WASHINGTON — A new report from the National Academies of Sciences, Engineering, and Medicine assesses the Human Intervention Motivational Study (HIMS) program for pilots and the Flight Attendant Drug and Alcohol Program (FADAP). The report recommends that the Federal Aviation Administration update the programs to follow best practices in the substance use disorder treatment fields, to the extent possible in the aviation setting, and improve data collection and transparency.

While there are limited data on aviation professionals specifically, researchers assume that substance use disorders affect pilots and flight attendants at the same rate as the general population — around 15 percent. Due to the high-risk nature of their jobs, however, aircraft operators are held to a higher standard for substance misuse on the job. Ensuring that pilots and flight attendants who misuse substances are excused from duties and receive effective treatment is essential for their personal health and for general public safety, says the report. The HIMS program is available to the 48,750 active commercial pilots employed in the U.S., and FADAP is available to 108,480 flight attendants. 

In addition to safety being paramount, training new pilots and flight attendants is a long and costly process, and job loss can have detrimental effects on all aspects of a person’s life. Therefore, the report says, it is in the interest of the workforce, the FAA, and the airline companies to support effective treatment programs for substance misuse. 

To improve the programs and provide the best possible treatment for pilots and flight attendants misusing substances, the FAA should require HIMS and FADAP to collect and maintain reliable data, the report recommends. While HIMS in particular is considered by some to be the gold standard among programs to address substance use disorders within the global transportation industry, evidence to support the assertion of its effectiveness is lacking. The committee that wrote the report concluded that the available data do not support suggestions that either program should fully serve as a model for other segments of the transportation industry. 

The report notes that the committee faced challenges in obtaining needed data from HIMS and the FAA. Repeated requests to share de-identified program outcome data were denied by HIMS administrators. The committee also created a “call for perspectives” for pilots but only received nine responses; it received over 1,000 responses to a call for perspectives from flight attendants. Despite these data limitations, the committee was able to reach a number of conclusions and provide recommendations on how to increase the reach and effectiveness of the two programs.

“Collecting and maintaining reliable data will be the first step in allowing the FAA to improve these substance misuse programs,” said Richard G. Frank, chair of the committee that wrote the report, and the Leonard D. Schaeffer Chair in Economic Studies at the Brookings Institution. “Our committee brought extensive knowledge of best practices in substance misuse treatment to our report, and our listening sessions provided important context to direct our recommendations.” 

Currently, many pilots and flight attendants are prescribed the same level of treatment, regardless of the severity of illness. The report recommends FAA revise sections of the Code of Federal Regulations to align, as much as possible given the limitations of the aviation setting, with the most current evidence-based methods for diagnosing substance use disorders — which consider illness severity and lead to more personalized immediate and ongoing treatment. The FAA should also require rigorous screening for substance misuse in mandated annual physical exams for all professions that require a high level of safety proficiency and responsiveness. 

The FAA should also encourage airlines to remove barriers to early identification and treatment, the report says. While job termination is reasonable for employees who do not meet treatment requirements, airlines should find ways to make pilots and flight attendants more likely to self-report early without fear of losing their jobs, such as providing opportunities for disclosure of a substance use problem outside of professional performance reviews. 

Commercial airline carriers should also provide affordable access to insurance benefits for mental health and substance misuse disorder services for pilots and flight attendants consistent with the Mental Health Parity and Addiction Equity Act.

The committee focused on examining the evidence base and best practices around alcohol use disorder treatment after learning that alcohol was by far the most prominent substance being misused in the commercial aviation industry, but the report’s findings can also be used in the context of treatment for other addictive substances, including misused prescription drugs and opioids. 

The congressionally mandated study — undertaken by the Committee on the HIMS, FADAP, and Other Drug and Alcohol Programs within the USDOT — was sponsored by the U.S. Department of Transportation. 

The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, engineering, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

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