A Traditional HIMS Program Begins with Intensive Treatment
The FAA and the Part 121 carriers see residential rehabilitation as the entry for a traditional HIMS program. These programs last from thirty to ninety days depending on the program and the pilot’s condition on entry. The most familiar programs in HIMS use a so-called Minnesota model which combines principles of 12-Step therapy with other treatments, like Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Acceptance and Commitment Therapy, and other scientifically validated techniques. The best programs also add attention to spirituality, family systems, recreation, creativity, and nutrition.
What counts as intensive treatment? The best way to determine if your program meets the standards is to ask at your company. A Part 121 carrier will already have relationships with the best centers in the country. If your airline refers you to a program, you can be confident the program will be acceptable to the airline and the FAA.
If you are not supported by a Part 121 carrier, you should ask programs about where they lie on the ASAM (American Society of Addiction Medicine) Levels of Care Continuum. A comprehensive program suitable for a pilot is going to be a designated at ASAM 3.5, 3.7 or 4. If the program doesn’t know or can’t answer the question, the program may not be a good fit for you. You need not become an expert in the continuum, just know that a program below 3.5 may not be comprehensive enough to satisfy HIMS standards.
Although residential treatment is preferred by the FAA and the Part 121 carriers, other options exist. An Intensive Outpatient Program, as defined on the ASAM Levels of Care spectrum, meets three hours per session, three times per week, and typically for not less than four weeks. Some programs last up to twelve weeks.
An IOP should be considered a second choice for a professional pilot. IOPs have good data to support their clinical utility, but these programs are not yet embraced as the gold-standard for the treatment of pilots. Residential programs are the standard for professional aviators.
An acceptable IOP is designated as a ASAM Level of Care 2.1. Sometimes, these programs first begin a 2.5 level Partial Hospitalization Program for the first few days or weeks of the program.
A First Class pilot should have a hardship reason to pursue an IOP instead of residential treatment. For example, a single parent with small children may prefer an IOP since the pilot is at home most of the week. Financial hardship also becomes a reason to pursue an IOP. You can expect that it will take longer to demonstrate to the FAA your stability if your pursue a lower-level of treatment like an IOP.
After Intensive Treatment, HIMS Treatment Splits into Three Parallel Tracks
Aftercare Led by a Professional
Aftercare programs are group therapy sessions led by a licensed counselor. Typical programs meet for either sixty or ninety minutes every week. The FAA and the Part 121 carriers expect the pilot to attend as often as possible and set a baseline of at least two meetings per month.
Your program must provide documentation to either your EAP, HIMS AME, or aviation psychiatrist. Before joining a program, ask the organization about their documentation standards. If the program does not produce written reports for your HIMS AME or company, they will be a poor fit for your care.
Self-Help Groups
The most common self-help group supported by evidence is a 12-Step program, like Alcoholics Anonymous. AA and similar 12-Step programs have the advantage of being available nearly everywhere and at no cost. The gold-standard pilot attends a meeting once per day for the first three months after leaving intensive treatment for the so-called “ninety (meetings) in ninety (days).” The pilot also needs to work the full program by having a sponsor and going through the steps.
Not every pilot takes to the 12-Step model; there are alternatives. When the pilot chooses a different self-help group, the pilot should engage a model with peer-reviewed scientific validation as a proven component of recovery. Also, the pilot in an alternate model still needs to meet as often as a pilot in AA.
Sobriety Monitoring
The third component of HIMS monitoring after intensive treatment is for the pilot to engage a sobriety monitoring program. The type and frequency of monitoring must match the clinical issues in the pilot’s recovery. Some pilots need more frequent monitoring but the FAA has established monitoring minimums of at least one sobriety test per month, and sometimes two.
When appropriate, pilots may also use a portable alcohol monitor. The portable monitor has pros and cons.
Whether the pilot’s sobriety is monitored by a portable device or a no-notice testing regime, the plan should conform to the norms of the carrier or HIMS AME depending on who is responsible for monitoring testing results.