lbfowlerjrmd

Q: I am soon to be denied on my first attempt at a 2nd class medical due to my past alcohol abuse. I was hoping to gather some information about what to do after the denial. I have 3 years sober right now but I didn't do it using AA or any of those types of programs so I was told my sobriety is not valid. Is there any hope aside from getting into AA for X amount of years and then reapplying?

A: Your sobriety is good and to be congratulated . You do not have to use AA or any program ... but sobriety has to be documented especially with 1st class. But you are seeking other than ... so we shall discuss that. (As usual any letters you have received from the FAA are helpful to me). I suspect you will have to go the HIMS route and you could anticipate flying in about 6 months after it officially begins with the FAA. But it is possible, if the FAA gives you the option, to document your sobriety with letter(s) from any sobriety community, pastors, doctors, etc for the past 2 years. Again it depends on your denial letter and options made available to you by them. I have many pilots with problematic alcohol abuse in their past ... and for 3rd class if it have been > 2 years some documentation usually suffices. A 2nd class allows for commercial flying and come with more hoops to jump through ... a thought for you to ponder if flying for hire is not in your immediate future.

lbfowlerjrmd

realtime anonymous case ... continued:

Q: First request by FAA was for an explanation about my last arrest and a copy of my driving record . I provided those things as well as 3 character reference letters for good measure and they then sent me back a request for a substance abuse evaluation. I went to an evaluation but the evaluator told me I was abstaining but not in recovery (due to no affiliation with AA) and she told me that any report she wrote up would not be very favorable. I figured I'd be better off letting the 60 day time period lapse than to send the FAA such a report so I told her not to bother writing me a report.
December 1st will be the 60 day limit so thats where I stand. I had given up but figured I'd give it one last ditch effort. Your advice appreciated.

A: For non-pilots recovery is in the eyes of the beholder! I do not think any professional can pronounce one in recovery and attendance at AA is not required. What you got was typical for the standard civilian type eval. For the FAA sobriety has to be documented ... or as i indicated previously - with self stated 2+ year sobriety it is possible for anything less than 1st class. New information you have now revealed to me is the ARREST! To let the FAA request time out ... or not ... that is the ?

Requesting the HIMS route covers all bases (sub abuse eval, shrink, documents sobriety etc), is quicker for most without your stated sobriety, costs much more, but with the arrest it may become your only option. I think it would be better to send what you have and again state your sobriety date; or request the HIMS route. I would respond. You may elect to bag flying ... but you CAN get a medical. Your decision.
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lbfowlerjrmd

Q: Ah yes, multiple arrests actually. All of which the FAA knows about and the only one they asked for info on was my most recent (2011) for fighting in public. They asked if alcohol was involved and I had to honestly say it was since I was at a bar when the altercation took place. Wouldn't have been there if I didn't drink. 2003-Possession of marijuana. 2003- DUI. 2005- Possession of alcohol by minor. There are other arrests too but they aren't related to booze or drugs so I'll spare you the details unless you want those too. That 2011 arrest was my last offense of any kind. I can pass any amount of random drug/alcohol tests for however long I just didn't want to have to go fake reliance on AA to appease the FAA. I don't have an evaluation to send the FAA so all I can do at this point is wait for the denial.

A: send in the sub abuse evaluation you mentioned. Reply! With this additional info i am pretty sure you will need to request - or FAA will recommend a HIMS approach ... for any class medical. If you decide to pursue, have any primary care doctor start random urine full drug testing with EtG and EtS ... at least 14 tests in a 12 month period. Also find a facilitated group meeting for drug and alcohol counselling and begin weekly attendance. Good luck.

ps fax or email me FAA letter(s) including the last one you will get in Dec or Jan. I am always learning too! lbfjrmd gmail 8504335881

Xdashdriver

At what point does the FAA start looking at a personality disorder with so many arrests across a wide range of issues?

lbfowlerjrmd

let me research this a little more and report back. These traits usually only become apparent when arrests, drugs, alcohol and depression are being investigated.

atpwannabe

Good God in heaven lbfowlerjrmd, IMHO, this guy has an uphill battle second to none. You are correct informing him that the HIMS route is the way that FAA will probably want him to go. I would strongly encouraged him to do what the FAA advises & suggests and not, I repeat..NOT to offer a personal opinion on how and why the FAA reaches any conclusions on his case.

