Recommended Practices: Identification
There are many unique factors that make identification of chemical dependency in the pilot population a difficult task. For a detailed discussion of these factors, please refer to the “Identification” section under the “Disease Info” menu of this website. But, even with a good understanding of these factors, and the aviation profession, individuals suffering from this disease often go undetected for a significant period. Since these same individuals represent a potential threat to aviation safety and to their own wellbeing, it is essential they be identified and afforded treatment for their condition.
For some chemically dependent pilots, the identification process will not be protracted or difficult. Cases that involve exceedingly high blood alcohol levels, the manifestation of withdrawal symptoms, multiple cases of hazardous use such as multiple DUI convictions, the use of illicit substances, or impairment on duty will quickly result in a diagnosis of chemical dependency. However, these are examples of behavior seen in the “later stages” of the disease. For pilots experiencing early symptoms of chemical dependency, a diagnosis will not be so obvious.
In this section we will try to describe program characteristics that enhance the identification process. Such characteristics include a strong continuing education component, cooperation between management and employees when dealing with situations which may involve addictive illness, thorough assessment protocols, clear understanding of assessment and representative functions within the pilot union, and support for a patient and confidential approach to disease identification. We hope a discussion of each of these characteristics will provide you with some ideas about how identification of potentially chemically dependent employees may be enhanced on your property.
Many early and middle stage chemically dependent individuals are identified because the people who interact with them are educated about the common symptoms of the disease, and are also aware of the rehabilitation opportunities available. Nonetheless, most people are loath to become involved in identifying people that display addictive behavior. To help overcome this reticence, one must undertake efforts to teach managers and employees about chemical dependency illness. When one understands the illness, one will also understand the affected individual is largely incapable of helping him or herself. It is equally important to provide education about substance abuse policies and rehabilitation opportunities, as individuals are more likely to intervene and help with identification if that action is seen as beneficial and not punitive.
A large number of opportunities exist for educating employees, managers, and others who may come in contact with a person afflicted by this disease. This website is one means, but there is also an opportunity to educate with traditional printed media. Union magazines, base newsletters, bulletin boards, safety publications, aircrew health bulletins, and even brochure mailings have all been used to provide education about chemical dependency disease. While such printed material certainly helps “carry the message” about addictive disease, one should not expect an immediate increase in the identification rate as a result of their publication. Experience has shown this material is most effective at raising the target audience’s awareness of the problem and rarely results in an immediate change in behavior. This is not to say this effort is ineffective, though, as many people who do report their concerns cite these materials as influential in helping them make the decision to do so.
One may also educate others through the use of personal briefings. Both large and small group education can be effective, and is particularly good at personalizing the concept of chemical dependency illness. Of course, such encounters also provide a great opportunity for questions and feedback, so their use is highly encouraged. Examples of such personal contact are new hire briefings, operations manager training, one-on-one discussions with Chief Pilots and other supervisors, and HIMS Basic Training Seminars. Such personal contact requires more time and effort than creating a written communication, but it is one of our most impactful means of creating a supportive and knowledgeable workforce.
Finally, one may also use available electronic means to educate others about the disease and applicable policies. Company and union websites are good places to provide resources and material. In addition to posting contact information for those individuals who are willing to provide assistance, one can also post electronic versions of written material including published company policies related to substance use and abuse. At some airlines, a portion of the digital recurrent training program has been devoted to chemical dependency education. So, there are multiple effective means available, the important thing is to use them. A vigorous and on-going educational effort will greatly enhance the probability of identification by soliciting the cooperation of individuals in contact with the affected pilot. Lack of such an educational program will hamper the effort to get help to those who need it.
Management / Employee Cooperation
People who suffer from chemical dependency illness demonstrate some common characteristics that create barriers to identification. The “party” behavior that frequently accompanies misuse often leads to shame and regret for the dependent individual. These emotions will make it very likely the person will engage in rationalization and/or denial surrounding these events and behaviors. Of course, the mood-altering nature of the chemicals also skews self-awareness and recall. As these psychological effects and defense mechanisms operate, information is altered and compartmentalized. So, it is often very difficult to obtain an accurate and complete picture of events from the afflicted individual. Being aware of this process should create an expectation for those hearing about such events that they are not hearing the “whole story.” In fact, providing only portions of “the truth” is a very common aspect of the manifestation of denial. It becomes necessary, therefore, to put the pieces of the “puzzle” together to get a clear understanding of what is actually taking place.
Companies and unions, by their very nature, tend to have different pieces of the available information. For example, a union volunteer may have a report from a concerned co-worker while the company may have information related to training problems or sick leave usage. In order to determine the probability that chemical dependency illness may be a common underlying cause for these issues, it is very important to be aware of all the available information. On most properties the union is uncomfortable with company access to information that was presented to union representatives, but it is a necessary requirement for some person to be given the opportunity to assess the information held by both parties. This individual also needs to be versed in the symptoms of chemical dependency disease and be able to make a balanced judgment about whether the weight of the evidence is sufficient to take action. Additionally, the person must, of course, be willing to maintain a high level of confidentiality about their investigation and it’s conclusions. In most cases, this task will fall to a member of the company’s Employee Assistance Program, a contracted addiction specialist, or to a member of the union’s HIMS committee.
