‘he medical monitor then submits the following reports to the Federal Air
Surgeon for evaluation:

1) Psychiatric and psychological evaluations.
2) Hospital records from inpatient treatment.
3) Report from aftercare program.

4) FAA Form 8500-8, physical examination report.
5) Summary of the case by medical monitor.

A special issuance is received within 1 year of treatment in 80% of the
cases (see Figure 2). Monitoring requirements are specified when the special
issuance is granted. Monthly reports from the flight operations supervisor of
the airline and an ALPA representative attesting to the individual's sobriety
are submitted to the medical monitor. Quarterly reports from the aftercare
program and annual or semiannual psychiatric evaluations are also required.
All followup reports are forwarded to the FAA Aeromedical Certification
Branch, by the medical monitor, every 6 months or annually with his/her phys-
ical examination (FAA 8500-8). After 24 months, he/she may petition the
Federal Air Surgeon to remove the monitoring requirement. The monitoring may
continue if the evaluating psychiatrist, aftercare counselor, or medical
monitor feels the individual has not achieved stable sobriety.

The remaining 20% of the cases in which a medical certificate is not
issued within the first year are often deferred pending receipt of more infor-
mation. Some airline pilots have residual effects from prolonged alcohol
abuse and need more time to recover. Some cases are deferred due to pilots’
lack of participation in aftercare.

Since 1976, the FAA has worked cooperatively with ALPA and airline
companies to identify and rehabilitate airline pilots who have problems with
alcohol abuse. Nearly 600 airline pilots have been granted a special issuance
for alcoholism after treatment. The current rate of successful rehabilitation
is 85%. An airline pilot was considered rehabilitated if he/she held a valid
medical certificate on December 31, 1984, or retired with no relapse. This
includes pilots who have relapsed one or more times and regained their medical
certification.

There are approximately 39,000 airline pilots in the United States. Those
who have been granted a special issuance after treatment for alcoholism
probably represent only a small part of the alcohol-related problems in the
airline industry.

Very few studies are available that estimate the prevalence of alcoholism
among occupational groups. One such study by Mannello and Seaman in 1979
estimated the prevalence of problem drinking among railroad workers to be 19%
overall. Among operating personnel (engineers, conductors), 23% were problem
drinkers (6). Some occupational factors which are common to railroad con-
ductors, railroad engineers, and pilots are irregular working hours and long
layovers away from home. These factors may facilitate excessive drinking and
development of addiction in some predisposed individuals.

The onset of alcoholism is slow and insidious. An individual has often
alienated friends, family, and coworkers by the time alcoholism is diagnosed.
In other words, he/she has effectively destroyed the social network needed to
successfully recover from alcoholism (9).



0° O01 L£8S IWLOL
S* 471 $8 ‘TVLOLaAs
o°s¢ 8z suotzeot[dwog [eotpay 19420
8°0 ¢ aourt{duoouon
ram) T sesdertoy eeiyl
SL 6 sosde,ay omy,
ord wy asdeloy aud
peyeutmiay
s°s8 z0s TVLOLGNS
s*0 € sosdetoy omy,
0°79 Le asdertay aud
o°6L 29H asdelay ON
[N}ssaoons peitjzea oyM ssoy. pue
petstaaeo AT[eOTpow {1 TIS esoyy
SOpN{OUT -— pazeatT{Tqeysy AL [nyssaoong
quao1eg Aoduenberg sn}e3s

SMLVLS ASdVTFA AM WSIIOHOOTV HOA AONVASSI IV1OUdS GAINVYD SLOTId ANITWIV

I erqeg


mothers who were heavy drinkers or alcoholic (14% vs. 5%), and alcoholic
siblings (17% vs. 9%). Subjects who have an alcoholic family member may find
it easier to admit their own alcoholism and consequently have a more favorable
treatment outcome. Twenty percent of the success group were under 40 years of
age, as opposed to 37% of the relapse group.

Little difference was found regarding physical consequences of drinking
between relapse and success groups, The success group reported a higher rate
of alcoholic blackouts than the relapse groups (65% vs. 51%). This may indi-
cate that those pilots in the relapse group were less willing to admit to
adverse consequences of drinking, thus indicating a strong denial system. The
success groups had a lower rate of liver dysfunction than the relapse group
(51% vs. 63%). Figure 4 presents the number of special issuances by crew
position and relapse status.

SUMMARY

Of the 587 pilots who received special issuances, 380 are still flying; 66
retired at the age of 60 years; 115 dropped out (retired early, relapsed or
had other medical complications); 10 are deceased; and 16 are on strike or
laid off.

An airline pilot was considered rehabilitated if he/she held a valid
medical certificate on December 31, 1984, or had retired with no relapse.
This included pilots who relapsed one or more times and regained their medical
certification. The overall rate of success is 85%.

