the FAA were awarded to Air Line Pilots Association (ALPA) for continuation of the program. As of 2010, over 4500 pilots have been successfully treated and returned to flying under close supervision, carrying a long-term success rate of nearly 90%. The HIMS advisory board oversees the work, with representatives from the airline industry, FAA, and aeromedical groups. On average, about 120 pilots per year are being identified, treated, and returned to work. Over 40 airlines / corporations within North America have active HIMS programs, and it depends on a high degree of cooperation between the FAA, the airline company, and the pilot support group.
In addition to the obvious benefits of successful alcohol abuse / dependence treatment, there is another important benefit to the pilot who goes through the HIMS process – and that is the possibility of returning to flying within a matter of months, rather than years.
The over arching premise on which HIMS is based, is that substance abuse or dependence is a disease and not an act of moral weakness or lack of willpower. As a disease, it has a high rate of relapse, but nonetheless, a standardized and accepted set of diagnostic tools and treatment methods. As with many other diseases, the FAA allows pilots with serious but stable medical problems to hold medical certificates — under careful supervision — by way of a Special Issuance (SI) Authorization. This allows for time-limited certificates to be issued under medical monitoring, the guidelines of which are established by the FAA. The pilot must engage with an Aviation Medical Examiner (AME) who has specialized training and is approved by the FAA to evaluate and supervise HIMS cases. This AME therefore plays the role of an Independent Medical Sponsor (IMS).
A pilot may enter the HIMS program in one of many ways. This may be via a formal intervention, referral from pilot managers, DUI reports, or self-referral. In the world of professional pilots who work for airlines with active HIMS programs, the process is likely to be readily available with pilot support and health insurance built into the system. Pilots who work for airlines that do not have a program may find themselves unemployed and having to fund the entire process themselves. Self-employed or private pilots may even more hampered by shortage of peer support. In general, the HIMS program has been designed for the professional airline pilot, and any “customized” programs for general aviation pilots must be comparable.
The initial steps of the HIMS program are:
- substance abuse assessment
- 28 day (preferably in-patient) treatment program
- establish peer and company sponsorship
- 3 month intensive out patient follow up (IOP)
- heavy involvement in AA
- establishment in regular aftercare
- psychiatric and neuropsychological evaluations by HIMS-trained addiction specialists (P & P)
substance abuse assessment
The first step usually is for the pilot to undergo a substance abuse assessment. This can be performed by a variety of different types of professionals, but it is critical that they have experience and credentials in addiction medicine and an understanding of aeromedical standards. Sometimes this assessment is part of an admission procedure to an in-patient treatment center, and other times it may be part of a court-ordered assessment for a DUI. It is important to emphasis here that the FAA has more conservative definitions of definitions for substance abuse / dependence than may be in the medical diagnostic criteria. Because the FAA is not interested in the well-being of any individual pilot, but rather the safety of the public, the pilot needs to demonstrate to the FAA that they do not have alcoholism, while the doctor tries to find evidence if they do. It is also important to note that the FAA is interested in the quality of the assessment. One-page assessments that are court ordered but have little context will not be acceptable.
28 day (preferably in-patient) treatment program
The second step is to undergo the appropriate type of treatment program. In the airline world, this usually means a 28 day in-patient (residential) treatment center, followed by several weeks of intensive outpatient treatment before they are ready to considered for getting their medical back. In the general aviation (GA) world, this may not be an option financially, but nonetheless, an acceptable method of treatment must be devised. This may include, but not be limited to, partial inpatient, intensive outpatient, or other acceptable educational program.
establish peer and company sponsorship
During this time, it is important for the pilot to have a peer sponsor and if possible, a company sponsor. If the airline has a HIMS program, usually this is another line pilot who may be involved as a union representative. If this isn’t available, it is still important for the pilot in treatment to have some sort of sponsor either from the airline, or from the aviation industry. The chief pilot is the preferred company sponsor when applicable.
three month intensive out patient follow up
heavy involvement in AA
The initial phase of treatment is followed by another period of IOP, and this is where many residential programs may differ. The FAA’s gold standard is a 3 month program that includes daily Alcoholics Anonymous (AA) attendance -“90 in 90” – 90 meetings in 90 days. Some residential programs include IOP, but others may have shorter or less intense follow-up. This is even more difficult if the pilot lives far from the residential treatment center, and therefore returns home upon discharge. In such cases, an alternative IOP program must be found quickly upon return home. Birds of a Feather (BOAF) is an excellent AA resource, and often times a peer sponsor can be found in a local Nest.
establishment in regular aftercare
In order to document sobriety and identify challenges along the way (before they become obstacles to sobriety), it is necessary to transition to a regular aftercare program once discharged from IOP. For the purposes of continuous medical certification under SI, the FAA requires the pilot to participate in weekly group meetings, along with periodic one-on-one meetings with the addiction counselor. This aftercare program should be established in a smooth transition from IOP, and will be required for the entire duration of the HIMS SI Authorization. If the aftercare program does not include the necessary drug or alcohol testing, the IMS may order such tests randomly in parallel to aftercare.
psychiatric and neuropsychological evaluations by HIMS – trained & FAA approved addiction specialists
When consensus is reached by the sponsors, the counselor, and the IMS that the airman is ready to undergo the required FAA required psychiatric and psychological (P & P) testing, a referral is usually first made for the neuropsychological evaluation followed by the psychiatric evaluation, so that the psychiatrist has the cognitive testing results available prior to meeting the pilot. Pertinent reports will also have been forwarded by the IMS. The purpose of the neuropsychological testing is to determine whether there is any residual loss of cognitive functioning from the drug or alcohol use, and the psychiatric evaluation is to determine whether the pilot is stable enough in recovery to return to flying, that there are no other psychiatric conditions, and to make recommendations for further monitoring.
