Seeking the safe way back to the runway

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Problems with alcohol and other substances is not necessarily the end of your aviation career, and CASA is continually looking for ways to assist users in recovery to safely return to the sky. The alternative, of unreported drinking and substance abuse, is simply too dangerous.

The Human Intervention Motivation Study (HIMS)—a program new to Australia, is for members of the aviation community. It aims to help anyone whose use of alcohol or other drugs is of concern. It is a collaborative project initiated by airline unions, together with addiction medicine specialists and doctors from major operators and CASA. HIMS offers a pathway for substance use reporting and treatment and met last month to seek an improvement in both reporting and support for safe return to work of pilots and controllers with substance use problems.

‘Australia has a high incidence of alcohol and substance abuse as well as psychiatric illness,’ says CASA’s Principal Medical Officer Dr Michael Drane. ‘There are both short and long-term effects. It’s relevant to aviators that binge effects of alcohol persist well after the traditional eight hour ‘bottle to throttle’ time—affecting judgement and situational awareness for up to 48 hours.’

‘Long-term overuse is also important. There is a strong correlation between drug or alcohol use and psychiatric illness,’ Drane says. ‘Alcohol and drugs may exacerbate psychiatric illness, and psychiatric illness may trigger unsafe substance use. In addition there are important effects on risks of heart problems and cancer for example.’

‘Both drugs and alcohol may affect performance and executive function. This is consistent with the observation that 70 to 80 per cent of accidents have a human factors-related cause and an over-representation of drug and alcohol levels post-mortem.’

From 1975 to 2006, 89 per cent of alcohol-related aviation events in Australia resulted in an accident, 67 per cent of which were fatal.

CASA’s current approach

CASA promotes a just culture approach, working with pilots and operators to facilitate a safe landing. In practice, this means achieving a supported and monitored safe return to work through transparency, cooperation and coordination.

‘Traditionally ICAO medicals have focused on physical illness,’ says Drane. ‘This is now changing. In 2009, CASA’s application form focused on hazardous alcohol use and common psychiatric conditions. Approximately five per cent of applications suggest hazardous use of alcohol.’

‘One of the cardinal challenges with addictive behaviour is the denial by the individual concerned,’ says Drane. ‘HIMS provides a forum for the identification of such behaviours and uses this information to help individuals acknowledge and seek help for substance abuse.

‘Frequently, the recognition of this need to seek help is the crucial change in attitude needed to embark on a successful programme to recovery.

‘Concealment and denial are important reasons why detection can be difficult. Furthermore, the tendency to denial is consistent with the typical response to a request for further assessment of an individual’s use of alcohol. It is no coincidence that it is one of the most common sources of complaint to us.

ICAO defines “Problematic use of alcohol[1]and where identified, mandates a review and assessment process with issue of medical certificate when compliance with an agreed treatment strategy is demonstrated and monitoring is in place. Details of CASA’s approach are published in the Clinical Practice Guidelines, under Alcohol.

Treatment

Abstinence is the more successful treatment approach in terms of long-term substance use recovery. Some Australian treatment centres follow a harm-reduction approach. The lower success rate with this approach and difficulties identifying the return of hazardous use, make this a less successful risk mitigation strategy.

‘Alcohol abuse is a disease with serious medical complications and if untreated, a very poor prognosis,’ says Drane. ‘This aspect is often overlooked in the consideration of other aspects of the condition. Better identification and treatment also offer large health benefits, which also contribute to improved aviation safety.’

Statistically, long term recovery rate for pilots through inpatient treatment of the HIMS program and aftercare monitoring is approximately 89 per cent compared with far lower recovery achieved by other programs.

More information is available on the HIMS website.

[1] In Annex 1, Personnel Licensing, to the Chicago Convention, ‘Problematic use of substances’ is defined as follows:

‘The use of one or more psychoactive substances by aviation personnel in a way that:

  1. a) constitutes a direct hazard to the user or endangers the lives, health or welfare of others; and/or
  2. b) causes or worsens an occupational, social, mental or physical problem or disorder.’.

‘Psychoactive substances’ is there defined as ‘Alcohol, opioids, cannabinoids, sedatives and hypnotics, cocaine, other psychostimulants, hallucinogens, and volatile solvents, whereas coffee and tobacco are excluded.’.

 

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