Family participation in aftercare and treatment was considered to be a
major predictor of successful treatment, This participation included Alanon,
Alateen, and family or group therapy at an alcohol treatment center,

The subjects spent an average of 15 months in aftercare programs and 20
months in AA. Extended involvement in aftercare was also considered a major
factor in successful treatment. The strong support of ALPA and the interest
and encouragement from individual coworkers also helped improve the pilot's
chance of successful rehabilitation.

A government regulatory agency (FAA), a large union (ALPA), and the man-
agements of several airline companies have demonstrated the ability of some-
times opposing forces to work together to combat a major public health problem
and enhance air safety. In 1980, Zuska and Pursch described the U.S. Navy's
experience with alcoho! rehabilitation, The FAA hopes that much like the
Navy, the growing numbers of recovering alcoholic pilots will set off a “chain
reaction of health” and ultimately make it easier for those pilots who come
later to have an even greater rate of recovery.


The 24 months of monitoring help resolve this dilemma in several ways.
Monthly monitoring forces the airline pilot to be reminded that he/she is
indeed an alcoholic. Participation in Aftercare, Birds of a Feather and
Alcoholics Anonymous (AA) help him/her rebuild a social network of nondrinking
friends and become involved in a social environment that centers on
nondrinking activities. Many airline pilots find that, after the first year
or two of sobriety, their work and feelings of well-being are much improved
over pretreatment levels (11).

Airline pilots receive considerable support from ALPA, coworkers, and
often the airline company itself. Several airlines have their own in-house AA
meetings for alcoholic employees (3). Admission of alcoholism to coworkers
appears to be a major milestone in an airline pilot's recovery (1).

Seventy-nine percent of the subjects have not had a relapse since
receiving special issuance. Eighty-five percent have been successfully reha-
bilitated, some after one or two relapses. Nine percent have relapsed one or
more times and have not reapplied. One percent were terminated for failing to
comply with monitoring requirements, Five percent were terminated for other
medical complications (see Table I).

The mean age of the study group was 46 years. Sixty-seven percent were
married at the time of treatment; another 9 percent were married but sepa-
rated. The average cumulative flight time was 12,908 civil hours and 1,695
military hours. The relapse group had almost twice as many hours of military
flight time as those who did not relapse. This would indicate that relapse
cases may have spent a longer time in the military or perhaps participated in
military reserves,

When the data are examined by employment status, 380 pilots are still
flying after receiving special issuance; 66 retired at the age of 60 years;
115 dropped out (retired early, relapsed, or had other medical complications);
10 are deceased; and 16 are on strike or laid off (see Figure 3).

The mean time spent in inpatient treatment was 4 weeks and 6 days.
Sixty-three percent of the families of the successes participated in treatment
as opposed to 46% of the families of those who relapsed. Fifty-five percent
of the families of the success group participated in aftercare for 3 months or
more in contrast to 43% of the families of the relapse group. Family partici-
pation in aftercare included Alanon, Alateen, and family or group therapy at
an alcohol treatment center.

Aftercare participation data were collected by number of months of partic-
ipation as well as number of times attended per month. Participation in AA,
outpatient group therapy, and individual counseling were examined. Little
difference between groups was found. The participation overall was quite high
when compared with other occupational alcoholism programs (8,10).

The relapse cases had been drinking an average of 24 years in contrast to
an average of 28 years in the success group. When compared, family drinking
habits indicate that the success group versus the relapse group had a higher
percentage of fathers who were heavy drinkers or alcoholic (34% vs. 27%),


w

<* - EW ;
NUK 3:

]\\\\\\ el
2\\\~

<6

GOO NN NWN TT

@ Other

ES Relapse

A Success

granted special issuance

pilots

alcoholism - months from treat

airline

Figure 2. Time off work for

ial issuance

spec

ment to

for



Technical Report Documentation Page

1. Report No. 2. Government Accession No. T* Recipient's Catalog No.

DOT/FAA-AM-85-12

4. Title ond Subtitle 5. Report Date
October 1985

6. Performing Orgoni zation Code

ALCOHOL REHABILITATION OF AIRLINE PILOTS

=|

Performing Organization Report No.

7. Author! s)

Julia C. Russell and Audie W. Davis

9. Performing Organization Name and Address 10, Work Unit No. (TRAIS)
FAA Civil Aeromedical Institute

P.0. Box 25082 TI, Contract or Grant No.