All these documents and reports are forwarded to the airman’s IMS. Usually the pilot and IMS have met sometime between discharge from the hospital and referral for the P & P, often along with the peer or company sponsor. Consensus should be reached by all the parties (sponsors, P & P, IMS) that the pilot is ready before the FAA physical examination is scheduled.
If all is favorable, the flight physical examination is performed, and all records are forwarded to the FAA, along with the IMS’s suggested monitoring protocol. This protocol is often in the form of a contract between the IMS and the pilot. The final determination is made by the chief psychiatrist of the FAA in Washington DC, and the SI Authorization, along with a time-limited medical certificate, is sent to the pilot. A copy of the minimum requirements for continuation of certification under the SI process is included, and is usually based on the IMS’s recommendations. If the reports are not favorable or are incomplete, then the FAA will request further records and evaluations, with a 30day window in which to respond.
Once the flight physical examination is complete, the pilot should not relax in his or her abstinence program in any way. This is the time to begin preparation for the next cycle of flight physicals, as reports and documents are necessary to document continued sobriety. For most cases, the following are required for continued medical certification as long as the SI is in effect:
In order to recertify, the following apply:
- participation in weekly group meetings and periodic
- individual counseling
- peer/airline sponsorship with monthly reports to IMS
- regular AA attendance
- annual psychiatric or psychological follow-ups (HIMS trained)
- coordination and periodic visits with IMS, including random drug /alcohol testing
participation in weekly group meetings and periodic individual counseling
Once back to work, the airman is expected to meet at least 50% of weekly group meetings and monthly individual sessions with and addiction counselor, who provides quarterly progress reports. This documentation must be forwarded to the IMS, preferably well in advance of the next flight physical examination.
peer / airline sponsorship
The pilot is expected to meet at least monthly with the peer and company sponsors, and reports of those meetings should be forwarded to the IMS, preferably in advance of the flight physical examination. These reports should be typed – preferably on company letterhead – and should be written well enough to indicate that the sponsors are actually engaged with the pilot and they actually know how he or she really doing. Peer sponsorship is one of the most critical elements of a successful HIMS program, as this relationship is the pilot’s link between recovery and his or her job.
regular AA attendance
Although daily AA is not expected once a pilot is back to work, regular and meaningful AA participation is. AA or BOAF attendance 2-3 times per week is often adequate unless challenges to sobriety require more frequent AA involvement.
annual psychiatric or psychological follow-ups
On an annual basis, the pilot must undergo a follow-up evaluation with either a psychiatrist or psychologist, specified by the FAA. For the benefit of continuity, it is helpful if this is performed by the psychiatrist or psychologist that performed the initial evaluation. That person may communicate with the IMS in advance, as well as receive reports that the IMS has accumulated since the previous evaluation was done. This report should be forwarded to the IMS, preferably well in advance of the flight physical examination.
coordination with IMS AME, including periodic drug / alcohol testing
Depending on the situation, the IMS will likely require random urine testing for drugs, alcohol metabolites, or even blood tests as part of the monitoring process. These are in addition to any pre-employment or DOT tests the pilot may be required to undergo.
The length of time a pilot is monitored depends on the individual situation, although a standard “minimum” is three years. Pilots who relapse, or are at high risk of relapsing, may be monitored for longer. It goes without saying that once released from SI, the pilot must maintain sobriety. Often times “graduates” from HIMS become peer sponsors for other pilots as part of their commitment to their own continued sobriety program.
You might be asking yourself – if the FAA requires a two-year period of documentation of sobriety, then why would a pilot go through HIMS for three (or longer) years?
The work necessary for documentation of sobriety for 2 years followed by FAA review to determine eligibility may take well over 2 years, so it behooves the pilot to be going through the HIMS program early so that this documentation can take place. With HIMS, depending on the individual situation, a pilot may back to flying in less than one year.
It should be emphasized that this is not a checklist procedure – if a person has alcohol / drug abuse or dependence problems, then just maintaining abstinence for 24 months may not be adequate for lifelong sobriety. Commitment to a drug or alcohol free lifestyle is something that has to be worked every day, and usually cannot be accomplished alone. It is much more likely for a person to relapse if they are without a strong support network and monitoring program. In general, relapse rates are very high, except for programs such as HIMS. Furthermore, it is difficult for anyone to document sobriety without such a structure in place.
Most importantly, though, alcoholism is a disease that needs treatment, so it needs to be handled properly from the beginning in order to produce the best and healthiest outcome. Drug and alcohol treatment saves careers, families, and lives. If your airline has a HIMS program and you or someone you know needs help, please consider taking advantage of it!
As mentioned earlier, the HIMS program has grown over the years to include other substances of abuse, and has also expanded into the GA sector as well. Whether a HIMS program is ”customized” to fit a non-airline situation, the cornerstones of HIMS must be met in principle, even with respect to the private pilot.
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