Looking for Alcoholism

Editorial, by Jon L. Jordan, MD, JD

Social commentators frequently point out that a significant percentage of Americans meet the usual criteria for a diagnosis of alcoholism. Unfortunately, pilots are also included, possibly at about the same rate.

Though we believe that pilots, even those diagnosed with alcoholism, make a strong effort to comply with the rules regarding drinking and flying, it's inevitable that some will be involved in alcohol-related accidents.

Indeed, toxicology statistics from fatal aircraft accidents for many years have demonstrated just that. In 1995, for example, alcohol levels greater than 0.04 percent (40 mg/dL) were found in 4.5 percent of those accidents.

Recently, the media have focused public attention on the cases of a number of individuals who are or who have functioned as commercial pilots - despite behavioral, legal, and medical indications of this particular type of substance abuse.

The Federal Aviation Administration, of course, is blamed by critics for its alleged failure to identify and remove these individuals from the aviation environment. While each case is different, and we must deal with all the circumvention, denial, evasion, and outright falsehoods frequently employed by affected individuals, it's clear that we must renew our efforts. You, the aviation medical examiner, must play a major role in this effort.

Our medical school professors spoke often about the "need to exercise intuition and critical observation" when evaluating patients. In other words, you often find things when you think to look for them.

  • This certainly applies to your efforts to identify medical certificate applicants whose suitability, in terms of their use of alcohol, requires more scrutiny.
  • We surely should be concerned when an applicant shows up for examination bearing the strong odor of alcohol!
  • We need to know the specifics of traffic convictions or other brushes with the law, whenever they occurred.
  • We must question aberrant applicant behavior when observed in our offices or reported elsewhere.
  • We must carefully investigate and consider the information that comes from various sources, including employers, coworkers, spouses, and friends - even when these persons may have obvious reasons for impugning the applicant.
As aviation medical examiners acting on behalf of the FAA, you have a rare opportunity to ensure that proper evaluations are initiated; to ask the appropriate questions; to use your training, experience, and even your senses to identify persons who should not be given a medical certificate or who should, at least, be referred for further investigation.

We depend on you to warn us when you are concerned because an applicant appears unsafe or something is "just not right." Of course, you must neither delay nor deny medical certification unfairly, but you also should not miss opportunities to further refine your assessments.

While these thoughts really apply to all applicants, they are clearly of major significance when you suspect alcoholism or other substance abuse.