Oklahoma City, Oklahoma 73125
13. Type of Report and Period Covered

12. Sponsoring Agency Name ond Address
Office of Aviation Medicine
Federal Aviation Administration
800 Independence Avenue, SW.
Washington, DC 20591

Ta. Sponsoring Agency Code

15. Supplementary Notes

16. Abstract

In 1976, the Federal Aviation Administration (FAA), in conjunction with the Air
Line Pilots Association (ALPA) and several airline companies, initiated a plan for
the certification of rehabilitated alcoholic pilots, which has had a surprising rate
of success. The program itself and a number of demographic variables are examined
for the entire group.

This study involves a survey of medical records for over 500 airline pilots who have
been medically certified by the FAA after a diagnosis of alcoholism. The program
demonstrates an 85% rate of success since 1976. If a pilot experiences a relapse,
he/she is immediately taken off flight duty and recycled back through the program.
In no case where there has been a relapse has it been felt that aviation safety

was compromised.

The success of this program is due to several unique features, such as the coopera-
tion of the pilots' union, airline companies, and the FAA to identify and treat
alcoholic pilots. This program also includes peer identification and referral and
an intensive 2-year followup of pilots by all three groups mentioned above.

Ye pile Divas A Mypirmn

a ¥ pot fh
Moers’ Cis fle bb hom

17. Key Words 18, Distribution Statement
Alcoholic Pilots Document is available to the public
Rehabilitation through the National Technical

Information Service, Springfield, iy
Virginia 22161. \

19. Security Clossif, (of this report) 20, Security Classif. (of this page) TI. No. of Pages | 22. Price
Unclassified Unclassified 1
Form DOT F 1700.7 (8-72) Reproduction of completed page authorized



a) +


*WS|]0YO|D 40} aoUDNSS! |DIDad

s

pajupsb sjojid auljsip yo snjpjs yuawAojdwa juaiing ‘¢ asnbi4

Buthly HO  pasoarsq + *"O 09 aby
W88S PIO7 peddoiq /pesiiey

12410
asdojay &
ssa22ng FB

0
OS
OOl
OSL
007
OSZ
OOE
OSE
OOv

Aouanbasy



Frequency
100fr
90F

| TOTAL =587

MG
EAMWW WW O€TM>

Z Success
EA Relapse
WM Other

72 73 74 75 76 7

80
70
60
50F
40F
307
20
10
O

st
[oe)

fon)

[e)
oO

Oo
~

~
co <

>
ie

5
E

Figure |. Number of special issuances for alcoholism granted per year,
1972-84.


We reviewed 587 records of airline pilots granted special issuance after
treatment for alcoholism from 1972 through 1984, The subjects were almost
exclusively Caucasian males. Most possessed attributes that Kissen found to
be related to successful treatment of alcoholism; e.g., older age at diag-
nosis, white, married, high occupational achievement, high occupational sta-
bility, and few arrests (5). The subjects were generally early or middle
stage alcoholics. This also improved their chances of successful
rehabilitation,

The subjects were divided into three groups. The “relapse” group included
all airline pilots who had experienced a relapse after being granted a special
issuance from the FAA. This includes those who have received a second or
third special issuance. Airline pilots who had a relapse, later received a
special issuance, and then were terminated for other medical reasons were
included in this group. Figure 1 shows the number of airline pilots receiving
special issuance per year by relapse status, The “success” group included
only airline pilots who had one special issuance with no relapse of alcoholism,
The “other” group includes airline pilots who were terminated for noncom-
pliance with monitoring requirements and those terminated for other disqual-
ifying medical conditions (heart disease, cancer, diabetes, nervous disorders,
etc.).

Extensive pretreatment data were collected from the medical records of
each airline pilot. This consisted of sociodemographic information and data
regarding the health and social consequences of drinking.

RESULTS AND DISCUSSION

An airline pilot is identified as being alcoholic in a variety of ways.
Impaired performance on semiannual flight checks or difficulty experienced in
adapting to new equipment often leads to inquiries about his/her use of
alcohol, Coworkers are now more willing to report alcohol problems to the
airline company, since help is available in most cases without threat of
termination,

Sixty percent of the subjects were referred to treatment by the Air Line
Pilots Association (ALPA) and/or their employers. Seventeen percent were
referred by their families or other sources, such as courts or counseling
centers, Twenty-three percent sought treatment voluntarily. The high rate of
successful rehabilitation (85%) of airline pilots would tend to support the
idea that a basically coercive program can be beneficial to both the subject
and his/her employer.

In order to regain medical certification after being diagnosed as an
alcoholic, an airline pilot must first undergo approved inpatient treatment
and participate in an outpatient aftercare program, Psychiatric and psycho-
logical evaluations are done 1 to 3 months after treatment. To petition the
Federal Air Surgeon for special issuance, each airline pilot must have a med-
ical monitor, The monitor takes responsibility for the subsequent 24-month
monitoring period and is often the airline medical director, the ALPA medical
advisor, or an aviation medical examiner (AME) who is experienced in alcohol
treatment and counseling.




