Substance Misuse Programs in Commercial Aviation Safety First (2023) / Chapter Skim
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6 Summary Assessment: Conclusions and Recommendations
6 Summary Assessment: Conclusions and Recommendations
Pages 115-128
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From page 115... ...
With a grant from the National Institute on Alcohol Abuse and Alcoholism to the Air Line Pilots Association, International (ALPA) , and in cooperation with the FAA and airlines, the Human Intervention Motivational Study (HIMS)
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From page 116... ...
To supplement and independently assess the findings from these sources of information, the committee requested access to HIMS and FADAP outcome databases for analyses by a statistical consultant hired for the study. Furthermore, the committee developed a tool for obtaining testimonials of the lived experiences of pilots and flight attendants experiencing substance misuse problems through a "Call for Perspectives" issued to pilots and flight attendants.
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From page 117... ...
The remainder of this chapter presents a summary of the committee's findings, followed by its conclusions and recommendations. The committee prioritized findings it viewed as most helpful to aligning the treatment services and overall administration and management of programs for pilots and flight attendants with current evidence on effective treatment for substance use disorders and considerations for safety-sensitive professionals.
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From page 118... ...
The conclusions and recommendations are offered within each of these areas with the goal of identifying potential changes to HIMS and FADAP that could better align the programs with the current evidence base for substance use disorder programs and treatment. We reiterate that because published research on substance misuse among pilots or flight attendants, 1 While this report focuses on substance misuse prevention, intervention, and treatment to algin with the statement of task, the committee fully acknowledges that the FAA's primary responsibility is ensuring the safety of the national airspace.
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From page 119... ...
SUMMARY ASSESSMENT: CONCLUSIONS AND RECOMMENDATIONS 119 BOX 6-1 Committee-Identified Key Features of Evidence-Based Practices Diagnosis and Case Identification • Workplace policies that promote early identification and treatment • Evidence-based screening tools and assessment models • Diagnostic procedures and policies that use the most recent evidence-based definitions of substance use disorders (currently Diagnostic and S tatistical Manual of Mental Disorders, Fifth E dition) and align with the most current clinical evidence Removing Barriers to Identification and Treatment • Increasing awareness of substance use disorder programs • Decreasing stigma around mental illness and substance use disorders • Reducing as much as appropriate the fear of retaliation and of threat of termination Individualized Treatment Allowances • Identification of levels of care and treatment options that are based on an individual's unique clinical presentation • Lengths of stay that are based on an individual's needs and strengths Selecting Treatment Programs • Programs that use approaches supported by scientifically valid empirical data • Programs that offer cohort care and providers who are highly skilled, credentialed in evidence-based treatments, and experi enced in treating professionals in safety-sensitive occupations or even safety-sensitive professionals, is lacking, these conclusions and recommendations are based primarily on evidence from the robust literature available on the qualities of effective substance use programs in general that, in the committee's judgement, are sufficiently generalizable across individuals and contexts to be able to reasonably inform the management and implementation of programs for pilots and flight attendants, while noting special considerations that could apply to the aviation context.
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From page 120... ...
However, while full alignment with DSM criteria may not always be feasible without increasing significant operational risks, more consistent application of evidence-based diagnostic practices could better align treatment approaches with the current science. Conclusion: The Federal Aviation Administration needs to apply the criteria of the Diagnostic and Statistical Manual of Mental Disorders more consistently to its policies for better alignment with an evidence based approach to diagnosis and decisions about course of treatment as appropriate to the aviation context.
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From page 121... ...
Because screening for substance misuse and comorbid conditions during annual physical exams is known to help to identify misuse, and because existing screenings are yielding rates of 0.5 percent from aviation medical examiners (AME's) annual examinations, when general screening rates are typically greater than 14 percent, attention is needed to make the AME screening more rigorous and reliable.
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From page 122... ...
Recommendation 3: While employment termination is a legitimate outcome if return-to-work policies are not met, the Federal Aviation Administration should ensure that airlines identify and remove features of their workplace substance misuse policies and procedures that are likely barriers to early identification and treatment, such as disclosures that are not likely related to performance in a safety-sensitive position, and consider opportunities to promote more fully early identifica tion and treatment.2 • This committee recognizes the FAA's expectation of complete trans parency from pilots about their physical and mental health to ensure the safety of the public and the national airspace. We also rec ognize, however, that this requirement may lead pilots to avoid accessing care that is observable to the airlines and to the FAA, and/or lead to dishonest reporting on their Form 8500-8 to avoid jeopardizing their medical certification, and thereby their ability to fly.
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From page 123... ...
Smaller carriers with more limited budgets may leave pilots with much more limited financial protection for mandated treatment and required evaluations and limited financial support during the medical leave. Flight attendants are more likely than pilots to have limited funding sources to pay for treatment.
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From page 124... ...
Recommendation 5: Administrators of both the Human Intervention and Motivational Study and the Flight Attendant Drug and Alcohol Program, with the support of the Federal Aviation Administration, should encourage and support individualized treatment and continu ing care programs based on the severity of the individual pilot or flight attendant's substance misuse and that person's preferences. 3 Captain Dave Fielding, British Airways, presentation to the committee, November 1, 2022, that included an overview of substance use disorder and mental health support systems in UK aviation as a comparison to HIMS.
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From page 125... ...
• Aftercare planning should, at minimum, include peer support and offer nonspiritual options beyond AA, while being transparent on the depth of the evidence base for these different voluntary involve ment programs. Use of Evidence-Based Criteria in the Selection of Treatment Programs Each airline has substantial autonomy and discretion in the treatment options it chooses to offer under the auspices of HIMS and FADAP.
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From page 126... ...
In implementing this last recommendation, the key features of evidencebased practice previously mentioned in Box 6-1 should be considered when establishing criteria for the selection of effective substance use disorder treatment programs for transportation professionals. QUALITY OF DATA AND DATA ANALYSIS FOR PROGRAM MANAGEMENT AND DECISION-MAKING In its review, the committee encountered several areas where information is lacking that is necessary for the adequate assessment of program functions and performance.
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From page 127... ...
Likewise, the FADAP has major gaps in addressing substance misuse and substance use disorders for many flight attendants employed by U.S. commercial airlines.
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From page 128... ...
128 SUBSTANCE MISUSE PROGRAMS IN COMMERCIAL AVIATION for data collection and to include specific post-treatment outcome measures and follow-up assessments to ensure that more complete data are collected. • In the service of reviewing overall program effectiveness, deidenti fied data records that HIMS and FADAP collect should be able to be linked to the DOT's testing database and easily exported to allow more useful and transparent reporting to Congress and any other delegated independent auditors, a process that includes anonymization of data.6 • HIMS and FADAP should be required to report to the FAA how they are analyzing and using the data they collect to inform internal program improvements and external customer satisfaction in com pliance with EO 13642 and EO 14058.
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