If the investigation determines a high probability of chemical dependency as a source for the observed behaviors, one must then determine if an assessment is practical. In some cases a company can compel an employee to undergo a medical evaluation. In such cases, it is wise to include a chemical dependency evaluation as part of that process. In other cases, the company will not be able to direct an assessment. In those cases, one may be able to encourage the pilot to volunteer for the evaluation if punitive actions, which are commonly being contemplated, are held in abeyance. In all cases, the goal for the company and the union is to determine if the employee is suffering from an illness. That determination is accomplished by obtaining a substance abuse assessment, not by achieving some particular outcome. Qualified medical professionals should make the diagnosis of the illness.
Regardless of the circumstances that may have led to a chemical dependency assessment, the assessment process itself is critical to obtaining an accurate diagnosis. If a diagnosis is reached, that result may influence the company’s decision to pursue disciplinary actions against the individual. The diagnosis may also affect the pilot’s medical qualification for duty. One needs to recognize that a “no diagnosis” outcome for a person who is afflicted by the disease may have serious, negative repercussions. A person who is chemically dependent, but for whom insufficient information exists to make a diagnosis, will often come away from the experience with reinforced disease patterns. They will have increased their level of denial. They will likely become more secretive about their drinking or drug use. And, they will become more cognizant of disclosing information that might be used in the future to make a diagnosis. For these reasons, it is very important to only move to an assessment when information is sufficient to give the assessor a reasonably clear picture of the individual. It is equally important to ensure all possible pertinent information is made available.
Clearly, gathering and assessing information takes time. A thorough chemical dependency assessment will include contacting friends and family members about the individual’s behavior. Often information from these sources has not been obtained prior to the assessment. Additionally, a thorough assessment will involve physiological parameters (i.e. a physical exam and selected blood and enzyme laboratory tests), and psychological testing in addition to an analysis of behavior. Because some physiological and psychological effects of chemical use can diminish quickly it is imperative an assessment take place promptly. An immediate assessment also increases the likelihood the assessor will receive accurate data. An adequate period of time must be made available to ensure a proper assessment. FAA standards for an assessment are also somewhat unique, so consultation with a designated HIMS AME (HIMS AME’s) is highly recommended. An HIMS AME can recommend specially trained substance abuse professionals or an appropriate facility that has experience evaluating pilots. The current “gold standard” for chemical dependency assessments begins with immediate transport to the assessment facility, followed by a 3-4 day evaluation. Such an evaluation should encompass a review of all available historical data in addition to observation and measurement of physical, psychological, and behavioral parameters. With the pilot’s consent, it is also not uncommon for the assessment team to speak with significant other persons in order to obtain a more complete picture.
One of the lesser-known impediments to identification of chemically dependent individuals is a perceived conflict within union volunteer functions. HIMS volunteers are skilled in assessing addictive behavior either because they have extensive personal experience as pilots in recovery and/or they have had considerable local and national training in the field. These same volunteers, however, rarely have expertise in other union volunteer areas like representation or contract administration. Conversely, union experts in these other areas may have little or no education as it relates to chemical dependency disease. Without some basis for common understanding, sometimes these volunteers appear to act in conflict with each other while both are trying to serve the best interests of the affected pilot.
To clarify these perceived conflicts, it is important to clearly define the roles of the respective volunteers and to educate each about the other’s duties and responsibilities. Properly defined, a HIMS volunteer will have no representational or direct administrative responsibility. That volunteer, however, will need to understand when investigations or suggestions may overlap with the pilot’s legal rights and other alternative actions. Similarly, volunteers who have a duty of fair representation must understand that certain privileges extended to pilot/lawyer or pilot/union representative communications do not automatically apply to information voluntarily disclosed to a HIMS volunteer. This is not to say that such information should not be treated with discretion, but it does mean that information that is valuable to an assessor in making a proper diagnosis should not knowingly be withheld.
To overcome some of these problems we highly recommend that union leadership develop regular opportunities for HIMS volunteers to interact with other members of the pilot’s support network. Such interaction may be regular attendance at decision-making functions or training events. It is also important for volunteers in common areas of overlap such as representation, contract administration, legal affairs, pilot assistance, aero-medical concerns, training, and professional standards all have an active and communicative relationship with the HIMS volunteer. With proper communication and education, most issues of perceived conflict will be resolved of their own accord.
Patience and Confidentiality
Behavioral indications of addictive illness are most commonly intermittent in nature. As the disease progresses, signs and symptoms associated with the disease become more common and more prevalent. So, for individuals who are in earlier stages of the illness, those indicators often demonstrate a “now you see them, now you don’t” characteristic. On occasion, this means one may observe a clear example of drug or alcohol misuse, but be unable to determine if the behavior is a single instance or part of a larger pattern of abuse. When this situation occurs, it is best to be patient and wait for further information before taking any action prematurely. In most cases, a single incident of misuse is not sufficient to make a diagnostic determination, and people in the earlier stages of the disease often lack the definitive physiological effects that result from on-going misuse. Our experience shows that individuals who are in the early stages of alcohol or drug dependency almost always exhibit additional disease-related behavior over time.
It is also important to maintain confidentiality around the investigative process, or even the awareness of inappropriate behavior. Alcoholics and addicts are highly sensitive to other’s knowledge of their addictive behavior. It is usually extraordinarily important to them to maintain the appearance of normalcy as it relates to their consumption. They will often vary their behavior to avoid the appearance of overuse of alcohol, or any use of illicit drugs. Because their consumption is so central to their lives, they are usually very suspicious of others who show interest in their alcohol or drug use. Additionally, addictive disease is still a very personal health issue and often has pervasive societal overtones of shame and judgment. If a person suffers from this devastating illness, it is appropriate to limit that knowledge to those individuals trying to be of assistance.