I completed 3 HIMS evals. The first suggested that I not be medically certified. The two that followed did recommend certification, however, the Chief Psychiatrist for the FAA denied my request b/c I believe that I offered a rebuttal to his diagnosis. He concluded that my "law enforcement entanglements" were due to drug and alcohol abuse and stated that I suffer from ASPD (anti-social personality disorder). I would suspect this was based on the criteria that the FAA uses in situations such as these. I believe since I offered a rebuttal, the Chief Psychiatrist determined that I would never be medically certified. JMO though.

My advice: Comply with the FAA in terms of going to meetings; getting a sponsor and getting involved....and DOCUMENT EVERYTHING!

JMO.

All the best to him.

atp

lbfowlerjrmd

"Item 47. Psychiatric Conditions - Personality Disorder

The category of personality disorders severe enough to have repeatedly manifested itself by overt acts refers to diagnosed personality disorders that involve what is called "acting out" behavior. These personality problems relate to poor social judgment, impulsivity, and disregard or antagonism toward authority, especially rules and regulations.

A history of long-standing behavioral problems, whether major (criminal) or relatively minor (truancy, military misbehavior, petty criminal and civil indiscretions, and social instability), usually occurs with these disorders. Driving infractions and previous failures to follow aviation regulations are critical examples of these acts.

Certain personality disorders and other mental disorders that include conditions of limited duration and/or widely varying severity may be disqualifying. Under this category, the FAA is especially concerned with significant depressive episodes requiring treatment, even outpatient therapy. If these episodes have been severe enough to cause some disruption of vocational or educational activity, or if they have required medication or involved suicidal ideation, the application should be deferred or denied issuance.

Some personality disorders and situational dysphorias may be considered disqualifying for a limited time. These include such conditions as gross immaturity and some personality disorders not involving or manifested by overt acts."

that's it!
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MaxThrustPower

lbfowlerjrmd, I think your client is missing the entire point. I've been in recovery and affiliated with the HIMS program for many years.

True, people have been known to recover from addiction without AA or other 12-step programs. And the FAA doesn't actually mandate AA, although they *HIGHLY* encourage a pilot to use AA since it has the best overall track record of helping the alcoholic since it started back in the 1930's.

But what the psychiatrist meant when she said he was "abstaining but not in recovery" is much deeper than her noting that he was not attending a few AA meetings or "faking reliance on AA to appease the FAA." I believe she was actually noting that he was "white knuckling" his sobriety and that he had not done anything about his problem other than to stop consuming alcohol.

Alcoholism is a complex disease. And there is a HUGE difference in ABSTAINING and BEING IN RECOVERY. Your client needs to understand this difference or you are doing him a disservice. Alcoholism is a disease of the mind, body, and spirit. Abstaining from the use of alcohol or other mind or mood-altering substances is only PART of the solution. As the "Big Book" (textbook) of AA tells the alcoholic, "our drinking was but a SYMPTOM" (of a bigger problem.) Alcohol was not so much my PROBLEM as it was my SOLUTION. Once you take away my solution to dealing with life, I have to new coping mechanisms and ways of thinking. There is a lot of inside work involved and it takes time and dedication to be "in recovery."

HIMS professionals and psychiatrists know the hallmarks of the alcoholic personality and patterns of thinking. It was apparent in his meeting with her that, even if he had stopped drinking, he hadn't addressed the underlying problem. Being in recovery is about not only STOPPING the progression of the disease but about REVERSING it. The alcoholic in recovery undergoes a major change which your client would learn about if he attended AA, bought a Big Book, and read the chapter, "The Doctor's Opinion." And yes, while part of it is a spiritual process, it is much more than that alone. It's about a huge inner change.

I have benefited from multiple stays in In-patient and out-patient treatment as well as year of counseling, group therapy, and AA meetings to help unravel the underlying issues that were complicit in my alcoholism. It's a long process and much much more complicated that just putting the "plug in the jug". That's just the first part, and a very small one at that.

The FAA wants to see that pilots have not only abstained but that they are addressing whatever deeper problems were involved with their addiction. Being in recovery should be about being in contented sobriety as well as changing the way we perceive life and handle our problems.

If your client is serious about ever getting his medical certificate back, he needs to get serious about learning about alcoholism and recovery, and doing something about it to improve his life to change the direction that he's been headed.

lbfowlerjrmd

i agree and endorse AA NA etc and all you mentioned. I sure he will read this and benefit from it! It appears he will not respond to FAA ltr. He def has a long road to travel and he may been one that would not be approved by the aviation psychiatrist and the chief shrink at the FAA. My job is to start the process for the airman and follow the FAA's recs. Thanks again for your thoughtful post!

ps i am not his AME - just giving advice.