AINsight: DUIs and Substance Treatment

 - June 7, 2018, 10:26 PM

Driving under the influence of alcohol or drug violations must be reported to the FAA. In the past, only “convictions” for DUI needed to be reported on the FAA medical application form 8500-8 (now filled out online through the MedXpress process before each FAA exam with an AME).

Several years ago, the wording for this item (18v) changed to include “arrests and/or convictions.” The implications of this change were significant, as there were many pilots who previously could answer “no” to this question who subsequently had to change their answer to “yes,” even if an alcohol charge had never been convicted and had possibly occurred many years in the past.

While a report under item 18v is required at the time of the FAA medical exam, it behooves all pilots who have had a DUI arrest to contact their AME proactively, well before their next scheduled FAA exam, if at all possible. The AME can guide the pilot as to what documentation is needed and as to whether or not the medical certificate can be issued at the time of the upcoming exam. Even if the DUI arrest hasn’t yet been formally adjudicated, it still must be reported at the next FAA medical exam.

There is a second reporting requirement that is sometimes forgotten but is extremely important. FAR 61.15 requires reporting alcohol and/or drug-related motor vehicle “actions” within 60 days to the security and investigations division of the FAA. This applies to anyone who possesses a pilot certificate, including a student pilot. Even a pilot who has neither flown nor possessed a medical certificate for many years is required to comply with this regulation.

What the FAA considers an “action” is defined very specifically in FAR 61.15—this includes convictions, suspensions, and/or revocations of driving licenses. But what about “boating under the influence?” If the state where the offense occurred defines a boat as a “motor vehicle,” then the FAR 61.15 reporting requirement applies.

Lawn tractors and golf carts could apply, too, if a legal action occurred as a result of driving said vehicles under the influence. For all such violations, I recommend that pilots obtain appropriate legal counsel through an aviation attorney.

In a previous blog, I discussed the drug and alcohol testing requirements of the DOT random monitoring program. Most violations under this program require formal substance rehabilitation prior to regaining medical, and sometimes pilot, certificates.

Substance rehabilitation may be required after DUIs (multiple, or even single if the alcohol level was quite high). Fortunately, the most common way that pilots present for substance treatment is through a self-report, before their substance problems jeopardize their careers or get them into legal, family, or health problems.

The special issuance program to assist pilots in regaining flying privileges after substance treatment was initiated in the 1970s. Through the leadership of the Air Line Pilots Association (ALPA), along with funding provided by the National Institute for Alcohol Abuse and Alcoholism (NIAAA), the FAA agreed to pursue this enlightened and forward-thinking program. Since that time, approximately 6,000 airline pilots, as well as many non-airline commercial and private pilots, have returned to the cockpit safely as a result of this program, the Human Intervention Motivation Study (HIMS).

If the FAA is going to “give the keys back” to a pilot who has been treated for alcohol or drug problems, the treatment and follow-up requirements of the HIMS program understandably must be comprehensive and thorough. At present, most of the airlines have embraced the program, with the results being excellent.

Pilots in sobriety make good, reliable employees that often use less sick leave than their counterparts. The HIMS program has an impressive long-term sobriety rate in the 85 to 90 percent range. That we lose 10 to 15 percent, however, shows how difficult substance problems are. For a pilot to lose the career he/she spent much of their adult life earning speaks to the magnitude of the illness.

The HIMS program, the FAA, and the airlines embrace substance treatment as having a strong medical component. While substance issues, and most mental illness problems, remain overly stigmatized in our society, the success of the HIMS program speaks strongly to the medical illness concept.

The program is multifaceted, and typically includes treatment—either inpatient or intensive outpatient—at an established rehabilitation facility. After treatment, there are numerous ongoing follow-up requirements, which typically include aftercare (group meetings periodically at the treatment facility); ongoing drug and alcohol monitoring (frequent testing, separate and in addition to the random DOT program); periodic blood testing; monthly reports from the pilot’s management; and, before the initial return to flying, a comprehensive psychological and psychiatric evaluation.

Attendance at 12-step recovery meetings is strongly encouraged. There are many such meetings available, with Alcoholics Anonymous (AA) being the most recognized.

Finally, the AME must put together a formal packet of all relevant data—medical and legal—for FAA to review, along with a comprehensive cover letter outlining the case history, including a discussion about how the pilot is doing in recovery and recommendations for approval and additional considerations for the FAA.

Once approved, the pilot will be monitored for three to five years, and sometimes longer, depending on the severity of the presenting illness. There are occasional pilot cases that will include monitoring throughout the duration of their flying careers. Follow-up requirements include most of those outlined above, usually with the exception of the psychological evaluation. Psychiatric re-evaluations will take place at least annually.

Without overburdening the discussion with details and minutia of the HIMS program, please keep in mind that the purpose of the program is to get pilots back into the cockpit.  I assure you that if at all possible, the FAA wants to see pilots succeed in the program.

The HIMS program has probably been more successful than anyone anticipated at its inception in the 1970s, and the FAA and airlines want to see it continue to be so. It is hoped, of course, that as the popularity of the program becomes more well known, many more pilots will self-identify as needing help before their substance problems get them into trouble.

This program is now also finally entering the public field of view. It isn’t meant to be a deep secret known only to the innards of aviation. The airlines and the FAA are encouraging public knowledge of the program and its successes. 

Here are some takeaways:

Prescription narcotics are now part of the DOT random testing program. These are excellent medications with appropriate indications. However, they are also easily and readily abused. I recommend that a pilot wait at least 72 hours from the last dose before flying—and, of course, only when the pilot feels otherwise medically fit to fly. Most importantly, use these medications only under the guidance of a physician. The medication should be taken only if the pilot possesses a current prescription for precisely the reason the medication is being taken at that time—in other words, don’t fish old prescriptions out of the closet and “self-prescribe”.

If a pilot feels that a drug or alcohol problem is developing, please understand that there are very good resources available for help. The airlines support pilots who proactively deal with substance abuse problems, and typically pilots who self-disclose will not only save their jobs, they might save their families and their health.

There are no “free passes” on a first DUI any longer. All DUIs are reviewed carefully by the FAA. Reporting requirements include both at the time of the next FAA medical exam and within 60 days of any legal action as per FAR 61.15.

The HIMS program is an excellent resource to help struggling pilots get healthy and return to work. There are minor modifications to the program available to assist private and corporate pilots too—the program is not just for airline pilots.

Dr. Sancetta is a former DC-10 captain with 11,000 flight hours. He has worked as a Senior AME since 1993 and is appointed as AME Consultant to the Federal Air Surgeon.