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The New Zealand Air Line Pilots' Association Newsletter.

Medical and Welfare update: New medical questions on the CAA declaration

ANDREW PENDER, MEDICAL AND WELFARE DIRECTOR

Recent changes to the alcohol classification on the CAA Medical Declaration form has prompted the team and I to ensure members are aware of alcohol and its effects. I would also like to remind members that NZALPA offers comprehensive support through the Human Intervention Motivation Study (HIMS) for those who require it.

There has been a noticeable shift in the way that our drinking behaviours are being considered both in a medical sense and as it applies to being a licence holder.

The new CAA Medical Declaration form section which applies to drinking behaviours, follows the Alcohol and Liquor Advisory Council (ALAC) classification that has changed from stating the hazardous drinking level is 21 units per week to the new figure of 15 units per week. For more on this and what makes a unit, see here.

Of course you will all be aware of the lower drink drive limit and your legal obligations should you be caught over the limit. It is strongly advised that you seek NZALPA confidential advice if you find yourself in this situation.

The new medical questions included in the CAA Medical Declaration are derived from the World Health Organisation AUDIT questionnaire. 

Your views towards tolerable drinking habits are often formed by your own background. It pays to be aware of how your views compare to others in society today. Some of our members have unsuspectedly been asked to provide regular liver function tests as they were regarded to be at the hazardous end of drinking behaviours. If nothing else, take the AUDIT questionnaire after reading the IFALPA alcohol article, to get a sense of how you rate on it.

An online version can be taken here.

The use of the alcohol carbohydrate-deficient transferrin (CDT) test is a fairly common tool to refine concerns about alcohol use if there are other factors that have raised a flag. It will identify the effects on liver function from sustained heavy alcohol use (5+ units /day), or possibly less frequent very heavy binges.

These effects can show up for several weeks post-consumption. Possibly more concerning, however, is that even after metabolising back to a zero blood alcohol level after very heavy drinking, it can take up to 48 hrs for functions like inner ear balance to return to normal. 

NZALPA has confidential assistance if you would like to talk to someone or have concerns about a colleague's use of drugs (prescription or otherwise) or alcohol. 

The following article is about the HIMS programme, which is run by fellow pilots who understand the trials of dealing with the matters of alcohol use dependency.

HIMS: The intervention programme for those with dependency

The HIMS programme provides appropriate assistance to those at risk of alcohol or drug dependence.

A study compiled by the International Civil Aviation Organisation (ICAO) examined the worldwide database of crashes during a recent 21-year period. Ten accidents were assigned a medical cause by the investigators.

Of the 10 accidents, six had a significant finding attributing the crash to the use of alcohol or other drugs by the pilots. In an automated multi-crew environment, conditions causing risky behaviour are much more dangerous than dramatic incapacitations.

Just like any other occupational group, pilots and controllers are not immune to the effects of substance abuse or substance dependence. For pilots and controllers the substance most likely to cause problems is alcohol.

Symptoms of dependence

This might only concern a small group of individuals, but these signs relate to those who, over time, have gradually started to lose control of their drinking.

These signs include:

  • Compulsion drinking to stop from feeling unwell, unhappy or afraid, and not being able to say no.
  • Preoccupation – planning to drink to drunkenness and neglecting responsibilities because of drinking.
  • Tolerance – needing more alcohol to get the same ‘buzz’ and losing the ability to gauge when drunk.
  • Consequences – neglecting the impact on relationships, health, work performance and possibly trouble with the law.
  • Blackout – drinking to the point of not being able to remember what happened the night before.

“Around the world good, capable, intelligent and well-intentioned pilots continue to be caught with a positive breath alcohol test and often display the symptoms listed above.  The interesting and sad thing is that often their fellow pilots suspected (or knew) that there was a problem,” Medical and Welfare Director Andy Pender said.

Available Treatment

Alcohol dependence is an illness with a strong genetic predisposition, associated abnormal brain chemistry, and with a predictable symptom set. 

Aviation companies have random testing programmes that catch people but that does not solve the problem as testing programmes will often only identify a problem when the disease in a person has progressed, and if someone tests positive then it’s going to be hard for them to retain their job.

But there is a treatment.

The HIMS programme solves this issue and, although fairly new to New Zealand, it has been used for more than 40 years.

In the United States in the 1970s, identified alcohol dependence meant permanent loss of a pilot’s licence for medical reasons. So it was a problem that was never diagnosed – until too late. Then three doctors from the Federal Aviation Administration (FAA), the ALPA union and one of the airlines got together and decided there must be a better way. The programme created was called HIMS to give no clue as to what it was really about.

The HIMS purpose was about getting help early for pilots who were suspected by their colleagues or their loved ones of having a problem. The programme has successfully returned well over 6,000 US pilots to flying with an extraordinary long-term success rate of around 90 percent.

This is the power of a peer-led programme in which sobriety is a condition of continued employment.

HIMS for New Zealand Pilots and Air Traffic Controllers

HIMS in New Zealand has a shorter history but has been modelled on the US success. The programme helps pilots and air traffic controllers with alcohol and other chemical dependency issues return to work after successful treatment. HIMS does this by working within the New Zealand aviation industry, training people to be peer volunteers and by educating aviation management staff.

The CAA’s Principal Medical Officer, Dougal Watson, who has assisted with setting up HIMS New Zealand, said:

“Drug dependency, especially alcohol, has been a perennial issue. Each case needs to be handled differently, depending on the degree of addiction.”

HIMS New Zealand has put together a group of aviation specialists including pilots who have experienced dependence but turned their lives around.

The group has the written support of the leaders of Air New Zealand, Airways Corporation, the RNZAF, NZALPA, Federation of Air NZ Pilots, Qantas/Jetstar/Jetconnect, VANZ and the Director of Civil Aviation. The team is primarily made up of pilots and controllers aided by aviation doctors who will be involved when appropriate.

Principally HIMS is about providing a pathway whereby confidential concerns about a colleague, friend, or partner can be raised and we can provide advice, information and assistance in addressing dependency issues, and how to get help for pilots or controllers before they put their lives or livelihood at risk.

HIMS has extended its scope to aviation professionals nationwide including the military and general aviation (GA) sector.

Drugs and alcohol don’t mix with any type of flying and our aim is to get people assessed to see if they need treatment. They can then be helped into a recovery programme that provides help to anyone in the aviation community who needs it.

A proven sequence of steps – peer identification, intervention, evaluation and diagnosis, treatment and recertification, has a high rate of success.

“Some participants enrol in the programme on their own because they realise they have a problem and need to do something about it and soon,” Pender said.

“However, it is more common that pilots and controllers enter the HIMS programme as a result of an intervention by colleagues who support the programme, or by HIMS-trained airline personnel who encourage them into the programme.

“It is everyone’s responsibility to address a problem when they see it and any queries to the HIMS New Zealand team will be treated with strict confidentiality.”

For any matters of assistance, call 0800 NZALPA (0800 692 572) and ask to be connected through to the Peer Assistance Network team or Medical and Welfare director Captain Andy Pender.

For further information about HIMS, see here: http://www.hims.org.nz

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