INTERVENTION


An intervention is an event that presents reality (specific information) in a receivable form (with concern) to a person unable to see that reality (in denial).

Piloting an aircraft requires the highest levels of alertness and technical skill. Individuals who become successful airline pilots are intelligent and have strong ego structures. These characteristics are beneficial when operating an aircraft, but they can hinder the ability to break through a chemically dependent pilot’s denial. Denial, of course, is a hallmark of the disease of addiction (as detailed in the Disease Model). Simply said, denial is the inability of the alcoholic or addict to make the connection between their alcohol or drug use and the negative consequences associated with that use.

Due to the need for an uncompromising level of safety in aviation, it would be natural for someone to be concerned if they observed heavy or inappropriate use of alcohol or another drug by a pilot. We know that addiction, by its very nature, involves loss of control. There are medical and cognitive consequences that adversely impact safe performance of flight duties. The idea that a pilot with an active addiction is operating an aircraft compromises the safety of all involved. We know, however, the presence of denial in a pilot with chemical dependency means an inability to recognize a problem exists. Typical pilots’ personalities make the task of getting them to see a different reality than their own a very tough assignment. An intervention is one method that has been shown to be effective in breaking through denial.

The goal of the intervention is to have the pilot in question agree to a professional substance abuse evaluation/formal assessment. It is not to try and get the subject to admit that s/he is chemically dependent. The diagnosis will be made, or not made, as a result of the evaluation/assessment by a medical professional following the intervention.

Types of Intervention


Interventions are intended to interrupt the progression of chemical dependency disease. There are several types of intervention that can be conducted. The type that is used is largely dependent on the people involved in the intervention and the amount of information available. A useful way to examine the different types is to look at each as it relates to the participants involved. In all cases, it is imperative the intervention be led by someone who is trained in interventions. Usually, this means using a health care professional trained in substance abuse to lead, coordinate, and facilitate the event.

Classic

The “classic” intervention consists of family members and is conducted by an “interventionist,” i.e. a trained therapist. Family members often have the greatest amount of information indicating a possible problem with chemical misuse. They are also emotionally significant to the person being intervened upon. In recent years, the use of classic interventions has decreased as it requires many hours to prepare and is normally highly emotionally charged.

Today, this type of intervention is almost exclusively conducted off company property and rarely includes the direct involvement of company supervisors. A union representative may be in attendance, but are normally there for peer support and to assure the subject that his or her job is safe and that there are benefits available.

Some of the difficulties with this type of intervention are overcoming the existing family roles and dynamics. The family has probably enabled the pilot’s drinking or using overtime, and the pilot will use that fact as a rationalization to discount their current concern. Also, the pilot will have developed some strong defense mechanisms in relation to any specific family member. It is also often difficult for the family members to provide credible negative consequences to the pilot in that they love the pilot and are often financially dependent upon him/her.

All of these obstacles and problems can be overcome and, in many cases, a family intervention is the most effective of all types in breaking through an addicted pilot’s denial. However, it should be clear that an intervention of this type needs professional assistance and that family members should not attempt to conduct an intervention without help.

Company Lead

A company led intervention has both disadvantages and advantages when compared to a classic intervention. The company probably has less information specifically associated with alcohol or drug misuse. The company also has limitations on its authority to compel a pilot to undertake an assessment. These limitations may be statutory or contained in the company/union working agreement.

The company may, however, be able to provide a highly significant negative consequence for the pilot’s refusal to be evaluated: removal from flight status. The emotional significance of retaining his job is often a key in getting the pilot to agree to the assessment.
Managers are rarely comfortable when dealing with the issues of chemical dependency. Most lack training or background with the problem. By its nature, chemical dependency is a personal problem that is often expressed in behavior that wouldn’t even be examined under other medical circumstances. So, discomfort is understandable. In most cases, a manager can ably fill the role of a concerned and supportive supervisor, while maintaining good boundaries with the affected pilot.

Sometimes, though, being supportive may lead a supervisor to agree to actions that are not in the assessment’s best interest such as allowing the pilot to “go home for just a day or two” prior to the evaluation. Such inappropriate decisions can usually be avoided if the supervisor consults with a member of the HIMS committee before making any decisions related to the affected individual. Chemically dependent people are masters of delay and obfuscation. It is best not to give them any additional time to rationalize their behavior or to create support for their “story.”

However, one should realize that agreeing to the evaluation is not the same as breaking through the pilot’s denial. A pilot may well agree to go to the assessment, and even participate in extended treatment, while maintaining internally that s/he “really doesn’t have a problem.” Of course, in this case, the long-term maintenance of denial creates a significant risk of relapse.

