Recommended Practices

From the establishment of HIMS in 1974 to the present time, HIMS has constantly evolved. FAA minimum requirements were steadily increased as further experience and evidence indicated those changes would enhance recovery and flight safety. Advancements in testing for mood altering substances altered the landscape for abstinence testing. Airlines in partnership with their pilot unions developed monitoring policies that often extended the period of certain FAA requirements, and placed additional requirements on the affected airman beyond FAA’s minimums. Keeping this historical perspective in mind, any attempt to describe a set of “Recommended Practices” is, by definition, a snapshot taken in an ever-changing environment.

Additionally, one must recognize the cultural and practical differences between the many flight organizations that participate in HIMS. These differences were quite large when dealing with commercial carriers that varied from less than 100 pilots to over 10,000, but they are even greater today as FAA expands the use of HIMS to General Aviation pilots and other users. These group differences may make some recommended practices seem impractical for some groups, or financially unobtainable for others. But, ultimately, the success rate of HIMS pilots is more dependent upon a sincere commitment to the specific program than the employment of any particular practice or paradigm. In other words, we recommend you learn from the experience of others and give your program your best, sincere effort. If you do, you will find the rehabilitation of your pilots from chemical dependency disease to be rewarding for both you and your company.

In the description that follows, we will try to avoid spending too much time looking at HIMS past practices unless we feel that view will enhance understanding of current recommendations. As previously mentioned, the program has never been static and describing all practices that have been employed over the past 40+ years would easily double the length of this material. We also will attempt to clearly describe when more than one type of practice appears to generate similar results. In other words, these recommendations are based on past results, and no other criteria. So, if one method has the same success rate as another, we will describe both. We will also attempt to mention new practices that, as yet, do not have enough history to determine their relative effectiveness.

Finally, it is probably most useful to look at all practices from the perspective of the order of use. So, we have organized this information similarly to other sections of this website in that we will discuss Identification, Intervention, Treatment, Continuing Care, Medical Re-certification, Monitoring, Compliance Testing, Relapse Issues, and Special Considerations. Our goal is to give you a toolbox of highly effective practices and the knowledge to properly use them. Regardless of your decision to use these recommendations or not, please take the time to establish a dialogue with other HIMS programs. History has shown we develop the best HIMS programs by listening to and learning from each other. So, communicating with others in HIMS about your program is our first recommended practice.

To aid in this communication, and to provide a common language regarding the present use of certain terms in the HIMS program, we offer the following glossary of terms:

Glossary Of Terms

AA refers to Alcoholics Anonymous, a peer self-help program for those who have a desire to stop drinking based on a 12-step program. While having demonstrated therapeutic benefits, AA is not therapy in a clinical sense, but is instead a peer support group. AA became a model for developing self-help programs for other types of addiction including CA – Cocaine Anonymous, NA – Narcotics Anonymous, and SA – Sexaholics Anonymous.

Aftercare is an imprecise and somewhat dated term that is most commonly used as a synonym for Continuing Care (see below). Aftercare has also been used to describe clinical group therapy, and is sometimes used to mean the continuing care and monitoring aspects of a HIMS program that follow discharge from the treatment facility. Because of the variations in meaning associated with it, use of this term is discouraged.

ALPA refers to the Air Line Pilots Association, principle partner in the development of HIMS.

AMAS refers to the Aviation Medicine Advisory Service, a company which provides medical guidance to aviators and which has been historically tasked by ALPA to assist in executing the federal HIMS contracts.

AME refers to Aviation Medical Examiner, physicians who have undergone training and are FAA approved to issue pilot medical licenses.

BAC refers to Blood Alcohol Content and is commonly expressed as milligrams percent of ethanol per deciliter of blood.

Birds or BOAF refers to Birds Of A Feather International, an organization based on the principles of AA whose membership is limited to pilots. Breathalyzer is a term used to describe a variety of testing devices that measure BAC by analyzing the amount of ethanol exhaled by the subject.