ALCOHOL REHABILITATION OF AIRLINE PILOTS

INTRODUCTION

The Federal Aviation Administration (FAA) is responsible for issuing
medical certificates to all pilots in the United States and some international
airmen, Each pilot must have a current medical certificate to validate any
pilot certificate he/she may hold. The FAA will medically certify individuals
with certain disqualifying medical conditions if a determination is made that
such action does not compromise air safety.

Alcoholism is a significant public health problem and is considered a
disqualifying disease for medical certification under Federal Aviation
Regulations, Part 67, The FAA defines alcoholism as "a condition in which a
person's intake of alcohol is great enough to damage his/her physical health
or personal or social functioning, or when alcohol has become a prerequisite
to normal functioning.” It is estimated that the rate of alcoholism in the
general population is 7%. In the United States, about 15 million people may
be alcoholic (2). The estimated cost of alcohol to the economy is $89.5
billion dollars per year. This includes lost employment, reduced produc—
tivity, health care, car accidents, and excess morbidity and mortality (7).

Between 1960 and 1976, 29 pilots reported their alcoholism to the FAA; 14
were medically recertified after being grounded for a minimum of 2 years. The
threat of loss of employment caused the pilots and the aviation industry to
ignore alcohol abuse until the alcoholic pilot had progressed to the late
stages of alcoholism (4).

In 1976 the FAA reevaluated the standards regarding medical certification
of alcoholic airline pilots. This review resulted in a change in policy that
allows the FAA to issue a medical certificate to a recovering alcoholic air-
line pilot soon after completing treatment. The pilot's continuing certifi-
cation is contingent, on his/her total abstinence from alcohol and 24 months of
favorable reports from several monitoring sources.

The purpose of this study was to describe this population of airline
pilots in terms of sociodemographic, treatment, and posttreatment variables.
Some possible reasons this program has been so successful are discussed and
areas for future research examined.

METHODS

Data for this descriptive research study were obtained by review of
special issuance medical records maintained by the Aeromedical Certification
Branch of the FAA's Civil Aeromedical Institute in Oklahoma City, Oklahoma,
These records include FAA Form 8500-8 (a physical examination report that is
submitted periodically during a pilot's career), psychiatric and psychological
evaluations, results of psychological tests, hospital records, and monthly and
quarterly followup reports.



Acknowledgment

The authors express appreciation to Ms. Shirley Dark, Mrs. Leslie Downey,
and Mrs, Lisa Casey for their assistance in preparation of this study.
Appreciation is also extended to Dr. Charles F. Booze, Jr., Supervisor,
Medical Statistical Section, and Ms, Nova Green, Medical Qualifications
Staff, for their valuable comments and suggestions.


1

10.

ll.

REFERENCES

AA World Services, Twelve Steps and Twelve Traditions, New York,
AA World Services 1965.

Costello R. Evaluation of alcohol treatment programs. In: Pattison E and
Kaufman E, eds. Encyclopedic handbook of alcoholism. New York,
Gardner Press, 1982: 1192-1210.

Harper CR. Airline pilot alcoholism: one airline's experience. Aviat.
Space Environ. Med. 1983; 54:590-1.

Hoover EP, Kowalsky N, Masters R. Human intervention and motivation
study--an employee assistance program for professional pilots (an eight
year review) Air Line Pilots Association, Denver, Colorado, 1982: 1-6.

Kissen B. Patient characteristics and treatment specificity in
alcoholism. In: Idestrom C, ed. Recent advances in the study of
alcoholism, proceedings of the First International Magnus Huss Symposium,
Stockholm: 1976: 110-12.

Mannello TA, Seaman FJ. Prevalence, costs, and handling of drinking
problems on seven railroads, final report, U.S. Dept. of Transportation,
Federal Railroad Administration, DOT-TSC-1375, 1979: 108-20.

McDonald D. ADMHA Stressing prevention studies. U.S. Medicine, 19853
21:6, 47-8.

Solomon S. Tailoring alcoholism therapy to client needs. Rockville,
Maryland: U.S. Department of Health and Human Services, DHHS Publication
No. (ADM) 1981: 81-112.

Vaillant G. The natural history of alcoholism. Cambridge: Mass Harvard
Univ Press, 1983: 300-05.

Walker R, Donovan D, Kivlahan DK, O'Leary M. Length of stay, neuro-
psychological performance and aftercare: Influences on alcohol treatment
outcome. J. Consult. Clin. Psychol. 1983; 51:6, 900-11.

Zuska J, Pursch J. Long term management.- In: Gitlow S$ and Peyser H,

eds. Alcoholism: A practical treatment guide. New York, Grune and
Stratton, 1980: 131-63.

iL



poss

2.29
273 ja