Peer

A third type of intervention is one that is led by the pilot’s peers. This type of intervention is somewhat unique in that people who may be emotionally significant to the pilot lead it, usually with one-to-one contact between a HIMS committee member and the individual. These types of contacts are almost never sufficient in themselves to get the person to agree to an assessment unless the affected pilot initiated the contact. In those cases, the pilot may agree to an assessment. Otherwise, the typical response is denial of the problem and resistance to further inquiry because the peer is not in a position to provide a credible negative consequence.

As the title suggests, peer interventions are conducted without the direct participation of the company. Peers may have much of the same information as the company, and sometimes more information, but the pilot will rarely agree to an assessment unless a credible negative consequence can be created. Most effective peer interventions are orchestrated to involve the company in some respect. They are often held in the Chief Pilot’s offices without a company supervisor being present. The location allows the peers to present a circumstance to the pilot that demonstrates cooperation between the company and the peers. This setting causes the pilot to realize that lack of cooperation may result in further company actions.

Practically speaking, there are peer interventions that are conducted without company knowledge, and those conducted with company support. Experiences show that those interventions conducted with company support, i.e. on company property after the pilot has spoken with supervisors about the associated circumstances, are generally more successful. Usually, this success is not due to what is said by the participants but can be attributed to the subject being more willing to proceed to an assessment. Cooperation between the union and company, no matter how limited, increases the perceived cost of being uncooperative.

Union members on the HIMS committee are often more comfortable dealing with chemically dependent individuals. They understand the disease and the behavior. However, HIMS committee members might get confused about their role. Sometimes committee members try to take on the responsibilities of a pilot representative or contract administrator, or even a Chief Pilot. They also might confuse their function with those who act as a pilot’s AA or NA sponsor, particularly as it relates to a promise of anonymity or privacy. While anonymity and privacy are critical to some aspects of recovery and the functioning of HIMS, it must be appropriate. If the maintenance of anonymity or privacy acts to prevent or delay getting proper medical treatment to an individual who is known to be or is likely to be chemically dependent, such a position may not be in the person’s best interests. The disease state is enhanced and compounded by secrets, lies, deception, and poor communication.

Combination

The most effective intervention is probably one that includes all the people mentioned above: family members, company supervisors, and peers. However, such an intervention is extremely difficult and time consuming to coordinate and execute. This is not to say it shouldn’t be done. If all the elements are present (a willing family, concerned supervisors, and helpful peers), this type of intervention provides the pilot with the greatest opportunity for long-term recovery.

However, delaying an intervention because one or more of these elements is missing can lead to a missed opportunity to disrupt the progression of the disease. “Striking while the iron is hot” is a phrase that can be well applied to interventions. The longer the time period that transpires between the precipitating event and the intervention, the stronger the pilot’s rationalizations about the event and the more impenetrable his denial.

When there is strong evidence of a problem, and some significant possibility the behavior may be related to chemical dependency, most companies today will try to meet the legal basis needed to conduct a medical evaluation. This basis is normally expressed in the Pilot Working Agreement or Contract. One should note that chemical dependency disease is rarely clearly evident but may instead be expressed as spousal or child abuse, an argumentative attitude, lying, evasiveness, irregular performance, volatile personality, being accident-prone, tardiness, absenteeism, etc. Of course, sometimes these behaviors are not related to chemical dependency disease, but it often takes someone looking beyond the obvious facts to establish its presence or not. We, therefore, recommend that company directed medical evaluations include an assessment for chemical abuse or dependency.

FAA Mandated

An intervention may be the result of direct FAA action. In this case, the FAA becomes aware of questionable behavior either because the airman reported it when taking his/her physical, because of an inflight-event reported to the FAA or because it was discovered when checking the data in the National Drivers Record. Disclosure of multiple DUI’s or DUI’s with a high level Blood Alcohol Content (BAC) will commonly result in direction from the FAA to be assessed for chemical dependency disease. One doesn’t normally think of these directed assessments as interventions at all, but practically speaking, they achieve the same result.

Barriers


Silos of Information

Varying factors can act as a constraint against conducting an intervention. The first such factor is compartmentalization and timeliness of information. Over time, chemically dependent individuals will have multiple instances of inappropriate behavior. But, this behavior may not be apparent because of barriers to awareness. Turnover of supervisors is often high leading to little corporate memory of past events. Also, supervisors don’t normally share information about employee problems with HIMS committee volunteers.

