Substance Misuse Programs in Commercial Aviation Safety First (2023) / Chapter Skim
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2,3 is that the prevalence rate potentially lies in the 1 Although not a universally adopted term, the committee chose to follow the precedent of the Department of Health and Human Services, the Centers for Disease Control and Prevention, and the Surgeon General in using "substance misuse" in this report to describe a broad spectrum of substance use that could be considered problematic from a policy or regulatory perspective despite not meeting the diagnostic threshold of a substance use disorder. 2 Flight Attendant Drug and Alcohol Program (FADAP)
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For many reasons, it is in the public interest to help people obtain effective treatment for their substance misuse and return to work. Otherwise, society faces safety risks and the potential loss of highly skilled pilots and trained flight attendants from the commercial airline workforce.
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and its modal administrations, and similar industries and sectors, beyond HIMS and FADAP; • Review available assessments and evaluation information on the HIMS, FADAP, and any other identified drug and alcohol programs to identify: -- Best policies and practices within existing programs; and -- Best practices for prevention, early intervention, and return to work specifically around prescription medication abuse, with an emphasis on employee use of opioids; and -- To the extent justified by the evidence, provide recommenda tions to the FAA and other modal administrations within the DOT on how to implement programs, or change existing pro grams, that seek to help transportation workers get treatment for drug and alcohol abuse and return to work. The committee will deliver a report to FAA and the appropriate com mittees of Congress on the study, including findings, conclusions, and recommendations.
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In order to put the processes and approaches of the HIMS and FADAP in context, the committee reviewed the robust literature that has emerged over the past few decades on methods to treat and support people who have misuse substances and have substance use disorders. In reviewing this literature and consulting experts in substance use disorder treatment, the committee documented the changes occurring in treatment based on the disease model of addiction.
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In the case of FADAP only, the committee was able to commission the work of an independent consultant to help analyze program records, flight attendant survey results, and the qualitative interviews of several flight attendants who had either participated in FADAP directly or provided insights into the state of substance use within the profession. Unfortunately, the FADAP data were an incomplete reflection of the population of flight attendants, and a large share of participants were lost to follow-up and therefore outcome data were incomplete.
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Second, the implementation of substance misuse programs for pilots and flight attendants is highly decentralized, creating challenges for determining how to take the recommended actions that would align the programs with evidence-based practices. Third, the implementation of effective programs necessarily depends on the ability to assess and monitor practices and outcomes for appropriate management and oversight.
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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 continuing care programs based on the severity of the individual pilot's or flight attendant's substance misuse and that person's preferences. Recommendation 6: National Human Intervention Motivational Study (HIMS)
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