The appearance of industrial alcoholism programs in the early 1940's as an outgrowth of a) the successful recoveries effected through Alcoholics Anonymous, founded in 1935, and b) the founding in 1940 of the Section on Alcohol Studies, Laboratory of Applied Physiology at Yale University.
Beginning in the mid-1940's, tentative programs began to evolve within a handful of major industrial firms, the alcoholism movement had also been gaining strength and allies.
The basis idea back then, was that supervisors could be trained in the symptomatology of alcoholism and look for these symptoms among their subordinates. The most common symptoms mentioned were blood-shot eyes, trembling hands and the smell of alcohol on the breath. The image of the alcoholic employee was not far from the Skid-Row stereotype. The employees identified in these early programs were late alcoholics whose problems were so overt they were obvious to virtually everyone.
Over the years some major problems developed with this approach. To begin with, first line supervisors did the identification and diagnosis and as a result no one above his/her level received help. Consequently, the only people identified were non-supervisory employees even though all evidence indicated that alcoholism affects every occupational and professional level. Furthermore, expecting a supervisor to make medically related diagnoses resulted in legal problems for the supervisor.
A second major problem was that alcoholics were skillful at diverting attention away from their real problem – masters at employing the “Con Game." With relative ease, the employee convinced the supervisor that the “real problem" was a nagging or spendthrift spouse, an unmanageable child, a physical ailment, money problems, or plain bad luck. Matching a supervisor with a practicing alcoholic was simply no contest – the supervisor lost nearly every time. Termination or early retirement at a reduced income usually became the solution. Everyone lost.
Finally, because of the stigma associated with alcoholism, supervisors wanted to be certain beyond a reasonable doubt that alcoholism really was the problem. Fearing the embarrassment of misidentification, the supervisor waited until the employee evidenced several obvious chronic stage symptoms.
In 1972, the Occupational Programs Branch of the NIAAA surveyed existing employer programs countrywide. Out of approximately three hundred companies with a written policy, it was found that only a fraction were working with an acceptable degree of success. Most had started out fast because it was relatively easy to identify chronic or terminal stage alcoholics. After an initial surge, however, many programs slowed and penetration of the population at risk was low. However, there were some distinct elements common to the successful programs and it is from these that the “troubled employee" concept had its genesis and from which the Employee Assistance concept had its genesis.
The object of these early EAPs was to avoid the problems experienced in supervisory diagnostic alcoholism programs while successfully identifying and referring those who needed help. A variety of other problems, such as marital, financial, physical, psychological, legal, social, vocational misplacement and job boredom were found to also cause unacceptable job performance.
Under the EAP umbrella all troubled employees were offered assistance and supervisors were trained to monitor job performance and refer when normal progressive discipline failed to correct the behavior. The effectiveness of this approach rested in three areas: (1) a reduced stigma to the EAP, (2) earlier identification, and (3) the fact that the employer controlled the paycheck – in the case of addicted employees, the money needed to keep drinking or using drugs. Supervisors/managers were able to successfully intervene with resistant and troubled employees through the threat of job loss.
One of the 1974 initiatives of the NIAAA was funding of the HIMS. It was apparent to the Occupational Programs Branch that traditional intervention methods – referral by supervisors as a result of an employee's deteriorating performance, – did not work well for top executives, professionals, or safety-sensitive positions like air line pilots.
Executives and professionals had been virtually impossible for EAPs to reach, because slippages in work performance were harder to detect, and there were elaborate cover-ups by peers. By that time, groups such as doctors, lawyers and nurses were beginning to address peer-referral groups, but special EAPs for professionals and executives were virtually non-existent.
Pilots have a high degree of autonomy, strong denial mechanisms, and a great fear of admitting that they may have a substance abuse or emotional problem.
By the early 1970's, the art of identifying and treating employed alcoholics was progressing through a technique known as “constructive confrontation." While these confrontations were being applied with considerable success, even among other airline workgroups, little help was available for the employed pilot. Strict enforcement of regulations by the FAA continued to create an insurmountable obstacle for the afflicted pilot. Fellow pilots were reluctant to intervene (confront) for fear of threatening a colleague's livelihood.
In 1974 the Air Line Pilots Association (ALPA) took the initiative through a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). They, in cooperation with the FAA and airline management, developed a prototype occupational alcoholism program for pilots. The project was called the Human Intervention and Motivation Study (HIMS). There was no evidence to suggest that the level of alcohol abuse among pilots was different from any other population, but ALPA, the FAA and Airline leaders believed that any level of alcoholism was undesirable and should be identified and treaded.
Airline management participated with ALPA in “constructive confrontation" process and provided health benefits and job security. The FAA joined the initiative by developing an evaluation and monitoring procedure that ensured safety while enabling pilots, who achieved adequate recovery, to return to flying sooner than would otherwise have been possible. This cooperative tripartite system completed elements essential to the HIMS alcohol identification, intervention, treatment and medical clearance for return to work prototype.
The HIMS was founded upon the premise that pilot susceptibility to alcohol dependence was no different from members of other professional groups. However, periodic binges rather than daily drinking were typical pilot drinking patterns. The cockpit was usually the last place for symptoms to manifest themselves.
Like other groups, 8 to 12% of pilots who drink alcohol would at some point become alcohol dependent. Alcoholism, as manifested in those affected individuals, was characterized by denial which rendered the pilot incapable of voluntarily seeking help.
In the HIMS experience, almost 80% of pilots who used the program, needed some type of external, work related pressure to motivate them into treatment. For this program, that pressure constructive confrontation was defined as an intervention. In addition to an intervention system, the staff developed an evaluation and treatment component specific to the program and FAA medical certification standards.
This Professional Pilot Assistance Program was a partnership between management, union, and FAA all working together with confidentiality, to identify, assess, treat, and gain medical clearance within FAA standards, for a recovering chemically dependent pilot. A secondary focus was to help any pilot who had a chemically dependent spouse or child.
- By the close of the initial eight (8) year federally funded project, most major U.S. airlines had endorsed the model, and had HIMS trained management and union personnel on their property.
- The 800 recovering alcoholic pilots had achieved an 85% long-term abstinence rate.
- A cost benefit analysis showed a $9 return for every $1 spent on treatment.
- The program enhanced flight safety. When chemical dependency progressed without therapeutic intervention, it could involuntarily manifest itself by on-duty withdrawal seizures, by violation of governmental or company drinking rules regarding alcohol consumption, or by the insidious effects of hangovers while flying. Any of these could make the airline and the pilot culpable.
- When alcoholism progressed to middle or late stages, it often resulted in costly secondary health conditions that escalated sick leave usage and medical plan costs.