Similarly, committee volunteers may be reticent to share reports with company supervisors. Known events may occur years apart and not result in associating them as possible evidence of chemical dependency. Union policy may discourage the collection of information related to potential pilot problems or concerns. In short, any attempt to take a long- term, well-informed perspective of all available information is difficult. But, such a perspective is as essential as it is difficult, so we recommend diligent efforts to establish this long-term knowledge.

Legal Constraints

The language in various statutes and in the Pilot Working Agreement also may act as a constraint to taking action. In these cases, it is important to recognize the appropriate function served by this language. The company has interests that must be protected and risks that must be managed, but these interests and efforts must be kept in balance with the rights and interests of the individual.

Successful outcomes result from respecting these legal constraints and being patient. Poor outcomes result when one union committee function is working at cross-purposes with another. If sufficient cause for an intervention is not well established, an intervention and assessment’s outcome is likely to be uncertain. One may rest assured if an individual is chemically dependent, more evidence will become available over time. So, an intervention will still be an option at that later date.

Personal Relationships

Personal relationships with the affected pilot may also act as a constraint to performing an intervention. If the supervisor and the pilot have a positive history with each other, the supervisor may be less likely to compel an assessment. Those subject to interventions generally perceive them as “negative” events, so an “old friend” might choose to give the subject an “out.” Such acts of “generosity” typically delay getting help to someone who may suffer from a chronic, progressive fatal disease.

If the supervisor, instead, has negative past experience with the affected pilot, the supervisor may be less inclined to afford access to an assessment and treatment. The supervisor may feel that entrance into HIMS is letting the pilot “off the hook” for past misbehavior. The reality is the pilot’s past misbehavior leads to an extensive rehabilitation program. HIMS requires thousands of hours of participation in self-help groups and formal therapy, extensive medical evaluations, and abstinence for the remainder of one’s flying career. These are not small concessions.

In the end, an affected pilot who is successful in recovery will often exhibit loyalty, dependability, and gratitude far above those present in an average employee. They will, in fact, become a joy to know and with whom to work. We urge all involved to remember that those being intervened upon are sick. They need your compassion and support, not condemnation for exhibiting behavior related to their illness.

The Historical Perspective


Over the years there have been many advances in the science used to evaluate the disease of chemical dependency. Prior to these advancements, the behavior or physical consequences associated with the illness were often quite pronounced before a diagnosis was made. At the chronic stage of the disease, one might clearly observe cognitive impairment or the manifestation of physical symptoms such as jaundice or other changes in a person’s appearance. These facts were clear and easily established, and the relatively small community associated with commercial aviation 40 years ago made such information common knowledge.

At that time, though, it was socially more acceptable to drink regularly, and it usually required a significant level of misconduct for others to “intervene” in the affairs of the affected person. Also, medical understanding of the illness was much less developed, as was the effectiveness of the various treatment options available to deal with the problem. All of these factors supported an environment of “late” identification. More often than not, if the diagnosis wasn’t made from the presence of an undeniable symptom, such as alcohol-induced cirrhosis, the assessment process was initiated through the use of a classic formal intervention.

In present times, alcohol misuse and abuse is less tolerated than in the past. One need only examine the changes in DUI laws to verify this change in attitude. There have also been dramatic improvements in medical understanding of addictive disease and in the means to test for its presence. There has been increased education about the disease (in part due to HIMS) and a dramatic expansion of workplace drug and alcohol testing. Additionally, unlike many other medical conditions, FAA regulations specify the criteria used to diagnose chemical abuse and dependency in the pilot population.  The FAA has also expanded the sources of information it uses to evaluate chemical dependency illness to include such databases as the National Driver Register.

All of these changes have resulted in greater awareness of the disease and a desire to identify those who are afflicted as early as possible. However, by definition, disease in the earlier stages is less clearly manifested than later, and the basis to conduct a classic intervention weaker. Without a significant preponderance of evidence, it is more likely a means will be chosen to persuade the affected individual to seek help rather than to try to compel them to do so through the use of a classic intervention. One should also note the outcome of a classic intervention is not guaranteed, and a subject may refuse to get help. Hence the expansion of other non-classical means of intervening on a person suspected of having chemical dependency disease.

Resource Links


National Council on Alcoholism and Drug Dependence

National Institute on Alcohol Abuse and Alcoholism

Organizations Dedicated to Fighting Abuse

Intervention Center

SAMHSA

HIMS Program

HIMS is specific to commercial pilots and coordinates the identification, treatment and return to the cockpit of impaired aviators.