Alcohol Use and Misuse in Aviation Medicine

by | May 29, 2020 | Aviation Medicine

Return to flying after alcohol use requires documented abstinence from problematic use, no sequelae from use, and normalisation of blood tests (LFTS, MCV and carbohydrate deficient transferrin (CDT))

dr thomas perkins, casa designated aviation medical examiner

Definition

This protocol refers to suspected or confirmed “problematic use” of alcohol such as:

  • Positive workplace test
  • DAME opinion
  • DUI within 5 years of application
  • Self-reported use and confirmatory blood tests (e.g. LFT’s / MCV and CDT)

Aeromedical Implications

Effect of aviation on condition

  • Hypoxia – increase cognitive decrement caused by alcohol

Effect of condition on aviation

  • Subtle incapacitation – impaired alertness / reaction / decision-making
  • Loss of situational awareness & vertigo
  • Distraction due to impaired concentration.

Approach to medical certification

Based on the condition

  • As per CASR 67.150 Table 67.150.1.5 and 1.6.
    • demonstrated abstinence from problematic use
  • no sequelae from problematic use
  • Normalisation of blood tests

Based on Treatment

  • As per CASR 67.150 Table 67.150.1.5 and 1.6, 2.5 and 2.6, 3.5 and 3.6. – currently undertaking or completion of appropriate course of therapy
  • no safety-relevant medications (benzodiazepine or naltrexone)

Demonstrated Stability

  • Abstinence or harm minimisation as per risk stratification
  • Blood parameters and breath testing
  • Sponsor reports
  • Surveillance plan from applicant and/or employer detailing intended alcohol use and monitoring by doctor, laboratory and sponsors

Risk assessment protocol – Information required

New cases

  • Fellow of the Australasian Chapter of Addiction Medicine specialist [FAChAM] for an assessment in regards to:
    • diagnosis
    • past and present alcohol consumption
    • current clinical status
    • physical and psychological sequelae/co-morbidities
    • LFTS, MCV and carbohydrate deficient transferrin (CDT)
    • treatment, response to treatment and side effects
    • prognosis
    • ongoing management plan
  • FAChAM follow-up report, where applicable following treatment intervention, demonstrating
    • abstinence from problematic use of alcohol and other substances.
    • freedom from the ill-effects of substance misuse
    • recent blood tests (LFT’s, MCV and CDT)
  • Consider Police report

Renewal

  • Fellow of the Australasian Chapter of Addiction Medicine specialist FAChAM for an assessment in regards to:
    • diagnosis
    • alcohol consumption
    • review of physical and psychological sequelae/co-morbidities
    • current clinical status and compliance with established goals and requirements
    • review of LFTS, MCV and carbohydrate deficient transferrin (CDT)
    • review of sponsor reports and tests as listed below
    • treatment, response to treatment and side effects
    • prognosis
    • ongoing management and surveillance plan

(NOTE: In certain circumstances, reports may be accepted from psychiatrists or other alcohol or addiction medical specialists. Prior agreement must be sought to avoid unnecessary expense and delays.)

  • 3 monthly LFT’s MCV and CDT
  • Random breath alcohol testing
  • Sponsor / peer / employer reports (as appropriate)

Indicative outcomes

The onus is on the applicant to demonstrate fulfilment of the regulatory requirements. Careful attention to the conditions requiring testing or reports by a particular date, is essential to give confidence that aviation safety is being maintained. Failure to submit tests and reports on time will be treated as indicators of possible relapse.

Favourable

  • Demonstrated absence of problematic use for a pre-defined period. This is usually a minimum of 12 months, and includes sponsor and clinical reports
  • Ongoing normal blood and breath-alcohol tests

Unfavourable

  • Problematic use
  • 2 relapses following diagnosis
  • Alcohol-related convictions: 3 or more
  • Abnormal blood or breath-alcohol tests
  • Complications of alcohol-use e.g. psychiatric, portal hypertension, varices, clotting etc.

Pilot and Controller Information

  • The hazardous and problematic use of alcohol has been associated with aviation accidents
  • For pilots and controllers who have problematic use of alcohol, the most successful treatment has resulted from abstinence from all alcohol use. For this reason, certification may be possible when pilots and controllers demonstrate abstinence
  • The best way to demonstrate abstinence is through objective evidence of abstinence and careful attention to monitoring
  • Problematic use of alcohol is associated with serious medical problems quite apart from the hazard to aviation activities..

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.Last modified: 5 September 2018