CDT refers to the Carbohydrate Deficient Transferrin test. This blood test is a good diagnostic tool for differentiating between chronic, heavy drinking subjects and light social drinkers. It is not an effective tool for verifying abstinence.

CFR refers to Code of Federal Regulations.

Continuing Care refers to the aspects of the post-residential treatment recovery program that are directly related to healthcare. Group therapy, meetings with the AME, individual counseling, family therapy, relapse prevention treatment, and AA/NA meetings are included in this group.

DOT refers to the US Department of Transportation.

Drug Screen refers to a variety of testing methods used to identify drug ingestion. Urine screens include tests for different classes of drugs and each class is analyzed using a particular “panel.” DOT testing utilizes a 5-panel test. Abstinence compliance testing is typically a 10 or 12-panel test. Other methods of testing include hair and nail samples. The detection window varies depending on the drug consumed and the method of testing that’s employed.

Dx is medical shorthand for Diagnosis.

EtG refers to the Ethyl Glucuronide, a specific direct biomarker of ethanol ingestion. EtG urine testing is very sensitive and may be positive due to incidental alcohol exposure such as through the use of mouthwash, over-the-counter medications, or other consumer products. The detection window for ETG tests is typically 1 to 2 days.

EtOH is the chemical name for ethyl alcohol.

EtS refers to Ethyl Sulfate, another specific direct biomarker of ethanol ingestion. Like EtG, EtS urine testing is very sensitive and can be positive due to incidental alcohol exposure. The detection window for EtS is also 1 to 2 days.

FAA refers to the US Federal Aviation Administration, a component of the DOT.

FAR refers to the Federal Aviation Regulations.

Group Therapy as used by FAA and HIMS refers to clinical group therapy, i.e. group therapy led by a trained clinician.

HIMS refers to the occupational substance abuse program specifically designed for commercial pilots. The acronym has its basis in the originating study called the Human Intervention Motivation Study.

IMS refers to Independent Medical Sponsor, the role established by FAA for AME’s who sponsor pilots for Special Issuance medical certificates.

LOA refers to Letter of Agreement, a form of formal written agreement entered into by companies and their associated union organizations.

Monitoring refers to the post-treatment activities that are directly related to compliance with the requirements of the SIA and the pilot’s HIMS program. Peer meetings, supervisory meetings, and sobriety testing fall within this group.

MOU refers to Memorandum Of Understanding, another form of formal written agreement entered into by companies and their union organizations.

NIAAA refers to the National Institute for Alcoholism and Alcohol Abuse. This organization provided partial funding of the original HIMS study.

P&P refers to the Psychological testing and Psychiatric evaluation required by FAA for a pilot to receive a Special Issuance medical under the HIMS protocol.

Part 61 refers to the portion of the FAR’s that deals with pilot certification.

Part 91 refers to the portion of the FAR’s that deals with general aviation.

Part 121 refers to the portion of the FAR’s that deals with mainline commercial passenger aircraft operations.

Part 135 refers to the portion of the FAR’s that deal with commuter and charter aircraft operations.

PEth refers to Phosphatidylethanol tests. PEth is a direct biomarker blood test that is considered an extremely accurate indicator of steady moderate and binge-type consumption. The test, while accurate, is not particularly sensitive to low levels of consumption. However, it is quite specific for EtOH, with no known false positives, and increases the detection window of a binge-type relapse for up to 3 weeks.

Pilot Assistance or PA is a general term used to refer to pilot occupational assistance programs dealing with issues such as addiction, depression, stress management, and physical illness.

PWA refers to Pilot Working Agreement: the formal, comprehensive written agreement between a pilots’ union group and the employer.

SI refers to the Special Issuance medical certificate. These FAA medical certificates are awarded to airman who meet special conditions and would otherwise be denied a medical certificate.

SIA refers to the Special Issuance Authorization (more correctly the Authorization for Special Issuance); a letter received by an airman stipulating the authority to issue, and requirements associated with, a Special Issuance medical certificate.

Tx is medical shorthand for Treatment.

12 Step Program is a treatment or recovery program that utilizes the 12 steps to recovery recommended by the founders of Alcoholics Anonymous.